anomalies and curiosities of medicine-第25部分

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l　of　Georgia　operated　inadvertently　at　the　second　and　third　month　in　two　cases　of　vesicovaginal　fistula　in　pregnant　women。　The　first　case　showed　no　interruption　of　pregnancy；　but　in　the　second　case　the　woman　nearly　died　and　the　fistula　remained　unhealed。　Engelmann　operated　on　a　large　rectovaginal　fistula　in　the　sixth　month　of　pregnancy　without　any　interruption　of　pregnancy；　which　is　far　from　the　general　result。　Cazin　and　Rey　both　produced　abortion　by　forcible　dilatation　of　the　anus　for　fissure；　but　Gayet　used　both　the　fingers　and　a　speculum　in　a　case　at　five　months　and　the　woman　went　to　term。　By　cystotomy　Reamy　removed　a　double　hair…pin　from　a　woman　pregnant　six　and　a　half　months；　without　interruption；　and　according　to　Mann　again；　McClintock　extracted　stones　from　the　bladder　by　the　urethra　in　the　fourth　month　of　pregnancy；　and　Phillips　did　the　same　in　the　seventh　month。　Hendenberg　and　Packard　report　the　removal　of　a　tumor　weighing　8　3/4　pounds　from　a　pregnant　uterus　without　interrupting　gestation。

The　following　extract　from　the　University　Medical　Magazine　of　Philadelphia　illustrates　the　after…effects　of　abdominal　hysteropasy　on　subsequent　pregnancies：

〃Fraipont　（Annales　de　la　Societe　Medico…Chirurgicale　de　Liege；　1894）　reports　four　cases　where　pregnancy　and　labor　were　practically　normal；　though　the　uterus　of　each　patient　had　been　fixed　to　the　abdominal　walls。　In　two　of　the　cases　the　hysteropexy　had　been　performed　over　five　years　before　the　pregnancy　occurred；　and；　although　the　bands　of　adhesion　between　the　fundus　and　the　parietes　must　have　become　very　tough　after　so　long　a　period；　no　special　difficulty　was　encountered。　In　two　of　the　cases　the　forceps　was　used；　but　not　on　account　of　uterine　inertia；　the　fetal　head　was　voluminous；　and　in　one　of　the　two　cases　internal　rotation　was　delayed。　The　placenta　was　always　expelled　easily；　and　no　serious　postpartum　hemorrhage　occurred。　Fraipont　observed　the　progress　of　pregnancy　in　several　of　these　cases。　The　uterus　does　not　increase　specially　in　its　posterior　part；　but　quite　uniformly；　so　that；　as　might　be　expected；　the　fundus　gradually　detaches　itself　from　the　abdominal　wall。　Even　if　the　adhesions　were　not　broken　down　they　would　of　necessity　be　so　stretched　as　to　be　useless　for　their　original　purpose　after　delivery。　Bands　of　adhesion　could　not　share　in　the　process　of　involution。　As；　however；　the　uterus　undergoes　perfect　involution；　it　is　restored　to　its　original　condition　before　the　onset　of　the　disease　which　rendered　hysteropexy　necessary。〃

The　coexistence　of　an　extensive　tumor　of　the　uterus　with　pregnancy　does　not　necessarily　mean　that　the　product　of　conception　will　be　blighted。　Brochin　speaks　of　a　case　in　which　pregnancy　was　complicated　with　fibroma　of　the　uterus；　the　accouchement　being　natural　at　term。　Byrne　mentions　a　case　of　pregnancy　complicated　with　a　large　uterine　fibroid。　Delivery　was　effected　at　full　term；　and　although　there　was　considerable　hemorrhage　the　mother　recovered。　Ingleby　describes　a　case　of　fibrous　tumor　of　the　uterus　terminating　fatally；　but　not　until　three　weeks　after　delivery。　Lusk　mentions　a　case　of　pregnancy　with　fibrocystic　tumor　of　the　uterus　occluding　the　cervix。　At　the　appearance　of　symptoms　of　eclampsia　version　was　performed　and　delivery　effected；　followed　by　postpartum　hemorrhage。　The　mother　died　from　peritonitis　and　collapse；　but　the　stillborn　child　was　resuscitated。　Roberts　reports　a　case　of　pregnancy　associated　with　a　large　fibrocellular　polypus　of　the　uterus。　A　living　child　was　delivered　at　the　seventh　month；　ecrasement　was　performed；　and　the　mother　recovered。

Von　Quast　speaks　of　a　fibromyoma　removed　five　days　after　labor。　Gervis　reports　the　removal　of　a　large　polypus　of　the　uterus　on　the　fifth　day　after　confinement。　Davis　describes　the　spontaneous　expulsion　of　a　large　polypus　two　days　after　the　delivery　of　a　fine；　healthy；　male　child。　Deason　mentions　a　case　of　anomalous　tumor　of　the　uterus　during　pregnancy　which　was　expelled　after　the　birth　of　the　child；　and　Daly　also　speaks　of　a　tumor　expelled　from　the　uterus　after　delivery。　Cathell　speaks　of　a　case　of　pregnancy　complicated　with　both　uterine　fibroids　and　measles。　Other　cases　of　a　similar　nature　to　the　foregoing　are　too　numerous　to　mention。　Figure　13；　taken　from　Spiegelberg；　shows　a　large　fibroid　blocking　the　pelvis　of　a　pregnant　woman。

There　are　several　peculiar　accidents　and　anomalies　not　previously　mentioned　which　deserve　a　place　here；　viz。；　those　of　the　membranes　surrounding　the　fetus。　Brown　speaks　of　protrusion　of　the　membranes　from　the　vulva　several　weeks　before　confinement。　Davies　relates　an　instance　in　which　there　was　a　copious　watery　discharge　during　pregnancy　not　followed　by　labor。　There　is　a　case　mentioned　in　which　an　accident　and　an　inopportune　dose　of　ergot　at　the　fifth　month　of　pregnancy　were　followed　by　rupture　of　the　amniotic　sac；　and　subsequently　a　constant　flow　of　watery　fluid　continued　for　the　remaining　three　months　of　pregnancy。　The　fetus　died　at　the　time；　and　was　born　in　an　advanced　state　of　putrefaction；　by　version；　three　months　after　the　accident。　The　mother　died　five　months　after　of　carcinoma　of　the　uterus。　Montgomery　reports　the　instance　of　a　woman　who　menstruated　last　on　May　22；　1850；　and　quickened　on　September　26th；　and　continued　well　until　the　11th　of　November。　At　this　time；　as　she　was　retiring；　she　became　conscious　that　there　was　a　watery　discharge　from　the　vagina；　which　proved　to　be　liquor　amnii。　Her　health　was　good。　The　discharge　continued；　her　size　increased；　and　the　motions　of　the　child　continued　active。　On　the　18th　of　January　a　full…sized　eight　months'　child　was　born。　It　had　an　incessant；　wailing；　low　cry；　always　of　evil　augury　in　new…born　infants。　The　child　died　shortly　after。　The　daily　discharge　was　about　5　ounces；　and　had　lasted　sixty…eight　days；　making　21　pints　in　all。　The　same　accident　of　rupture　of　the　membranes　long　before　labor　happened　to　the　patient's　mother。

Bardt　speaks　of　labor　twenty…three　days　after　the　flow　of　the　waters；　and　Cobleigh　one　of　seventeen　days；　Bradley　relates　the　history　of　a　case　of　rupture　of　the　membranes　six　weeks　before　delivery。　Rains　cites　an　instance　in　which　gestation　continued　three　months　after　rupture　of　the　membranes；　the　labor…pains　lasting　thirty…six　hours。　Griffiths　speaks　of　rupture　of　the　amniotic　sac　at　about　the　sixth　month　of　pregnancy　with　no　untoward　interruption　of　the　completion　of　gestation　and　with　delivery　of　a　living　child。　There　is　another　observation　of　an　accouchement　terminating　successfully　twenty…three　days　after　the　loss　of　the　amniotic　fluid。　Campbell　mentions　delivery　of　a　living　child　twelve　days　after　rupture　of　the　membranes。　Chesney　relates　the　history　of　a　double　collection　of　waters。　Wood　reports　a　case　in　which　there　was　expulsion　of　a　bag　of　waters　before　the　rupture　of　the　membranes。　Bailly；　Chestnut；　Bjering；　Cowger；　Duncan；　and　others　also　record　premature　rupture　of　the　membranes　without　interruption　of　pregnancy。

Harris　gives　an　instance　of　the　membranes　being　expelled　from　the　uterus　a　few　days　before　delivery　at　the　full　term。　Chatard；　Jr。；　mentions　extrusion　of　the　fetal　membranes　at　the　seventh　month　of　pregnancy　while　the　patient　was　taking　a　long　afternoon　walk；　their　subsequent　retraction；　and　normal　labor　at　term。　Thurston　tells　of　a　case　in　which　Nature　had　apparently　effected　the　separation　of　the　placenta　without　alarming　hemorrhage；　the　ease　being　one　of　placenta　praevia；　terminating　favorably　by　natural　processes。　Playfair　speaks　of　the　detachment　of　the　uterine　decidua　without　the　interruption　of　pregnancy。

Guerrant　gives　a　unique　example　of　normal　birth　at　full　term　in　which　the　placenta　was　found　in　the　vagina；　but　not　a　vestige　of　the　membranes　was　noticed。　The　patient　had　experienced　nothing　unusual　until　within　three　months　of　expected　confinement；　since　which　time　there　had　been　a　daily　loss　of　water　from　the　uterus。　She　recovered　and　was　doing　her　work。　There　was　no　possibility　that　this　was　a　case　of　retained　secundines。

Anomalies　of　the　Umbilical　Cord。Absence　of　the　membranes　has　its　counterpart　in　the　deficiency　of　the　umbilical　cord；　so　frequently　noticed　in　old　reports。　The　Ephemerides；　Osiander；　Stark's　Archives；　Thiebault；　van　der　Wiel；　Chatton；　and　Schurig　all　speak　of　it；　and　it　has　been　noticed　since。　Danthez　speaks　of　the　development　of　a　fetus　in　spite　of　the　absence　of　an　umbilical　cord。　Stute　reports　an　observation　of　total　absence　of　the　umbilical　cord；　with　placental　insertion　near　the　cervix　of　the　uterus。

There　is　mentioned　a　bifid　funis。　The　Ephemerides　and　van　der　Wiel　speak　of　a　duplex　funis。　Nolde　reports　a　cord　38　inches　long；　and　Werner　cites　the　instance　of　a　funis　51　inches　long。　There　are　modern　instances　in　which　the　funis　has　been　bifid　or　duplex；　and　there　is　also　a　case　reported　in　which　there　were　two　cords　in　a　twin　pregnancy；　each　of　them　measuring　five　feet　in　length。　The　Lancet　gives　the　account　of　a　most　peculiar　pregnancy　consisting　of　a　placenta　alone；　the　fetus　wanting。　What　this　〃placenta〃　was　will　always　be　a　matter　of　conjecture。

Occasionally　death　of　the　fetus　is　caused　by　the　formation　of　knots　in　the　cord；　shutting　off　the　fetal　circulation；　Gery；　Grieve；　Mastin；　Passot；　Piogey；　Woets；　and　others　report　instances　of　this　nature。　Newman　reports　a　curious　case　of　twins；　in　which　the　cord　of　one　child　was　encircled　by　a　knot　on　the　cord　of　the　other。　Among　others；　Latimer　and　Motte　report　instances　of　the　accidental　tying　of　the　bowel　with　the　funis；　causing　an　artificial　anus。

The　diverse　causes　of　abortion　are　too　numerous　to　attempt　giving　them　all；　but　some　are　so　curious　and　anomalous　that　they　deserve　mention。　Epidemics　of　abortion　are　spoken　of　by　Fickius；　Fischer；　and　the　Ephemerides。　Exposure　to　cold　is　spoken　of　as　a　cause；　and　the　same　is　alluded　to　by　the　Ephemerides；　while　another　case　is　given　as　due　to　exposure　white　nude。　There　are　several　cases　among　the　older　writers　in　which　odors　are　said　to　have　produced　abortion；　but　as　analogues　are　not　to　be　found　in　modern　literature；　unless　the　odor　is　very　poisonous　or　pungent；　we　can　give　them　but　little　credence。　The　Ephemerides　gives　the　odor　of　urine　as　provocative　of　abortion；　Sulzberger；　Meyer；　and　Albertus　all　mention　odors；　and　Vesti　giv