PRENATAL ANOMALIES. 3 page

the 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

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