CHAPTER II.

PRENATAL ANOMALIES.

Extrauterine Pregnancy.--In the consideration of prenatal anomalies,

the first to be discussed will be those of extrauterine pregnancy. This

abnormalism has been known almost as long as there has been any real

knowledge of obstetrics. In the writings of Albucasis, during the

eleventh century, extrauterine pregnancy is discussed, and later the

works of N. Polinus and Cordseus, about the sixteenth century, speak of

it; in the case of Cordseus the fetus was converted into a lithopedion

and carried in the abdomen twenty-eight years. Horstius in the

sixteenth century relates the history of a woman who conceived for the

third time in March, 1547, and in 1563 the remains of the fetus were

still in the abdomen.

Israel Spach, in an extensive gynecologic work published in 1557,

figures a lithopedion drawn in situ in the case of a woman with her

belly laid open. He dedicated to this calcified fetus, which he

regarded as a reversion, the following curious epigram, in allusion to

the classical myth that after the flood the world was repopulated by

the two survivors, Deucalion and Pyrrha, who walked over the earth and

cast stones behind them, which, on striking the ground, became people.

Roughly translated from the Latin, this epigram read as follows:

"Deucalion cast stones behind him and thus fashioned our tender race

from the hard marble. How comes it that nowadays, by a reversal of

things, the tender body of a little babe has limbs nearer akin to

stone?" Many of the older writers mention this form of fetation as a

curiosity, but offer no explanation as to its cause. Mauriceau and de

Graaf discuss in full extrauterine pregnancy, and Salmuth, Hannseus,

and Bartholinus describe it. From the beginning of the eighteenth

century this subject always demanded the attention and interest of

medical observers. In more modern times, Campbell and

Geoffroy-Saint-Hilaire, who named it "Grossesse Pathologique," have

carefully defined and classified the forms, and to-day every text-book

on obstetrics gives a scientific discussion and classification of the

different forms of extrauterine pregnancy.

The site of the conception is generally the wall of the uterus, the

Fallopian tube, or the ovary, although there are instances of pregnancy

in the vagina, as for example when there is scirrhus of the uterus; and

again, cases supposed to be only extrauterine have been instances

simply of double uterus, with single or concurrent pregnancy. Ross

speaks of a woman of thirty-three who had been married fourteen years,

had borne six children, and who on July 16, 1870, miscarried with twins

of about five months' development. After a week she declared that she

was still pregnant with another child, but as the physician had placed

his hand in the uterine cavity after the abortion, he knew the fetus

must be elsewhere or that no pregnancy existed. We can readily see how

this condition might lead to a diagnosis of extrauterine pregnancy, but

as the patient insisted on a thorough examination, the doctor found by

the stethoscope the presence of a beating fetal heart, and by vaginal

examination a double uterus. On introducing a sound into the new

aperture he discovered that it opened into another cavity; but as the

woman was pregnant in this, he proceeded no further. On October 31st

she was delivered of a female child of full growth. She had menstruated

from this bipartite uterus three times during the period between the

miscarriage of the twins and the birth of the child. Both the mother

and child did well.

In most cases there is rupture of the fetal sac into the abdominal

cavity or the uterus, and the fetus is ejected into this location, from

thence to be removed or carried therein many years; but there are

instances in which the conception has been found in situ, as depicted

in Figure 2. A sturdy woman of thirty was executed on January 16, 1735,

for the murder of her child. It was ascertained that she had passed her

catamenia about the first of the month, and thereafter had sexual

intercourse with one of her fellow-prisoners. On dissection both

Fallopian tubes were found distended, and the left ovary, which bore

signs of conception, was twice as large as the right. Campbell quotes

another such case in a woman of thirty-eight who for twenty years had

practised her vocation as a Cyprian, and who unexpectedly conceived. At

the third month of pregnancy a hard extrauterine tumor was found, which

was gradually increasing in size and extending to the left side of the

hypogastrium, the associate symptoms of pregnancy, sense of pressure,

pain, tormina, and dysuria, being unusually severe. There was

subsequently at attack of inflammatory fever, followed by tumefaction

of the abdomen, convulsions, and death on the ninth day. The fetus had

been contained in the peritoneal coat of the ovary until the fourth

month, when one of the feet passed through the cyst and caused the

fatal result. Signs of acute peritonitis were seen postmortem, the

abdominal cavity was full of blood, and the ovary much lacerated.

The termination of extrauterine pregnancy varies; in some cases the

fetus is extracted by operation after rupture; in others the fetus has

been delivered alive by abdominal section; it may be partially

absorbed, or carried many years in the abdomen; or it may ulcerate

through the confining walls, enter the bowels or bladder, and the

remnants of the fetal body be discharged.

The curious cases mentioned by older writers, and called abortion by

the mouth, etc., are doubtless, in many instances, remnants of

extrauterine pregnancies or dermoid cysts. Maroldus speaks in full of

such cases; Bartholinus, Salmuth, and a Reyes speak of women vomiting

remnants of fetuses. In Germany, in the seventeenth century, there

lived a woman who on three different occasions is said to have vomited

a fetus. The last miscarriage in this manner was of eight months'

growth and was accompanied by its placenta. The older observers thought

this woman must have had two orifices to her womb, one of which had

some connection with the stomach, as they had records of the dissection

of a female in whom was found a conformation similar to this.

Discharge of the fetal bones or even the whole of an extrauterine fetus

by the rectum is not uncommon. There are two early cases mentioned in

which the bones of a fetus were discharged at stool, causing intense

pain. Armstrong describes an anomalous case of pregnancy in a

syphilitic patient who discharged fetal bones by the rectum. Bubendorf

reports the spontaneous elimination of a fetal skeleton by the rectum

after five years of retention, with recovery of the patient. Butcher

speaks of delivery through the rectum at the fourth month, with

recovery. Depaul mentions a similar expulsion after a pregnancy of

about two months and a half. Jackson reports the dissection of an

extrauterine sac which communicated freely with the large intestine.

Peck has an example of spontaneous delivery of an extrauterine fetus by

the rectum, with recovery of the mother. Skippon, in the early part of

the last century, reports the discharge of the bones of a fetus through

an "imposthume" in the groin. Other cases of anal discharge of the

product of extrauterine conception are recorded by Winthrop, Woodbury,

Tuttle, Atkinson, Browne, Weinlechner, Gibson, Littre, Magruder,

Gilland, and many others. De Brun du Bois-Noir speaks of the expulsion

of extrauterine remains by the anus after seven years, and Heyerdahl

after thirteen years. Benham mentions the discharge of a fetus by the

rectum; there was a stricture of the rectum associated with syphilitic

patches, necessitating the performance of colotomy.

Bartholinus and Rosseus speak of fetal bones being discharged from the

urinary passages. Ebersbach, in the Ephemerides of 1717, describes a

necropsy in which a human fetus was found contained in the bladder. In

1878 White reported an instance of the discharge of fetal remains

through the bladder.

Discharge of the Fetus through the Abdominal Walls.--Margaret Parry of

Berkshire in 1668 voided the bones of a fetus through the flesh above

the os pubis, and in 1684 she was alive and well, having had healthy

children afterward. Brodie reports the history of a case in a negress

who voided a fetus from an abscess at the navel about the seventeenth

month of conception. Modern instances of the discharge of the

extrauterine fetus from the walls of the abdomen are frequently

reported. Algora speaks of an abdominal pregnancy in which there was

spontaneous perforation of the anterior abdominal parietes, followed by

death. Bouzal cites an extraordinary case of ectopic gestation in which

there was natural expulsion of the fetus through abdominal walls, with

subsequent intestinal strangulation. An artificial anus was established

and the mother recovered. Brodie, Dunglison, Erich, Rodbard, Fox, and

Wilson are among others reporting the expulsion of remnants of ectopic

pregnancies through the abdominal parietes. Campbell quotes the case of

a Polish woman, aged thirty-five, the mother of nine children, most of

whom were stillborn, who conceived for the tenth time, the gestation

being normal up to the lying-in period. She had pains followed by

extraordinary effusion and some blood into the vagina. After various

protracted complaints the abdominal tumor became painful and inflamed

in the umbilical region. A breach in the walls soon formed, giving exit

to purulent matter and all the bones of a fetus. During this process

the patient received no medical treatment, and frequently no assistance

in dressing the opening. She recovered, but had an artificial anus all

her life. Sarah McKinna was married at sixteen and menstruated for the

first time a month thereafter. Ten months after marriage she showed

signs of pregnancy and was delivered at full term of a living child;

the second child was born ten months after the first, and the second

month after the second birth she again showed signs of pregnancy. At

the close of nine months these symptoms, with the exception of the

suppression of menses, subsided, and in this state she continued for

six years. During the first four years she felt discomfort in the

region of the umbilicus. About the seventh year she suffered

tumefaction of the abdomen and thought she had conceived again. The

abscess burst and an elbow of the fetus protruded from the wound. A

butcher enlarged the wound and, fixing his finger under the jaw of the

fetus, extracted the head. On looking into the abdomen he perceived a

black object, whereupon he introduced his hand and extracted piecemeal

an entire fetal skeleton and some decomposed animal-matter. The abdomen

was bound up, and in six weeks the woman was enabled to superintend her

domestic affairs; excepting a ventral hernia she had no bad

after-results. Kimura, quoted by Whitney, speaks of a case of

extrauterine pregnancy in a Japanese woman of forty-one similar to the

foregoing, in which an arm protruded through the abdominal wall above

the umbilicus and the remains of a fetus were removed through the

aperture. The accompanying illustration shows the appearance of the arm

in situ before extraction of the fetus and the location of the wound.

Bodinier and Lusk report instances of the delivery of an extrauterine

fetus by the vagina; and Mathieson relates the history of the delivery

of a living ectopic child by the vagina, with recovery of the mother.

Gordon speaks of a curious case in a negress, six months pregnant, in

which an extrauterine fetus passed down from the posterior culdesac and

occluded the uterus. It was removed through the vagina, and two days

later labor-pains set in, and in two hours she was delivered of a

uterine child. The placenta was left behind and drainage established

through the vagina, and the woman made complete recovery.

Combined Intrauterine and Extrauterine Gestation.--Many

well-authenticated cases of combined pregnancy, in which one of the

products of conception was intrauterine and the other of extrauterine

gestation, have been recorded. Clark and Ramsbotham report instances of

double conception, one fetus being born alive in the ordinary manner

and the other located extrauterine. Chasser speaks of a case in which

there was concurrent pregnancy in both the uterus and the Fallopian

tube. Smith cites an instance of a woman of twenty-three who became

pregnant in August, 1870. In the following December she passed fetal

bones from the rectum, and a month later gave birth to an intrauterine

fetus of six months' growth. McGee mentions the case of a woman of

twenty-eight who became pregnant in July, 1872, and on October 20th and

21st passed several fetal bones by the rectum, and about four months

later expelled some from the uterus. From this time she rapidly

recovered her strength and health. Devergie quotes an instance of a

woman of thirty who had several children, but who died suddenly, and

being pregnant was opened. In the right iliac fossa was found a male

child weighing 5 pounds and 5 ounces, 8 1/2 inches long, and of about

five months' growth. The uterus also contained a male fetus of about

three months' gestation. Figure 4 shows combined intrauterine and

extrauterine gestation. Hodgen speaks of a woman of twenty-seven, who

was regular until November, 1872; early in January, 1873, she had an

attack of pain with peritonitis, shortly after which what was

apparently an extrauterine pregnancy gradually diminished. On August

17, 1873, after a labor of eight hours, she gave birth to a healthy

fetus. The hand in the uterus detected a tumor to the left, which wag

reduced to about one-fourth the former size. In April, 1874, the woman

still suffered pain and tenderness in the tumor. Hodgen believed this

to have been originally a tubal pregnancy, which burst, causing much

hemorrhage and the death of the fetus, together with a limited

peritonitis. Beach has seen a twin compound pregnancy in which after

connection there was a miscarriage in six weeks, and four years after

delivery of an extrauterine fetus through the abdominal walls. Cooke

cites an example of intrauterine and extrauterine pregnancy progressing

simultaneously to full period of gestation, with resultant death.

Rosset reports the case of a woman of twenty-seven, who menstruated

last in November, 1878, and on August 5, 1879, was delivered of a

well-developed dead female child weighing seven pounds. The uterine

contractions were feeble, and the attached placenta was removed only

with difficulty; there was considerable hemorrhage. The hemorrhage

continued to occur at intervals of two weeks, and an extrauterine tumor

remained. Two weeks later septicemia supervened and life was despaired

of. On the 15th of October a portion of a fetus of five months' growth

in an advanced stage of decomposition protruded from the vulva. After

the escape of this putrid mass her health returned, and in four months

she was again robust and healthy. Whinery speaks of a young woman who

at the time of her second child-birth observed a tumor in the abdomen

on her right side and felt motion in it. In about a month she was with

severe pain which continued a week and then ceased. Health soon

improved, and the woman afterward gave birth to a third child;

subsequently she noticed that the tumor had enlarged since the first

birth, and she had a recurrence of pain and a slight hemorrhage every

three weeks, and distinctly felt motion in the tumor. This continued

for eighteen months, when, after a most violent attack of pain, all

movement ceased, and, as she expressed it, she knew the moment the

child died. The tumor lost its natural consistence and felt flabby and

dead. An incision was made through the linea alba, and the knife came

in contact with a hard, gritty substance, three or four lines thick.

The escape of several quarts of dark brown fluid followed the incision,

and the operation had to be discontinued on account of the ensuing

syncope. About six weeks afterward a bone presented at the orifice,

which the woman extracted, and this was soon followed by a mass of

bones, hair, and putrid matter. The discharge was small, and gradually

grew less in quantity and offensiveness, soon ceasing altogether, and

the wound closed. By December health was good and the menses had

returned.

Ahlfeld, Ambrosioni, Galabin, Packard, Thiernesse, Maxson, de

Belamizaran, Dibot, and Chabert are among others recording the

phenomenon of coexisting extrauterine and intrauterine pregnancy.

Argles mentions simultaneous extrauterine fetation and superfetation.

Sanger mentions a triple ectopic gestation, in which there was twin

pregnancy in the wall of the uterus and a third ovum at the fimbriated

end of the right tube. Careful examination showed this to be a case of

intramural twin pregnancy at the point of entrance of the tube and the

uterus, while at the abdominal end of the same tube there was another

ovum,--the whole being an example of triple unilateral ectopic

gestation.

The instances of delivery of an extrauterine fetus, with viability of

the child, from the abdomen of the mother would attract attention from

their rarity alone, but when coupled with associations of additional

interest they surely deserve a place in a work of this nature. Osiander

speaks of an abdominal fetus being taken out alive, and there is a

similar case on record in the early part of this century. The London

Medical and Physical Journal, in one of its early numbers, contained an

account of an abdominal fetus penetrating the walls of the bladder and

being extracted from the walls of the hypogastrium; but Sennertus gives

a case which far eclipses this, both mother and fetus surviving. He

says that in this case the woman, while pregnant, received a blow on

the lower part of her body, in consequence of which a small tumor

appeared shortly after the accident. It so happened in this case that

the peritoneum was extremely dilatable, and the uterus, with the child

inside, made its way into the peritoneal sac. In his presence an

incision was made and the fetus taken out alive. Jessop gives an

example of extrauterine gestation in a woman of twenty-six, who had

previously had normal delivery. In this case an incision was made and a

fetus of about eight months' growth was found lying loose in the

abdominal cavity in the midst of the intestines. Both the mother and

child were saved. This is a very rare result. Campbell, in his

celebrated monograph, in a total of 51 operations had only seen

recorded the accounts of two children saved, and one of these was too

marvelous to believe. Lawson Tait reports a case in which he saved the

child, but lost the mother on the fourth day. Parvin describes a case

in which death occurred on the third day. Browne quotes Parry as saying

that there is one twin pregnancy in 23 extrauterine conceptions. He

gives 24 cases of twin conception, one of which was uterine, the other

extrauterine, and says that of 7 in the third month, with no operation,

the mother died in 5. Of 6 cases of from four and a half to seven

months' duration, 2 lived, and in 1 case at the fifth month there was

an intrauterine fetus delivered which lived. Of 11 such cases at nine

months, 6 mothers lived and 6 intrauterine fetuses lived. In 6 of these

cases no operation was performed. In one case the mother died, but both

the uterine and the extrauterine conceptions lived. In another the

mother and intrauterine fetus died, and the extrauterine fetus lived.

Wilson a gives an instance of a woman delivered of a healthy female

child at eight months which lived. The after-birth came away without

assistance, but the woman still presented every appearance of having

another child within her, although examination by the vagina revealed

none. Wilson called Chatard in consultation, and from the fetal

heart-sounds and other symptoms they decided that there was another

pregnancy wholly extrauterine. They allowed the case to go twenty-three

days, until pains similar to those of labor occurred, and then decided

on celiotomy. The operation was almost bloodless, and a living child

weighing eight pounds was extracted. Unfortunately, the mother

succumbed after ninety hours, and in a month the intrauterine child

died from inanition, but the child of extrauterine gestation thrived.

Sales gives the case of a negress of twenty-two, who said that she had

been "tricked by a negro," and had a large snake in the abdomen, and

could distinctly feel its movements. She stoutly denied any

intercourse. It was decided to open the abdominal cyst; the incision

was followed by a gush of blood and a placenta came into view, which

was extracted with a living child. To the astonishment of the operators

the uterus was distended, and it was decided to open it, when another

living child was seen and extracted. The cyst and the uterus were

cleansed of all clots and the wound closed. The mother died of

septicemia, but the children both lived and were doing well six weeks

after the operation. A curious case was seen in 1814 of a woman who at

her fifth gestation suffered abdominal uneasiness at the third month,

and this became intolerable at the ninth month. The head of the fetus

could be felt through the abdomen; an incision was made through the

parietes; a fully developed female child was delivered, but,

unfortunately, the mother died of septic infection.

The British Medical Journal quotes: "Pinard (Bull. de l'Acad. de Med.,

August 6, 1895) records the following, which he describes as an ideal

case. The patient was aged thirty-six, had had no illness, and had been

regular from the age of fourteen till July, 1894. During August of that

year she had nausea and vomiting; on the 22d and 23d she lost a fluid,

which was just pink. The symptoms continued during September, on the

22d and 23d of which month there was a similar loss. In October she was

kept in bed for two days by abdominal pain, which reappeared in

November, and was then associated with pain in micturition and

defecation. From that time till February 26, 1895, when she came under

Pinard's care, she was attended by several doctors, each of whom

adopted a different diagnosis and treatment. One of them, thinking she

had a fibroid, made her take in all about an ounce of savin powder,

which did not, however, produce any ill effect. When admitted she

looked ill and pinched. The left thigh and leg were painful and

edematous. The abdomen looked like that of the sixth month of

pregnancy. The abdominal wall was tense, smooth, and without lineae

albicantes. Palpation revealed a cystic immobile tumor, extending 2

inches above the umbilicus and apparently fixed by deep adhesions. The

fetal parts could only be made out with difficulty by deep palpation,

but the heart-sounds were easily heard to the right of and below the

umbilicus. By the right side of this tumor one could feel a small one,

the size of a Tangerine orange, which hardened and softened under

examination. When contracted the groove between it and the large tumor

became evident. Vaginal examination showed that the cervix, which was

slightly deflected forward and to the right and softened, as in uterine

gestation, was continuous with the smaller tumor. Cephalic

ballottement was obtained in the large tumor. No sound was passed into

the uterus for fear of setting up reflex action; the diagnosis of

extrauterine gestation at about six and a half months with a living

child was established without requiring to be clinched by proving the

uterus empty. The patient was kept absolutely at rest in bed and the

edema of the left leg cured by position. On April 30th the fundus of

the tumor was 35 cm. above the symphysis and the uterus 11 1/2 cm.; the

cervix was soft as that of a primipara at term. Operation, May 2d:

Uterus found empty, cavity 14 1/2 cm. long. Median incision in

abdominal wall; cyst walls exposed; seen to be very slight and filled

with enormous vessels, some greater than the little finger. On seizing

the wall one of these vessels burst, and the hemorrhage was only

rendered greater on attempting to secure it, so great was the

friability of the walls. The cyst was therefore rapidly opened and the

child extracted by the foot. Hemorrhage was restrained first by

pressure of the hands, then by pressure-forceps and ligatures. The

walls of the cyst were sewn to the margins of the abdominal wound, the

edge of the placenta being included in the suture. A wound was thus

formed 10 cm. in diameter, with the placenta for its base; it was

filled with iodoform and salicylic gauze. The operation lasted an hour,

and the child, a boy weighing 5 1/2 pounds, after a brief period of

respiratory difficulties, was perfectly vigorous. There was at first a

slight facial asymmetry and a depression on the left upper jaw caused

by the point of the left shoulder, against which it had been pressed in

the cyst; these soon disappeared, and on the nineteenth day the boy

weighed 12 pounds. The maternal wound was not dressed till May 13th,

when it was washed with biniodid, 1:4000. The placenta came away

piecemeal between May 25th and June 2d. The wound healed up, and the

patient got up on the forty-third day, having suckled her infant from

the first day after its birth."

Quite recently Werder has investigated the question of the ultimate

fate of ectopic children delivered alive. He has been able to obtain

the record of 40 cases. Of these, 18 died within a week after birth; 5

within a month; 1 died at six months of bronchopneumonia; 1 at seven

months of diarrhea; 2 at eleven months, 1 from croup; 1 at eighteen

months from cholera infantum--making a total of 26 deaths and leaving

14 children to be accounted for. Of these, 5 were reported as living

and well after operation, with no subsequent report; 1 was strong and

healthy after three weeks, but there has been no report since; 1 was

well at six months, then was lost sight of; 1 was well at the Last

report; 2 live and are well at one year; 2 are living and well at two

years; 1 (Beisone's case) is well at seven years; and 1 (Tait's case)

is well at fourteen and one-half years. The list given on pages 60 and

61 has been quoted by Hirst and Dorland. It contains data relative to

17 cases in which abdominal section has been successfully performed for

advanced ectopic gestation with living children.

Long Retention of Extrauterine Pregnancy.--The time of the retention of

an extrauterine gestation is sometimes remarkable, and it is no

uncommon occurrence for several pregnancies to successfully ensue

during such retention. The Ephemerides contains examples of

extrauterine pregnancy remaining in the abdomen forty-six years;

Hannaeus mentioned an instance remaining ten years, the mother being

pregnant in the meantime; Primperosius speaks of a similar instance; de

Blegny, one of twenty-five years in the abdomen; Birch, a case of

eighteen years in the abdomen, the woman bearing in the meantime;

Bayle, one of twenty-six years, and the Ephemerides, another. In a

woman of forty-six, the labor pains intervened without expulsion of the

fetus. Impregnation ensued twice afterward, each followed by the birth

of a living child. The woman lived to be ninety-four, and was persuaded

that the fetus was still in the abdomen, and directed a postmortem

examination to be made after her decease, which was done, and a large

cyst containing an ossified fetus was discovered in the left side of

the cavity. In 1716 a woman of Joigny when thirty years old, having

been married four years, became pregnant, and three months later felt

movements and found milk in her breasts. At the ninth month she had

labor-pains, but the fetus failed to present; the pains ceased, but

recurred in a month, still with a negative result. She fell into a most

sickly condition and remained so for eighteen months, when the pains

returned again, but soon ceased. Menstruation ceased and the milk in

her breasts remained for thirty years. She died at sixty-one of

peripneumonia, and on postmortem examination a tumor was found

occupying part of the hypogastric and umbilical regions. It weighed

eight pounds and consisted of a male fetus of full term with six teeth;

it had no odor and its sac contained no liquid. The bones seemed

better developed than ordinarily; the skin was thick, callous, and

yellowish The chorion, amnion, and placenta were ossified and the cord

dried up. Walther mentions the case of an infant which remained almost

petrified in the belly of its mother for twenty-three years. No trace

of the placenta, cord, or enveloping membrane could be found.

Cordier publishes a paper on ectopic gestation, with particular

reference to tubal pregnancy, and mentions that when there is rupture

between the broad ligaments hemorrhage is greatly limited by the

resistance of the surrounding structures, death rarely resulting from

the primary rupture in this location. Cordier gives an instance in

which he successfully removed a full-grown child, the result of an

ectopic gestation which had ruptured intraligamentally and had been

retained nearly two years.

Lospichlerus gives an account of a mother carrying twins, extrauterine,

for six years. Mounsey of Riga, physician to the army of the Czarina,

sent to the Royal Society in 1748 the bones of a fetus that had been

extracted from one of the fallopian tubes after a lodgment of thirteen

years. Starkey Middleton read the report of a case of a child which had

been taken out of the abdomen, having lain there nearly sixteen years,

during which time the mother had borne four children. It was argued at

this time that boys were conceived on the right side and girls on the

left, and in commenting on this Middleton remarks that in this case the

woman had three boys and one girl after the right fallopian tube had

lost its function. Chester cites the instance of a fetus being retained

fifty-two years, the mother not dying until her eightieth year.

Margaret Mathew carried a child weighing eight pounds in her abdomen

for twenty-six years, and which after death was extracted. Aubrey

speaks of a woman aged seventy years unconsciously carrying an

extrauterine fetus for many years, which was only discovered

postmortem. She had ceased to menstruate at forty and had borne a child

at twenty-seven. Watkins speaks of a fetus being retained forty-three

years; James, others for twenty-five, thirty, forty-six, and fifty

years; Murfee, fifty-five years; Cunningham, forty years; Johnson,

forty-four years; Josephi, fifteen years (in the urinary bladder);

Craddock, twenty-two years, and da Costa Simoes, twenty-six years.

Long Retention of Uterine Pregnancy.--Cases of long retained

intrauterine pregnancies are on record and deserve as much

consideration as those that were extrauterine. Albosius speaks of a

mother carrying a child in an ossified condition in the uterus for

twenty-eight years. Cheselden speaks of a case in which a child was

carried many years in the uterus, being converted into a clay-like

substance, but preserving form and outline. Caldwell mentions the case

of a woman who carried an ossified fetus in her uterus for sixty years.

Camerer describes the retention of a fetus in the uterus for forty-six

years; Stengel, one for ten years, and Storer and Buzzell, for

twenty-two months. Hannaeus, in 1686, issued a paper on such a case

under the title, "Mater, Infantis Mortui Vivum Sepulchrum," which may

be found in French translation.

Buchner speaks of a fetus being retained in the uterus for six years,

and Horstius relates a similar case. Schmidt's Jahrbucher contain the

report of a woman of forty-nine, who had borne two children. While

threshing corn she felt violent pain like that of labor, and after an

illness suffered a constant fetid discharge from the vagina for eleven

years, fetal bones being discharged with occasional pain. This poor

creature worked along for eleven years, at the end of which time she

was forced to bed, and died of symptoms of purulent peritonitis. At the

necropsy the uterus was found adherent to the anterior wall of the

abdomen and containing remnants of a putrid fetus with its numerous

bones. There is an instance recorded of the death of a fetus occurring

near term, its retention and subsequent discharge being through a

spontaneous opening in the abdominal wall one or two months after.

Meigs cites the case of a woman who dated her pregnancy from March,

1848, and which proceeded normally for nine months, but no labor

supervened at this time and the menses reappeared. In March, 1849, she

passed a few fetal bones by the rectum, and in May, 1855, she died. At

the necropsy the uterus was found to contain the remains of a fully

developed fetus, minus the portions discharged through a fistulous

connection between the uterine cavity and the rectum. In this case

there had been retention of a fully developed fetus for nine years. Cox

describes the case of a woman who was pregnant seven months, and who

was seized with convulsions; the supposed labor-pains passed off, and

after death the fetus was found in the womb, having lain there for five

years. She had an early return of the menses, and these recurred

regularly for four years. Dewees quotes two cases, in one of which the

child was carried twenty months in the uterus; in the other, the mother

was still living two years and five months after fecundation. Another

case was in a woman of sixty, who had conceived at twenty-six, and

whose fetus was found, partly ossified, in the uterus after death.

There are many narratives of the long continuation of fetal movements,

and during recent years, in the Southern States, there was quite a

prevalence of this kind of imposters. Many instances of the exhibition

of fetal movements in the bellies of old negro women have been noticed

by the lay journals, but investigation proves them to have been nothing

more than an exceptional control over the abdominal muscles, with the

ability to simulate at will the supposed fetal jerks. One old woman

went so far as to show the fetus dancing to the music of a banjo with

rhythmical movements. Such imposters flourished best in the regions

given to "voodooism." We can readily believe how easy the deception

might be when we recall the exact simulation of the fetal movements in

instances of pseudocyesis.

The extraordinary diversity of reports concerning the duration of

pregnancy has made this a much mooted question. Many opinions relative

to the longest and shortest period of pregnancy, associated with

viability of the issue, have been expressed by authors on medical

jurisprudence. There is perhaps no information more unsatisfactory or

uncertain. Mistakes are so easily made in the date of the occurrence of

pregnancy, or in the date of conception, that in the remarkable cases

we can hardly accept the propositions as worthy evidence unless

associated with other and more convincing facts, such as the appearance

and stage of development of the fetus, or circumstances making

conception impossible before or after the time mentioned, etc. It will

be our endeavor to cite the more seemingly reliable instances of the

anomalies of the time or duration of pregnancy reported in reputable

periodicals or books.

Short Pregnancies.--Hasenet speaks of the possibility of a living birth

at four months; Capuron relates the instance of Fortunio Liceti, who

was said to have been born at the end of four and a half months and

lived to complete his twenty-fourth year. In the case of the Marechal

de Richelieu, the Parliament of Paris decreed that an infant of five

months possessed that capability of living the ordinary period of

existence, i.e., the "viabilite," which the law of France requires for

the establishment of inheritance. In his seventh book Pliny gives

examples of men who were born out of time. Jonston gives instances of

births at five, six, seven, and eight months. Bonnar quotes 5 living

births before the one hundred and fiftieth day; 1 of one hundred and

twenty-five days; 1 of one hundred and twenty days; 1 of one hundred

and thirty-three days, surviving to twenty-one months; and 1 of one

hundred and thirty-five days' pregnancy surviving to eighty years.

Maisonneuve describes a case in which abortion took place at four and a

half months; he found the fetus in its membranes two hours after

delivery, and, on laying the membranes open, saw that it was living. He

applied warmth, and partly succeeded in restoring it; for a few minutes

respiratory movements were performed regularly, but it died in six

hours. Taylor quotes Carter concerning the case of a fetus of five

months which cried directly after it was born, and in the half hour it

lived it tried frequently to breathe. He also quotes Davies, mentioning

an instance of a fetus of five months, which lived twelve hours,

weighing 2 pounds, and measuring 12 inches, and which cried vigorously.

The pupillary membrane was entire, the testes had not descended, and

the head was well covered with hair. Usher speaks of a woman who in

1876 was delivered of 2 male children on the one hundred and

thirty-ninth day; both lived for an hour; the first weighed 10 ounces 6

drams and measured 9 3/4 inches; the other 10 ounces 7 drams, with the

same length as the first. Routh speaks of a Mrs. F----, aged

thirty-eight, who had borne 9 children and had had 3 miscarriages, the

last conception terminating as such. Her husband was away, and returned

October 9, 1869. She did not again see her husband until the 3d or 4th

of January. The date of quickening was not observed, and the child was

born June 8, 1870. During gestation she was much frightened by a rat.

The child was weak, the testes undescended, and it lived but eighteen

days, dying of symptoms of atrophy. The parents were poor, of excellent

character, and although, according to the evidence, this pregnancy

lasted but twenty-two weeks and two days, there was absolutely no

reason to suspect infidelity.

Ruttel speaks of a child of five months who lived twenty-four hours;

and he saw male twins born at the sixth month weighing 3 pounds each

who were alive and healthy a year after. Barker cites the case of a

female child born on the one hundred and fifty-eighth day that weighed

1 pound and was 11 inches long. It had rudimentary nails, very little

hair on the head, its eyelids were closed, and the skin much shriveled;

it did not suckle properly, and did not walk until nineteen months old.

Three and a half years after, the child was healthy and thriving, but

weighed only 29 1/2 pounds. At the time of birth it was wrapped up in a

box and placed before the fire. Brouzet speaks of living births of from

five to six months' pregnancy, and Kopp speaks of a six months' child

which lived four days. The Ephemerides contains accounts of living

premature births.

Newinton describes a pregnancy of five months terminating with the

birth of twins, one of whom lived twenty minutes and the other fifteen.

The first was 11 1/2 inches long, and weighed 1 pound 3 1/2 ounces, and

the other was 11 inches long, and weighed 1 pound. There is a recent

instance of premature birth following a pregnancy of between five and a

half and six months, the infant weighing 955 grams. One month after

birth, through the good offices of the wet-nurse and M. Villemin, who

attended the child and who invented a "couveuse" for the occasion, it

measured 38 cm. long.

Moore is accredited with the trustworthy report of the case of a woman

who bore a child at the end of the fifth month weighing 1 1/2 pounds

and measuring 9 inches. It was first nourished by dropping liquid food

into its mouth; and at the age of fifteen months it was healthy and

weighed 18 pounds. Eikam saw a case of abortion at the fifth month in

which the fetus was 6 inches in length and weighed about 8 ounces. The

head was sufficiently developed and the cranial bones considerably

advanced in ossification. He tied the cord and placed the fetus in warm

water. It drew up its feet and arms and turned its head from one side

to the other, opening its mouth and trying to breathe. It continued in

this wise for an hour, the action of the heart being visible ten

minutes after the movements ceased. From its imperfectly developed

genitals it was supposed to have been a female. Professor J. Muller, to

whom it was shown, said that it was not more than four months old, and

this coincided with the mother's calculation.

Villemin before the Societe Obstetricale et Gynecologique reported the

case of a two-year-old child, born in the sixth month of pregnancy.

That the child had not had six months of intrauterine life he could

vouch, the statement being borne out by the last menstrual period of

the mother, the date of the first fetal movements, the child's weight,

which was 30 1/2 ounces, and its appearance. Budin had had this infant

under observation from the beginning and corroborated Villemin's

statements. He had examined infants of six or seven months that had

cried and lived a few days, and had found the alveolar cavities filled

with epithelial cells, the lung sinking when placed in a vessel of

water. Charpentier reported a case of premature birth in his practice,

the child being not more than six and a half months and weighing 33 1/2

ounces. So sure was he that it would not live that he placed it in a

basin while he attended to the mother. After this had been done, the

child being still alive, he wrapped it in cotton and was surprised next

day to find it alive. It was then placed in a small, well-heated room

and fed with a spoon on human milk; on the twelfth day it could take

the breast, since which time it thrived and grew.

There is a case on record of a child viable at six months and twenty

days. The mother had a miscarriage at the beginning of 1877, after

which menstruation became regular, appearing last from July 3 to 9,

1877. On January 28, 1878, she gave birth to a male infant, which was

wrapped in wadding and kept at an artificial temperature. Being unable

to suckle, it was fed first on diluted cow's milk. It was so small at

birth that the father passed his ring over the foot almost to the knee.

On the thirteenth day it weighed 1250 grams, and at the end of a week

it was taking the breast. In December, 1879, it had 16 teeth, weighed

10 kilograms, walked with agility, could pronounce some words, and was

especially intelligent. Capuron relates an instance of a child born

after a pregnancy of six and a half months and in excellent health at

two years, and another living at ten years of the same age at birth.

Tait speaks of a living female child, born on the one hundred and

seventy-ninth day, with no nails on its fingers or toes, no hair, the

extremities imperfectly developed, and the skin florid and thin. It was

too feeble to grasp its mother's nipple, and was fed for three weeks by

milk from the breast through a quill. At forty days it weighed 3 pounds

and measured 13 inches. Before the expiration of three months it died

of measles. Dodd describes a case in which the catamenia were on the

24th of June, 1838, and continued a week; the woman bore twins on

January 11, 1839, one of which survived, the other dying a few minutes

after birth. She was never irregular, prompt to the hour, and this

fact, coupled with the diminutive size of the children, seemed to

verify the duration of the pregnancy. In 1825, Baber of Buxur, India,

spoke of a child born at six and a half months, who at the age of fifty

days weighed 1 pound and 13 ounces and was 14 inches long. The longest

circumference of the head was 10 inches and the shortest 9.1 inches.

The child suckled freely and readily. In Spaeth's clinic there was a

viable infant at six and a half months weighing 900 grams. Spaeth says

that he has known a child of six months to surpass in eventual

development its brothers born at full term.

In some cases there seems to be a peculiarity in women which manifests

itself by regular premature births. La Motte, van Swieten, and Fordere

mention females who always brought forth their conceptions at the

seventh month.

The incubator seems destined to be the future means of preserving these

premature births. Several successful cases have been noticed, and by

means of an incubator Tarnier succeeded in raising infants which at the

age of six months were above the average. A full description of the

incubator may be found. The modified Auvard incubator is easily made;

the accompanying illustrations (Figs. 5, 6, and 7) explain its

mechanism. Several improved incubators have been described in recent

years, but the Auvard appears to be the most satisfactory.

The question of retardation of labor, like that of premature birth, is

open to much discussion, and authorities differ as to the limit of

protraction with viability. Aulus Gellius says that, after a long

conversation with the physicians and wise men, the Emperor Adrian

decided in a case before him, that of a woman of chaste manners and

irreproachable character, the child born eleven months after her

husband's death was legitimate. Under the Roman law the Decenviri

established that a woman may bear a viable child at the tenth month of

pregnancy. Paulus Zacchias, physician to Pope Innocent X, declared that

birth may be retarded to the tenth month, and sometimes to a longer

period. A case was decided in the Supreme Court of Friesland, a

province in the northern part of the Netherlands, October, 1634, in

which a child born three hundred and thirty-three days after the death

of the husband was pronounced legitimate. The Parliament of Paris was

gallant enough to come to the rescue of a widow and save her reputation

by declaring that a child born after a fourteen months' gestation was

legitimate. Bartholinus speaks of an unmarried woman of Leipzig who was

delivered after a pregnancy of sixteen months. The civil code of France

provides that three hundred days shall constitute the longest period of

the legitimacy of an infant; the Scottish law, three hundred days; and

the Prussian law, three hundred and one days.

There are numerous cases recorded by the older writers. Amman has one

of twelve months' duration; Enguin, one of twelve months'; Buchner, a

case of twelve months'; Benedictus, one of fourteen months'; de Blegny,

one of nineteen months'; Marteau, Osiander, and others of forty-two and

forty-four weeks'; and Stark's Archives, one of forty-five weeks',

living, and also another case of forty-four weeks'. An incredible case

is recorded of an infant which lived after a three years' gestation.

Instances of twelve months' duration are also recorded. Jonston quotes

Paschal in relating an instance of birth after pregnancy of

twenty-three months; Aventium, one after two years; and Mercurialis, a

birth after a four years' gestation--which is, of course, beyond belief.

Thormeau writes from Tours, 1580, of a case of gestation prolonged to

the twenty-third month, and Santorini, at Venice, in 1721, describes a

similar case, the child reaching adult life. Elvert records a case of

late pregnancy, and Henschel one of forty-six weeks, but the fetus was

dead. Schneider cites an instance of three hundred and eight days'

duration. Campbell says that Simpson had cases of three hundred and

nineteen, three hundred and thirty-two, and three hundred and

thirty-six days'; Meigs had one of four hundred and twenty. James Reid,

in a table of 500 mature births, gives 14 as being from three hundred

and two to three hundred and fifteen days'.

Not so long ago a jury rendered a verdict of guilty of fornication and

bastardy when it was alleged that the child was born three hundred and

seventeen days after intercourse. Taylor relates a case of pregnancy in

which the wife of a laborer went to America three hundred and

twenty-two days before the birth. Jaffe describes an instance of the

prolongation of pregnancy for three hundred and sixty-five days, in

which the developments and measurements corresponded to the length of

protraction. Bryan speaks of a woman of twenty-five who became pregnant

on February 10, 1876, and on June 17th felt motion. On July 28th she

was threatened with miscarriage, and by his advice the woman weaned the

child at the breast. She expected to be confined the middle of

November, 1876, but the expected event did not occur until April 26,

1877, nine months after the quickening and four hundred and forty days

from the time of conception. The boy was active and weighed nine

pounds. The author cites Meigs' case, and also one of Atlee's, at three

hundred and fifty-six days.

Talcott, Superintendent of the State Homeopathic Asylum for the Insane,

explained the pregnancy of an inmate who had been confined for four

years in this institution as one of protracted labor. He said that many

such cases have been reported, and that something less than two years

before he had charge of a case in which the child was born. He made the

report to the New York Senate Commission on Asylums for the Insane as

one of three years' protraction. Tidd speaks of a woman who was

delivered of a male child at term, and again in ten months delivered of

a well-developed male child weighing 7 1/4 pounds; he relates the

history of another case, in Clifton, W. Va., of a woman expecting

confinement on June 1st going over to September 16th, the fetus being

in the uterus over twelve months, and nine months after quickening was

felt.

Two extraordinary cases are mentioned, one in a woman of thirty-five,

who expected to be confined April 24, 1883. In May she had a few

labor-pains that passed away, and during the next six months she

remained about as large as usual, and was several times thought to be

in the early stages of labor. In September the os dilated until the

first and second fingers could be passed directly to the head. This

condition lasted about a month, but passed away. At times during the

last nine months of pregnancy she was almost unable to endure the

movements of the child. Finally, on the morning of November 6th, after

a pregnancy of four hundred and seventy-six days, she was delivered of

a male child weighing 13 pounds. Both the mother and child did well

despite the use of chloroform and forceps. The other case was one

lasting sixteen months and twenty days.

In a rather loose argument, Carey reckons a case of three hundred and

fifty days. Menzie gives an instance in a woman aged twenty-eight, the

mother of one child, in whom a gestation was prolonged to the

seventeenth month. The pregnancy was complicated by carcinoma of the

uterus. Ballard describes the case of a girl of sixteen years and six

months, whose pregnancy, the result of a single intercourse, lasted

three hundred and sixty days. Her labor was short and easy for a

primipara, and the child was of the average size. Mackenzie cites the

instance of a woman aged thirty-two, a primipara, who had been married

ten years and who always had been regular in menstruation. The menses

ceased on April 28, 1888, and she felt the child for the first time in

September. She had false pains in January, 1889, and labor did not

begin until March 8th, lasting sixty-six hours. If all these statements

are correct, the probable duration of this pregnancy was eleven months

and ten days.

Lundie relates an example of protracted gestation of eleven months, in

which an anencephalous fetus was born; and Martin of Birmingham

describes a similar case of ten and a half months' duration.

Raux-Tripier has seen protraction to the thirteenth month. Enguin

reports an observation of an accouchement of twins after a pregnancy

that had been prolonged for eleven months. Resnikoff mentions a

pregnancy of eleven months' duration in an anemic secundipara. The case

had been under his observation from the beginning of pregnancy; the

patient would not submit to artificial termination at term, which he

advised. After a painful labor of twenty-four hours a macerated and

decomposed child was born, together with a closely-adherent placenta.

Tarnier reports an instance of partus serotinus in which the product of

conception was carried in the uterus forty days after term. The fetus

was macerated but not putrid, and the placenta had undergone fatty

degeneration. At a recent meeting of the Chicago Gynecological Society,

Dr. F. A. Stahl reported the case of a German-Bohemian woman in which

the fifth pregnancy terminated three hundred and two days after the

last menstruation. Twenty days before there had occurred pains similar

to those of labor, but they gradually ceased. The sacral promontory was

exaggerated, and the anteroposterior pelvic diameter of the inlet in

consequence diminished. The fetus was large and occupied the first

position. Version was with difficulty effected and the passage of the

after-coming head through the superior strait required expression and

traction, during which the child died. The mother suffered a deep

laceration of the perineum involving an inch of the wall of the rectum.

Among others reporting instances of protracted pregnancy are Collins,

eleven months; Desbrest, eighteen months; Henderson, fifteen months;

Jefferies, three hundred and fifty-eight days, and De la Vergne gives

the history of a woman who carried an infant in her womb for

twenty-nine months; this case may possibly belong under the head of

fetus long retained in the uterus.

Unconscious Pregnancy.--There are numerous instances of women who have

had experience in pregnancy unconsciously going almost to the moment of

delivery, yet experiencing none of the usual accompanying symptoms of

this condition. Crowell speaks of a woman of good social position who

had been married seven years, and who had made extensive preparations

for a long journey, when she was seized with a "bilious colic," and, to

her dismay and surprise, a child was born before the arrival of the

doctor summoned on account of her sudden colic and her inability to

retain her water. A peculiar feature of this case was the fact that

mental disturbance set in immediately afterward, and the mother became

morbid and had to be removed to an asylum, but recovered in a few

months. Tanner saw a woman of forty-two who had been suffering with

abdominal pains. She had been married three years and had never been

pregnant. Her catamenia were very scant, but this was attributed to her

change of life. She had conceived, had gone to the full term of

gestation, and was in labor ten hours without any suspicion of

pregnancy. She was successfully delivered of a girl, which occasioned

much rejoicing in the household.

Tasker of Kendall's Mills, Me., reports the case of a young married

woman calling him for bilious colic. He found the stomach slightly

distended and questioned her about the possibility of pregnancy. Both

she and her husband informed him that such could not be the case, as

her courses had been regular and her waist not enlarged, as she had

worn a certain corset all the time. There were no signs of quickening,

no change in the breasts, and, in fact, none of the usual signs of

pregnancy present. He gave her an opiate, and to her surprise, in about

six hours she was the mother of a boy weighing five pounds. Both the

mother and child made a good recovery. Duke cites the instance of a

woman who supposed that she was not pregnant up to the night of her

miscarriage. She had menstruated and was suckling a child sixteen

months old. During the night she was attacked with pains resembling

those of labor and a fetus slipped into the vagina without any

hemorrhage; the placenta came away directly afterward. In this peculiar

case the woman was menstruating regularly, suckling a child, and at the

same time was unconsciously pregnant.

Isham speaks of a case of unconscious pregnancy in which extremely

small twins were delivered at the eighth month. Fox cites an instance

of a woman who had borne eight children, and yet unconscious of

pregnancy. Merriman speaks of a woman forty years of age who had not

borne a child for nine years, but who suddenly gave birth to a stout,

healthy boy without being cognizant of pregnancy. Dayral tells of a

woman who carried a child all through pregnancy, unconscious of her

condition, and who was greatly surprised at its birth. Among the French

observers speaking of pregnancy remaining unrecognized by the mother

until the period of accouchement, Lozes and Rhades record peculiar

cases; and Mouronval relates an instance in which a woman who had borne

three children completely ignored the presence of pregnancy until the

pains of labor were felt. Fleishman and Munzenthaler also record

examples of unconscious pregnancy.

Pseudocyesis.--On the other hand, instances of pregnancy with imaginary

symptoms and preparations for birth are sometimes noticed, and many

cases are on record. In fact, nearly every text-book on obstetrics

gives some space to the subject of pseudocyesis. Suppression of the

menses, enlargement of the abdomen, engorgement of the breasts,

together with the symptoms produced by the imagination, such as nausea,

spasmodic contraction of the abdomen, etc., are for the most part the

origin of the cases of pseudocyesis. Of course, many of the cases are

not examples of true pseudocyesis, with its interesting phenomena, but

instances of malingering for mercenary or other purposes, and some are

calculated to deceive the most expert obstetricians by their tricks.

Weir Mitchell delineates an interesting case of pseudocyesis as

follows: "A woman, young, or else, it may be, at or past the

climacteric, eagerly desires a child or is horribly afraid of becoming

pregnant. The menses become slight in amount, irregular, and at last

cease or not. Meanwhile the abdomen and breasts enlarge, owing to a

rapid taking on of fat, and this is far less visible elsewhere. There

comes with this excess of fat the most profound conviction of the fact

of pregnancy. By and by the child is felt, the physician takes it for

granted, and this goes on until the great diagnostician, Time, corrects

the delusion. Then the fat disappears with remarkable speed, and the

reign of this singular simulation is at an end." In the same article,

Dr. Mitchell cites the two following cases under his personal

observation: "I was consulted by a lady in regard to a woman of thirty

years of age, a nurse in whom she was interested. This person had been

married some three years to a very old man possessed of a considerable

estate. He died, leaving his wife her legal share and the rest to

distant cousins, unless the wife had a child. For two months before he

died the woman, who was very anemic, ceased to menstruate. She became

sure that she was pregnant, and thereupon took on flesh at a rate and

in a way which seemed to justify her belief. Her breasts and abdomen

were the chief seats of this overgrowth. The menses did not return, her

pallor increased; the child was felt, and every preparation made for

delivery. At the eighth month a physician made an examination and

assured her of the absence of pregnancy. A second medical opinion

confirmed the first, and the tenth month found her of immense size and

still positive as to her condition. At the twelfth month her menstrual

flow returned, and she became sure it was the early sign of labor. When

it passed over she became convinced of her error, and at once dropped

weight at the rate of half a pound a day despite every effort to limit

the rate of this remarkable loss. At the end of two months she had

parted with fifty pounds and was, on the whole, less anemic. At this

stage I was consulted by letter, as the woman had become exceedingly

hysteric. This briefly stated case, which occurred many years ago, is a

fair illustration of my thesis.

"Another instance I saw when in general practice. A lady who had

several children and suffered much in her pregnancies passed five years

without becoming impregnated. Then she missed a period, and had, as

usual, vomiting. She made some wild efforts to end her supposed

pregnancy, and failing, acquiesced in her fate. The menses returned at

the ninth month and were presumed to mean labor. Meanwhile she vomited,

up to the eighth month, and ate little. Nevertheless, she took on fat

so as to make the abdomen and breasts immense and to excite unusual

attention. No physician examined her until the supposed labor began,

when, of course, the truth came out. She was pleased not to have

another child, and in her case, as in all the others known to me, the

fat lessened as soon as the mind was satisfied as to the non-existence

of pregnancy. As I now recall the facts, this woman was not more than

two months in getting rid of the excess of adipose tissue. Dr. Hirst

tells me he has met with cases of women taking on fat with cessation of

the menses, and in which there was also a steady belief in the

existence of pregnancy. He has not so followed up these cases as to

know if in them the fat fell away with speed when once the patient was

assured that no child existed within her."

Hirst, in an article on the difficulties in the diagnosis of pregnancy,

gives several excellent photographs showing the close resemblance

between several pathologic conditions and the normal distention of the

abdomen in pregnancy. A woman who had several children fell sick with a

chest-affection, followed by an edema. For fifteen months she was

confined to her bed, and had never had connection with her husband

during that time. Her menses ceased; her mammae became engorged and

discharged a serous lactescent fluid; her belly enlarged, and both she

and her physician felt fetal movements in her abdomen. As in her

previous pregnancies, she suffered nausea. Naturally, a suspicion as to

her virtue came into her husband's mind, but when he considered that

she had never left her bed for fifteen months he thought the pregnancy

impossible. Still the wife insisted that she was pregnant and was

confirmed in the belief by a midwife. The belly continued to increase,

and about eleven months after the cessation of the menses she had the

pains of labor. Three doctors and an accoucheur were present, and when

they claimed that the fetal head presented the husband gave up in

despair; but the supposed fetus was born shortly after, and proved to

be only a mass of hydatids, with not the sign of a true pregnancy.

Girard of Lyons speaks of a female who had been pregnant several times,

but again experienced the signs of pregnancy. Her mammae were engorged

with a lactescent fluid, and she felt belly-movements like those of a

child; but during all this time she had regular menstruation. Her

abdomen progressively increased in size, and between the tenth and

eleventh months she suffered what she thought to be labor-pains. These

false pains ceased upon taking a bath, and with the disappearance of

the other signs was dissipated the fallacious idea of pregnancy.

There is mentioned an instance of medicolegal interest of a young girl

who showed all the signs of pregnancy and confessed to her parents that

she had had commerce with a man. The parents immediately prosecuted the

seducer by strenuous legal methods, but when her ninth month came, and

after the use of six baths, all the signs of pregnancy vanished. Harvey

cites several instances of pseudocyesis, and says we must not rashly

determine of the the inordinate birth before the seventh or after the

eleventh month. In 1646 a woman, after having laughed heartily at the

jests of an ill-bred, covetous clown, was seized with various movements

and motions in her belly like those of a child, and these continued for

over a month, when the courses appeared again and the movements ceased.

The woman was certain that she was pregnant.

The most noteworthy historic case of pseudocyesis is that of Queen Mary

of England, or "Bloody Mary," as she was called. To insure the

succession of a Catholic heir, she was most desirous of having a son by

her consort, Philip, and she constantly prayed and wished for

pregnancy. Finally her menses stopped; the breasts began to enlarge

and became discolored around the nipples. She had morning-sickness of a

violent nature and her abdomen enlarged. On consultation with the

ladies of her court, her opinion of pregnancy was strongly confirmed.

Her favorite amusement then was to make baby-clothes and count on her

fingers the months of pregnancy. When the end of the ninth month

approached, the people were awakened one night by the joyous peals of

the bells of London announcing the new heir. An ambassador had been

sent to tell the Pope that Mary could feel the new life within her, and

the people rushed to St. Paul's Cathedral to listen to the venerable

Archbishop of Canterbury describe the baby-prince and give thanks for

his deliverance. The spurious labor pains passed away, and after being

assured that no real pregnancy existed in her case, Mary went into

violent hysterics, and Philip, disgusted with the whole affair,

deserted her; then commenced the persecution of the Protestants, which

blighted the reign.

Putnam cites the case of a healthy brunet, aged forty, the mother of

three children. She had abrupt vertical abdominal movements, so strong

as to cause her to plunge and sway from side to side. Her breasts were

enlarged, the areolae dark, and the uterus contained an elastic tumor,

heavy and rolling under the hand. Her abdomen progressively enlarged to

the regular size of matured gestation; but the extrauterine pregnancy,

which was supposed to have existed, was not seen at the autopsy,

nothing more than an enlarged liver being found. The movement was due

to spasmodic movements of the abdominal muscles, the causes being

unknown. Madden gives the history of a primipara of twenty-eight,

married one year, to whom he was called. On entering the room he was

greeted by the midwife, who said she expected the child about 8 P.M.

The woman was lying in the usual obstetric position, on the left side,

groaning, crying loudly, and pulling hard at a strap fastened to the

bed-post. She had a partial cessation of menses, and had complained of

tumultuous movements of the child and overflow of milk from the

breasts. Examination showed the cervix low down, the os small and

circular, and no signs of pregnancy in the uterus. The abdomen was

distended with tympanites and the rectum much dilated with accumulated

feces. Dr. Madden left her, telling her that she was not pregnant, and

when she reappeared at his office in a few days, he reassured her of

the nonexistence of pregnancy; she became very indignant, triumphantly

squeezed lactescent fluid from her breasts, and, insisting that she

could feel fetal movements, left to seek a more sympathetic accoucheur.

Underhill, in the words of Hamilton, describes a woman as "having

acquired the most accurate description of the breeding symptoms, and

with wonderful facility imagined that she had felt every one of them."

He found the woman on a bed complaining of great labor-pains, biting a

handkerchief, and pulling on a cloth attached to her bed. The finger on

the abdomen or vulva elicited symptoms of great sensitiveness. He told

her she was not pregnant, and the next day she was sitting up, though

the discharge continued, but the simulated throes of labor, which she

had so graphically pictured, had ceased.

Haultain gives three examples of pseudocyesis, the first with no

apparent cause, the second due to carcinoma of the uterus, while in the

third there was a small fibroid in the anterior wall of the uterus.

Some cases are of purely nervous origin, associated with a purely

muscular distention of the abdomen. Clay reported a case due to

ascites. Cases of pseudocyesis in women convicted of murder are not

uncommon, though most of them are imposters hoping for an extra lease

of life.

Croon speaks of a child seven years old on whom he performed ovariotomy

for a round-celled sarcoma. She had been well up to May, but since then

she had several times been raped by a boy, in consequence of which she

had constant uterine hemorrhage. Shortly after the first coitus her

abdomen began to enlarge, the breasts to develop, and the areolae to

darken. In seven months the abdomen presented the signs of pregnancy,

but the cervix was soft and patulous; the sound entered three inches

and was followed by some hemorrhage. The child was well developed, the

mons was covered with hair, and all the associate symptoms tended to

increase the deception.

Sympathetic Male Nausea of Pregnancy.--Associated with pregnancy there

are often present morning-nausea and vomiting as prominent and reliable

symptoms. Vomiting is often so excessive as to be provocative of most

serious issue and even warranting the induction of abortion. This fact

is well known and has been thoroughly discussed, but with it is

associated an interesting point, the occasional association of the same

symptoms sympathetically in the husband. The belief has long been a

superstition in parts of Great Britain, descending to America, and even

exists at the present day. Sir Francis Bacon has written on this

subject, the substance of his argument being that certain loving

husbands so sympathize with their pregnant wives that they suffer

morning-sickness in their own person. No less an authority than S. Weir

Mitchell called attention to the interesting subject of sympathetic

vomiting in the husband in his lectures on nervous maladies some years

ago. He also quotes the following case associated with pseudocyesis:--

"A woman had given birth to two female children. Some years passed and

her desire for a boy was ungratified. Then she missed her flow once,

and had thrice after this, as always took place with her when pregnant,

a very small but regular loss. At the second month morning-vomiting

came on as usual with her. Meanwhile she became very fat, and as the

growth was largely, in fact excessively, abdominal, she became easily

sure of her condition. She was not my patient, but her husband

consulted me as to his own morning-sickness, which came on with the

first occurrence of this sign in his wife, as had been the case twice

before in her former pregnancies. I advised him to leave home, and this

proved effectual. I learned later that the woman continued to gain

flesh and be sick every morning until the seventh month. Then

menstruation returned, an examination was made, and when sure that

there was no possibility of her being pregnant she began to lose flesh,

and within a few months regained her usual size."

Hamill reports an instance of morning-sickness in a husband two weeks

after the appearance of menstruation in the wife for the last time. He

had daily attacks, and it was not until the failure of the next menses

that the woman had any other sign of pregnancy than her husband's

nausea. His nausea continued for two months, and was the same as that

which he had suffered during his wife's former pregnancies, although

not until both he and his wife became aware of the existence of

pregnancy. The Lancet describes a case in which the husband's nausea

and vomiting, as well as that of the wife, began and ended

simultaneously. Judkins cites an instance of a man who was sick in the

morning while his wife was carrying a child. This occurred during every

pregnancy, and the man related that his own father was similarly

affected while his mother was in the early months of pregnancy with

him, showing an hereditary predisposition.

The perverted appetites and peculiar longings of pregnant women furnish

curious matter for discussion. From the earliest times there are many

such records. Borellus cites an instance, and there are many others, of

pregnant women eating excrement with apparent relish. Tulpius, Sennert,

Langius, van Swieten, a Castro, and several others report depraved

appetites. Several writers have seen avidity for human flesh in such

females. Fournier knew a woman with an appetite for the blood of her

husband. She gently cut him while he lay asleep by her side and sucked

blood from the wounds--a modern "Succubus." Pare mentions the perverted

appetites of pregnant women, and says that they have been known to eat

plaster, ashes, dirt, charcoal, flour, salt, spices, to drink pure

vinegar, and to indulge in all forms of debauchery. Plot gives the case

of a woman who would gnaw and eat all the linen off her bed. Hufeland's

Journal records the history of a case of a woman of thirty-two, who had

been married ten years, who acquired a strong taste for charcoal, and

was ravenous for it. It seemed to cheer her and to cure a supposed

dyspepsia. She devoured enormous quantities, preferring hard-wood

charcoal. Bruyesinus speaks of a woman who had a most perverted

appetite for her own milk, and constantly drained her breasts;

Krafft-Ebing cites a similar case. Another case is that of a pregnant

woman who had a desire for hot and pungent articles of food, and who in

a short time devoured a pound of pepper. Scheidemantel cites a case in

which the perverted appetite, originating in pregnancy, became

permanent, but this is not the experience of most observers. The

pregnant wife of a farmer in Hassfort-on-the-Main ate the excrement of

her husband.

Many instances could be quoted, some in which extreme cases of

polydipsia and bulimia developed; these can be readily attributed to

the increased call for liquids and food. Other cases of diverse new

emotions can be recalled, such as lasciviousness, dirty habits,

perverted thoughts, and, on the other hand, extreme piety, chastity,

and purity of the mind. Some of the best-natured women are when

pregnant extremely cross and irritable and many perversions of

disposition are commonly noticed in pregnancy. There is often a

longing for a particular kind of food or dish for which no noticeable

desire had been displayed before.

Maternal Impressions.--Another curious fact associated with pregnancy

is the apparent influence of the emotions of the mother on the child in

utero. Every one knows of the popular explanation of many birth-marks,

their supposed resemblance to some animal or object seen by the mother

during pregnancy, etc. The truth of maternal impressions, however,

seems to be more firmly established by facts of a substantial nature.

There is a natural desire to explain any abnormality or anomaly of the

child as due to some incident during the period of the mother's

pregnancy, and the truth is often distorted and the imagination heavily

drawn upon to furnish the satisfactory explanation. It is the customary

speech of the dime-museum lecturer to attribute the existence of some

"freak" to an episode in the mother's pregnancy. The poor

"Elephant-man" firmly believed his peculiarity was due to the fact that

his mother while carrying him in utero was knocked down at the circus

by an elephant. In some countries the exhibition of monstrosities is

forbidden because of the supposed danger of maternal impression. The

celebrated "Siamese Twins" for this reason were forbidden to exhibit

themselves for quite a period in France.

We shall cite only a few of the most interesting cases from medical

literature. Hippocrates saved the honor of a princess, accused of

adultery with a negro because she bore a black child, by citing it as a

case of maternal impression, the husband of the princess having placed

in her room a painting of a negro, to the view of which she was

subjected during the whole of her pregnancy. Then, again, in the

treatise "De Superfoetatione" there occurs the following distinct

statement: "If a pregnant woman has a longing to eat earth or coals,

and eats of them, the infant which is born carries on its head the mark

of these things." This statement, however, occurs in a work which is

not mentioned by any of the ancient authorities, and is rejected by

practically all the modern ones; according to Ballantyne, there is,

therefore, no absolute proof that Hippocrates was a believer in one of

the most popular and long-persisting beliefs concerning fetal

deformities.

In the explanation of heredity, Hippocrates states "that the body of

the male as well as that of the female furnishes the semen. That which

is weak (unhealthy) is derived from weak (unhealthy) parts, that which

is strong (healthy) from strong (healthy) parts, and the fetus will

correspond to the quality of the semen. If the semen of one part come

in greater quantity from the male than from the female, this part will

resemble more closely the father; if, however, it comes more from the

female, the part will rather resemble the mother. If it be true that

the semen comes from both parents, then it is impossible for the whole

body to resemble either the mother or the father, or neither the one

nor the other in anything, but necessarily the child will resemble both

the one and the other in something. The child will most resemble the

one who contributes most to the formation of the parts." Such was the

Hippocratic theory of generation and heredity, and it was ingeniously

used to explain the hereditary nature of certain diseases and

malformations. For instance, in speaking of the sacred disease

(epilepsy), Hippocrates says: "Its origin is hereditary, like that of

other diseases; for if a phlegmatic person be born of a phlegmatic, and

a bilious of a bilious, and a phthisical of a phthisical, and one

having spleen disease of another having disease of the spleen, what is

to hinder it from happening that where the father and mother were

subject to this disease certain of their offspring should be so

affected also? As the semen comes from all parts of the body, healthy

particles will come from healthy parts, and unhealthy from unhealthy

parts."

According to Pare, Damascene saw a girl with long hair like a bear,

whose mother had constantly before her a picture of the hairy St. John.

Pare also appends an illustration showing the supposed resemblance to a

bear. Jonston quotes a case of Heliodorus; it was an Ethiopian, who by

the effect of the imagination produced a white child. Pare describes

this case more fully: "Heliodorus says that Persina, Queen of Ethiopia,

being impregnated by Hydustes, also an Ethiopian, bore a daughter with

a white skin, and the anomaly was ascribed to the admiration that a

picture of Andromeda excited in Persina throughout the whole of the

pregnancy." Van Helmont cites the case of a tailor's wife at Mechlin,

who during a conflict outside her house, on seeing a soldier lose his

hand at her door, gave birth to a daughter with one hand, the other

hand being a bleeding stump; he also speaks of the case of the wife of

a merchant at Antwerp, who after seeing a soldier's arm shot off at the

siege of Ostend gave birth to a daughter with one arm. Plot speaks of a

child bearing the figure of a mouse; when pregnant, the mother had been

much frightened by one of these animals. Gassendus describes a fetus

with the traces of a wound in the same location as one received by the

mother. The Lancet speaks of several cases--one of a child with a face

resembling a dog whose mother had been bitten; one of a child with one

eye blue and the other black, whose mother during confinement had seen

a person so marked; of an infant with fins as upper and lower

extremities, the mother having seen such a monster; and another, a

child born with its feet covered with scalds and burns, whose mother

had been badly frightened by fireworks and a descending rocket. There

is the history of a woman who while pregnant at seven months with her

fifth child was bitten on the right calf by a dog. Ten weeks after, she

bore a child with three marks corresponding in size and appearance to

those caused by the dog's teeth on her leg. Kerr reports the case of a

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.