anomalies and curiosities of medicine-第21部分

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y；　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　efficacy　of　fetal　therapeutics　have　been　made　from　time　to　time　with　varying　results。

Gusserow　of　Strasbourg　tested　for　iodin；　chloroform；　and　salicylic　acid　in　the　blood　and　secretions　of　the　fetus　after　maternal　administration　just　before　death。　In　14　cases　in　which　iodin　had　been　administered；　he　examined　the　fetal　urine　of　11　cases；　in　5；　iodin　was　present；　and　in　the　others；　absent。　He　made　some　similar　experiments　on　the　lower　animals。　Benicke　reports　having　given　salicylic　acid　just　before　birth　in　25　cases；　and　in　each　case　finding　it　in　the　urine　of　the　child　shortly　after　birth。

At　a　discussion　held　in　New　York　some　years　ago　as　to　the　real　effect　on　the　fetus　of　giving　narcotics　to　the　mother；　Dr。　Gaillard　Thomas　was　almost　alone　in　advocating　that　the　effect　was　quite　visible。　Fordyce　Barker　was　strongly　on　the　negative　side。　Henning　and　Ahlfeld；　two　German　observers；　vouch　for　the　opinion　of　Thomas；　and　Thornburn　states　that　he　has　witnessed　the　effect　of　nux　vomica　and　strychnin　on　the　fetus　shortly　after　birth。　Over　fifty　years　ago；　in　a　memoir　on　〃Placental　Phthisis；〃　Sir　James　Y。　Simpson　advanced　a　new　idea　in　the　recommendation　of　potassium　chlorate　during　the　latter　stages　of　pregnancy。　The　efficacy　of　this　suggestion　is　known；　and　whether；　as　Simpson　said；　it　acts　by　supplying　extra　oxygen　to　the　blood；　or　whether　the　salt　itself　is　conveyed　to　the　fetus；　has　never　been　definitely　settled。

McClintock；　who　has　been　a　close　observer　on　this　subject；　reports　some　interesting　cases。　In　his　first　case　he　tried　a　mixture　of　iron　perchlorid　and　potassium　chlorate　three　times　a　day　on　a　woman　who　had　borne　three　dead　children；　with　a　most　successful　result。　His　second　case　failed；　but　in　a　third　he　was　successful　by　the　same　medication　with　a　woman　who　had　before　borne　a　dead　child。　In　a　fourth　case　of　unsuccessful　pregnancy　for　three　consecutive　births　he　was　successful。　His　fifth　case　was　extraordinary：　It　was　that　of　a　woman　in　her　tenth　pregnancy；　who；　with　one　exception；　had　always　borne　a　dead　child　at　the　seventh　or　eighth　month。　The　one　exception　lived　a　few　hours　only。　Under　this　treatment　he　was　successful　in　carrying　the　woman　safely　past　her　time　for　miscarriage；　and　had　every　indication　for　a　normal　birth　at　the　time　of　report。　Thornburn　believes　that　the　administration　of　a　tonic　like　strychnin　is　of　benefit　to　a　fetus　which；　by　its　feeble　heart…beats　and　movements；　is　thought　to　be　unhealthy。　Porak　has　recently　investigated　the　passage　of　substances　foreign　to　the　organism　through　the　placenta；　and　offers　an　excellent　paper　on　this　subject；　which　is　quoted　in　brief　in　a　contemporary　number　of　Teratologia。

In　this　important　paper；　Porak；　after　giving　some　historical　notes；　describes　a　long　series　of　experiments　performed　on　the　guinea…pig　in　order　to　investigate　the　passage　of　arsenic；　copper；　lead；　mercury；　phosphorus；　alizarin；　atropin；　and　eserin　through　the　placenta。　The　placenta　shows　a　real　affinity　for　some　toxic　substances；　in　it　accumulate　copper　and　mercury；　but　not　lead；　and　it　is　therefore　through　it　that　the　poison　reaches　the　fetus；　in　addition　to　its　pulmonary；　intestinal；　and　renal　functions；　it　fixes　glycogen　and　acts　as　an　accumulator　of　poisons；　and　so　resembles　in　its　action　the　liver；　therefore　the　organs　of　the　fetus　possess　only　a　potential　activity。　The　storing　up　of　poisons　in　the　placenta　is　not　so　general　as　the　accumulation　of　them　in　the　liver　of　the　mother。　It　may　be　asked　if　the　placenta　does　not　form　a　barrier　to　the　passage　of　poisons　into　the　circulation　of　the　fetus；　this　would　seem　to　be　demonstrated　by　mercury；　which　was　always　found　in　the　placenta　and　never　in　the　fetal　organs。　In　poisoning　by　lead　and　copper　the　accumulation　of　the　poison　in　the　fetal　tissues　is　greater　than　in　the　maternal；　perhaps　from　differences　in　assimilation　and　disassimilation　or　from　greater　diffusion。　Whilst　it　is　not　an　impermeable　barrier　to　the　passage　of　poisons；　the　placenta　offers　a　varying　degree　of　obstruction：　it　allows　copper　and　lead　to　pass　easily；　arsenic　with　greater　difficulty。　The　accumulation　of　toxic　substances　in　the　fetus　does　not　follow　the　same　law　as　in　the　adult。　They　diffuse　more　widely　in　the　fetus。　In　the　adult　the　liver　is　the　chief　accumulatory　organ。　Arsenic；　which　in　the　mother　elects　to　accumulate　in　the　liver；　is　in　the　fetus　stored　up　in　the　skin；　copper　accumulates　in　the　fetal　liver；　central　nervous　system；　and　sometimes　in　the　skin；　lead　which　is　found　specially　in　the　maternal　liver；　but　also　in　the　skin；　has　been　observed　in　the　skin；　liver；　nervous　centers；　and　elsewhere　in　the　fetus。　The　frequent　presence　of　poisons　in　the　fetal　skin　demonstrates　its　physiologic　importance。　It　has　probably　not　a　very　marked　influence　on　its　health。　On　the　contrary；　accumulation　in　the　placenta　and　nerve　centers　explains　the　pathogenesis　of　abortion　and　the　birth　of　dead　fetuses　（〃mortinatatite〃）　Copper　and　lead　did　not　cause　abortion；　but　mercury　did　so　in　two　out　of　six　cases。　Arsenic　is　a　powerful　abortive　agent　in　the　guinea…pig；　probably　on　account　of　placental　hemorrhages。　An　important　deduction　is　that　whilst　the　placenta　is　frequently　and　seriously　affected　in　syphilis；　it　is　also　the　special　seat　for　the　accumulation　of　mercury。　May　this　not　explain　its　therapeutic　action　in　this　disease？　The　marked　accumulation　of　lead　in　the　central　nervous　system　of　the　fetus　explains　the　frequency　and　serious　character　of　saturnine　encephalopathic　lesions。　The　presence　of　arsenic　in　the