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

Date: 2014-12-29; view: 679