anomalies and curiosities of medicine-第32部分

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the　child　might　have　been　saved　by　ligature　of　the　funis。　Not　until　the　arrival　of　the　clergyman　was　anything　done；　and　death　ultimately　ensued。

A　most　wonderful　case　of　endurance　of　pain　and　heroism　was　one　occurring　in　Italy；　which　attracted　much　European　comment　at　the　time。　A　young　woman；　illegitimately　pregnant；　at　full　term；　on　March　28th；　at　dawn；　opened　her　own　abdomen　on　the　left　side　with　a　common　knife　such　as　is　generally　used　in　kitchens。　The　wound　measured　five　inches；　and　was　directed　obliquely　outward　and　downward。　She　opened　the　uterus　in　the　same　direction；　and　endeavored　to　extract　the　fetus。　To　expedite　the　extraction；　she　drew　out　an　arm　and　amputated　it；　and　finding　the　extraction　still　difficult；　she　cut　off　the　head　and　completely　emptied　the　womb；　including　the　placenta。　She　bound　a　tight　bandage　around　her　body　and　hid　the　fetus　in　a　straw　mattress。　She　then　dressed　herself　and　attended　to　her　domestic　duties。　She　afterward　mounted　a　cart　and　went　into　the　city　of　Viterbo；　where　she　showed　her　sister　a　cloth　bathed　in　blood　as　menstrual　proof　that　she　was　not　pregnant。　On　returning　home；　having　walked　five　hours；　she　was　seized　with　an　attack　of　vomiting　and　fainted。　The　parents　called　Drs。　Serpieri　and　Baliva；　who　relate　the　case。　Thirteen　hours　had　elapsed　from　the　infliction　of　the　wound；　through　which　the　bulk　of　the　intestines　had　been　protruding　for　the　past　six　hours。　The　abdomen　was　irrigated；　the　toilet　made；　and　after　the　eighteenth　day　the　process　of　healing　was　well　progressed；　and　the　woman　made　a　recovery　after　her　plucky　efforts　to　hide　her　shame。

Cases　like　the　foregoing　excite　no　more　interest　than　those　on　record　in　which　an　abdominal　section　has　been　accidental；　as；　for　instance；　by　cattle…horns；　and　the　fetus　born　through　the　wound。　Zuboldie　speaks　of　a　case　in　which　a　fetus　was　born　from　the　wound　made　by　a　bull's　horn　in　the　mother's　abdomen。　Deneux　describes　a　case　in　which　the　wound　made　by　the　horn　was　not　sufficiently　large　to　permit　the　child's　escape；　but　it　was　subsequently　brought　through　the　opening。　Pigne　speaks　of　a　woman　of　thirty…eight；　who　in　the　eighth　month　of　her　sixth　pregnancy　was　gored　by　a　bull；　the　horn　effecting　a　transverse　wound　27　inches　long；　running　from　one　anterior　spine　to　the　other。　The　woman　was　found　cold　and　insensible　and　with　an　imperceptible　pulse。　The　small　intestines　were　lying　between　the　thighs　and　covered　with　coagulated　blood。　In　the　process　of　cleansing；　a　male　child　was　expelled　spontaneously　through　a　rent　in　the　uterus。　The　woman　was　treated　with　the　usual　precautions　and　was　conscious　at　midday。　In　a　month　she　was　up。　She　lived　twenty　years　without　any　inconvenience　except　that　due　to　a　slight　hernia　on　the　left　side。　The　child　died　at　the　end　of　a　fortnight。

In　a　very　exhaustive　article　Harris　of　Philadelphia　has　collected　nearly　all　the　remaining　cases　on　record；　and　brief　extracts　from　some　of　them　will　be　given　below。　In　Zaandam；　Holland；　1647；　a　farmer's　wife　was　tossed　by　a　furious　bull。　Her　abdomen　was　ripped　open；　and　the　child　and　membranes　escaped。　The　child　suffered　no　injuries　except　a　bruised　upper　lip　and　lived　nine　months。　The　mother　died　within　forty　hours　of　her　injuries。　Figure　19　taken　from　an　engraving　dated　1647；　represents　an　accouchement　by　a　mad　bull；　possibly　the　same　case。　In　Dillenberg；　Germany；　in　1779；　a　multipara　was　gored　by　an　ox　at　her　sixth　month　of　pregnancy；　the　horn　entered　the　right　epigastric　region；　three　inches　from　the　linea　alba；　and　perforated　the　uterus。　The　right　arm　of　the　fetus　protruded；　the　wound　was　enlarged　and　the　fetus　and　placenta　delivered。　Thatcher　speaks　of　a　woman　who　was　gored　by　a　cow　in　King's　Park；　and　both　mother　and　child　were　safely　delivered　and　survived。

In　the　Parish　of　Zecoytia；　Spain；　in　1785；　Marie　Gratien　was　gored　by　an　ox　in　the　superior　portion　of　her　epigastrium；　making　a　wound　eight　inches　long　which　wounded　the　uterus　in　the　same　direction。　Dr。　Antonio　di　Zubeldia　and　Don　Martin　Monaco　were　called　to　take　charge　of　the　case。　While　they　were　preparing　to　effect　delivery　by　the　vagina；　the　woman；　in　an　attack　of　singultus；　ruptured　the　line　of　laceration　and　expelled　the　fetus；　dead。　On　the　twenty…first　day　the　patient　was　doing　well。　The　wound　closed　at　the　end　of　the　sixteenth　week。　The　woman　subsequently　enjoyed　excellent　health　and；　although　she　had　a　small　ventral　hernia；　bore　and　nursed　two　children。

Marsh　cites　the　instance　of　a　woman　of　forty…two；　the　mother　of　eight　children；　who　when　eight　months　pregnant　was　horned　by　a　cow。　Her　clothes　were　not　torn；　but　she　felt　that　the　child　had　slipped　out；　and　she　caught　it　in　her　dress。　She　was　seen　by　some　neighbors　twelve　yards　from　the　place　of　accident；　and　was　assisted　to　her　house。　The　bowels　protruded　and　the　child　was　separated　from　the　funis。　A　physician　saw　the　woman　three…quarters　of　an　hour　afterward　and　found　her　pulseless　and　thoroughly　exhausted。　There　was　considerable　but　not　excessive　loss　of　blood；　and　several　feet　of　intestine　protruded　through　the　wound。　The　womb　was　partially　inverted　through　the　wound；　and　the　placenta　was　still　attached　to　the　inverted　portion。　The　wound　in　the　uterus　was　Y…shaped。　The　mother　died　in　one　and　a　half　hours　from　the　reception　of　her　injuries；　but　the　child　was　uninjured。

Scott　mentions　the　instance　of　a　woman　thirty…four　years　old　who　was　gored　by　an　infuriated　ox　while　in　the　ninth　month　of　her　eighth　pregnancy。　The　horn　entered　at　the　anterior　superior　spinous　process　of　the　ilium；　involving　the　parietes　and　the　uterus。　The　child　was　extruded　through　the　wound　about　half　an　hour　after　the　occurrence　of　the　accident。　The　cord　was　cut　and　the　child　survived　and　thrived；　though　the　mother　soon　died。　Stalpart　tells　the　almost　incredible　story　of　a　soldier's　wife　who　went　to　obtain　water　from　a　stream　and　was　cut　in　two　by　a　cannonball　while　stooping　over。　A　passing　soldier　observed　something　to　move　in　the　water；　which；　on　investigation；　he　found　to　be　a　living　child　in　its　membranes。　It　was　christened　by　order　of　one　Cordua　and　lived　for　some　time　after。

Postmortem　Cesarean　Section。The　possibility　of　delivering　a　child　by　Cesarean　section　after　the　death　of　the　mother　has　been　known　for　a　long　time　to　the　students　of　medicine。　In　the　olden　times　there　were　laws　making　compulsory　the　opening　of　the　dead　bodies　of　pregnant　women　shortly　after　death。　Numa　Pompilius　established　the　first　law；　which　was　called　〃les　regia；〃　and　in　later　times　there　were　many　such　ordinances。　A　full　description　of　these　laws　is　on　record。　Life　was　believed　possible　after　a　gestation　of　six　months　or　over；　and；　as　stated；　some　famous　men　were　supposed　to　have　been　born　in　this　manner。　Francois　de　Civile；　who　on　great　occasions　signed　himself　〃trois　fois　enterre　et　trois　fois　par　le　grace　de　Dieu　ressucite；〃　saw　the　light　of　the　world　by　a　happy　Cesarean　operation　on　his　exhumed　mother。　Fabricius　Hildanus　and　Boarton　report　similar　instances。　Bourton　cites　among　others　the　case　of　an　infant　who　was　found　living　twelve　hours　after　the　death　of　his　mother。　Dufour　and　Mauriceau　are　two　older　French　medical　writers　who　discuss　this　subject。　Flajani　speaks　of　a　case　in　which　a　child　was　delivered　at　the　death　of　its　mother；　and　some　of　the　older　Italian　writers　discuss　the　advisability　of　the　operation　in　the　moribund　state　before　death　actually　ensues。　Heister　writes　of　the　delivery　of　the　child　after　the　death　of　the　mother　by　opening　the　abdomen　and　uterus

Harris　relates　several　interesting　examples。　In　Peru　in　1794　a　Sambi　woman　was　killed　by　lightning；　and　the　next　day　the　abdomen　was　opened　by　official　command　and　a　living　child　was　extracted。　The　Princess　von　Swartzenberg；　who　was　burned　to　death　at　a　ball　in　Paris　in　1810；　was　said　to　have　had　a　living　child　removed　from　her　body　the　next　day。　Like　all　similar　instances；　this　was　proved　to　be　false；　as　her　body　was　burned　beyond　the　possibility　of　recognition；　and；　besides；　she　was　only　four　months　pregnant。　Harris　mentions　another　case　of　a　young　woman　who　threw　herself　from　the　Pont　Neuf　into　the　Seine。　Her　body　was　recovered；　and　a　surgeon　who　was　present　seized　a　knife　from　a　butcher　standing　by　and　extracted　a　living　child　in　the　presence　of　the　curious　spectators。　Campbell　discusses　this　subject　most　thoroughly；　though　he　advances　no　new　opinions　upon　it。

Duer　tabulates　the　successful　results　of　a　number　of　cases　of　Cesarean　section　after　death　as　follows：

Children　extracted　　between　1　and　5　minutes　after　death　of　the　mother；　21　〃　　　〃　　　10　and　15　　　〃　　　　〃　　　　〃　　　〃　　　　〃　　　　〃　　　　　　13　　　　〃　　　〃　　　15　and　30　　　〃　　　　〃　　　　〃　　　〃　　　　〃　　　　〃　　　　　　　2　〃　　　〃　　　1　hour　　　　　　〃　　　　〃　　　　〃　　　〃　　　　〃　　　　〃　　　　　　　2　〃　　　〃　　　2　hours　　　　　〃　　　　〃　　　　〃　　　〃　　　　〃　　　　〃　　　　　　　2

Garezky　of　St。　Petersburg　collected　reports　of　379　cases　of　Cesarean　section　after　death　with　the　following　results：　308　were　extracted　dead；　37　showed　signs　of　life；　34　were　born　alive。　Of　the　34；　only　5　lived　for　any　length　of　time。　He　concludes　that　if　extracted　within　five　or　six　minutes　after　death；　they　may　be　born　alive；　if　from　six　to　ten　minutes；　they　may　still　be　born　alive；　though　asphyxiated；　if　from　ten　to　twenty…six　minutes；　they　will　be　highly　asphyxiated。　In　a　great　number　of　these　cases　the　infant　was　asphyxiated　or　dead　in　one　minute。　Of　course；　if　the　death　is　sudden；　as　by　apoplexy；　accident；　or　suicide；　the　child's　chances　are　better。　These　statistics　seem　conscientious　and　reliable；　and　we　are　safe　in　taking　them　as　indicative　of　the　usual　result；　which　discountenances　the　old　reports　of　death　as　taking　place　some　time　before　extraction。

Peuch　is　credited　with　statistics　showing　that　in　453　operations　101　children　gave　signs　of　life；　but　only　45　survived。

During　the　Commune　of　Paris；　Tarnier；　one　night　at　the　Maternite；　was　called　to　an　inmate　who；　while　lying　in　bed　near　the　end　of　pregnancy；　had　been　killed　by　a　ball　which　fractured　the　base　of　the　skull　and　entered　the　brain。　He　removed　the　child　by　Cesarean　section　and　it　lived　for　several　days。　In　another　case　a　pregnant　woman　fell　from　a　window　for　a　distance　of　more　than　30　feet；　instant　death　resulting；　thirty　minutes　at　least　after　the　death　of　the　mother　an　infant　was　removed；