anomalies and curiosities of medicine-第29部分

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ifice；　and；　on　introducing　the　finger　along　the　anterior　wall　of　the　rectum；　a　fistula　was　found；　communicating　with　the　vagina；　above　this　point　the　arrangement　and　the　situation　of　the　parts　were　normal。　The　woman　had　given　birth　to　three　still…born　children；　and　always　menstruated　easily。　Coitus　always　seemed　satisfactory；　and　no　suspicion　existed　in　the　patient's　mind；　and　had　never　been　suggested　to　her；　of　her　abnormality。

Harrison　saw　a　fetus　delivered　by　the　anus　after　rupture　of　the　uterus；　the　membranes　came　away　by　the　same　route。　In　this　case　the　neck　of　the　uterus　was　cartilaginous　and　firmly　adherent　to　the　adjacent　parts。　In　seven　days　after　the　accouchement　the　woman　had　completely　regained　her　health。　Vallisneri　reports　the　instance　of　a　woman　who　possessed　two　uteruses；　one　communicating　with　the　vagina；　the　other　with　the　rectum。　She　had　permitted　rectal　copulation　and　had　become　impregnated　in　this　manner。　Louis；　the　celebrated　French　surgeon；　created　a　furore　by　a　pamphlet　entitled　〃De　partium　externarum　generationi　inservientium　in　mulieribus　naturali　vitiosa　et　morbosa　dispositione；　etc。；〃　for　which　he　was　punished　by　the　Sorbonne；　but　absolved　by　the　Pope。　He　described　a　young　lady　who　had　no　vaginal　opening；　but　who　regularly　menstruated　by　the　rectum。　She　allowed　her　lover　to　have　connection　with　her　in　the　only　possible　way；　by　the　rectum；　which；　however；　sufficed　for　impregnation；　and　at　term　she　bore　by　the　rectum　a　well…formed　child。　Hunter　speaks　of　a　case　of　pregnancy　in　a　woman　with　a　double　vagina；　who　was　delivered　at　the　seventh　month　by　the　rectum。　Mekeln　and　Andrews　give　instances　of　parturition　through　the　anus。　Morisani　describes　a　case　of　extrauterine　pregnancy　with　tubal　rupture　and　discharge　into　the　culdesac；　in　which　there　was　delivery　by　the　rectum。　After　an　attack　of　severe　abdominal　pain；　followed　by　hemorrhage；　the　woman　experienced　an　urgent　desire　to　empty　the　rectum。　The　fetal　movements　ceased；　and　a　recurrence　of　these　symptoms　led　the　patient　to　go　to　stool；　at　which　she　passed　blood　and　a　seromucoid　fluid。　She　attempted　manually　to　remove　the　offending　substances　from　the　rectum；　and　in　consequence　grasped　the　leg　of　a　fetus。　She　was　removed　to　a　hospital；　where　a　fetus　nine　inches　long　was　removed　from　the　rectum。　The　rectal　opening　gradually　cicatrized；　the　sac　became　obliterated；　and　the　woman　left　the　hospital　well。

Birth　Through　Perineal　Perforation。Occasionally　there　is　perineal　perforation　during　labor；　with　birth　of　the　child　through　the　opening。　Brown　mentions　a　case　of　rupture　of　the　perineum　with　birth　of　a　child　between　the　vaginal　opening　and　the　anus。　Cassidy　reports　a　case　of　child…birth　through　the　perineum。　A　successful　operation　was　performed　fifteen　days　after　the　accident。　Dupuytren　speaks　of　the　passage　of　an　infant　through　a　central　opening　of　the　perineum。　Capuron；　Gravis；　and　Lebrun　all　report　accouchement　through　a　perineal　perforation；　without　alteration　in　the　sphincter　ani　or　the　fourchet。　In　his　〃Diseases　of　Women〃　Simpson　speaks　of　a　fistula　left　by　the　passage　of　an　infant　through　the　perineum。　Wilson；　Toloshinoff；　Stolz；　Argles；　Demarquay；　Harley；　Hernu；　Martyn；　Lamb；　Morere；　Pollock；　and　others　record　the　birth　of　children　through　perineal　perforations。

Birth　Through　the　Abdominal　Wall。Hollerius　gives　a　very　peculiar　instance　in　which　the　abdominal　walls　gave　way　from　the　pressure　exerted　by　the　fetus；　and　the　uterus　ruptured；　allowing　the　child　to　be　extracted　by　the　hand　from　the　umbilicus；　the　mother　made　a　speedy　recovery。　In　such　cases　delivery　is　usually　by　means　of　operative　interference　（which　will　be　spoken　of　later）；　but　rarely；　as　here；　spontaneously。　Farquharson　and　Ill　both　mention　rupture　of　the　abdominal　parietes　during　labor。

There　have　been　cases　reported　in　which　the　recto…vaginal　septum　has　been　ruptured；　as　well　as　the　perineum　and　the　sphincter　ani；　giving　all　the　appearance　of　a　birth　by　the　anus。

There　is　an　account　of　a　female　who　had　a　tumor　projecting　between　the　vagina　and　rectum；　which　was　incised　through　the　intestine；　and　proved　to　be　a　dead　child。　Saviard　reported　what　he　considered　a　rather　unique　case；　in　which　the　uterus　was　ruptured　by　external　violence；　the　fetus　being　thrown　forward　into　the　abdomen　and　afterward　extracted　from　an　umbilical　abscess。

Birth　of　the　Fetus　Enclosed　in　the　Membranes。Harvey　says　that　an　infant　can　rest　in　its　membranes　several　hours　after　birth　without　loss　of　life。　Schurig　eventrated　a　pregnant　bitch　and　her　puppies　lived　in　their　membranes　half　an　hour。　Wrisberg　cites　three　observations　of　infants　born　closed　in　their　membranes；　one　lived　seven　minutes；　the　other　two　nine　minutes；　all　breathed　when　the　membranes　were　cut　and　air　admitted。　Willoughby　recorded　the　history　of　a　case　which　attracted　much　comment　at　the　time。　It　was　the　birth　of　twins　enclosed　in　their　secundines。　The　sac　was　opened　and；　together　with　the　afterbirth；　was　laid　over　some　hot　coals；　there　was；　however；　a　happy　issue；　the　children　recovering　and　living。　Since　Willoughby's　time　several　cases　of　similar　interest　have　been　noticed；　one　in　a　woman　of　forty；　who　had　been　married　sixteen　years；　and　who　had　had　several　pregnancies　in　her　early　married　life　and　a　recent　abortion。　Her　last　pregnancy　lasted　about　twenty…eight　or　twenty…nine　weeks；　and　terminated；　after　a　short　labor；　by　the　expulsion　of　the　ovum　entire。　The　membranes　had　not　been　ruptured；　and　still　enclosed　the　fetus　and　the　liquor　amnii。　On　breaking　them；　the　fetus　was　seen　floating　on　the　waters；　alive；　and；　though　very　diminutive；　was　perfectly　formed。　It　continued　to　live；　and　a　day　afterward　took　the　breast　and　began　to　cry　feebly。　At　six　weeks　it　weighed　2　pounds　2　ounces；　and　at　ten　months；　12　pounds；　but　was　still　very　weak　and　ill…nourished。　Evans　has　an　instance　of　a　fetus　expelled　enveloped　in　its　membranes　entire　and　unruptured。　The　membranes　were　opaque　and　preternaturally　thickened；　and　were　opened　with　a　pair　of　scissors；　strenuous　efforts　were　made　to　save　the　child；　but　to　no　purpose。　The　mother；　after　a　short　convalescence；　made　a　good　recovery。　Forman　reports　an　instance　of　unruptured　membranes　at　birth；　the　delivery　following　a　single　pain；　in　a　woman　of　twenty…two；　pregnant　for　a　second　time。　Woodson　speaks　of　a　case　of　twins；　one　of　which　was　born　enveloped　in　its　secundines。

Van　Bibber　was　called　in　great　haste　to　see　a　patient　in　labor。　He　reached　the　house　in　about　fifteen　minutes；　and　was　told　by　the　midwife；　a　woman　of　experience；　that　she　had　summoned　him　because　of　the　expulsion　from　the　womb　of　something　the　like　of　which　she　had　never　seen　before。　She　thought　it　must　have　been　some　variety　of　false　conception；　and　had　wrapped　it　up　in　some　flannel。　It　proved　to　be　a　fetus　enclosed　in　its　sac；　with　the　placenta；　all　having　been　expelled　together　and　intact。　He　told　the　nurse　to　rupture　the　membranes；　and　the　child；　which　had　been　in　the　unruptured　sac　for　over　twenty　minutes；　began　to　cry。　The　infant　lived　for　over　a　month；　but　eventually　died　of　bronchitis。

Cowger　reports　labor　at　the　end　of　the　seventh　month　without　rupture　of　the　fetal　sac。　Macknus　and　Rootes　speak　of　expulsion　of　the　entire　ovum　at　the　full　period　of　gestation。　Roe　mentions　a　case　of　parturition　with　unruptured　membrane。　Slusser　describes　the　delivery　of　a　full…grown　fetus　without　rupture　of　the　membrane。

〃Dry　Births。〃The　reverse　of　the　foregoing　are　those　cases　in　which；　by　reason　of　the　deficiency　of　the　waters；　the　birth　is　dry。　Numerous　causes　can　be　stated　for　such　occurrences；　and　the　reader　is　referred　elsewhere　for　them；　the　subject　being　an　old　one。　The　Ephemerides　speaks　of　it；　and　Rudolph　discusses　its　occurrence　exhaustively　and　tells　of　the　difficulties　of　such　a　labor。　Burrall　mentions　a　case　of　labor　without　apparent　liquor　amnii；　delivery　being　effected　by　the　forceps。　Strong　records　an　unusual　obstetric　case　in　which　there　was　prolongation　of　the　pregnancy；　with　a　large　child；　and　entire　absence　of　liquor　amnii。　The　case　was　also　complicated　with　interstitial　and　subserous　fibroids　and　a　contracted　pelvis；　combined　with　a　posterior　position　of　the　occiput　and　nonrotation　of　the　head。　Lente　mentions　a　case　of　labor　without　liquor　amnii；　and　Townsend　records　delivery　without　any　sanguineous　discharge。　Cosentino　mentions　a　case　of　the　absence　of　liquor　amnii　associated　with　a　fetal　monstrosity。

Delivery　After　Death　of　the　Mother。Curious　indeed　are　those　anomalous　cases　in　which　the　delivery　is　effected　spontaneously　after　the　death　of　the　mother；　or　when；　by　manipulation；　the　child　is　saved　after　the　maternal　decease。　Wegelin　gives　the　account　of　a　birth　in　which　version　was　performed　after　death　and　the　child　successfully　delivered。　Bartholinus；　Wolff；　Schenck；　Horstius；　Hagendorn；　Fabricius　Hildanus；　Valerius；　Rolfinck；　Cornarius；　Boener；　and　other　older　writers　cite　cases　of　this　kind。　Pinard　gives　a　most　wonderful　case。　The　patient　was　a　woman　of　thirty…eight　who　had　experienced　five　previous　normal　labors。　On　October　27th　she　fancied　she　had　labor　pains　and　went　to　the　Lariboisiere　Maternite；　where；　after　a　careful　examination；　three　fetal　poles　were　elicited；　and　she　was　told；　to　her　surprise；　of　the　probability　of　triplets。　At　6　P。M。；　November　13th；　the　pains　of　labor　commenced。　Three　hours　later　she　was　having　great　dyspnea　with　each　pain。　This　soon　assumed　a　fatal　aspect　and　the　midwife　attempted　to　resuscitate　the　patient　by　artificial　respiration；　but　failed　in　her　efforts；　and　then　she　turned　her　attention　to　the　fetuses；　and；　one　by　one；　she　extracted　them　in　the　short　space　of　five　minutes；　the　last　one　was　born　twelve　minutes　after　the　mother's　death。　They　all　lived　（the　first　two　being　females）；　and　they　weighed　from　4　1/4　to　6　1/2　pounds。

Considerable　attention　has　been　directed　to　the　advisability　of　accelerated　and　forced　labor　in　the　dying；　in　order　that　the　child　may　be　saved。　Belluzzi　has　presented　several　papers　on　this　subject。　Csurgay　of　Budapest　mentions　saving　the　child　by　forced　labor　in　the　death　agonies　of　the　mother。　Devilliers　considers　this　question　from　both　the　obstetric　and　medicolegal　points　of　view。　Hyneaux　mentions　forcible　accouchement　practised　on　both　the　dead　and　the　dyi