PRENATAL ANOMALIES. 4 page

woman in her seventh month whose daughter fell on a cooking stove,

shocking the mother, who suspected fatal burns. The woman was delivered

two months later of an infant blistered about the mouth and extremities

in a manner similar to the burns of her sister. This infant died on the

third day, but another was born fourteen months later with the same

blisters. Inflammation set in and nearly all the fingers and toes

sloughed of. In a subsequent confinement, long after the mental

agitation, a healthy unmarked infant was born.

Hunt describes a case which has since become almost classic of a woman

fatally burned, when pregnant eight months, by her clothes catching

fire at the kitchen grate. The day after the burns labor began and was

terminated by the birth of a well-formed dead female child, apparently

blistered and burned in extent and in places corresponding almost

exactly to the locations of the mother's injuries. The mother died on

the fourth day.

Webb reports the history of a negress who during a convulsion while

pregnant fell into a fire, burning the whole front of the abdomen, the

front and inside of the thighs to the knees, the external genitals, and

the left arm. Artificial delivery was deemed necessary, and a dead

child, seemingly burned much like its mother, except less intensely,

was delivered. There was also one large blister near the inner canthus

of the eye and some large blisters about the neck and throat which the

mother did not show. There was no history of syphilis nor of any

eruptive fever in the mother, who died on the tenth day with tetanus.

Graham describes a woman of thirty-five, the mother of seven children,

who while pregnant was feeding some rabbits, when one of the animals

jumped at her with its eyes "glaring" upon her, causing a sudden

fright. Her child was born hydrocephalic. Its mouth and face were small

and rabbit-shaped. Instead of a nose, it had a fleshy growth 3/4 inch

long by 1/4 inch broad, directed upward at an angle of 45 degrees. The

space between this and the mouth was occupied by a body resembling an

adult eye. Within this were two small, imperfect eyes which moved

freely while life lasted (ten minutes). The child's integument was

covered with dark, downy, short hair. The woman recovered and afterward

bore two normal children.

Parvin mentions an instance of the influence of maternal impression in

the causation of a large, vivid, red mark or splotch on the face: "When

the mother was in Ireland she was badly frightened by a fire in which

some cattle were burned. Again, during the early months of her

pregnancy she was frightened by seeing another woman suddenly light the

fire with kerosene, and at that time became firmly impressed with the

idea that her child would be marked." Parvin also pictures the

"turtle-man," an individual with deformed extremities, who might be

classed as an ectromelus, perhaps as a phocomelus, or seal-like

monster. According to the story, when the mother was a few weeks

pregnant her husband, a coarse, rough fisherman, fond of rude jokes,

put a large live turtle in the cupboard. In the twilight the wife went

to the cupboard and the huge turtle fell out, greatly startling her by

its hideous appearance as it fell suddenly to the floor and began to

move vigorously.

Copeland mentions a curious case in which a woman was attacked by a

rattlesnake when in her sixth month of pregnancy, and gave birth to a

child whose arm exhibited the shape and action of a snake, and

involuntarily went through snake-like movements. The face and mouth

also markedly resembled the head of a snake.

The teeth were situated like a serpent's fangs. The mere mention of a

snake filled the child (a man of twenty-nine) with great horror and

rage, "particularly in the snake season." Beale gives the history of a

case of a child born with its left eye blackened as by a blow, whose

mother was struck in a corresponding portion of the face eight hours

before confinement. There is on record an account of a young man of

twenty-one suffering from congenital deformities attributed to the fact

that his mother was frightened by a guinea-pig having been thrust into

her face during pregnancy. He also had congenital deformity of the

right auricle. At the autopsy, all the skin, tissues, muscles, and

bones were found involved. Owen speaks of a woman who was greatly

excited ten months previously by a prurient curiosity to see what

appearance the genitals of her brother presented after he had submitted

to amputation of the penis on account of carcinoma. The whole penis had

been removed. The woman stated that from the time she had thus

satisfied herself, her mind was unceasingly engaged in reflecting and

sympathizing on the forlorn condition of her brother. While in this

mental state she gave birth to a son whose penis was entirely absent,

but who was otherwise well and likely to live. The other portions of

the genitals were perfect and well developed. The appearance of the

nephew and the uncle was identical. A most peculiar case is stated by

Clerc as occurring in the experience of Kuss of Strasburg. A woman had

a negro paramour in America with whom she had had sexual intercourse

several times. She was put in a convent on the Continent, where she

stayed two years. On leaving the convent she married a white man, and

nine months after she gave birth to a dark-skinned child. The

supposition was that during her abode in the convent and the nine

months subsequently she had the image of her black paramour constantly

before her. Loin speaks of a woman who was greatly impressed by the

actions of a clown at a circus, and who brought into the world a child

that resembled the fantastic features of the clown in a most striking

manner.

Mackay describes five cases in which fright produced distinct marks on

the fetus. There is a case mentioned in which a pregnant woman was

informed that an intimate friend had been thrown from his horse; the

immediate cause of death was fracture of the skull, produced by the

corner of a dray against which the rider was thrown. The mother was

profoundly impressed by the circumstance, which was minutely described

to her by an eye-witness. Her child at birth presented a red and

sensitive area upon the scalp corresponding in location with the fatal

injury in the rider. The child is now an adult woman, and this area

upon the scalp remains red and sensitive to pressure, and is almost

devoid of hair. Mastin of Mobile, Alabama, reports a curious instance

of maternal impression. During the sixth month of the pregnancy of the

mother her husband was shot, the ball passing out through the left

breast. The woman was naturally much shocked, and remarked to Dr.

Mastin: "Doctor, my baby will be ruined, for when I saw the wound I put

my hands over my face, and got it covered with blood, and I know my

baby will have a bloody face." The child came to term without a bloody

face. It had, however, a well-defined spot on the left breast just

below the site of exit of the ball from its father's chest. The spot

was about the size of a silver half-dollar, and had elevated edges of a

bright red color, and was quite visible at the distance of one hundred

feet. The authors have had personal communication with Dr. Mastin in

regard to this case, which he considers the most positive evidence of a

case of maternal impression that he has ever met.

Paternal Impressions.--Strange as are the foregoing cases, those of

paternal impression eclipse them. Several are on record, but none are

of sufficient authenticity to warrant much discussion on the subject.

Those below are given to illustrate the method of report. Stahl, quoted

by Steinan, 1843, speaks of the case of a child, the father being a

soldier who lost an eye in the war. The child was born with one of its

eyes dried up in the orbit, in this respect presenting an appearance

like that of the father. Schneider says a man whose wife was expecting

confinement dreamt that his oldest son stood beside his bedside with

his genitals much mutilated and bleeding. He awoke in a great state of

agitation, and a few days later the wife was delivered of a child with

exstrophy of the bladder. Hoare recites the curious story of a man who

vowed that if his next child was a daughter he would never speak to it.

The child proved to be a son, and during the whole of the father's life

nothing could induce the son to speak to his father, nor, in fact, to

any other male person, but after the father's death he talked fluently

to both men and women. Clark reports the birth of a child whose father

had a stiff knee-joint, and the child's knee was stiff and bent in

exactly the same position as that of its father.

Telegony.--The influence of the paternal seed on the physical and

mental constitution of the child is well known. To designate this

condition, Telegony is the word that was coined by Weismann in his "Das

Keimplasma," and he defines it as "Infection of the Germ," and, at

another time, as "Those doubtful instances in which the offspring is

said to resemble, not the father, but an early mate of the

mother,"--or, in other words, the alleged influence of a previous sire

on the progeny produced by a subsequent one from the same mother. In a

systematic discussion of telegony before the Royal Medical Society,

Edinburgh, on March 1, 1895, Brunton Blaikie, as a means of making the

definition of telegony plainer by practical example, prefaced his

remarks by citing the classic example which first drew the attention of

the modern scientific world to this phenomenon. The facts of this case

were communicated in a letter from the Earl of Morton to the President

of the Royal Society in 1821, and were as follows: In the year 1816

Lord Morton put a male quagga to a young chestnut mare of 7/8 Arabian

blood, which had never before been bred from. The result was a female

hybrid which resembled both parents. He now sold the mare to Sir Gore

Ousley, who two years after she bore the hybrid put her to a black

Arabian horse. During the two following years she had two foals which

Lord Morton thus describes: "They have the character of the Arabian

breed as decidedly as can be expected when 15/16 of the blood are

Arabian, and they are fine specimens of the breed; but both in their

color and in the hair of their manes they have a striking resemblance

to the quagga. Their color is bay, marked more or less like the quagga

in a darker tint. Both are distinguished by the dark line along the

ridge of the back, the dark stripes across the forehand, and the dark

bars across the back part of the legs." The President of the Royal

Society saw the foals and verified Lord Morton's statement.

"Herbert Spencer, in the Contemporary Review for May, 1893, gives

several cases communicated to him by his friend Mr. Fookes, whom

Spencer says is often appointed judge of animals at agricultural shows.

After giving various examples he goes on to say: 'A friend of mine near

this had a valuable Dachshund bitch, which most unfortunately had a

litter by a stray sheep-dog. The next year the owner sent her on a

visit to a pure Dachshund dog, but the produce took quite as much of

the first father as the second, and the next year he sent her to

another Dachshund, with the same result. Another case: A friend of mine

in Devizes had a litter of puppies unsought for, by a setter from a

favorite pointer bitch, and after this she never bred any true

pointers, no matter what the paternity was.'

"Lord Polwarth, whose very fine breed of Border Leicesters is famed

throughout Britain, and whose knowledge on the subject of breeding is

great, says that 'In sheep we always consider that if a ewe breeds to a

Shrop ram, she is never safe to breed pure Leicesters from, as dun or

colored legs are apt to come even when the sire is a pure Leicester.

This has been proved in various instances, but is not invariable.'"

Hon. Henry Scott says: "Dog-breeders know this theory well; and if a

pure-bred bitch happens to breed to a dog of another breed, she is of

little use for breeding pure-bred puppies afterward. Animals which

produce large litters and go a short time pregnant show this throwing

back to previous sires far more distinctly than others--I fancy dogs

and pigs most of all, and probably horses least. The influence of

previous sires may be carried into the second generation or further, as

I have a cat now which appears to be half Persian (long hair). His dam

has very long hair and every appearance of being a half Persian,

whereas neither have really any Persian blood, as far as I know, but

the grand-dam (a very smooth-haired cat) had several litters by a

half-Persian tom-cat, and all her produce since have showed the

influence retained. The Persian tom-cat died many years ago, and was

the only one in the district, so, although I cannot be absolutely

positive, still I think this case is really as stated."

Breeders of Bedlington terriers wish to breed dogs with as powerful

jaws as possible. In order to accomplish this they put the Bedlington

terrier bitch first to a bull-terrier dog, and get a mongrel litter

which they destroy. They now put the bitch to a Bedlington terrier dog

and get a litter of puppies which are practically pure, but have much

stronger jaws than they would otherwise have had, and also show much of

the gameness of the bull-terrier, thus proving that physiologic as well

as anatomic characters may be transmitted in this way.

After citing the foregoing examples, Blaikie directs his attention to

man, and makes the following interesting remarks:--

"We might expect from the foregoing account of telegony amongst animals

that whenever a black woman had a child to a white man, and then

married a black man, her subsequent children would not be entirely

black. Dr. Robert Balfour of Surinam in 1851 wrote to Harvey that he

was continually noticing amongst the colored population of Surinam

'that if a negress had a child or children by a white, and afterward

fruitful intercourse with a negro, the latter offspring had generally a

lighter color than the parents.' But, as far as I know, this is the

only instance of this observation on record. Herbert Spencer has shown

that when a pure-bred animal breeds with an animal of a mixed breed,

the offspring resembles much more closely the parent of pure blood, and

this may explain why the circumstance recorded by Balfour has been so

seldom noted. For a negro, who is of very pure blood, will naturally

have a stronger influence on the subsequent progeny than an

Anglo-Saxon, who comes of a mixed stock. If this be the correct

explanation, we should expect that when a white woman married first a

black man, and then a white, the children by the white husband would be

dark colored. Unfortunately for the proof of telegony, it is very rare

that a white woman does marry a black man, and then have a white as

second husband; nevertheless, we have a fair number of recorded

instances of dark-colored children being born in the above way of white

parents.

"Dr. Harvey mentions a case in which 'a young woman, residing in

Edinburgh, and born of white (Scottish) parents, but whose mother, some

time previous to her marriage, had a natural (mulatto) child by a negro

man-servant in Edinburgh, exhibits distinct traces of the negro. Dr.

Simpson--afterward Sir James Simpson--whose patient the young woman at

one time was, has had no recent opportunities of satisfying himself as

to the precise extent to which the negro character prevails in her

features; but he recollects being struck with the resemblance, and

noticed particularly that the hair had the qualities characteristic of

the negro.' Herbert Spencer got a letter from a 'distinguished

correspondent' in the United States, who said that children by white

parents had been 'repeatedly' observed to show traces of black blood

when the women had had previous connection with (i.e., a child by) a

negro. Dr. Youmans of New York interviewed several medical professors,

who said the above was 'generally accepted as a fact.' Prof. Austin

Flint, in 'A Text-book of Human Physiology,' mentioned this fact, and

when asked about it said: 'He had never heard the statement questioned.'

"But it is not only in relation to color that we find telegony to have

been noticed in the human subject. Dr. Middleton Michel gives a most

interesting case in the American Journal of the Medical Sciences for

1868: 'A black woman, mother of several negro children, none of whom

were deformed in any particular, had illicit intercourse with a white

man, by whom she became pregnant. During gestation she manifested great

uneasiness of mind, lest the birth of a mulatto offspring should

disclose her conduct.... It so happened that her negro husband

possessed a sixth digit on each hand, but there was no peculiarity of

any kind in the white man, yet when the mulatto child was born it

actually presented the deformity of a supernumerary finger.' Taruffi,

the celebrated Italian teratologist, in speaking of the subject, says:

'Our knowledge of this strange fact is by no means recent for Fienus,

in 1608, said that most of the children born in adultery have a greater

resemblance to the legal than to the real father'--an observation that

was confirmed by the philosopher Vanini and by the naturalist

Ambrosini. From these observations comes the proverb: 'Filium ex

adultera excusare matrem a culpa.' Osiander has noted telegony in

relation to moral qualities of children by a second marriage. Harvey

said that it has long been known that the children by a second husband

resemble the first husband in features mind, and disposition. He then

gave a case in which this resemblance was very well marked. Orton,

Burdach (Traite de Physiologie), and Dr. William Sedgwick have all

remarked on this physical resemblance; and Dr. Metcalfe, in a

dissertation delivered before this society in 1855, observed that in

the cases of widows remarrying the children of the second marriage

frequently resemble the first husband.

"An observation probably having some bearing on this subject was made

by Count de Stuzeleci (Harvey, loc. cit.). He noticed that when an

aboriginal female had had a child by a European, she lost the power of

conception by a male of her own race, but could produce children by a

white man. He believed this to be the case with many aboriginal races;

but it has been disproved, or at all events proved to be by no means a

universal law, in every case except that of the aborigines of Australia

and New Zealand. Dr. William Sedgwick thought it probable that the

unfruitfulness of prostitutes might in some degree be due to the same

cause as that of the Australian aborigines who have had children by

white men.

"It would seem as though the Israelites had had some knowledge of

telegony, for in Deuteronomy we find that when a man died leaving no

issue, his wife was commanded to marry her husband's brother, in order

that he might 'raise up seed to his brother.'"

We must omit the thorough inquiry into this subject that is offered by

Mr. Blaikie. The explanations put forward have always been on one of

three main lines:--

(1) The imagination-theory, or, to quote Harvey: "Due to mental causes

so operating either on the mind of the female and so acting on her

reproductive powers, or on the mind of the male parent, and so

influencing the qualities of his semen, as to modify the nutrition and

development of the offspring."

(2) Due to a local influence on the reproductive organs of the mother.

(3) Due to a general influence through the fetus on the mother.

Antenatal Pathology.--We have next to deal with the diseases,

accidents, and operations that affect the pregnant uterus and its

contents; these are rich in anomalies and facts of curious interest,

and have been recognized from the earliest times. In the various works

usually grouped together under the general designation of "Hippocratic"

are to be found the earliest opinions upon the subject of antenatal

pathology which the medical literature of Greece has handed down to

modern times. That there were medical writers before the time of

Hippocrates cannot be doubted, and that the works ascribed to the

"Father of Medicine" were immediately followed by those of other

physicians, is likewise not to be questioned; but whilst nearly all the

writings prior to and after Hippocrates have been long lost to the

world, most of those that were written by the Coan physician and his

followers have been almost miraculously preserved. As Littre puts it,

"Les ecrits hippocratiques demeurent isoles au milieu des debris de

l'antique litterature medicale."--(Ballantyne.)

The first to be considered is the transmission of contagious disease to

the fetus in utero. The first disease to attract attention was

small-pox. Devilliers, Blot, and Depaul all speak of congenital

small-pox, the child born dead and showing evidences of the typical

small-pox pustulation, with a history of the mother having been

infected during pregnancy. Watson reports two cases in which a child in

utero had small-pox. In the first case the mother was infected in

pregnancy; the other was nursing a patient when seven months pregnant;

she did not take the disease, although she had been infected many

months before. Mauriceau delivered a woman of a healthy child at full

term after she had recovered from a severe attack of this disease

during the fifth month of gestation. Mauriceau supposed the child to be

immune after the delivery. Vidal reported to the French Academy of

Medicine, May, 1871, the case of a woman who gave birth to a living

child of about six and one-half months' maturation, which died some

hours after birth covered with the pustules of seven or eight days'

eruption. The pustules on the fetus were well umbilicated and typical,

and could have been nothing but those of small-pox; besides, this

disease was raging in the neighborhood at the time. The mother had

never been infected before, and never was subsequently. Both parents

were robust and neither of them had ever had syphilis. About the time

of conception, the early part of December, 1870, the father had

suffered from the semiconfluent type, but the mother, who had been

vaccinated when a girl, had never been stricken either during or after

her husband's sickness. Quirke relates a peculiar instance of a child

born at midnight, whose mother was covered with the eruption eight

hours after delivery. The child was healthy and showed no signs of the

contagion, and was vaccinated at once. Although it remained with its

mother all through the sickness, it continued well, with the exception

of the ninth day, when a slight fever due to its vaccination appeared.

The mother made a good recovery, and the author remarks that had the

child been born a short time later, it would most likely have been

infected.

Ayer reports an instance of congenital variola in twins. Chantreuil

speaks of a woman pregnant with twins who aborted at five and a half

months. One of the fetuses showed distinct signs of congenital variola,

although the mother and other fetus were free from any symptoms of the

disease. In 1853 Charcot reported the birth of a premature fetus

presenting numerous variolous pustules together with ulcerations of the

derm and mucous membranes and stomach, although the mother had

convalesced of the disease some time before. Mitchell describes a case

of small-pox occurring three days after birth, the mother not having

had the disease since childhood. Shertzer relates an instance of

confluent small-pox in the eighth month of pregnancy. The child was

born with the disease, and both mother and babe recovered. Among many

others offering evidence of variola in utero are Degner, Derham, John

Hunter, Blot, Bulkley, Welch, Wright, Digk, Forbes, Marinus, and

Bouteiller.

Varicella, Measles, Pneumonia, and even Malaria are reported as having

been transmitted to the child in utero. Hubbard attended a woman on

March 17, 1878, in her seventh accouchement. The child showed the rash

of varicella twenty-four hours after birth, and passed through the

regular coarse of chicken-pox of ten days' duration. The mother had no

signs of the disease, but the children all about her were infected.

Ordinarily the period of incubation is from three to four days, with a

premonitory fever of from twenty-four to seventy-two hours' duration,

when the rash appears; this case must therefore have been infected in

utero. Lomer of Hamburg tells of the case of a woman, twenty-two

years, unmarried, pregnant, who had measles in the eighth month, and

who gave birth to an infant with measles. The mother was attacked with

pneumonia on the fifth day of her puerperium, but recovered; the child

died in four weeks of intestinal catarrh. Gautier found measles

transmitted from the mother to the fetus in 6 out of 11 cases, there

being 2 maternal deaths in the 11 cases.

Netter has observed the case of transmission of pneumonia from a mother

to a fetus, and has seen two cases in which the blood from the uterine

vessels of patients with pneumonia contained the pneumococcus. Wallick

collected a number of cases of pneumonia occurring during pregnancy,

showing a fetal mortality of 80 per cent.

Felkin relates two instances of fetal malaria in which the infection

was probably transmitted by the male parent. In one case the father

near term suffered severely from malaria; the mother had never had a

chill. The violent fetal movements induced labor, and the spleen was so

large as to retard it. After birth the child had seven malarial

paroxysms but recovered, the splenic tumor disappearing.

The modes of infection of the fetus by syphilis, and the infection of

the mother, have been well discussed, and need no mention here.

There has been much discussion on the effects on the fetus in utero of

medicine administered to the pregnant mother, and the opinions as to

the reliability of this medication are so varied that we are in doubt

as to a satisfactory conclusion. The effects of drugs administered and

eliminated by the mammary glands and transmitted to the child at the

breast are well known, and have been witnessed by nearly every

physician, and, as in cases of strong metallic purges, etc., need no

other than the actual test. However, scientific experiments as to the

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