anomalies and curiosities of medicine-第23部分

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been　thrust　into　a　fetus　in　utero；　Verduc　offers　several　examples；　one　a　dislocation　of　the　fetal　foot　from　a　maternal　fall；　Plocquet　gives　an　instance　of　fractured　femur；　Walther　describes　a　case　of　dislocation　of　the　vertebrae　from　a　fall；　and　there　is　also　a　case　of　a　fractured　fetal　vertebra　from　a　maternal　fall。　There　is　recorded　a　fetal　scalp　injury；　together　with　clotted　blood　in　the　hair；　after　a　fall　of　the　mother：　Autenrieth　describes　a　wound　of　the　pregnant　uterus；　which　had　no　fatal　issue；　and　there　is　also　another　similar　case　on　record。　

The　modern　records　are　much　more　interesting　and　wonderful　on　this　subject　than　the　older　ones。　Richardson　speaks　of　a　woman　falling　down　a　few　weeks　before　her　delivery。　Her　pelvis　was　roomy　and　the　birth　was　easy；　but　the　infant　was　found　to　have　extensive　wounds　on　the　back；　reaching　from　the　3d　dorsal　vertebra　across　the　scapula；　along　the　back　of　the　humerus；　to　within　a　short　distance　of　the　elbow。　Part　of　these　wounds　were　cicatrized　and　part　still　granulating；　which　shows　that　the　process　of　reparation　is　as　active　in　utero　as　elsewhere。

Injuries　about　the　genitalia　would　naturally　be　expected　to　exercise　some　active　influence　on　the　uterine　contents；　but　there　are　many　instances　reported　in　which　the　escape　of　injury　is　marvelous。　Gibb　speaks　of　a　woman；　about　eight　months　pregnant；　who　fell　across　a　chair；　lacerating　her　genitals　and　causing　an　escape　of　liquor　amnii。　There　was　regeneration　of　this　fluid　and　delivery　beyond　term。　The　labor　was　tedious　and　took　place　two　and　a　half　months　after　the　accident。　The　mother　and　the　female　child　did　well。　Purcell　reports　death　in　a　pregnant　woman　from　contused　wound　of　the　vulva。　Morland　relates　an　instance　of　a　woman　in　the　fifth　month　of　her　second　pregnancy；　who　fell　on　the　roof　of　a　woodshed　by　slipping　from　one　of　the　steps　by　which　she　ascended　to　the　roof；　in　the　act　of　hanging　out　some　clothes　to　dry。　She　suffered　a　wound　on　the　internal　surface　of　the　left　nympha　1　1/2　inch　long　and　1/2　inch　deep。　She　had　lost　about　three　quarts　of　blood；　and　had　applied　ashes　to　the　vagina　to　stop　the　bleeding。　She　made　a　recovery　by　the　twelfth　day；　and　the　fetal　sounds　were　plainly　audible。　Cullingworth　speaks　of　a　woman　who；　during　a　quarrel　with　her　husband；　was　pushed　away　and　fell　between　two　chairs；　knocking　one　of　them　over；　and　causing　a　trivial　wound　one　inch　long　in　the　vagina；　close　to　the　entrance。　She　screamed；　there　was　a　gush　of　blood；　and　she　soon　died。　The　uterus　contained　a　fetus　three　or　four　months　old；　with　the　membranes　intact；　the　maternal　death　being　due　to　the　varicosity　of　the　pregnant　pudenda；　the　slight　injury　being　sufficient　to　produce　fatal　hemorrhage。　Carhart　describes　the　case　of　a　pregnant　woman；　who；　while　in　the　stooping　position；　milking　a　cow；　was　impaled　through　the　vagina　by　another　cow。　The　child　was　born　seven　days　later；　with　its　skull　crushed　by　the　cow's　horn。　The　horn　had　entered　the　vagina；　carrying　the　clothing　with　it。

There　are　some　marvelous　cases　of　recovery　and　noninterference　with　pregnancy　after　injuries　from　horns　of　cattle。　Corey　speaks　of　a　woman　of　thirty…five；　three　months　pregnant；　weighing　135　pounds；　who　was　horned　by　a　cow　through　the　abdominal　parietes　near　the　hypogastric　region；　she　was　lifted　into　the　air；　carried；　and　tossed　on　the　ground　by　the　infuriated　animal。　There　was　a　wound　consisting　of　a　ragged　rent　from　above　the　os　pubis；　extending　obliquely　to　the　left　and　upward；　through　which　protruded　the　great　omentum；　the　descending　and　transverse　colon；　most　of　the　small　intestines；　as　well　as　the　pyloric　extremity　of　the　stomach。　The　great　omentum　was　mangled　and　comminuted；　and　bore　two　lacerations　of　two　inches　each。　The　intestines　and　stomach　were　not　injured；　but　there　was　considerable　extravasation　of　blood　into　the　abdominal　cavity。　The　intestines　were　cleansed　and　an　unsuccessful　attempt　was　made　to　replace　them。　The　intestines　remained　outside　of　the　body　for　two　hours；　and　the　great　omentum　was　carefully　spread　out　over　the　chest　to　prevent　interference　with　the　efforts　to　return　the　intestines。　The　patient　remained　conscious　and　calm　throughout；　finally　deep　anesthesia　was　produced　by　ether　and　chloroform；　three　and　a　half　hours　after　the　accident；　and　in　twenty　minutes　the　intestines　were　all　replaced　in　the　abdominal　cavity。　The　edges　were　pared；　sutured；　and　the　wound　dressed。　The　woman　was　placed　in　bed；　on　the　right　side；　and　morphin　was　administered。　The　sutures　were　removed　on　the　ninth　day；　and　the　wound　had　healed　except　at　the　point　of　penetration。　The　woman　was　discharged　twenty　days　after；　and；　incredible　to　relate；　was　delivered　of　a　well…developed；　full…term　child　just　two　hundred　and　two　days　from　the　time　of　the　accident。　Both　the　mother　and　child　did　well。

Luce　speaks　of　a　pregnant　woman　who　was　horned　in　the　lower　part　of　the　abdomen　by　a　cow；　and　had　a　subsequent　protrusion　of　the　intestines　through　the　wound。　After　some　minor　complications；　the　wound　healed　fourteen　weeks　after　the　accident；　and　the　woman　was　confined　in　natural　labor　of　a　healthy；　vigorous　child。　In　this　case　no　blood　was　found　on　the　cow's　horn；　and　the　clothing　was　not　torn；　so　that　the　wound　must　have　been　made　by　the　side　of　the　horn　striking　the　greatly　distended　abdomen。

Richard；　quoted　also　by　Tiffany；　speaks　of　a　woman；　twenty…two；　who　fell　in　a　dark　cellar　with　some　empty　bottles　in　her　hand；　suffering　a　wound　in　the　abdomen　2　inches　above　the　navel　on　the　left　side　8　cm。　long。　Through　this　wound　a　mass　of　intestines；　the　size　of　a　man's　head；　protruded。　Both　the　mother　and　the　child　made　a　good　convalescence。　Harris　cites　the　instance　of　a　woman　of　thirty；　a　multipara；　six　months　pregnant；　who　was　gored　by　a　cow；　her　intestines　and　omentum　protruded　through　the　rip　and　the　uterus　was　bruised。　There　was　rapid　recovery　and　delivery　at　term。　Wetmore　of　Illinois　saw　a　woman　who　in　the　summer　of　1860；　when　about　six　months　pregnant；　was　gored　by　a　cow；　and　the　large　intestine　and　the　omentum　protruded　through　the　wound。　Three　hours　after　the　injury　she　was　found　swathed　in　rags　wet　with　a　compound　solution　of　whiskey　and　camphor；　with　a　decoction　of　tobacco。　The　intestines　were　cold　to　the　touch　and　dirty；　but　were　washed　and　replaced。　The　abdomen　was　sewed　up　with　a　darning　needle　and　black　linen　thread；　the　woman　recovered　and　bore　a　healthy　child　at　the　full　maturity　of　her　gestation。　Crowdace　speaks　of　a　female　pauper；　six　months　pregnant；　who　was　attacked　by　a　buffalo；　and　suffered　a　wound　about　1　1/2　inch　long　and　1/2　inch　wide　just　above　the　umbilicus。　Through　this　small　opening　19　inches　of　intestine　protruded。　The　woman　recovered；　and　the　fetal　heart…beats　could　be　readily　auscultated。

Major　accidents　in　pregnant　women　are　often　followed　by　the　happiest　results。　There　seems　to　be　no　limit　to　what　the　pregnant　uterus　can　successfully　endure。　Tiffany；　who　has　collected　some　statistics　on　this　subject；　as　well　as　on　operations　successfully　performed　during　pregnancy；　which　will　be　considered　later；　quotes　the　account　of　a　woman　of　twenty…seven；　eight　months　pregnant；　who　was　almost　buried　under　a　clay　wall。　She　received　terrible　wounds　about　the　head；　32　sutures　being　used　in　this　location　alone。　Subsequently　she　was　confined；　easily　bore　a　perfectly　normal　female　child；　and　both　did　well。　Sibois　describes　the　case　of　a　woman　weighing　190　pounds；　who　fell　on　her　head　from　the　top　of　a　wall　from　10　to　12　feet　high。　For　several　hours　she　exhibited　symptoms　of　fracture　of　the　base　of　the　skull；　and　the　case　was　so　diagnosed；　fourteen　hours　after　the　accident　she　was　perfectly　conscious　and　suffered　terrible　pain　about　the　head；　neck；　and　shoulders。　Two　days　later　an　ovum　of　about　twenty　days　was　expelled；　and　seven　months　after　she　was　delivered　of　a　healthy　boy　weighing　10　1/2　pounds。　She　had　therefore　lost　after　the　accident　one…half　of　a　double　conception。

Verrier　has　collected　the　results　of　traumatism　during　pregnancy；　and　summarizes　61　cases。　Prowzowsky　cites　the　instance　of　a　patient　in　the　eighth　month　of　her　first　pregnancy　who　was　wounded　by　many　pieces　of　lead　pipe　fired　from　a　gun　but　a　few　feet　distant。　Neither　the　patient　nor　the　child　suffered　materially　from　the　accident；　and　gestation　proceeded；　the　child　died　on　the　fourth　day　after　birth　without　apparent　cause。　Milner　records　an　instance　of　remarkable　tolerance　of　injury　in　a　pregnant　woman。　During　her　six　months　of　pregnancy　the　patient　was　accidentally　shot　through　the　abdominal　cavity　and　lower　part　of　the　thorax。　The　missile　penetrated　the　central　tendon　of　the　diaphragm　and　lodged　in　the　lung。　The　injury　was　limited　by　localized　pneumonia　and　peritonitis；　and　the　wound　was　drained　through　the　lung　by　free　expectoration。　Recovery　ensued；　the　patient　giving　birth　to　a　healthy　child　sixteen　weeks　later。　Belin　mentions　a　stab…wound　in　a　pregnant　woman　from　which　a　considerable　portion　of　the　epiploon　protruded。　Sloughing　ensued；　but　the　patient　made　a　good　recovery；　gestation　not　being　interrupted。　Fancon　describes　the　case　of　a　woman　who　had　an　injury　to　the　knee　requiring　drainage。　She　was　attacked　by　erysipelas；　which　spread　over　the　whole　body　with　the　exception　of　the　head　and　neck；　yet　her　pregnancy　was　uninterrupted　and　recovery　ensued。　Fancon　also　speaks　of　a　girl　of　nineteen；　frightened　by　her　lover；　who　threatened　to　stab　her；　who　jumped　from　a　second…story　window。　For　three　days　after　the　fall　she　had　a　slight　bloody　flow　from　the　vulva。　Although　she　was　six　months　pregnant　there　was　no　interruption　of　the　normal　course　of　gestation。

Bancroft　speaks　of　a　woman　who；　being　mistaken　for　a　burglar；　was　shot　by　her　husband　with　a　44…caliber　bullet。　The　missile　entered　the　second　and　third　ribs　an　inch　from　the　sternum；　passed　through　the　right　lung；　and　escaped　at　the　inferior　angle　of　the　scapula；　about　three　inches　below　the　spine；　after　leaving　her　body　it　went　through　a　pine　door。　She　suffered　much　hemorrhage　and　shock；　but　made　a　fair　recovery　at　the　end　of　four　weeks；　though　pregnant　with　her　first　child　at　the　seventh　month。　At　full　term　she　was　delivered　by　foot…presentation　of　a　healthy　boy。　The　mother　at　the　time　of　report　was　healthy　and　free　from　cough；　and　was