OBSTETRIC ANOMALIES.

General Considerations.--In discussing obstetric anomalies we shall

first consider those strange instances in which stages of parturition

are unconscious and for some curious reason the pains of labor absent.

Some women are anatomically constituted in a manner favorable to

child-birth, and pass through the experience in a comparatively easy

manner; but to the great majority the throes of labor are anticipated

with extreme dread, particularly by the victims of the present fashion

of tight lacing.

It seems strange that a physiologic process like parturition should be

attended by so much pain and difficulty. Savages in their primitive and

natural state seem to have difficulty in many cases, and even animals

are not free from it. We read of the ancient wild Irish women breaking

the pubic bones of their female children shortly after birth, and by

some means preventing union subsequently, in order that these might

have less trouble in child-birth--as it were, a modified and early form

of symphysiotomy. In consequence of this custom the females of this

race, to quote an old English authority, had a "waddling, lamish

gesture in their going." These old writers said that for the same

reason the women in some parts of Italy broke the coccyxes of their

female children. This report is very likely not veracious, because this

bone spontaneously repairs itself so quickly and easily. Rodet and

Engelmunn, in their most extensive and interesting papers on the modes

of accouchement among the primitive peoples, substantiate the fear,

pain, and difficulty with which labor is attended, even in the lowest

grades of society.

In view of the usual occurrence of pain and difficulty with labor, it

seems natural that exceptions to the general rule should in all ages

have attracted the attention of medical men, and that literature should

be replete with such instances. Pechlin and Muas record instances of

painless births. The Ephemerides records a birth as having occurred

during asphyxia, and also one during an epileptic attack. Storok also

speaks of birth during unconsciousness in an epileptic attack; and Haen

and others describe cases occurring during the coma attending

apoplectic attacks. King reports the histories of two married women,

fond mothers and anticipating the event, who gave birth to children,

apparently unconsciously. In the first case, the appearance of the

woman verified the assertion; in the second, a transient suspension of

the menstrual influence accounted for it. After some months epilepsy

developed in this case. Crawford speaks of a Mrs. D., who gave birth to

twins in her first confinement at full term, and who two years after

aborted at three months. In December, 1868, a year after the abortion,

she was delivered of a healthy, living fetus of about five or six

months' growth in the following manner: While at stool, she discovered

something of a shining, bluish appearance protruding through the

external labia, but she also found that when she lay down the tumor

disappeared. This tumor proved to be the child, which had been expelled

from the uterus four days before, with the waters and membranes intact,

but which had not been recognized; it had passed through the os without

pain or symptoms, and had remained alive in the vagina over four days,

from whence it was delivered, presenting by the foot.

The state of intoxication seems by record of several cases to render

birth painless and unconscious, as well as serving as a means of

anesthesia in the preanesthetic days.

The feasibility of practising hypnotism in child-birth has been

discussed, and Fanton reports 12 cases of parturition under the

hypnotic influence. He says that none of the subjects suffered any pain

or were aware of the birth, and offers the suggestion that to

facilitate the state of hypnosis it should be commenced before strong

uterine contractions have occurred.

Instances of parturition or delivery during sleep, lethargies, trances,

and similar conditions are by no means uncommon. Heister speaks of

birth during a convulsive somnolence, and Osiander of a case during

sleep. Montgomery relates the case of a lady, the mother of several

children, who on one occasion was unconsciously delivered in sleep.

Case relates the instance of a French woman residing in the town of

Hopedale, who, though near confinement, attributed her symptoms to

over-fatigue on the previous day. When summoned, the doctor found that

she had severe lumbar pains, and that the os was dilated to the size of

a half-dollar. At ten o'clock he suggested that everyone retire, and

directed that if anything of import occurred he should be called. About

4 A.M. the husband of the girl, in great fright, summoned the

physician, saying: "Monsieur le Medecin, il y a quelque chose entre les

jambes de ma femme," and, to Dr. Case's surprise, he found the head of

a child wholly expelled during a profound sleep of the mother. In

twenty minutes the secundines followed. The patient, who was only

twenty years old, said that she had dreamt that something was the

matter with her, and awoke with a fright, at which instant, most

probably, the head was expelled. She was afterward confined with the

usual labor-pains.

Palfrey speaks of a woman, pregnant at term, who fell into a sleep

about eleven o'clock, and dreamed that she was in great pain and in

labor, and that sometime after a fine child was crawling over the bed.

After sleeping for about four hours she awoke and noticed a discharge

from the vagina. Her husband started for a light, but before he

obtained it a child was born by a head-presentation. In a few minutes

the labor-pains returned and the feet of a second child presented, and

the child was expelled in three pains, followed in ten minutes by the

placenta. Here is an authentic case in which labor progressed to the

second stage during sleep.

Weill describes the case of a woman of twenty-three who gave birth to a

robust boy on the 16th of June, 1877, and suckled him eleven months.

This birth lasted one hour. She became pregnant again and was delivered

under the following circumstances: She had been walking on the evening

of September 5th and returned home about eleven o'clock to sleep. About

3 A.M. she awoke, feeling the necessity of passing urine. She arose and

seated herself for the purpose. She at once uttered a cry and called

her husband, telling him that a child was born and entreating him to

send for a physician. Weill saw the woman in about ten minutes and she

was in the same position, so he ordered her to be carried to bed. On

examining the urinal he found a female child weighing 10 pounds. He

tied the cord and cared for the child. The woman exhibited little

hemorrhage and made a complete recovery. She had apparently slept

soundly through the uterine contractions until the final strong pain,

which awoke her, and which she imagined was a call for urination.

Samelson says that in 1844 he was sent for in Zabelsdorf, some 30 miles

from Berlin, to attend Hannah Rhode in a case of labor. She had passed

easily through eight parturitions. At about ten o'clock in the morning,

after a partially unconscious night, there was a sudden gush of blood

and water from the vagina; she screamed and lapsed into an unconscious

condition. At 10.35 the face presented, soon followed by the body,

after which came a great flow of blood, welling out in several waves.

The child was a male middle-sized, and was some little time in making

himself heard. Only by degrees did the woman's consciousness return.

She felt weary and inclined to sleep, but soon after she awoke and was

much surprised to know what had happened. She had seven or eight pains

in all. Schultze speaks of a woman who, arriving at the period for

delivery, went into an extraordinary state of somnolence, and in this

condition on the third day bore a living male child.

Berthier in 1859 observed a case of melancholia with delirium which

continued through pregnancy. The woman was apparently unconscious of

her condition and was delivered without pain. Cripps mentions a case

in which there was absence of pain in parturition. Depaul mentions a

woman who fell in a public street and was delivered of a living child

during a syncope which lasted four hours. Epley reports painless labor

in a patient with paraplegia. Fahnestock speaks of the case of a woman

who was delivered of a son while in a state of artificial somnambulism,

without pain to herself or injury to the child. Among others mentioning

painless or unconscious labor are Behrens (during profound sleep),

Eger, Tempel, Panis, Agnoia, Blanckmeister, Whitehill, Gillette,

Mattei, Murray, Lemoine, and Moglichkeit.

Rapid Parturition Without Usual Symptoms.--Births unattended by

symptoms that are the usual precursors of labor often lead to speedy

deliveries in awkward places. According to Willoughby, in Darby,

February 9, 1667, a poor fool, Mary Baker, while wandering in an open,

windy, and cold place, was delivered by the sole assistance of Nature,

Eve's midwife, and freed of her afterbirth. The poor idiot had leaned

against a wall, and dropped the child on the cold boards, where it lay

for more than a quarter of an hour with its funis separated from the

placenta. She was only discovered by the cries of the infant. In

"Carpenter's Physiology" is described a remarkable case of instinct in

an idiotic girl in Paris, who had been seduced by some miscreant; the

girl had gnawed the funis in two, in the same manner as is practised by

the lower animals. From her mental imbecility it can hardly be imagined

that she had any idea of the object of this separation, and it must

have been instinct that impelled her to do it. Sermon says the wife of

Thomas James was delivered of a lusty child while in a wood by herself.

She put the child in an apron with some oak leaves, marched stoutly to

her husband's uncle's house a half mile distant, and after two hours'

rest went on her journey one mile farther to her own house; despite all

her exertions she returned the next day to thank her uncle for the two

hours' accommodation. There is related the history of a case of a woman

who was delivered of a child on a mountain during a hurricane, who took

off her gown and wrapped the child up in it, together with the

afterbirth, and walked two miles to her cottage, the funis being

unruptured.

Harvey relates a case, which he learned from the President of Munster,

Ireland, of a woman with child who followed her husband, a soldier in

the army, in daily march. They were forced to a halt by reason of a

river, and the woman, feeling the pains of labor approaching, retired

to a thicket, and there alone brought forth twins. She carried them to

the river, washed them herself, did them up in a cloth, tied them to

her back, and that very day marched, barefooted, 12 miles with the

soldiers, and was none the worse for her experience. The next day the

Deputy of Ireland and the President of Munster, affected by the story,

to repeat the words of Harvey, "did both vouchsafe to be godfathers of

the infants."

Willoughby relates the account of a woman who, having a cramp while in

bed with her sister, went to an outhouse, as if to stool, and was there

delivered of a child. She quickly returned to bed, her going and her

return not being noticed by her sleeping sister. She buried the child,

"and afterward confessed her wickedness, and was executed in the

Stafford Gaol, March 31, 1670." A similar instance is related by the

same author of a servant in Darby in 1647. Nobody suspected her, and

when delivered she was lying in the same room with her mistress. She

arose without awakening anyone, and took the recently delivered child

to a remote place, and hid it at the bottom of a feather tub, covering

it with feathers; she returned without any suspicion on the part of her

mistress. It so happened that it was the habit of the Darby soldiers to

peep in at night where they saw a light, to ascertain if everything was

all right, and they thus discovered her secret doings, which led to her

trial at the next sessions at Darby.

Wagner relates the history of a case of great medicolegal interest. An

unmarried servant, who was pregnant, persisted in denying it, and took

every pains to conceal it. She slept in a room with two other maids,

and, on examination, she stated that on the night in question she got

up toward morning, thinking to relieve her bowels. For this purpose she

secured a wooden tub in the room, and as she was sitting down the child

passed rapidly into the empty vessel. It was only then that she became

aware of the nature of her pains. She did not examine the child

closely, but was certain it neither moved nor cried. The funis was no

doubt torn, and she made an attempt to tie it. Regarding the event as a

miscarriage, she took up the tub with its contents and carried it to a

sand pit about 30 paces distant, and threw the child in a hole in the

sand that she found already made. She covered it up with sand and

packed it firmly so that the dogs could not get it. She returned to her

bedroom, first calling up the man-servant at the stable. She awakened

her fellow-servants, and feeling tired sat down on a stool. Seeing the

blood on the floor, they asked her if she had made way with the child.

She said: "Do you take me for an old sow?" But, having their suspicions

aroused, they traced the blood spots to the sand pit. Fetching a

spade, they dug up the child, which was about one foot below the

surface. On the access of air, following the removal of the sand and

turf, the child began to cry, and was immediately taken up and carried

to its mother, who washed it and laid it on her bed and soon gave it

the breast. The child was healthy with the exception of a club-foot,

and must have been under ground at least fifteen minutes and no air

could have reached it. It seems likely that the child was born

asphyxiated and was buried in this state, and only began to assume

independent vitality when for the second time exposed to the air. This

curious case was verified to English correspondents by Dr. Wagner, and

is of unquestionable authority; it became the subject of a thorough

criminal investigation in Germany.

During the funeral procession of Marshal MacMahon in Paris an enormous

crowd was assembled to see the cortege pass, and in this crowd was a

woman almost at the time of delivery; the jostling which she received

in her endeavors to obtain a place of vantage was sufficient to excite

contraction, and, in an upright position, she gave birth to a fetus,

which fell at her feet. The crowd pushed back and made way for the

ambulance officials, and mother and child were carried off, the mother

apparently experiencing little embarrassment. Quoted by Taylor,

Anderson speaks of a woman accused of child murder, who walked a

distance of 28 miles on a single day with her two-days-old child on her

back.

There is also a case of a female servant named Jane May, who was

frequently charged by her mistress with pregnancy but persistently

denied it. On October 26th she was sent to market with some poultry.

Returning home, she asked the boy who drove her to stop and allow her

to get out. She went into a recess in a hedge. In five minutes she was

seen to leave the hedge and follow the cart, walking home, a distance

of a mile and a half. The following day she went to work as usual, and

would not have been found out had not a boy, hearing feeble cries from

the recess of the hedge, summoned a passer-by, but too late to save the

child. At her trial she said she did not see her babe breathe nor cry,

and she thought by the sudden birth that it must have been a still-born

child.

Shortt says that one day, while crossing the esplanade at Villaire,

between seven and eight o'clock in the morning, he perceived three

Hindoo women with large baskets of cakes of "bratties" on their heads,

coming from a village about four miles distant. Suddenly one of the

women stood still for a minute, stooped, and to his surprise dropped a

fully developed male child to the ground. One of her companions ran

into the town, about 100 yards distant, for a knife to divide the cord.

A few of the female passers-by formed a screen about the mother with

their clothes, and the cord was divided. The after-birth came away, and

the woman was removed to the town. It was afterward discovered that she

was the mother of two children, was twenty-eight years old, had not the

slightest sign of approaching labor, and was not aware of parturition

until she actually felt the child between her thighs.

Smith of Madras, in 1862, says he was hastily summoned to see an

English lady who had borne a child without the slightest warning. He

found the child, which had been born ten minutes, lying close to the

mother's body, with the funis uncut. The native female maid, at the

lady's orders, had left the child untouched, lifting the bed-clothes to

give it air. The lady said that she arose at 5.30 feeling well, and

during the forenoon had walked down a long flight of steps across a

walk to a small summer-house within the enclosure of her grounds.

Feeling a little tired, she had lain down on her bed, and soon

experienced a slight discomfort, and was under the impression that

something solid and warm was lying in contact with her person. She

directed the servant to look below the bed-clothes, and then a female

child was discovered. Her other labors had extended over six hours,

and were preceded by all the signs distinctive of childbirth, which

fact attaches additional interest to the case. The ultimate fate of the

child is not mentioned. Smith quotes Wilson, who said he was called to

see a woman who was delivered without pain while walking about the

house. He found the child on the floor with its umbilical cord torn

across.

Langston mentions the case of a woman, twenty-three, who, between 4 and

5 A.M., felt griping pains in the abdomen. Knowing her condition she

suspected labor, and determined to go to a friend's house where she

could be confined in safety. She had a distance of about 600 yards to

go, and when she was about half way she was delivered in an upright

position of a child, which fell on the pavement and ruptured its funis

in the fall. Shortly after, the placenta was expelled, and she

proceeded on her journey, carrying the child in her arms. At 5.50 the

physician saw the woman in bed, looking well and free from pain, but

complaining of being cold. The child, which was her first, was healthy,

well nourished, and normal, with the exception of a slight ecchymosis

of the parietal bone on the left side. The funis was lacerated

transversely four inches from the umbilicus. Both mother and child

progressed favorably. Doubtless the intense cold had so contracted the

blood-vessels as to prevent fatal hemorrhage to mother and child. This

case has a legal bearing in the supposition that the child had been

killed in the fall.

There is reported the case of a woman in Wales, who, while walking with

her husband, was suddenly seized with pains, and would have been

delivered by the wayside but for the timely help of Madame Patti, the

celebrated diva, who was driving by, and who took the woman in her

carriage to her palatial residence close by. It was to be christened in

a few days with an appropriate name in remembrance of the occasion.

Coleman met an instance in a married woman, who without the slightest

warning was delivered of a child while standing near a window in her

bedroom. The child fell to the floor and ruptured the cord about one

inch from the umbilicus, but with speedy attention the happiest results

were attained. Twitchell has an example in the case of a young woman of

seventeen, who was suddenly delivered of a child while ironing some

clothes. The cord in this case was also ruptured, but the child

sustained no injury. Taylor quotes the description of a child who died

from an injury to the head caused by dropping from the mother at an

unexpected time, while she was in the erect position; he also speaks of

a parallel case on record.

Unusual Places of Birth.--Besides those mentioned, the other awkward

positions in which a child may be born are so numerous and diversified

that mention of only a few can be made here. Colton tells of a

painless labor in an Irish girl of twenty-three, who felt a desire to

urinate, and while seated on the chamber dropped a child. She never

felt a labor-pain, and twelve days afterward rode 20 miles over a rough

road to go to her baby's funeral. Leonhard describes the case of a

mother of thirty-seven, who had borne six children alive, who was

pregnant for the tenth time, and who had miscalculated her pregnancy.

During pregnancy she had an attack of small-pox and suffered all

through pregnancy with constipation. She had taken a laxative, and when

returning to bed from stool was surprised to find herself attached to

the stool by a band. The child in the vessel began to cry and was

separated from the woman, who returned to bed and suddenly died

one-half hour later. The mother was entirely unconscious of the

delivery. Westphal mentions a delivery in a water-closet.

Brown speaks of a woman of twenty-six who had a call of nature while in

bed, and while sitting up she gave birth to a fine, full-grown child,

which, falling on the floor, ruptured the funis. She took her child,

lay down with it for some time, and feeling easier, hailed a cab, drove

to a hospital with the child in her arms, and wanted to walk upstairs.

She was put to bed and delivered of the placenta, there being but

little hemorrhage from the cord; both she and her child made speedy

recoveries. Thebault reports an instance of delivery in the erect

position, with rupture of the funis at the placenta. There was recently

a rumor, probably a newspaper fabrication, that a woman while at stool

in a railway car gave birth to a child which was found alive on the

track afterward.

There is a curious instance on record in which a child was born in a

hip-bath and narrowly escaped drowning. The mother was a European woman

aged forty, who had borne two children, the last nine years before. She

was supposed to have dropsy of the abdomen, and among other treatments

was the use of a speculum and caustic applications for inflammation of

the womb. The escape of watery fluid for two days was considered

evidence of the rupture of an ovarian cyst. At the end of two days,

severe pains set in, and a warm hip-bath and an opiate were ordered.

While in the bath she bore a fully-matured, living, male child, to the

great surprise of herself and her friends. The child might have been

drowned had not assistance been close at hand.

Birth by the Rectum.--In some cases in which there is some obstacle to

the delivery of a child by the natural passages, the efforts of nature

to expel the product of conception lead to an anomalous exit. There are

some details of births by the rectum mentioned in the last century by

Reta and others. Payne cites the instance of a woman of thirty-three,

in labor thirty-six hours, in whom there was a congenital absence of

the vaginal orifice. The finger, gliding along the perineum, arrived

at a distended anus, just inside of which was felt a fetal head. He

anesthetized the patient and delivered the child with forceps, and

without perineal rupture. There was little hemorrhage, and the placenta

was removed with slight difficulty. Five months later, Payne found an

unaltered condition of the perineum and vicinity; there was absence of

the vaginal orifice, and, on introducing the finger along the anterior

wall of the rectum, a fistula was found, communicating with the vagina;

above this point the arrangement and the situation of the parts were

normal. The woman had given birth to three still-born children, and

always menstruated easily. Coitus always seemed satisfactory, and no

suspicion existed in the patient's mind, and had never been suggested

to her, of her abnormality.

Harrison saw a fetus delivered by the anus after rupture of the uterus;

the membranes came away by the same route. In this case the neck of the

uterus was cartilaginous and firmly adherent to the adjacent parts. In

seven days after the accouchement the woman had completely regained her

health. Vallisneri reports the instance of a woman who possessed two

uteruses, one communicating with the vagina, the other with the rectum.

She had permitted rectal copulation and had become impregnated in this

manner. Louis, the celebrated French surgeon, created a furore by a

pamphlet entitled "De partium externarum generationi inservientium in

mulieribus naturali vitiosa et morbosa dispositione, etc.," for which

he was punished by the Sorbonne, but absolved by the Pope. He described

a young lady who had no vaginal opening, but who regularly menstruated

by the rectum. She allowed her lover to have connection with her in the

only possible way, by the rectum, which, however, sufficed for

impregnation, and at term she bore by the rectum a well-formed child.

Hunter speaks of a case of pregnancy in a woman with a double vagina,

who was delivered at the seventh month by the rectum. Mekeln and

Andrews give instances of parturition through the anus. Morisani

describes a case of extrauterine pregnancy with tubal rupture and

discharge into the culdesac, in which there was delivery by the rectum.

After an attack of severe abdominal pain, followed by hemorrhage, the

woman experienced an urgent desire to empty the rectum. The fetal

movements ceased, and a recurrence of these symptoms led the patient to

go to stool, at which she passed blood and a seromucoid fluid. She

attempted manually to remove the offending substances from the rectum,

and in consequence grasped the leg of a fetus. She was removed to a

hospital, where a fetus nine inches long was removed from the rectum.

The rectal opening gradually cicatrized, the sac became obliterated,

and the woman left the hospital well.

Birth Through Perineal Perforation.--Occasionally there is perineal

perforation during labor, with birth of the child through the opening.

Brown mentions a case of rupture of the perineum with birth of a child

between the vaginal opening and the anus. Cassidy reports a case of

child-birth through the perineum. A successful operation was performed

fifteen days after the accident. Dupuytren speaks of the passage of an

infant through a central opening of the perineum. Capuron, Gravis, and

Lebrun all report accouchement through a perineal perforation, without

alteration in the sphincter ani or the fourchet. In his "Diseases of

Women" Simpson speaks of a fistula left by the passage of an infant

through the perineum. Wilson, Toloshinoff, Stolz, Argles, Demarquay,

Harley, Hernu, Martyn, Lamb, Morere, Pollock, and others record the

birth of children through perineal perforations.

Birth Through the Abdominal Wall.--Hollerius gives a very peculiar

instance in which the abdominal walls gave way from the pressure

exerted by the fetus, and the uterus ruptured, allowing the child to be

extracted by the hand from the umbilicus; the mother made a speedy

recovery. In such cases delivery is usually by means of operative

interference (which will be spoken of later), but rarely, as here,

spontaneously. Farquharson and Ill both mention rupture of the

abdominal parietes during labor.

There have been cases reported in which the recto-vaginal septum has

been ruptured, as well as the perineum and the sphincter ani, giving

all the appearance of a birth by the anus.

There is an account of a female who had a tumor projecting between the

vagina and rectum, which was incised through the intestine, and proved

to be a dead child. Saviard reported what he considered a rather unique

case, in which the uterus was ruptured by external violence, the fetus

being thrown forward into the abdomen and afterward extracted from an

umbilical abscess.

Birth of the Fetus Enclosed in the Membranes.--Harvey says that an

infant can rest in its membranes several hours after birth without loss

of life. Schurig eventrated a pregnant bitch and her puppies lived in

their membranes half an hour. Wrisberg cites three observations of

infants born closed in their membranes; one lived seven minutes; the

other two nine minutes; all breathed when the membranes were cut and

air admitted. Willoughby recorded the history of a case which attracted

much comment at the time. It was the birth of twins enclosed in their

secundines. The sac was opened and, together with the afterbirth, was

laid over some hot coals; there was, however, a happy issue, the

children recovering and living. Since Willoughby's time several cases

of similar interest have been noticed, one in a woman of forty, who had

been married sixteen years, and who had had several pregnancies in her

early married life and a recent abortion. Her last pregnancy lasted

about twenty-eight or twenty-nine weeks, and terminated, after a short

labor, by the expulsion of the ovum entire. The membranes had not been

ruptured, and still enclosed the fetus and the liquor amnii. On

breaking them, the fetus was seen floating on the waters, alive, and,

though very diminutive, was perfectly formed. It continued to live, and

a day afterward took the breast and began to cry feebly. At six weeks

it weighed 2 pounds 2 ounces, and at ten months, 12 pounds, but was

still very weak and ill-nourished. Evans has an instance of a fetus

expelled enveloped in its membranes entire and unruptured. The

membranes were opaque and preternaturally thickened, and were opened

with a pair of scissors; strenuous efforts were made to save the child,

but to no purpose. The mother, after a short convalescence, made a good

recovery. Forman reports an instance of unruptured membranes at birth,

the delivery following a single pain, in a woman of twenty-two,

pregnant for a second time. Woodson speaks of a case of twins, one of

which was born enveloped in its secundines.

Van Bibber was called in great haste to see a patient in labor. He

reached the house in about fifteen minutes, and was told by the

midwife, a woman of experience, that she had summoned him because of

the expulsion from the womb of something the like of which she had

never seen before. She thought it must have been some variety of false

conception, and had wrapped it up in some flannel. It proved to be a

fetus enclosed in its sac, with the placenta, all having been expelled

together and intact. He told the nurse to rupture the membranes, and

the child, which had been in the unruptured sac for over twenty

minutes, began to cry. The infant lived for over a month, but

eventually died of bronchitis.

Cowger reports labor at the end of the seventh month without rupture of

the fetal sac. Macknus and Rootes speak of expulsion of the entire ovum

at the full period of gestation. Roe mentions a case of parturition

with unruptured membrane. Slusser describes the delivery of a

full-grown fetus without rupture of the membrane.

"Dry Births."--The reverse of the foregoing are those cases in which,

by reason of the deficiency of the waters, the birth is dry. Numerous

causes can be stated for such occurrences, and the reader is referred

elsewhere for them, the subject being an old one. The Ephemerides

speaks of it, and Rudolph discusses its occurrence exhaustively and

tells of the difficulties of such a labor. Burrall mentions a case of

labor without apparent liquor amnii, delivery being effected by the

forceps. Strong records an unusual obstetric case in which there was

prolongation of the pregnancy, with a large child, and entire absence

of liquor amnii. The case was also complicated with interstitial and

subserous fibroids and a contracted pelvis, combined with a posterior

position of the occiput and nonrotation of the head. Lente mentions a

case of labor without liquor amnii; and Townsend records delivery

without any sanguineous discharge. Cosentino mentions a case of the

absence of liquor amnii associated with a fetal monstrosity.

Delivery After Death of the Mother.--Curious indeed are those anomalous

cases in which the delivery is effected spontaneously after the death

of the mother, or when, by manipulation, the child is saved after the

maternal decease. Wegelin gives the account of a birth in which version

was performed after death and the child successfully delivered.

Bartholinus, Wolff, Schenck, Horstius, Hagendorn, Fabricius Hildanus,

Valerius, Rolfinck, Cornarius, Boener, and other older writers cite

cases of this kind. Pinard gives a most wonderful case. The patient was

a woman of thirty-eight who had experienced five previous normal

labors. On October 27th she fancied she had labor pains and went to

the Lariboisiere Maternite, where, after a careful examination, three

fetal poles were elicited, and she was told, to her surprise, of the

probability of triplets. At 6 P.M., November 13th, the pains of labor

commenced. Three hours later she was having great dyspnea with each

pain. This soon assumed a fatal aspect and the midwife attempted to

resuscitate the patient by artificial respiration, but failed in her

efforts, and then she turned her attention to the fetuses, and, one by

one, she extracted them in the short space of five minutes; the last

one was born twelve minutes after the mother's death. They all lived

(the first two being females), and they weighed from 4 1/4 to 6 1/2

pounds.

Considerable attention has been directed to the advisability of

accelerated and forced labor in the dying, in order that the child may

be saved. Belluzzi has presented several papers on this subject.

Csurgay of Budapest mentions saving the child by forced labor in the

death agonies of the mother. Devilliers considers this question from

both the obstetric and medicolegal points of view. Hyneaux mentions

forcible accouchement practised on both the dead and the dying.

Rogowicz advocates artificial delivery by the natural channel in place

of Cesarian section in cases of pending or recent death, and Thevenot

discussed this question at length at the International Medico-Legal

Congress in 1878. Duer presented the question of postmortem delivery in

this country.

Kelly reports the history of a woman of forty who died in her eighth

pregnancy, and who was delivered of a female child by version and

artificial means. Artificial respiration was successfully practised on

the child, although fifteen minutes had elapsed from the death of the

mother to its extraction. Driver relates the history of a woman of

thirty-five, who died in the eighth month of gestation, and who was

delivered postmortem by the vagina, manual means only being used. The

operator was about to perform Cesarean section when he heard the noise

of the membranes rupturing. Thornton reports the extraction of a living

child by version after the death of the mother. Aveling has compiled

extensive statistics on all varieties of postmortem deliveries,

collecting 44 cases of spontaneous expulsion of the fetus after death

of the mother.

Aveling states that in 1820 the Council of Cologne sanctioned the

placing of a gag in the mouth of a dead pregnant woman, thereby hoping

to prevent suffocation of the infant, and there are numerous such laws

on record, although most of them pertain to the performance of Cesarean

section immediately after death.

Reiss records the death of a woman who was hastily buried while her

husband was away, and on his return he ordered exhumation of her body,

and on opening the coffin a child's cry was heard. The infant had

evidently been born postmortem. It lived long afterward under the name

of "Fils de la terre." Willoughby mentions the curious instance in

which rumbling was heard from the coffin of a woman during her hasty

burial. One of her neighbors returned to the grave, applied her ear to

the ground, and was sure she heard a sighing noise. A soldier with her

affirmed her tale, and together they went to a clergyman and a justice,

begging that the grave be opened. When the coffin was opened it was

found that a child had been born, which had descended to her knees. In

Derbyshire, to this day, may be seen on the parish register: "April ye

20, 1650, was buried Emme, the wife of Thomas Toplace, who was found

delivered of a child after she had lain two hours in the grave."

Johannes Matthaeus relates the case of a buried woman, and that some

time afterward a noise was heard in the tomb. The coffin was

immediately opened, and a living female child rolled to the feet of the

corpse. Hagendorn mentions the birth of a living child some hours after

the death of the mother. Dethardingius mentions a healthy child born

one-half hour after the mother's death. In the Gentleman's Magazine

there is a record of an instance, in 1759, in which a midwife, after

the death of a woman whom she had failed to deliver, imagined that she

saw a movement under the shroud and found a child between its mother's

legs. It died soon after. Valerius Maximus says that while the body of

the mother of Gorgia Epirotas was being carried to the grave, a loud

noise was heard to come from the coffin and on examination a live child

was found between the thighs,--whence arose the proverb: "Gorgiam prius

ad funus elatum, quam natum fuisse."

Other cases of postmortem delivery are less successful, the delivery

being delayed too late for the child to be viable. The first of

Aveling's cases was that of a pregnant woman who was hanged by a

Spanish Inquisitor in 1551 While still hanging, four hours later, two

children were said to have dropped from her womb. The second case was

of a woman of Madrid, who after death was shut in a sepulcher. Some

months after, when the tomb was opened, a dead infant was found by the

side of the corpse. Rolfinkius tells of a woman who died during

parturition, and her body being placed in a cellar, five days later a

dead boy and girl were found on the bier. Bartholinus is accredited

with the following: Three midwives failing to deliver a woman, she

died, and forty-eight hours after death her abdomen swelled to such an

extent as to burst her grave-clothes, and a male child, dead, was seen

issuing from the vagina. Bonet tells of a woman, who died in Brussels

in 1633, who, undelivered, expired in convulsions on Thursday. On

Friday abdominal movements in the corpse were seen, and on Sunday a

dead child was found hanging between the thighs. According to Aveling,

Herman of Berne reports the instance of a young lady whose body was far

advanced in putrefaction, from which was expelled an unbroken ovum

containing twins. Even the placenta showed signs of decomposition.

Naumann relates the birth of a child on the second day after the death

of the mother. Richter of Weissenfels, in 1861, reported the case of a

woman who died in convulsions, and sixty hours after death an eight

months' fetus came away. Stapedius writes to a friend of a fetus being

found dead between the thighs of a woman who expired suddenly of an

acute disease. Schenk mentions that of a woman, dying at 5 P.M., a

child having two front teeth was born at 3 A.M. Veslingius tells of a

woman dying of epilepsy on June 6, 1630, from whose body, two days

later, issued a child. Wolfius relates the case of a woman dying in

labor in 1677. Abdominal movements being seen six hours after death,

Cesarean section was suggested, but its performance was delayed, and

eighteen hours after a child was spontaneously born. Hoyer of Mulhausen

tells of a child with its mouth open and tongue protruding, which was

born while the mother was on the way to the grave. Bedford of Sydney,

according to Aveling, relates the story of a case in which malpractice

was suspected on a woman of thirty-seven, who died while pregnant with

her seventh child. The body was exhumed, and a transverse rupture of

the womb six inches long above the cervix was found, and the body of a

dead male child lay between the thighs. In 1862, Lanigan tells of a

woman who was laid out for funeral obsequies, and on removal of the

covers for burial a child was found in bed with her. Swayne is credited

with the description of the death of a woman whom a midwife failed to

deliver. Desiring an inquest, the coroner had the body exhumed, when,

on opening the coffin, a well-developed male infant was found parallel

to and lying on the lower limbs, the cord and placenta being entirely

unattached from the mother.

Some time after her decease Harvey found between the thighs of a dead

woman a dead infant which had been expelled postmortem. Mayer relates

the history of a case of a woman of forty-five who felt the movement of

her child for the fourth time in the middle of November. In the

following March she had hemoptysis, and serious symptoms of

inflammation in the right lung following, led to her apparent death on

the 31st of the month. For two days previous to her death she had

failed to perceive the fetal movements. She was kept on her back in a

room, covered up and undisturbed, for thirty-six hours, the members of

the family occasionally visiting her to sprinkle holy water on her

face. There was no remembrance of cadaveric distortion of the features

or any odor. When the undertakers were drawing the shroud on they

noticed a half-round, bright-red, smooth-looking body between the

genitals which they mistook for a prolapsed uterus. Early on April 2d,

a few hours before interment, the men thought to examine the swelling

they had seen the day before. A second look showed it to be a dead

female child, now lying between the thighs and connected with the

mother by the umbilical cord. The interment was stopped, and Mayer was

called to examine the body, but with negative results, though the signs

of death were not plainly visible for a woman dead fifty-eight hours.

By its development the body of the fetus confirmed the mother's account

of a pregnancy of twenty-one weeks. Mayer satisfies himself at least

that the mother was in a trance at the time of delivery and died soon

afterward.

Moritz gives the instance of a woman dying in pregnancy, undelivered,

who happened to be disinterred several days after burial. The body was

in an advanced state of decomposition, and a fetus was found in the

coffin. It was supposed that the pressure of gas in the mother's body

had forced the fetus from the uterus. Ostmann speaks of a woman

married five months, who was suddenly seized with rigors, headache, and

vomiting. For a week she continued to do her daily work, and in

addition was ill-treated by her husband. She died suddenly without

having any abdominal pain or any symptoms indicative of abortion. The

body was examined twenty-four hours after death and was seen to be

dark, discolored, and the abdomen distended. There was no sanguineous

discharge from the genitals, but at the time of raising the body to

place it in the coffin, a fetus, with the umbilical cord, escaped from

the vagina. There seemed to have been a rapid putrefaction in this

ease, generating enough pressure of gas to expel the fetus as well as

the uterus from the body. This at least is the view taken by Hoffman

and others in the solution of these strange cases.

Antepartum Crying of the Child.--There are on record fabulous cases of

children crying in the uterus during pregnancy, and all sorts of

unbelievable stories have been constructed from these reported

occurrences. Quite possible, however, and worthy of belief are the

cases in which the child has been heard to cry during the progress of

parturition--that is, during delivery. Jonston speaks of infants

crying in the womb, and attempts a scientific explanation of the fact.

He also quotes the following lines in reference to this subject:--

"Mirandum foetus nlaterna clausus in alvo Dicitur insuetos ore dedisse

sonos. Causa subest; doluit se angusta sede telleri Et cupiit magnae

cernere moliis opus. Aut quia quaerendi studio vis fessa parentum

Aucupii aptas innuit esse manus."

Date: 2014-12-29; view: 744