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PRENATAL ANOMALIES. 3 pagethe history of a woman who carried an infant in her womb for twenty-nine months; this case may possibly belong under the head of fetus long retained in the uterus.
Unconscious Pregnancy.--There are numerous instances of women who have had experience in pregnancy unconsciously going almost to the moment of delivery, yet experiencing none of the usual accompanying symptoms of this condition. Crowell speaks of a woman of good social position who had been married seven years, and who had made extensive preparations for a long journey, when she was seized with a "bilious colic," and, to her dismay and surprise, a child was born before the arrival of the doctor summoned on account of her sudden colic and her inability to retain her water. A peculiar feature of this case was the fact that mental disturbance set in immediately afterward, and the mother became morbid and had to be removed to an asylum, but recovered in a few months. Tanner saw a woman of forty-two who had been suffering with abdominal pains. She had been married three years and had never been pregnant. Her catamenia were very scant, but this was attributed to her change of life. She had conceived, had gone to the full term of gestation, and was in labor ten hours without any suspicion of pregnancy. She was successfully delivered of a girl, which occasioned much rejoicing in the household.
Tasker of Kendall's Mills, Me., reports the case of a young married woman calling him for bilious colic. He found the stomach slightly distended and questioned her about the possibility of pregnancy. Both she and her husband informed him that such could not be the case, as her courses had been regular and her waist not enlarged, as she had worn a certain corset all the time. There were no signs of quickening, no change in the breasts, and, in fact, none of the usual signs of pregnancy present. He gave her an opiate, and to her surprise, in about six hours she was the mother of a boy weighing five pounds. Both the mother and child made a good recovery. Duke cites the instance of a woman who supposed that she was not pregnant up to the night of her miscarriage. She had menstruated and was suckling a child sixteen months old. During the night she was attacked with pains resembling those of labor and a fetus slipped into the vagina without any hemorrhage; the placenta came away directly afterward. In this peculiar case the woman was menstruating regularly, suckling a child, and at the same time was unconsciously pregnant.
Isham speaks of a case of unconscious pregnancy in which extremely small twins were delivered at the eighth month. Fox cites an instance of a woman who had borne eight children, and yet unconscious of pregnancy. Merriman speaks of a woman forty years of age who had not borne a child for nine years, but who suddenly gave birth to a stout, healthy boy without being cognizant of pregnancy. Dayral tells of a woman who carried a child all through pregnancy, unconscious of her condition, and who was greatly surprised at its birth. Among the French observers speaking of pregnancy remaining unrecognized by the mother until the period of accouchement, Lozes and Rhades record peculiar cases; and Mouronval relates an instance in which a woman who had borne three children completely ignored the presence of pregnancy until the pains of labor were felt. Fleishman and Munzenthaler also record examples of unconscious pregnancy.
Pseudocyesis.--On the other hand, instances of pregnancy with imaginary symptoms and preparations for birth are sometimes noticed, and many cases are on record. In fact, nearly every text-book on obstetrics gives some space to the subject of pseudocyesis. Suppression of the menses, enlargement of the abdomen, engorgement of the breasts, together with the symptoms produced by the imagination, such as nausea, spasmodic contraction of the abdomen, etc., are for the most part the origin of the cases of pseudocyesis. Of course, many of the cases are not examples of true pseudocyesis, with its interesting phenomena, but instances of malingering for mercenary or other purposes, and some are calculated to deceive the most expert obstetricians by their tricks. Weir Mitchell delineates an interesting case of pseudocyesis as follows: "A woman, young, or else, it may be, at or past the climacteric, eagerly desires a child or is horribly afraid of becoming pregnant. The menses become slight in amount, irregular, and at last cease or not. Meanwhile the abdomen and breasts enlarge, owing to a rapid taking on of fat, and this is far less visible elsewhere. There comes with this excess of fat the most profound conviction of the fact of pregnancy. By and by the child is felt, the physician takes it for granted, and this goes on until the great diagnostician, Time, corrects the delusion. Then the fat disappears with remarkable speed, and the reign of this singular simulation is at an end." In the same article, Dr. Mitchell cites the two following cases under his personal observation: "I was consulted by a lady in regard to a woman of thirty years of age, a nurse in whom she was interested. This person had been married some three years to a very old man possessed of a considerable estate. He died, leaving his wife her legal share and the rest to distant cousins, unless the wife had a child. For two months before he died the woman, who was very anemic, ceased to menstruate. She became sure that she was pregnant, and thereupon took on flesh at a rate and in a way which seemed to justify her belief. Her breasts and abdomen were the chief seats of this overgrowth. The menses did not return, her pallor increased; the child was felt, and every preparation made for delivery. At the eighth month a physician made an examination and assured her of the absence of pregnancy. A second medical opinion confirmed the first, and the tenth month found her of immense size and still positive as to her condition. At the twelfth month her menstrual flow returned, and she became sure it was the early sign of labor. When it passed over she became convinced of her error, and at once dropped weight at the rate of half a pound a day despite every effort to limit the rate of this remarkable loss. At the end of two months she had parted with fifty pounds and was, on the whole, less anemic. At this stage I was consulted by letter, as the woman had become exceedingly hysteric. This briefly stated case, which occurred many years ago, is a fair illustration of my thesis.
"Another instance I saw when in general practice. A lady who had several children and suffered much in her pregnancies passed five years without becoming impregnated. Then she missed a period, and had, as usual, vomiting. She made some wild efforts to end her supposed pregnancy, and failing, acquiesced in her fate. The menses returned at the ninth month and were presumed to mean labor. Meanwhile she vomited, up to the eighth month, and ate little. Nevertheless, she took on fat so as to make the abdomen and breasts immense and to excite unusual attention. No physician examined her until the supposed labor began, when, of course, the truth came out. She was pleased not to have another child, and in her case, as in all the others known to me, the fat lessened as soon as the mind was satisfied as to the non-existence of pregnancy. As I now recall the facts, this woman was not more than two months in getting rid of the excess of adipose tissue. Dr. Hirst tells me he has met with cases of women taking on fat with cessation of the menses, and in which there was also a steady belief in the existence of pregnancy. He has not so followed up these cases as to know if in them the fat fell away with speed when once the patient was assured that no child existed within her."
Hirst, in an article on the difficulties in the diagnosis of pregnancy, gives several excellent photographs showing the close resemblance between several pathologic conditions and the normal distention of the abdomen in pregnancy. A woman who had several children fell sick with a chest-affection, followed by an edema. For fifteen months she was confined to her bed, and had never had connection with her husband during that time. Her menses ceased; her mammae became engorged and discharged a serous lactescent fluid; her belly enlarged, and both she and her physician felt fetal movements in her abdomen. As in her previous pregnancies, she suffered nausea. Naturally, a suspicion as to her virtue came into her husband's mind, but when he considered that she had never left her bed for fifteen months he thought the pregnancy impossible. Still the wife insisted that she was pregnant and was confirmed in the belief by a midwife. The belly continued to increase, and about eleven months after the cessation of the menses she had the pains of labor. Three doctors and an accoucheur were present, and when they claimed that the fetal head presented the husband gave up in despair; but the supposed fetus was born shortly after, and proved to be only a mass of hydatids, with not the sign of a true pregnancy. Girard of Lyons speaks of a female who had been pregnant several times, but again experienced the signs of pregnancy. Her mammae were engorged with a lactescent fluid, and she felt belly-movements like those of a child; but during all this time she had regular menstruation. Her abdomen progressively increased in size, and between the tenth and eleventh months she suffered what she thought to be labor-pains. These false pains ceased upon taking a bath, and with the disappearance of the other signs was dissipated the fallacious idea of pregnancy.
There is mentioned an instance of medicolegal interest of a young girl who showed all the signs of pregnancy and confessed to her parents that she had had commerce with a man. The parents immediately prosecuted the seducer by strenuous legal methods, but when her ninth month came, and after the use of six baths, all the signs of pregnancy vanished. Harvey cites several instances of pseudocyesis, and says we must not rashly determine of the the inordinate birth before the seventh or after the eleventh month. In 1646 a woman, after having laughed heartily at the jests of an ill-bred, covetous clown, was seized with various movements and motions in her belly like those of a child, and these continued for over a month, when the courses appeared again and the movements ceased. The woman was certain that she was pregnant.
The most noteworthy historic case of pseudocyesis is that of Queen Mary of England, or "Bloody Mary," as she was called. To insure the succession of a Catholic heir, she was most desirous of having a son by her consort, Philip, and she constantly prayed and wished for pregnancy. Finally her menses stopped; the breasts began to enlarge and became discolored around the nipples. She had morning-sickness of a violent nature and her abdomen enlarged. On consultation with the ladies of her court, her opinion of pregnancy was strongly confirmed. Her favorite amusement then was to make baby-clothes and count on her fingers the months of pregnancy. When the end of the ninth month approached, the people were awakened one night by the joyous peals of the bells of London announcing the new heir. An ambassador had been sent to tell the Pope that Mary could feel the new life within her, and the people rushed to St. Paul's Cathedral to listen to the venerable Archbishop of Canterbury describe the baby-prince and give thanks for his deliverance. The spurious labor pains passed away, and after being assured that no real pregnancy existed in her case, Mary went into violent hysterics, and Philip, disgusted with the whole affair, deserted her; then commenced the persecution of the Protestants, which blighted the reign.
Putnam cites the case of a healthy brunet, aged forty, the mother of three children. She had abrupt vertical abdominal movements, so strong as to cause her to plunge and sway from side to side. Her breasts were enlarged, the areolae dark, and the uterus contained an elastic tumor, heavy and rolling under the hand. Her abdomen progressively enlarged to the regular size of matured gestation; but the extrauterine pregnancy, which was supposed to have existed, was not seen at the autopsy, nothing more than an enlarged liver being found. The movement was due to spasmodic movements of the abdominal muscles, the causes being unknown. Madden gives the history of a primipara of twenty-eight, married one year, to whom he was called. On entering the room he was greeted by the midwife, who said she expected the child about 8 P.M. The woman was lying in the usual obstetric position, on the left side, groaning, crying loudly, and pulling hard at a strap fastened to the bed-post. She had a partial cessation of menses, and had complained of tumultuous movements of the child and overflow of milk from the breasts. Examination showed the cervix low down, the os small and circular, and no signs of pregnancy in the uterus. The abdomen was distended with tympanites and the rectum much dilated with accumulated feces. Dr. Madden left her, telling her that she was not pregnant, and when she reappeared at his office in a few days, he reassured her of the nonexistence of pregnancy; she became very indignant, triumphantly squeezed lactescent fluid from her breasts, and, insisting that she could feel fetal movements, left to seek a more sympathetic accoucheur. Underhill, in the words of Hamilton, describes a woman as "having acquired the most accurate description of the breeding symptoms, and with wonderful facility imagined that she had felt every one of them." He found the woman on a bed complaining of great labor-pains, biting a handkerchief, and pulling on a cloth attached to her bed. The finger on the abdomen or vulva elicited symptoms of great sensitiveness. He told her she was not pregnant, and the next day she was sitting up, though the discharge continued, but the simulated throes of labor, which she had so graphically pictured, had ceased.
Haultain gives three examples of pseudocyesis, the first with no apparent cause, the second due to carcinoma of the uterus, while in the third there was a small fibroid in the anterior wall of the uterus. Some cases are of purely nervous origin, associated with a purely muscular distention of the abdomen. Clay reported a case due to ascites. Cases of pseudocyesis in women convicted of murder are not uncommon, though most of them are imposters hoping for an extra lease of life.
Croon speaks of a child seven years old on whom he performed ovariotomy for a round-celled sarcoma. She had been well up to May, but since then she had several times been raped by a boy, in consequence of which she had constant uterine hemorrhage. Shortly after the first coitus her abdomen began to enlarge, the breasts to develop, and the areolae to darken. In seven months the abdomen presented the signs of pregnancy, but the cervix was soft and patulous; the sound entered three inches and was followed by some hemorrhage. The child was well developed, the mons was covered with hair, and all the associate symptoms tended to increase the deception.
Sympathetic Male Nausea of Pregnancy.--Associated with pregnancy there are often present morning-nausea and vomiting as prominent and reliable symptoms. Vomiting is often so excessive as to be provocative of most serious issue and even warranting the induction of abortion. This fact is well known and has been thoroughly discussed, but with it is associated an interesting point, the occasional association of the same symptoms sympathetically in the husband. The belief has long been a superstition in parts of Great Britain, descending to America, and even exists at the present day. Sir Francis Bacon has written on this subject, the substance of his argument being that certain loving husbands so sympathize with their pregnant wives that they suffer morning-sickness in their own person. No less an authority than S. Weir Mitchell called attention to the interesting subject of sympathetic vomiting in the husband in his lectures on nervous maladies some years ago. He also quotes the following case associated with pseudocyesis:--
"A woman had given birth to two female children. Some years passed and her desire for a boy was ungratified. Then she missed her flow once, and had thrice after this, as always took place with her when pregnant, a very small but regular loss. At the second month morning-vomiting came on as usual with her. Meanwhile she became very fat, and as the growth was largely, in fact excessively, abdominal, she became easily sure of her condition. She was not my patient, but her husband consulted me as to his own morning-sickness, which came on with the first occurrence of this sign in his wife, as had been the case twice before in her former pregnancies. I advised him to leave home, and this proved effectual. I learned later that the woman continued to gain flesh and be sick every morning until the seventh month. Then menstruation returned, an examination was made, and when sure that there was no possibility of her being pregnant she began to lose flesh, and within a few months regained her usual size."
Hamill reports an instance of morning-sickness in a husband two weeks after the appearance of menstruation in the wife for the last time. He had daily attacks, and it was not until the failure of the next menses that the woman had any other sign of pregnancy than her husband's nausea. His nausea continued for two months, and was the same as that which he had suffered during his wife's former pregnancies, although not until both he and his wife became aware of the existence of pregnancy. The Lancet describes a case in which the husband's nausea and vomiting, as well as that of the wife, began and ended simultaneously. Judkins cites an instance of a man who was sick in the morning while his wife was carrying a child. This occurred during every pregnancy, and the man related that his own father was similarly affected while his mother was in the early months of pregnancy with him, showing an hereditary predisposition.
The perverted appetites and peculiar longings of pregnant women furnish curious matter for discussion. From the earliest times there are many such records. Borellus cites an instance, and there are many others, of pregnant women eating excrement with apparent relish. Tulpius, Sennert, Langius, van Swieten, a Castro, and several others report depraved appetites. Several writers have seen avidity for human flesh in such females. Fournier knew a woman with an appetite for the blood of her husband. She gently cut him while he lay asleep by her side and sucked blood from the wounds--a modern "Succubus." Pare mentions the perverted appetites of pregnant women, and says that they have been known to eat plaster, ashes, dirt, charcoal, flour, salt, spices, to drink pure vinegar, and to indulge in all forms of debauchery. Plot gives the case of a woman who would gnaw and eat all the linen off her bed. Hufeland's Journal records the history of a case of a woman of thirty-two, who had been married ten years, who acquired a strong taste for charcoal, and was ravenous for it. It seemed to cheer her and to cure a supposed dyspepsia. She devoured enormous quantities, preferring hard-wood charcoal. Bruyesinus speaks of a woman who had a most perverted appetite for her own milk, and constantly drained her breasts; Krafft-Ebing cites a similar case. Another case is that of a pregnant woman who had a desire for hot and pungent articles of food, and who in a short time devoured a pound of pepper. Scheidemantel cites a case in which the perverted appetite, originating in pregnancy, became permanent, but this is not the experience of most observers. The pregnant wife of a farmer in Hassfort-on-the-Main ate the excrement of her husband.
Many instances could be quoted, some in which extreme cases of polydipsia and bulimia developed; these can be readily attributed to the increased call for liquids and food. Other cases of diverse new emotions can be recalled, such as lasciviousness, dirty habits, perverted thoughts, and, on the other hand, extreme piety, chastity, and purity of the mind. Some of the best-natured women are when pregnant extremely cross and irritable and many perversions of disposition are commonly noticed in pregnancy. There is often a longing for a particular kind of food or dish for which no noticeable desire had been displayed before.
Maternal Impressions.--Another curious fact associated with pregnancy is the apparent influence of the emotions of the mother on the child in utero. Every one knows of the popular explanation of many birth-marks, their supposed resemblance to some animal or object seen by the mother during pregnancy, etc. The truth of maternal impressions, however, seems to be more firmly established by facts of a substantial nature. There is a natural desire to explain any abnormality or anomaly of the child as due to some incident during the period of the mother's pregnancy, and the truth is often distorted and the imagination heavily drawn upon to furnish the satisfactory explanation. It is the customary speech of the dime-museum lecturer to attribute the existence of some "freak" to an episode in the mother's pregnancy. The poor "Elephant-man" firmly believed his peculiarity was due to the fact that his mother while carrying him in utero was knocked down at the circus by an elephant. In some countries the exhibition of monstrosities is forbidden because of the supposed danger of maternal impression. The celebrated "Siamese Twins" for this reason were forbidden to exhibit themselves for quite a period in France.
We shall cite only a few of the most interesting cases from medical literature. Hippocrates saved the honor of a princess, accused of adultery with a negro because she bore a black child, by citing it as a case of maternal impression, the husband of the princess having placed in her room a painting of a negro, to the view of which she was subjected during the whole of her pregnancy. Then, again, in the treatise "De Superfoetatione" there occurs the following distinct statement: "If a pregnant woman has a longing to eat earth or coals, and eats of them, the infant which is born carries on its head the mark of these things." This statement, however, occurs in a work which is not mentioned by any of the ancient authorities, and is rejected by practically all the modern ones; according to Ballantyne, there is, therefore, no absolute proof that Hippocrates was a believer in one of the most popular and long-persisting beliefs concerning fetal deformities.
In the explanation of heredity, Hippocrates states "that the body of the male as well as that of the female furnishes the semen. That which is weak (unhealthy) is derived from weak (unhealthy) parts, that which is strong (healthy) from strong (healthy) parts, and the fetus will correspond to the quality of the semen. If the semen of one part come in greater quantity from the male than from the female, this part will resemble more closely the father; if, however, it comes more from the female, the part will rather resemble the mother. If it be true that the semen comes from both parents, then it is impossible for the whole body to resemble either the mother or the father, or neither the one nor the other in anything, but necessarily the child will resemble both the one and the other in something. The child will most resemble the one who contributes most to the formation of the parts." Such was the Hippocratic theory of generation and heredity, and it was ingeniously used to explain the hereditary nature of certain diseases and malformations. For instance, in speaking of the sacred disease (epilepsy), Hippocrates says: "Its origin is hereditary, like that of other diseases; for if a phlegmatic person be born of a phlegmatic, and a bilious of a bilious, and a phthisical of a phthisical, and one having spleen disease of another having disease of the spleen, what is to hinder it from happening that where the father and mother were subject to this disease certain of their offspring should be so affected also? As the semen comes from all parts of the body, healthy particles will come from healthy parts, and unhealthy from unhealthy parts."
According to Pare, Damascene saw a girl with long hair like a bear, whose mother had constantly before her a picture of the hairy St. John. Pare also appends an illustration showing the supposed resemblance to a bear. Jonston quotes a case of Heliodorus; it was an Ethiopian, who by the effect of the imagination produced a white child. Pare describes this case more fully: "Heliodorus says that Persina, Queen of Ethiopia, being impregnated by Hydustes, also an Ethiopian, bore a daughter with a white skin, and the anomaly was ascribed to the admiration that a picture of Andromeda excited in Persina throughout the whole of the pregnancy." Van Helmont cites the case of a tailor's wife at Mechlin, who during a conflict outside her house, on seeing a soldier lose his hand at her door, gave birth to a daughter with one hand, the other hand being a bleeding stump; he also speaks of the case of the wife of a merchant at Antwerp, who after seeing a soldier's arm shot off at the siege of Ostend gave birth to a daughter with one arm. Plot speaks of a child bearing the figure of a mouse; when pregnant, the mother had been much frightened by one of these animals. Gassendus describes a fetus with the traces of a wound in the same location as one received by the mother. The Lancet speaks of several cases--one of a child with a face resembling a dog whose mother had been bitten; one of a child with one eye blue and the other black, whose mother during confinement had seen a person so marked; of an infant with fins as upper and lower extremities, the mother having seen such a monster; and another, a child born with its feet covered with scalds and burns, whose mother had been badly frightened by fireworks and a descending rocket. There is the history of a woman who while pregnant at seven months with her fifth child was bitten on the right calf by a dog. Ten weeks after, she bore a child with three marks corresponding in size and appearance to those caused by the dog's teeth on her leg. Kerr reports the case of a Date: 2014-12-29; view: 743
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