PRENATAL ANOMALIES. 2 page extrauterine pregnancy remaining in the abdomen forty-six years;
Hannaeus mentioned an instance remaining ten years, the mother being
pregnant in the meantime; Primperosius speaks of a similar instance; de
Blegny, one of twenty-five years in the abdomen; Birch, a case of
eighteen years in the abdomen, the woman bearing in the meantime;
Bayle, one of twenty-six years, and the Ephemerides, another. In a
woman of forty-six, the labor pains intervened without expulsion of the
fetus. Impregnation ensued twice afterward, each followed by the birth
of a living child. The woman lived to be ninety-four, and was persuaded
that the fetus was still in the abdomen, and directed a postmortem
examination to be made after her decease, which was done, and a large
cyst containing an ossified fetus was discovered in the left side of
the cavity. In 1716 a woman of Joigny when thirty years old, having
been married four years, became pregnant, and three months later felt
movements and found milk in her breasts. At the ninth month she had
labor-pains, but the fetus failed to present; the pains ceased, but
recurred in a month, still with a negative result. She fell into a most
sickly condition and remained so for eighteen months, when the pains
returned again, but soon ceased. Menstruation ceased and the milk in
her breasts remained for thirty years. She died at sixty-one of
peripneumonia, and on postmortem examination a tumor was found
occupying part of the hypogastric and umbilical regions. It weighed
eight pounds and consisted of a male fetus of full term with six teeth;
it had no odor and its sac contained no liquid. The bones seemed
better developed than ordinarily; the skin was thick, callous, and
yellowish The chorion, amnion, and placenta were ossified and the cord
dried up. Walther mentions the case of an infant which remained almost
petrified in the belly of its mother for twenty-three years. No trace
of the placenta, cord, or enveloping membrane could be found.
Cordier publishes a paper on ectopic gestation, with particular
reference to tubal pregnancy, and mentions that when there is rupture
between the broad ligaments hemorrhage is greatly limited by the
resistance of the surrounding structures, death rarely resulting from
the primary rupture in this location. Cordier gives an instance in
which he successfully removed a full-grown child, the result of an
ectopic gestation which had ruptured intraligamentally and had been
retained nearly two years.
Lospichlerus gives an account of a mother carrying twins, extrauterine,
for six years. Mounsey of Riga, physician to the army of the Czarina,
sent to the Royal Society in 1748 the bones of a fetus that had been
extracted from one of the fallopian tubes after a lodgment of thirteen
years. Starkey Middleton read the report of a case of a child which had
been taken out of the abdomen, having lain there nearly sixteen years,
during which time the mother had borne four children. It was argued at
this time that boys were conceived on the right side and girls on the
left, and in commenting on this Middleton remarks that in this case the
woman had three boys and one girl after the right fallopian tube had
lost its function. Chester cites the instance of a fetus being retained
fifty-two years, the mother not dying until her eightieth year.
Margaret Mathew carried a child weighing eight pounds in her abdomen
for twenty-six years, and which after death was extracted. Aubrey
speaks of a woman aged seventy years unconsciously carrying an
extrauterine fetus for many years, which was only discovered
postmortem. She had ceased to menstruate at forty and had borne a child
at twenty-seven. Watkins speaks of a fetus being retained forty-three
years; James, others for twenty-five, thirty, forty-six, and fifty
years; Murfee, fifty-five years; Cunningham, forty years; Johnson,
forty-four years; Josephi, fifteen years (in the urinary bladder);
Craddock, twenty-two years, and da Costa Simoes, twenty-six years.
Long Retention of Uterine Pregnancy.--Cases of long retained
intrauterine pregnancies are on record and deserve as much
consideration as those that were extrauterine. Albosius speaks of a
mother carrying a child in an ossified condition in the uterus for
twenty-eight years. Cheselden speaks of a case in which a child was
carried many years in the uterus, being converted into a clay-like
substance, but preserving form and outline. Caldwell mentions the case
of a woman who carried an ossified fetus in her uterus for sixty years.
Camerer describes the retention of a fetus in the uterus for forty-six
years; Stengel, one for ten years, and Storer and Buzzell, for
twenty-two months. Hannaeus, in 1686, issued a paper on such a case
under the title, "Mater, Infantis Mortui Vivum Sepulchrum," which may
be found in French translation.
Buchner speaks of a fetus being retained in the uterus for six years,
and Horstius relates a similar case. Schmidt's Jahrbucher contain the
report of a woman of forty-nine, who had borne two children. While
threshing corn she felt violent pain like that of labor, and after an
illness suffered a constant fetid discharge from the vagina for eleven
years, fetal bones being discharged with occasional pain. This poor
creature worked along for eleven years, at the end of which time she
was forced to bed, and died of symptoms of purulent peritonitis. At the
necropsy the uterus was found adherent to the anterior wall of the
abdomen and containing remnants of a putrid fetus with its numerous
bones. There is an instance recorded of the death of a fetus occurring
near term, its retention and subsequent discharge being through a
spontaneous opening in the abdominal wall one or two months after.
Meigs cites the case of a woman who dated her pregnancy from March,
1848, and which proceeded normally for nine months, but no labor
supervened at this time and the menses reappeared. In March, 1849, she
passed a few fetal bones by the rectum, and in May, 1855, she died. At
the necropsy the uterus was found to contain the remains of a fully
developed fetus, minus the portions discharged through a fistulous
connection between the uterine cavity and the rectum. In this case
there had been retention of a fully developed fetus for nine years. Cox
describes the case of a woman who was pregnant seven months, and who
was seized with convulsions; the supposed labor-pains passed off, and
after death the fetus was found in the womb, having lain there for five
years. She had an early return of the menses, and these recurred
regularly for four years. Dewees quotes two cases, in one of which the
child was carried twenty months in the uterus; in the other, the mother
was still living two years and five months after fecundation. Another
case was in a woman of sixty, who had conceived at twenty-six, and
whose fetus was found, partly ossified, in the uterus after death.
There are many narratives of the long continuation of fetal movements,
and during recent years, in the Southern States, there was quite a
prevalence of this kind of imposters. Many instances of the exhibition
of fetal movements in the bellies of old negro women have been noticed
by the lay journals, but investigation proves them to have been nothing
more than an exceptional control over the abdominal muscles, with the
ability to simulate at will the supposed fetal jerks. One old woman
went so far as to show the fetus dancing to the music of a banjo with
rhythmical movements. Such imposters flourished best in the regions
given to "voodooism." We can readily believe how easy the deception
might be when we recall the exact simulation of the fetal movements in
instances of pseudocyesis.
The extraordinary diversity of reports concerning the duration of
pregnancy has made this a much mooted question. Many opinions relative
to the longest and shortest period of pregnancy, associated with
viability of the issue, have been expressed by authors on medical
jurisprudence. There is perhaps no information more unsatisfactory or
uncertain. Mistakes are so easily made in the date of the occurrence of
pregnancy, or in the date of conception, that in the remarkable cases
we can hardly accept the propositions as worthy evidence unless
associated with other and more convincing facts, such as the appearance
and stage of development of the fetus, or circumstances making
conception impossible before or after the time mentioned, etc. It will
be our endeavor to cite the more seemingly reliable instances of the
anomalies of the time or duration of pregnancy reported in reputable
periodicals or books.
Short Pregnancies.--Hasenet speaks of the possibility of a living birth
at four months; Capuron relates the instance of Fortunio Liceti, who
was said to have been born at the end of four and a half months and
lived to complete his twenty-fourth year. In the case of the Marechal
de Richelieu, the Parliament of Paris decreed that an infant of five
months possessed that capability of living the ordinary period of
existence, i.e., the "viabilite," which the law of France requires for
the establishment of inheritance. In his seventh book Pliny gives
examples of men who were born out of time. Jonston gives instances of
births at five, six, seven, and eight months. Bonnar quotes 5 living
births before the one hundred and fiftieth day; 1 of one hundred and
twenty-five days; 1 of one hundred and twenty days; 1 of one hundred
and thirty-three days, surviving to twenty-one months; and 1 of one
hundred and thirty-five days' pregnancy surviving to eighty years.
Maisonneuve describes a case in which abortion took place at four and a
half months; he found the fetus in its membranes two hours after
delivery, and, on laying the membranes open, saw that it was living. He
applied warmth, and partly succeeded in restoring it; for a few minutes
respiratory movements were performed regularly, but it died in six
hours. Taylor quotes Carter concerning the case of a fetus of five
months which cried directly after it was born, and in the half hour it
lived it tried frequently to breathe. He also quotes Davies, mentioning
an instance of a fetus of five months, which lived twelve hours,
weighing 2 pounds, and measuring 12 inches, and which cried vigorously.
The pupillary membrane was entire, the testes had not descended, and
the head was well covered with hair. Usher speaks of a woman who in
1876 was delivered of 2 male children on the one hundred and
thirty-ninth day; both lived for an hour; the first weighed 10 ounces 6
drams and measured 9 3/4 inches; the other 10 ounces 7 drams, with the
same length as the first. Routh speaks of a Mrs. F----, aged
thirty-eight, who had borne 9 children and had had 3 miscarriages, the
last conception terminating as such. Her husband was away, and returned
October 9, 1869. She did not again see her husband until the 3d or 4th
of January. The date of quickening was not observed, and the child was
born June 8, 1870. During gestation she was much frightened by a rat.
The child was weak, the testes undescended, and it lived but eighteen
days, dying of symptoms of atrophy. The parents were poor, of excellent
character, and although, according to the evidence, this pregnancy
lasted but twenty-two weeks and two days, there was absolutely no
reason to suspect infidelity.
Ruttel speaks of a child of five months who lived twenty-four hours;
and he saw male twins born at the sixth month weighing 3 pounds each
who were alive and healthy a year after. Barker cites the case of a
female child born on the one hundred and fifty-eighth day that weighed
1 pound and was 11 inches long. It had rudimentary nails, very little
hair on the head, its eyelids were closed, and the skin much shriveled;
it did not suckle properly, and did not walk until nineteen months old.
Three and a half years after, the child was healthy and thriving, but
weighed only 29 1/2 pounds. At the time of birth it was wrapped up in a
box and placed before the fire. Brouzet speaks of living births of from
five to six months' pregnancy, and Kopp speaks of a six months' child
which lived four days. The Ephemerides contains accounts of living
premature births.
Newinton describes a pregnancy of five months terminating with the
birth of twins, one of whom lived twenty minutes and the other fifteen.
The first was 11 1/2 inches long, and weighed 1 pound 3 1/2 ounces, and
the other was 11 inches long, and weighed 1 pound. There is a recent
instance of premature birth following a pregnancy of between five and a
half and six months, the infant weighing 955 grams. One month after
birth, through the good offices of the wet-nurse and M. Villemin, who
attended the child and who invented a "couveuse" for the occasion, it
measured 38 cm. long.
Moore is accredited with the trustworthy report of the case of a woman
who bore a child at the end of the fifth month weighing 1 1/2 pounds
and measuring 9 inches. It was first nourished by dropping liquid food
into its mouth; and at the age of fifteen months it was healthy and
weighed 18 pounds. Eikam saw a case of abortion at the fifth month in
which the fetus was 6 inches in length and weighed about 8 ounces. The
head was sufficiently developed and the cranial bones considerably
advanced in ossification. He tied the cord and placed the fetus in warm
water. It drew up its feet and arms and turned its head from one side
to the other, opening its mouth and trying to breathe. It continued in
this wise for an hour, the action of the heart being visible ten
minutes after the movements ceased. From its imperfectly developed
genitals it was supposed to have been a female. Professor J. Muller, to
whom it was shown, said that it was not more than four months old, and
this coincided with the mother's calculation.
Villemin before the Societe Obstetricale et Gynecologique reported the
case of a two-year-old child, born in the sixth month of pregnancy.
That the child had not had six months of intrauterine life he could
vouch, the statement being borne out by the last menstrual period of
the mother, the date of the first fetal movements, the child's weight,
which was 30 1/2 ounces, and its appearance. Budin had had this infant
under observation from the beginning and corroborated Villemin's
statements. He had examined infants of six or seven months that had
cried and lived a few days, and had found the alveolar cavities filled
with epithelial cells, the lung sinking when placed in a vessel of
water. Charpentier reported a case of premature birth in his practice,
the child being not more than six and a half months and weighing 33 1/2
ounces. So sure was he that it would not live that he placed it in a
basin while he attended to the mother. After this had been done, the
child being still alive, he wrapped it in cotton and was surprised next
day to find it alive. It was then placed in a small, well-heated room
and fed with a spoon on human milk; on the twelfth day it could take
the breast, since which time it thrived and grew.
There is a case on record of a child viable at six months and twenty
days. The mother had a miscarriage at the beginning of 1877, after
which menstruation became regular, appearing last from July 3 to 9,
1877. On January 28, 1878, she gave birth to a male infant, which was
wrapped in wadding and kept at an artificial temperature. Being unable
to suckle, it was fed first on diluted cow's milk. It was so small at
birth that the father passed his ring over the foot almost to the knee.
On the thirteenth day it weighed 1250 grams, and at the end of a week
it was taking the breast. In December, 1879, it had 16 teeth, weighed
10 kilograms, walked with agility, could pronounce some words, and was
especially intelligent. Capuron relates an instance of a child born
after a pregnancy of six and a half months and in excellent health at
two years, and another living at ten years of the same age at birth.
Tait speaks of a living female child, born on the one hundred and
seventy-ninth day, with no nails on its fingers or toes, no hair, the
extremities imperfectly developed, and the skin florid and thin. It was
too feeble to grasp its mother's nipple, and was fed for three weeks by
milk from the breast through a quill. At forty days it weighed 3 pounds
and measured 13 inches. Before the expiration of three months it died
of measles. Dodd describes a case in which the catamenia were on the
24th of June, 1838, and continued a week; the woman bore twins on
January 11, 1839, one of which survived, the other dying a few minutes
after birth. She was never irregular, prompt to the hour, and this
fact, coupled with the diminutive size of the children, seemed to
verify the duration of the pregnancy. In 1825, Baber of Buxur, India,
spoke of a child born at six and a half months, who at the age of fifty
days weighed 1 pound and 13 ounces and was 14 inches long. The longest
circumference of the head was 10 inches and the shortest 9.1 inches.
The child suckled freely and readily. In Spaeth's clinic there was a
viable infant at six and a half months weighing 900 grams. Spaeth says
that he has known a child of six months to surpass in eventual
development its brothers born at full term.
In some cases there seems to be a peculiarity in women which manifests
itself by regular premature births. La Motte, van Swieten, and Fordere
mention females who always brought forth their conceptions at the
seventh month.
The incubator seems destined to be the future means of preserving these
premature births. Several successful cases have been noticed, and by
means of an incubator Tarnier succeeded in raising infants which at the
age of six months were above the average. A full description of the
incubator may be found. The modified Auvard incubator is easily made;
the accompanying illustrations (Figs. 5, 6, and 7) explain its
mechanism. Several improved incubators have been described in recent
years, but the Auvard appears to be the most satisfactory.
The question of retardation of labor, like that of premature birth, is
open to much discussion, and authorities differ as to the limit of
protraction with viability. Aulus Gellius says that, after a long
conversation with the physicians and wise men, the Emperor Adrian
decided in a case before him, that of a woman of chaste manners and
irreproachable character, the child born eleven months after her
husband's death was legitimate. Under the Roman law the Decenviri
established that a woman may bear a viable child at the tenth month of
pregnancy. Paulus Zacchias, physician to Pope Innocent X, declared that
birth may be retarded to the tenth month, and sometimes to a longer
period. A case was decided in the Supreme Court of Friesland, a
province in the northern part of the Netherlands, October, 1634, in
which a child born three hundred and thirty-three days after the death
of the husband was pronounced legitimate. The Parliament of Paris was
gallant enough to come to the rescue of a widow and save her reputation
by declaring that a child born after a fourteen months' gestation was
legitimate. Bartholinus speaks of an unmarried woman of Leipzig who was
delivered after a pregnancy of sixteen months. The civil code of France
provides that three hundred days shall constitute the longest period of
the legitimacy of an infant; the Scottish law, three hundred days; and
the Prussian law, three hundred and one days.
There are numerous cases recorded by the older writers. Amman has one
of twelve months' duration; Enguin, one of twelve months'; Buchner, a
case of twelve months'; Benedictus, one of fourteen months'; de Blegny,
one of nineteen months'; Marteau, Osiander, and others of forty-two and
forty-four weeks'; and Stark's Archives, one of forty-five weeks',
living, and also another case of forty-four weeks'. An incredible case
is recorded of an infant which lived after a three years' gestation.
Instances of twelve months' duration are also recorded. Jonston quotes
Paschal in relating an instance of birth after pregnancy of
twenty-three months; Aventium, one after two years; and Mercurialis, a
birth after a four years' gestation--which is, of course, beyond belief.
Thormeau writes from Tours, 1580, of a case of gestation prolonged to
the twenty-third month, and Santorini, at Venice, in 1721, describes a
similar case, the child reaching adult life. Elvert records a case of
late pregnancy, and Henschel one of forty-six weeks, but the fetus was
dead. Schneider cites an instance of three hundred and eight days'
duration. Campbell says that Simpson had cases of three hundred and
nineteen, three hundred and thirty-two, and three hundred and
thirty-six days'; Meigs had one of four hundred and twenty. James Reid,
in a table of 500 mature births, gives 14 as being from three hundred
and two to three hundred and fifteen days'.
Not so long ago a jury rendered a verdict of guilty of fornication and
bastardy when it was alleged that the child was born three hundred and
seventeen days after intercourse. Taylor relates a case of pregnancy in
which the wife of a laborer went to America three hundred and
twenty-two days before the birth. Jaffe describes an instance of the
prolongation of pregnancy for three hundred and sixty-five days, in
which the developments and measurements corresponded to the length of
protraction. Bryan speaks of a woman of twenty-five who became pregnant
on February 10, 1876, and on June 17th felt motion. On July 28th she
was threatened with miscarriage, and by his advice the woman weaned the
child at the breast. She expected to be confined the middle of
November, 1876, but the expected event did not occur until April 26,
1877, nine months after the quickening and four hundred and forty days
from the time of conception. The boy was active and weighed nine
pounds. The author cites Meigs' case, and also one of Atlee's, at three
hundred and fifty-six days.
Talcott, Superintendent of the State Homeopathic Asylum for the Insane,
explained the pregnancy of an inmate who had been confined for four
years in this institution as one of protracted labor. He said that many
such cases have been reported, and that something less than two years
before he had charge of a case in which the child was born. He made the
report to the New York Senate Commission on Asylums for the Insane as
one of three years' protraction. Tidd speaks of a woman who was
delivered of a male child at term, and again in ten months delivered of
a well-developed male child weighing 7 1/4 pounds; he relates the
history of another case, in Clifton, W. Va., of a woman expecting
confinement on June 1st going over to September 16th, the fetus being
in the uterus over twelve months, and nine months after quickening was
felt.
Two extraordinary cases are mentioned, one in a woman of thirty-five,
who expected to be confined April 24, 1883. In May she had a few
labor-pains that passed away, and during the next six months she
remained about as large as usual, and was several times thought to be
in the early stages of labor. In September the os dilated until the
first and second fingers could be passed directly to the head. This
condition lasted about a month, but passed away. At times during the
last nine months of pregnancy she was almost unable to endure the
movements of the child. Finally, on the morning of November 6th, after
a pregnancy of four hundred and seventy-six days, she was delivered of
a male child weighing 13 pounds. Both the mother and child did well
despite the use of chloroform and forceps. The other case was one
lasting sixteen months and twenty days.
In a rather loose argument, Carey reckons a case of three hundred and
fifty days. Menzie gives an instance in a woman aged twenty-eight, the
mother of one child, in whom a gestation was prolonged to the
seventeenth month. The pregnancy was complicated by carcinoma of the
uterus. Ballard describes the case of a girl of sixteen years and six
months, whose pregnancy, the result of a single intercourse, lasted
three hundred and sixty days. Her labor was short and easy for a
primipara, and the child was of the average size. Mackenzie cites the
instance of a woman aged thirty-two, a primipara, who had been married
ten years and who always had been regular in menstruation. The menses
ceased on April 28, 1888, and she felt the child for the first time in
September. She had false pains in January, 1889, and labor did not
begin until March 8th, lasting sixty-six hours. If all these statements
are correct, the probable duration of this pregnancy was eleven months
and ten days.
Lundie relates an example of protracted gestation of eleven months, in
which an anencephalous fetus was born; and Martin of Birmingham
describes a similar case of ten and a half months' duration.
Raux-Tripier has seen protraction to the thirteenth month. Enguin
reports an observation of an accouchement of twins after a pregnancy
that had been prolonged for eleven months. Resnikoff mentions a
pregnancy of eleven months' duration in an anemic secundipara. The case
had been under his observation from the beginning of pregnancy; the
patient would not submit to artificial termination at term, which he
advised. After a painful labor of twenty-four hours a macerated and
decomposed child was born, together with a closely-adherent placenta.
Tarnier reports an instance of partus serotinus in which the product of
conception was carried in the uterus forty days after term. The fetus
was macerated but not putrid, and the placenta had undergone fatty
degeneration. At a recent meeting of the Chicago Gynecological Society,
Dr. F. A. Stahl reported the case of a German-Bohemian woman in which
the fifth pregnancy terminated three hundred and two days after the
last menstruation. Twenty days before there had occurred pains similar
to those of labor, but they gradually ceased. The sacral promontory was
exaggerated, and the anteroposterior pelvic diameter of the inlet in
consequence diminished. The fetus was large and occupied the first
position. Version was with difficulty effected and the passage of the
after-coming head through the superior strait required expression and
traction, during which the child died. The mother suffered a deep
laceration of the perineum involving an inch of the wall of the rectum.
Among others reporting instances of protracted pregnancy are Collins,
eleven months; Desbrest, eighteen months; Henderson, fifteen months;
Jefferies, three hundred and fifty-eight days, and De la Vergne gives
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