anomalies and curiosities of medicine-第34部分

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ters　of　an　hour　after　the　intestines　had　been　found　in　the　yard　（where　the　brute　had　thrown　them）；　still　alive　and　reproaching　her　murderer。　Hoffman　cites　an　instance　in　which　a　midwife；　in　her　anxiety　to　extract　the　afterbirth；　made　traction　on　the　cord；　brought　out　the　uterus；　ovaries；　and　tubes；　and　tore　the　vulva　and　perineum　as　far　as　the　anus。

Woodson　tells　the　story　of　a　negress　who　was　four　months　pregnant；　and　who；　on　being　seized　with　severe　uterine　pains　in　a　bath；　succeeded　in　seizing　the　fetus　and　dragging　it　out；　but　inverting　the　uterus　in　the　operation。　There　is　a　case　recorded　of　a　girl　of　eighteen；　near　her　labor；　who；　being　driven　from　her　house　by　her　father；　took　refuge　in　a　neighboring　house；　and　soon　felt　the　pains　of　child…birth。　The　accoucheur　was　summoned；　pronounced　them　false　pains；　and　went　away。　On　his　return　he　found　the　girl　dying；　with　her　uterus　completely　inverted　and　hanging　between　her　legs。　This　unfortunate　maiden　had　been　delivered　while　standing　upright；　with　her　elbows　on　the　back　of　a　chair。　The　child　suddenly　escaped；　bringing　with　it　the　uterus；　but　as　the　funis　ruptured　the　child　fell　to　the　floor。　Wagner　pictures　partial　prolapse　of　the　womb　in　labor。

It　would　too　much　extend　this　chapter　to　include　the　many　accidents　incident　to　labor；　and　only　a　few　of　especial　interest　will　be　given。　Cases　like　rupture　of　an　aneurysm　during　labor；　extensive　hemorrhage；　the　entrance　of　air　into　the　uterine　veins　and　sinuses；　and　common　lacerations　will　be　omitted；　together　with　complicated　births　like　those　of　double　monsters；　etc。；　but　there　are　several　other　cases　that　deserve　mention。　Eldridge　gives　an　instance　of　separation　of　the　symphysis　pubis　during　labor；a　natural　symphysiotomy。　A　separation　of　3/4　inch　could　be　discerned　at　the　symphysis；　and　in　addition　the　sacroiliac　synchondrosis　was　also　quite　movable。　The　woman　had　not　been　able　to　walk　in　the　latter　part　of　her　pregnancy。　The　child　weighed　10　1/2　pounds　and　had　a　large　head　in　a　remarkably　advanced　stage　of　ossification；　with　the　fontanelles　nearly　closed。　Delivery　was　effected；　though　during　the　passage　of　the　head　the　pubes　separated　to　such　an　extent　that　Eldridge　placed　two　fingers　between　them。　The　mother　recovered；　and　had　perfect　union　and　normal　locomotion。

Sanders　reports　a　case　of　the　separation　of　the　pubic　bones　in　labor。　Studley　mentions　a　case　of　fracture　of　the　pelvis　during　instrumental　delivery。　Humphreys　cites　a　most　curious　instance。　The　patient；　it　appears；　had　a　large　exostosis　on　the　body　of　the　pubes　which；　during　parturition；　was　forced　through　the　walls　of　the　uterus　and　bladder；　resulting　in　death。　Kilian　reports　four　cases　of　death　from　perforation　of　the　uterus　in　this　manner。　Schauta　pictures　such　an　exostosis。

Chandler　relates　an　instance　in　which　there　was　laceration　of　the　liver　during　parturition；　and　Hubbard　records　a　case　of　rupture　of　the　spleen　after　labor。

Symphysiotomy　is　an　operation　consisting　of　division　of　the　pubic　symphysis　in　order　to　facilitate　delivery　in　narrow　pelves。　This　operation　has　undergone　a　most　remarkable　revival　during　the　past　two　years。　It　originated　in　a　suggestion　by　Pineau　in　his　work　on　surgery　in　1598；　and　in　1665　was　first　performed　by　La　Courvee　upon　a　dead　body　in　order　to　save　the　child；　and　afterward　by　Plenk；　in　1766；　for　the　same　purpose。　In　1777　Sigault　first　proposed　the　operation　on　the　living；　and　Ferrara　was　the　one　to　carry　out；　practically；　the　proposition；although　Sigault　is　generally　considered　to　be　the　first　symphysiotormist；　and　the　procedure　is　very　generally　known　as　the　〃Sigaultean　operation。〃　From　Ferrara's　time　to　1858；　when　the　operation　had　practically　died　out；　it　had　been　performed　85　times；　with　a　recorded　mortality　of　33　per　cent。　In　1866　the　Italians；　under　the　leadership　of　Morisani　of　Naples；　revived　the　operation；　and　in　twenty　years　had　performed　it　70　times　with　a　mortality　of　24　per　cent。　Owing　to　rigid　antiseptic　technic；　the　last　38　of　these　operations　（1886　to　1891）　showed　a　mortality　of　only　50　per　cent；　while　the　infant…mortality　was　only　10　2/3　per　cent。　The　modern　history　of　this　operation　is　quite　interesting；　and　is　very　completely　reviewed　by　Hirst　and　Dorland。　

In　November；　1893；　Hirst　reported　212　operations　since　1887；　with　a　maternal　mortality　of　12。73　per　cent　and　a　fetal　mortality　of　28　per　cent。　In　his　later　statistics　Morisani　gives　55　cases　with　2　maternal　deaths　and　1　infantile　death；　while　Zweifel　reports　14　cases　from　the　Leipzig　clinic　with　no　maternal　death　and　2　fetal　deaths；　1　from　asphyxia　and　1　from　pneumonia；　two　days　after　birth。　All　the　modern　statistics　are　correspondingly　encouraging。

Irwin　reports　a　case　in　which　the　firm　attachment　of　the　fetal　head　to　the　uterine　parietes　rendered　delivery　without　artificial　aid　impossible；　and　it　was　necessary　to　perform　craniotomy。　The　right　temporal　region　of　the　child　adhered　to　the　internal　surface　of　the　neck　of　the　uterus；　being　connected　by　membranes。　The　woman　was　forty…four　years　old；　and　the　child　was　her　fourth。

Delay　in　the　Birth　of　the　Second　Twin。In　twin　pregnancies　there　is　sometimes　a　delay　of　many　days　in　the　birth　of　a　second　child；　even　to　such　an　extent　as　to　give　suspicion　of　superfetation。　Pignot　speaks　of　one　twin　two　months　before　the　other。　De　Bosch　speaks　of　a　delay　of　seventeen　days；　and　there　were　2　cases　on　record　in　France　in　the　last　century；　one　of　which　was　delayed　ten　days；　and　the　other　showed　an　interval　of　seven　weeks　between　the　delivery　of　the　twins。　There　is　an　old　case　on　record　in　which　there　was　an　interval　of　six　weeks　between　deliveries；　Jansen　gives　an　account　of　three　births　in　ten　months；　Pinart　mentions　a　case　with　an　interval　of　ten　days；　Thilenius；　one　of　thirteen　days；　and　Ephemerides；　one　of　one　week。　Wildberg　describes　a　case　in　which　one　twin　was　born　two　months　after　the　other；　and　there　was　no　secretion　of　milk　until　after　the　second　birth。　A　full　description　of　Wildberg's　case　is　given　in　another　journal　in　brief；　as　follows：　A　woman；　eighteen　months　married；　was　in　labor　in　the　eighth　month　of　pregnancy。　She　gave　birth　to　a　child；　which；　though　not　fully　matured；　lived。　There　was　no　milk…secretion　in　her　breasts；　and　she　could　distinctly　feel　the　movements　of　another　child；　her　abdomen　increased　in　size。　After　two　months　she　had　another　labor；　and　a　fully　developed　and　strong　child　was　born；　much　heavier　than　the　first。　On　the　third　day　after；　the　breasts　became　enlarged；　and　she　experienced　considerable　fever。　It　was　noticeable　in　this　case　that　a　placenta　was　discharged　a　quarter　of　an　hour　after　the　first　birth。　Irvine　relates　an　instance　of　thirty…two　days'　delay；　and　Pfau　one　of　seven　days'。

Carson　cites　the　instance　of　a　noblewoman　of　forty；　the　mother　of　four　children；　who　was　taken　ill　about　two　weeks　before　confinement　was　expected；　and　was　easily　delivered　of　a　male　child；　which　seemed　well　formed；　with　perfect　nails；　but　weakly。　After　the　birth　the　mother　never　became　healthy　or　natural　in　appearance。　She　was　supposed　to　be　dying　of　dropsy；　but　after　forty…four　days　the　mystery　was　cleared　by　the　birth　of　a　fine；　well…grown；　and　healthy　daughter。　Both　mother　and　child　did　well。

Addison　describes　the　case　of　a　woman　who　was　delivered　of　a　healthy　male　child；　and　everything　was　well　until　the　evening　of　the　fourth　day；　when　intense　labor…pains　set　in；　and　well…formed　twins　about　the　size　of　a　pigeon's　egg　were　born。　In　this　strange　case；　possibly　an　example　of　superfetation；　the　patient　made　a　good　recovery　and　the　first　child　lived。　A　similar　case　is　reported　by　Lumby　in　which　a　woman　was　delivered　on　January　18th；　by　a　midwife；　of　a　full…grown　and　healthy　female　child。　On　the　third　day　she　came　down…stairs　and　resumed　her　ordinary　duties；　which　she　continued　until　February　4th　（seventeen　days　after）。　At　this　time　she　was　delivered　of　twins；　a　boy　and　a　girl；　healthy　and　well…developed。　The　placenta　was　of　the　consistency　of　jelly　and　had　to　be　scooped　away　with　the　hand。　The　mother　and　children　did　well。　This　woman　was　the　mother　of　ten　children　besides　the　product　of　this　conception；　and　at　the　latter　occurrence　had　entire　absence　of　pains　and　a　very　easy　parturition。

Pincott　had　a　case　with　an　interval　of　seven　weeks　between　the　births；　Vale　1　of　two　months；　Bush　1　of　seventeen　days；　and　Burke　1　with　an　interval　of　two　months。　Douglas　cites　an　instance　of　twins　being　born　four　days　apart。　Bessems　of　Antwerp；　in　1866；　mentions　a　woman　with　a　bicornate　uterus　who　bore　two　twins　at　fifty…four　days'　interval。



CHAPTER　IV。

PROLIFICITY。

General　Historic　Observations。Prolificity　is　a　much　discussed　subject；　for　besides　its　medical　and　general　interest　it　is　of　importance　in　social　as　well　as　in　political　economy。　Superfluous　population　was　a　question　that　came　to　consciousness　early；　Aristotle　spoke　of　legislation　to　prevent　the　increase　of　population　and　the　physical　and　mental　deterioration　of　the　race；he　believed　in　a　population　fixed　as　regards　numbers；and　later　Lycurgus　transformed　these　precepts　into　a　terrible　law。　Strabonius　reports　that　the　inhabitants　of　Cathea　brought　their　infants　at　the　age　of　two　months　before　a　magistrate　for　inspection。　The　strong　and　promising　were　preserved　and　the　weak　destroyed。　The　founders　of　the　Roman　Empire　followed　a　similar　usage。　With　great　indignation　Seneca；　Ovid；　and　Juvenal　reproved　this　barbarity　of　the　Romans。　With　the　domination　of　Christianity　this　custom　gradually　diminished；　and　Constantine　stopped　it　altogether；　ordering　succor　to　the　people　too　poor　to　rear　their　own　children。　The　old　Celts　were　so　jealous　of　their　vigor　that　they　placed　their　babes　on　a　shield　in　the　river；　and　regarded　those　that　the　waves　respected　as　legitimate　and　worthy　to　become　members　of　their　clans。　In　many　of　the　Oriental　countries；　where　the　population　is　often　very　excessive　and　poverty　great；　the　girl　babies　of　the　lower　classes　were　destroyed。　At　one　time　the　crocodiles；　held　sacred　in　the　Nile；　were　given　the　surplus　infants。　By　destroying　the　females　the　breeding　necessarily　diminished；　and　the　number　of　the　weaker　and　dependent　classes　became　less。　In　other　countries　persons　having　children　beyond　their　ability　to　support　were