CHAPTER III.

OBSTETRIC ANOMALIES.

General Considerations.--In discussing obstetric anomalies we shall

first consider those strange instances in which stages of parturition

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

Some women are anatomically constituted in a manner favorable to

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

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

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

of tight lacing.

It seems strange that a physiologic process like parturition should be

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

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

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

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

some means preventing union subsequently, in order that these might

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

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

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

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

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

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

bone spontaneously repairs itself so quickly and easily. Rodet and

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

of accouchement among the primitive peoples, substantiate the fear,

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

grades of society.

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

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

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

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

painless births. The Ephemerides records a birth as having occurred

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

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

and others describe cases occurring during the coma attending

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

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

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

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

the menstrual influence accounted for it. After some months epilepsy

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

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

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

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

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

something of a shining, bluish appearance protruding through the

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

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

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

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

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

from whence it was delivered, presenting by the foot.

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

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

anesthesia in the preanesthetic days.

The feasibility of practising hypnotism in child-birth has been

discussed, and Fanton reports 12 cases of parturition under the

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

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

facilitate the state of hypnosis it should be commenced before strong

uterine contractions have occurred.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

usual labor-pains.

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

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

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

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

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

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

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

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

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

second stage during sleep.

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

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

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

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

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

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

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

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

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

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

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

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

hemorrhage and made a complete recovery. She had apparently slept

soundly through the uterine contractions until the final strong pain,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

condition on the third day bore a living male child.

Berthier in 1859 observed a case of melancholia with delirium which

continued through pregnancy. The woman was apparently unconscious of

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

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

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

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

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

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

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

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

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

Mattei, Murray, Lemoine, and Moglichkeit.

Rapid Parturition Without Usual Symptoms.--Births unattended by

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

unruptured.

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

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

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

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

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

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

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

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

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

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

the infants."

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

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

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

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

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

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

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

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

arose without awakening anyone, and took the recently delivered child

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

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

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

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

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

trial at the next sessions at Darby.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

criminal investigation in Germany.

During the funeral procession of Marshal MacMahon in Paris an enormous

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

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

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

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

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

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

apparently experiencing little embarrassment. Quoted by Taylor,

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

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

back.

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

frequently charged by her mistress with pregnancy but persistently

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

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

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

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

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

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

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

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

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

child.

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

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

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

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

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

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

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

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

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

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

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

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

until she actually felt the child between her thighs.

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

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

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

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

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

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

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

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

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

experienced a slight discomfort, and was under the impression that

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

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

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

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

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

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

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

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

across.

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

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

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

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

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

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

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

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

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

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

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

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

transversely four inches from the umbilicus. Both mother and child

progressed favorably. Doubtless the intense cold had so contracted the

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

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

killed in the fall.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

a parallel case on record.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

recoveries. Thebault reports an instance of delivery in the erect

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

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

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

track afterward.

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

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

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

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

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

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

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

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

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

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

drowned had not assistance been close at hand.

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

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

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

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

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

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

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

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

anesthetized the patient and delivered the child with forceps, and

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

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

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

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

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

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

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

always menstruated easily. Coitus always seemed satisfactory, and no

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

to her, of her abnormality.

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

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

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

seven days after the accouchement the woman had completely regained her

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

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

She had permitted rectal copulation and had become impregnated in this

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

pamphlet entitled "De partium externarum generationi inservientium in

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

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

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

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

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

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

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

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

Andrews give instances of parturition through the anus. Morisani

describes a case of extrauterine pregnancy with tubal rupture and

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

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

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

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

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

attempted manually to remove the offending substances from the rectum,

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

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

The rectal opening gradually cicatrized, the sac became obliterated,

and the woman left the hospital well.

Birth Through Perineal Perforation.--Occasionally there is perineal

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

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

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

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

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

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

Lebrun all report accouchement through a perineal perforation, without

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

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

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

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

birth of children through perineal perforations.

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

instance in which the abdominal walls gave way from the pressure

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

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

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

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

spontaneously. Farquharson and Ill both mention rupture of the

abdominal parietes during labor.

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

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

all the appearance of a birth by the anus.

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

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

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

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

being thrown forward into the abdomen and afterward extracted from an

umbilical abscess.

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

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

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

their membranes half an hour. Wrisberg cites three observations of

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

expelled enveloped in its membranes entire and unruptured. The

membranes were opaque and preternaturally thickened, and were opened

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

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

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

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

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

which was born enveloped in its secundines.

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

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

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

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

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

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

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

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

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

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

eventually died of bronchitis.

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

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

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

with unruptured membrane. Slusser describes the delivery of a

full-grown fetus without rupture of the membrane.

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

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

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

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

speaks of it, and Rudolph discusses its occurrence exhaustively and

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

labor without apparent liquor amnii, delivery being effected by the

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

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

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

subserous fibroids and a contracted pelvis, combined with a posterior

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

case of labor without liquor amnii; and Townsend records delivery

without any sanguineous discharge. Cosentino mentions a case of the

absence of liquor amnii associated with a fetal monstrosity.

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

cases in which the delivery is effected spontaneously after the death

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

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

was performed after death and the child successfully delivered.

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

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

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

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

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

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

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

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

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

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

resuscitate the patient by artificial respiration, but failed in her

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

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

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

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

pounds.

Considerable attention has been directed to the advisability of

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

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

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

death agonies of the mother. Devilliers considers this question from

both the obstetric and medicolegal points of view. Hyneaux mentions

forcible accouchement practised on both the dead and the dying.

Rogowicz advocates artificial delivery by the natural channel in place

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

discussed this question at length at the International Medico-Legal

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

this country.

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

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

artificial means. Artificial respiration was successfully practised on

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

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

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

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

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

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

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

extensive statistics on all varieties of postmortem deliveries,

collecting 44 cases of spontaneous expulsion of the fetus after death

of the mother.

Aveling states that in 1820 the Council of Cologne sanctioned the

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

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

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

section immediately after death.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ad funus elatum, quam natum fuisse."

Other cases of postmortem delivery are less successful, the delivery

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

advanced in putrefaction, from which was expelled an unbroken ovum

containing twins. Even the placenta showed signs of decomposition.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

unattached from the mother.

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

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

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

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

following March she had hemoptysis, and serious symptoms of

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

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

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

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

the family occasionally visiting her to sprinkle holy water on her

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

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

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

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

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

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

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

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

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

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

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

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

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

afterward.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

and others in the solution of these strange cases.

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

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

unbelievable stories have been constructed from these reported

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

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

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

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

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

"Mirandum foetus nlaterna clausus in alvo Dicitur insuetos ore dedisse

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

cernere moliis opus. Aut quia quaerendi studio vis fessa parentum

Aucupii aptas innuit esse manus."

The Ephemerides gives examples of the child hiccoughing in the uterus.

Cases of crying before delivery, some in the vagina, some just before

the complete expulsion of the head from the os uteri, are very numerous

in the older writers; and it is quite possible that on auscultation of

the pregnant abdomen fetal sounds may have been exaggerated into cries.

Bartholinus, Borellus, Boyle, Buchner, Paullini, Mezger, Riolanus,

Lentillus, Marcellus Donatus, and Wolff all speak of children crying

before delivery; and Mazinus relates the instance of a puppy whose

feeble cries could be heard before expulsion from the bitch. Osiander

fully discusses the subject of infants crying during parturition.

McLean describes a case in which he positively states that a child

cried lustily in utero during application of the forceps. He compared

the sound as though from a voice in the cellar. This child was in the

uterus, not in the vagina, and continued the crying during the whole of

the five minutes occupied by delivery.

Cesarean Section.--Although the legendary history of Cesarean section

is quite copious, it is very seldom that we find authentic records in

the writings of the older medical observers. The works of Hippocrates,

Aretxeus, Galen, Celsus, and Aetius contain nothing relative to records

of successful Cesarean sections. However, Pliny says that Scipio

Africanus was the first and Manlius the second of the Romans who owed

their lives to the operation of Cesarean section; in his seventh book

he says that Julius Caesar was born in this way, the fact giving origin

to his name. Others deny this and say that his name came from the thick

head of hair which he possessed. It is a frequent subject in old Roman

sculpture, and there are many delineations of the birth of Bacchus by

Cesarean section from the corpse of Semele. Greek mythology tells us of

the birth of Bacchus in the following manner: After Zeus burnt the

house of Semele, daughter of Cadmus, he sent Hermes in great haste with

directions to take from the burnt body of the mother the fruit of seven

months. This child, as we know, was Bacchus. Aesculapius, according to

the legend of the Romans, had been excised from the belly of his dead

mother, Corinis, who was already on the funeral pile, by his

benefactor, Apollo; and from this legend all products of Cesarean

sections were regarded as sacred to Apollo, and were thought to have

been endowed with sagacity and bravery.

Old records tell us that one of the kings of Navarre was delivered in

this way, and we also have records of the birth of the celebrated Doge,

Andreas Doria, by this method. Jane Seymour was supposed to have been

delivered of Edward VI by Cesarean section, the father, after the

consultation of the physicians was announced to him, replying: "Save

the child by all means, for I shall be able to get mothers enough."

Robert II of Scotland was supposed to have been delivered in this way

after the death of his mother, Margery Bruce, who was killed by being

thrown from a horse. Shakespere's immortal citation of Macduff, "who

was from his mother's womb untimely ripped," must have been such a

case, possibly crudely done, perchance by cattle-horn. Pope Gregory XIV

was said to have been taken from his mother's belly after her death.

The Philosophical Transactions, in the last century contain accounts of

Cesarean section performed by an ignorant butcher and also by a

midwife; and there are many records of the celebrated case performed by

Jacob Nufer, a cattle gelder, at the beginning of the sixteenth century.

By the advent of antisepsis and the improvements of Porro and others,

Cesarean section has come to be a quite frequent event, and a record of

the successful cases would hardly be considered a matter of

extraordinary interest, and would be out of the province of this work,

but a citation of anomalous cases will be given. Baldwin reports a case

of Cesarean section on a typical rachitic dwarf of twenty-four, who

weighed 100 pounds and was only 47 1/2 inches tall. It was the ninth

American case, according to the calculation of Harris, only the third

successful one, and the first successful one in Ohio. The woman had a

uniformly contracted pelvis whose anteroposterior diameter was about 1

1/4 inches. The hygienic surroundings for the operation were not of the

best, as the woman lived in a cellar. Tait's method of performing the

operation was determined upon and successfully performed. Convalescence

was prompt, and in three weeks the case was dismissed. The child was a

female of 7 1/2 pounds which inherited the deformities of its mother.

It thrived for nine and a half months, when it died of angina Ludovici.

Figure 15 represents the mother and child.

Harris gives an account of an operation upon a rachitic dwarf who was

impregnated by a large man, a baby weighing 14 pounds and measuring 20

inches being delivered by the knife. St. Braun gives the account of a

Porro-Cesarean operation in the case of a rachitic dwarf 3 feet 10

inches tall, in which both the mother and child recovered. Munde speaks

of twins being delivered by Cesarean section. Franklin gives the

instance of a woman delivered at full term of a living child by this

means, in whom was also found a dead fetus. It lay behind the stump of

the amputated cervix, in the culdesac of Douglas. The patient died of

hemorrhage.

Croston reports a case of Cesarean section on a primipara of

twenty-four at full term, with the delivery of a double female monster

weighing 12 1/2 pounds. This monster consisted of two females of about

the same size, united from the sternal notch to the navel, having one

cord and one placenta. It was stillborn. The diagnosis was made before

operation by vaginal examination. In a communication to Croston,

Harris remarked that this was the first successful Cesarean section for

double monstrous conception in America, and added that in 1881 Collins

and Leidy performed the same operation without success.

Instances of repeated Cesarean section were quite numerous, and the

pride of the operators noteworthy, before the uterus was removed at the

first operation, as is now generally done. Bacque reports two sections

in the same woman, and Bertrandi speaks of a case in which the

operation was successfully executed many times in the same woman.

Rosenberg reports three cases repeated successfully by Leopold of

Dresden. Skutsch reports a case in which it was twice performed on a

woman with a rachitic pelvis, and who the second time was pregnant with

twins; the children and mother recovered. Zweifel cites an instance in

which two Cesarean sections were performed on a patient, both of the

children delivered being in vigorous health. Stolz relates a similar

case. Beck gives an account of a Cesarean operation twice on the same

woman; in the first the child perished, but in the second it survived.

Merinar cites an instance of a woman thrice opened. Parravini gives a

similar instance. Charlton gives an account of the performance carried

out successfully four times in the same woman; Chisholm mentions a case

in which it was twice performed. Michaelis of Kiel gives an instance

in which he performed the same operation on a woman four times, with

successful issues to both mother and children, despite the presence of

peritonitis the last time. He had operated in 1826, 1830, 1832, and

1836. Coe and Gueniot both mention cases in which Cesarean section had

been twice performed with successful terminations as regards both

mothers and children. Rosenberg tabulates a number of similar cases

from medical literature.

Cases of Cesarean section by the patient herself are most curious, but

may be readily believed if there is any truth in the reports of the

operation being done in savage tribes. Felkin gives an account of a

successful case performed in his presence, with preservation of the

lives of both mother and child, by a native African in Kahura, Uganda

Country. The young girl was operated on in the crudest manner, the

hemorrhage being checked by a hot iron. The sutures were made by means

of seven thin, hot iron spikes, resembling acupressure-needles, closing

the peritoneum and skin. The wound healed in eleven days, and the

mother made a complete recovery. Thomas Cowley describes the case of a

negro woman who, being unable to bear the pains of labor any longer,

took a sharp knife and made a deep incision in her belly--deep enough

to wound the buttocks of her child, and extracted the child, placenta

and all. A negro horse-doctor was called, who sewed the wound up in a

manner similar to the way dead bodies are closed at the present time.

Barker gives the instance of a woman who, on being abused by her

husband after a previous tedious labor, resolved to free herself of the

child, and slyly made an incision five inches long on the left side of

the abdomen with a weaver's knife. When Barker arrived the patient was

literally drenched with blood and to all appearance dead. He extracted

a dead child from the abdomen and bandaged the mother, who lived only

forty hours. In his discourses on Tropical Diseases Moseley speaks of a

young negress in Jamaica who opened her uterus and extracted therefrom

a child which lived six days; the woman recovered. Barker relates

another case in Rensselaer County, N.Y., in which the incision was made

with the razor, the woman likewise recovering. There is an interesting

account of a poor woman at Prischtina, near the Servian frontier, who,

suffering greatly from the pains of labor, resolved to open her abdomen

and uterus. She summoned a neighbor to sew up the incision after she

had extracted the child, and at the time of report, several months

later, both the mother and child were doing well.

Madigan cites the case of a woman of thirty-four, in her seventh

confinement, who, while temporarily insane, laid open her abdomen with

a razor, incised the uterus, and brought out a male child. The

abdominal wound was five inches long, and extended from one inch above

the umbilicus straight downward. There was little or no bleeding and

the uterus was firmly contracted. She did not see a physician for three

hours. The child was found dead and, with the placenta, was lying by

her side. The neighbors were so frightened by the awful sight that they

ran away, or possibly the child might have been saved by ligature of

the funis. Not until the arrival of the clergyman was anything done,

and death ultimately ensued.

A most wonderful case of endurance of pain and heroism was one

occurring in Italy, which attracted much European comment at the time.

A young woman, illegitimately pregnant, at full term, on March 28th, at

dawn, opened her own abdomen on the left side with a common knife such

as is generally used in kitchens. The wound measured five inches, and

was directed obliquely outward and downward. She opened the uterus in

the same direction, and endeavored to extract the fetus. To expedite

the extraction, she drew out an arm and amputated it, and finding the

extraction still difficult, she cut off the head and completely emptied

the womb, including the placenta. She bound a tight bandage around her

body and hid the fetus in a straw mattress. She then dressed herself

and attended to her domestic duties. She afterward mounted a cart and

went into the city of Viterbo, where she showed her sister a cloth

bathed in blood as menstrual proof that she was not pregnant. On

returning home, having walked five hours, she was seized with an attack

of vomiting and fainted. The parents called Drs. Serpieri and Baliva,

who relate the case. Thirteen hours had elapsed from the infliction of

the wound, through which the bulk of the intestines had been protruding

for the past six hours. The abdomen was irrigated, the toilet made, and

after the eighteenth day the process of healing was well progressed,

and the woman made a recovery after her plucky efforts to hide her

shame.

Cases like the foregoing excite no more interest than those on record

in which an abdominal section has been accidental, as, for instance, by

cattle-horns, and the fetus born through the wound. Zuboldie speaks of

a case in which a fetus was born from the wound made by a bull's horn

in the mother's abdomen. Deneux describes a case in which the wound

made by the horn was not sufficiently large to permit the child's

escape, but it was subsequently brought through the opening. Pigne

speaks of a woman of thirty-eight, who in the eighth month of her sixth

pregnancy was gored by a bull, the horn effecting a transverse wound 27

inches long, running from one anterior spine to the other. The woman

was found cold and insensible and with an imperceptible pulse. The

small intestines were lying between the thighs and covered with

coagulated blood. In the process of cleansing, a male child was

expelled spontaneously through a rent in the uterus. The woman was

treated with the usual precautions and was conscious at midday. In a

month she was up. She lived twenty years without any inconvenience

except that due to a slight hernia on the left side. The child died at

the end of a fortnight.

In a very exhaustive article Harris of Philadelphia has collected

nearly all the remaining cases on record, and brief extracts from some

of them will be given below. In Zaandam, Holland, 1647, a farmer's wife

was tossed by a furious bull. Her abdomen was ripped open, and the

child and membranes escaped. The child suffered no injuries except a

bruised upper lip and lived nine months. The mother died within forty

hours of her injuries. Figure 19 taken from an engraving dated 1647,

represents an accouchement by a mad bull, possibly the same case. In

Dillenberg, Germany, in 1779, a multipara was gored by an ox at her

sixth month of pregnancy; the horn entered the right epigastric region,

three inches from the linea alba, and perforated the uterus. The right

arm of the fetus protruded; the wound was enlarged and the fetus and

placenta delivered. Thatcher speaks of a woman who was gored by a cow

in King's Park, and both mother and child were safely delivered and

survived.

In the Parish of Zecoytia, Spain, in 1785, Marie Gratien was gored by

an ox in the superior portion of her epigastrium, making a wound eight

inches long which wounded the uterus in the same direction. Dr. Antonio

di Zubeldia and Don Martin Monaco were called to take charge of the

case. While they were preparing to effect delivery by the vagina, the

woman, in an attack of singultus, ruptured the line of laceration and

expelled the fetus, dead. On the twenty-first day the patient was doing

well. The wound closed at the end of the sixteenth week. The woman

subsequently enjoyed excellent health and, although she had a small

ventral hernia, bore and nursed two children.

Marsh cites the instance of a woman of forty-two, the mother of eight

children, who when eight months pregnant was horned by a cow. Her

clothes were not torn, but she felt that the child had slipped out, and

she caught it in her dress. She was seen by some neighbors twelve yards

from the place of accident, and was assisted to her house. The bowels

protruded and the child was separated from the funis. A physician saw

the woman three-quarters of an hour afterward and found her pulseless

and thoroughly exhausted. There was considerable but not excessive loss

of blood, and several feet of intestine protruded through the wound.

The womb was partially inverted through the wound, and the placenta was

still attached to the inverted portion. The wound in the uterus was

Y-shaped. The mother died in one and a half hours from the reception of

her injuries, but the child was uninjured.

Scott mentions the instance of a woman thirty-four years old who was

gored by an infuriated ox while in the ninth month of her eighth

pregnancy. The horn entered at the anterior superior spinous process of

the ilium, involving the parietes and the uterus. The child was

extruded through the wound about half an hour after the occurrence of

the accident. The cord was cut and the child survived and thrived,

though the mother soon died. Stalpart tells the almost incredible

story of a soldier's wife who went to obtain water from a stream and

was cut in two by a cannonball while stooping over. A passing soldier

observed something to move in the water, which, on investigation, he

found to be a living child in its membranes. It was christened by order

of one Cordua and lived for some time after.

Postmortem Cesarean Section.--The possibility of delivering a child by

Cesarean section after the death of the mother has been known for a

long time to the students of medicine. In the olden times there were

laws making compulsory the opening of the dead bodies of pregnant women

shortly after death. Numa Pompilius established the first law, which

was called "les regia," and in later times there were many such

ordinances. A full description of these laws is on record. Life was

believed possible after a gestation of six months or over, and, as

stated, some famous men were supposed to have been born in this manner.

Francois de Civile, who on great occasions signed himself "trois fois

enterre et trois fois par le grace de Dieu ressucite," saw the light of

the world by a happy Cesarean operation on his exhumed mother.

Fabricius Hildanus and Boarton report similar instances. Bourton cites

among others the case of an infant who was found living twelve hours

after the death of his mother. Dufour and Mauriceau are two older

French medical writers who discuss this subject. Flajani speaks of a

case in which a child was delivered at the death of its mother, and

some of the older Italian writers discuss the advisability of the

operation in the moribund state before death actually ensues. Heister

writes of the delivery of the child after the death of the mother by

opening the abdomen and uterus.

Harris relates several interesting examples. In Peru in 1794 a Sambi

woman was killed by lightning, and the next day the abdomen was opened

by official command and a living child was extracted. The Princess von

Swartzenberg, who was burned to death at a ball in Paris in 1810, was

said to have had a living child removed from her body the next day.

Like all similar instances, this was proved to be false, as her body

was burned beyond the possibility of recognition, and, besides, she was

only four months pregnant. Harris mentions another case of a young

woman who threw herself from the Pont Neuf into the Seine. Her body was

recovered, and a surgeon who was present seized a knife from a butcher

standing by and extracted a living child in the presence of the curious

spectators. Campbell discusses this subject most thoroughly, though he

advances no new opinions upon it.

Duer tabulates the successful results of a number of cases of Cesarean

section after death as follows:--

Children extracted

between 1 and 5 minutes after death of the mother, 21

" " 10 and 15 " " " " " " 13

" " 15 and 30 " " " " " " 2

" " 1 hour " " " " " " 2

" " 2 hours " " " " " " 2

Garezky of St. Petersburg collected reports of 379 cases of Cesarean

section after death with the following results: 308 were extracted

dead; 37 showed signs of life; 34 were born alive. Of the 34, only 5

lived for any length of time. He concludes that if extracted within

five or six minutes after death, they may be born alive; if from six to

ten minutes, they may still be born alive, though asphyxiated; if from

ten to twenty-six minutes, they will be highly asphyxiated. In a great

number of these cases the infant was asphyxiated or dead in one minute.

Of course, if the death is sudden, as by apoplexy, accident, or

suicide, the child's chances are better. These statistics seem

conscientious and reliable, and we are safe in taking them as

indicative of the usual result, which discountenances the old reports

of death as taking place some time before extraction.

Peuch is credited with statistics showing that in 453 operations 101

children gave signs of life, but only 45 survived.

During the Commune of Paris, Tarnier, one night at the Maternite, was

called to an inmate who, while lying in bed near the end of pregnancy,

had been killed by a ball which fractured the base of the skull and

entered the brain. He removed the child by Cesarean section and it

lived for several days. In another case a pregnant woman fell from a

window for a distance of more than 30 feet, instant death resulting;

thirty minutes at least after the death of the mother an infant was

removed, which, after some difficulty, was resuscitated and lived for

thirteen years. Tarnier states that delivery may take place

three-quarters of an hour or even an hour after the death of the

mother, and he also quotes an extraordinary case by Hubert of a

successful Cesarean operation two hours after the mother's death; the

woman, who was eight months pregnant, was instantly killed while

crossing a railroad track.

Hoffman records the case of a successful Cesarean section done ten

minutes after death. The patient was a woman of thirty-six, in her

eighth month of pregnancy, who was suddenly seized with eclampsia,

which terminated fatally in ten hours. Ten minutes after her last

respiration the Cesarean section was performed and a living male child

delivered. This infant was nourished with the aid of a spoon, but it

died in twenty-five hours in consequence of its premature birth and

enfeebled vitality.

Green speaks of a woman, nine months pregnant, who was run over by a

heavily laden stage-coach in the streets of Southwark. She died in

about twenty minutes, and in about twenty minutes more a living child

was extracted from her by Cesarean section. There was a similar case in

the Hopital St. Louis, in Paris, in 1829; but in this case the child

was born alive five minutes after death. Squire tells of a case in

which the mother died of dilatation of the aorta, and in from twenty to

thirty minutes the child was saved. In comment on this case Aveling is

quoted as saying that he believed it possible to save a child one hour

after the death of the mother. No less an authority than Playfair

speaks of a case in which a child was born half an hour after the death

of the mother. Beckman relates the history of a woman who died suddenly

in convulsions. The incision was made about five minutes after death,

and a male child about four pounds in weight was extracted. The child

exhibited feeble heart-contractions and was despaired of. Happily,

after numerous and persistent means of resuscitation, applied for about

two and a half hours, regular respirations were established and the

child eventually recovered. Walter reports a successful instance of

removal of the child after the death of the mother from apoplexy.

Cleveland gives an account of a woman of forty-seven which is of

special interest. The mother had become impregnated five months after

the cessation of menstruation, and a uterine sound had been used in

ignorance of the impregnation at this late period. The mother died, and

one hour later a living child was extracted by Cesarean section. There

are two other recent cases recorded of extraction after an hour had

expired from the death. One is cited by Veronden in which the

extraction was two hours after death, a living child resulting, and the

other by Blatner in which one hour had elapsed after death, when the

child was taken out alive.

Cases of rupture of the uterus during pregnancy from the pressure of

the contents and delivery of the fetus by some unnatural passage are

found in profusion through medical literature, and seem to have been of

special interest to the older observers. Benivenius saw a case in

which the uterus ruptured and the intestines protruded from the vulva.

An instance similar to the one recorded by Benivenius is also found in

the last century in Germany. Bouillon and Desbois, two French

physicians of the last century, both record examples of the uterus

rupturing in the last stages of pregnancy and the mother recovering.

Schreiber gives an instance of rupture of the uterus occasioned by the

presence of a 13-pound fetus, and there is recorded the account of a

rupture caused by a 20-pound fetus that made its way into the abdomen.

We find old accounts of cases of rupture of the uterus with birth by

the umbilicus and the recovery of the woman. Vespre describes a case in

which the uterus was ruptured by the feet of the fetus.

Farquharson has an account of a singular case in midwifery in which

abdomen ruptured from the pressure of the fetus; and quite recently

Geoghegan illustrates the possibilities of uterine pressure in

pregnancy by a postmortem examination after a fatal parturition, in

which the stomach was found pushed through the diaphragm and lying

under the left clavicle. Heywood Smith narrates the particulars of a

case of premature labor at seven months in which rupture of the uterus

occurred and, notwithstanding the fact that the case was complicated by

placenta praevia, the patient recovered.

Rupture of the uterus and recovery does not necessarily prevent

subsequent successful pregnancy and delivery by the natural channels.

Whinery relates an instance of a ruptured uterus in a healthy Irish

woman of thirty-seven from whom a dead child was extracted by abdominal

section and who was safely delivered of a healthy female child about

one year afterward. Analogous to this case is that of Lawrence, who

details the instance of a woman who had been delivered five times of

dead children; she had a very narrow pelvis and labor was always

induced at the eighth month to assure delivery. In her sixth pregnancy

she had miscalculated her time, and, in consequence, her uterus

ruptured in an unexpected parturition, but she recovered and had

several subsequent pregnancies.

Occasionally there is a spontaneous rupture of the vagina during the

process of parturition, the uterus remaining intact. Wiltshire reports

such a case in a woman who had a most prominent sacrum; the laceration

was transverse and quite extensive, but the woman made a good recovery.

Schauta pictures an exostosis on the promontory of the sacrum.

Blenkinsop cites an instance in which the labor was neither protracted

nor abnormally severe, yet the rupture of the vagina took place with

the escape of the child into the abdomen of the mother, and was from

thence extracted by Cesarean section. A peculiarity of this case was

the easy expulsion from the uterus, no instrumental or other manual

interference being attempted and the uterus remaining perfectly intact.

In some cases there is extensive sloughing of the genitals after

parturition with recovery far beyond expectation. Gooch mentions a case

in which the whole vagina sloughed, yet to his surprise the patient

recovered. Aetius and Benivenius speak of recovery in such cases after

loss of the whole uterus. Cazenave of Bordeaux relates a most marvelous

case in which a primipara suffered in labor from an impacted head. She

was twenty-five, of very diminutive stature, and was in labor a long

time. After labor, sloughing of the parts commenced and progressed to

such an extent that in one month there were no traces of the labia,

nymphae, vagina, perineum, or anus. There was simply a large opening

extending from the meatus urinarius to the coccyx. The rectovaginal

septum, the lower portion of the rectum, and the neck of the bladder

were obliterated. The woman survived, although she always experienced

great difficulty in urination and in entirely emptying the rectum. A

similar instance is reported in a woman of thirty who was thirty-six

hours in labor. The fundus of the uterus descended into the vagina and

the whole uterine apparatus was removed. The lower part of the rectum

depended between the labia; in the presence of the physician the nurse

drew this out and it separated at the sphincter ani. On examining the

parts a single opening was seen, as in the preceding case, from the

pubes to the coccyx. Some time afterward the end of the intestine

descended several inches and hung loosely on the concave surface of the

rectum. A sponge was introduced to support the rectum and prevent

access of air. The destruction of the parts was so complete and the

opening so large as to bring into view the whole inner surface of the

pelvis, in spite of which, after prolonged suppuration, the wound

cicatrized from behind forward and health returned, except as regards

the inconvenience of feces and urine. Milk-secretion appeared late and

lasted two months without influencing the other functions.

There are cases in which, through the ignorance of the midwife or the

physician, prolapsed pelvic organs are mistaken for afterbirth and

extracted. There have been instances in which the whole uterus and its

appendages, not being recognized, have been dragged out. Walters cites

the instance of a woman of twenty-two, who was in her third

confinement. The midwife in attendance, finding the afterbirth did not

come away, pulled at the funis, which broke at its attachment. She then

introduced her hand and tore away what proved to be the whole of the

uterus, with the right ovary and fallopian tube, a portion of the round

ligament, and the left tube and ovarian ligament attached to it. A

large quantity of omentum protruded from the vulva and upper part of

the vagina, and an enormous rent was left. Walters saw the woman

twenty-one hours afterward, and ligated and severed the protruding

omentum. On the twenty-eighth day, after a marvelous recovery, she was

able to drive to the Royal Berkshire Hospital, a distance of five

miles. At the time of report, two years and six months after the

mutilation, she was in perfect health. Walters looked into the

statistics of such cases and found 36 accidental removals of the uterus

in the puerperium with 14 recoveries. All but three of these were

without a doubt attended by previous inversion of the uterus.

A medical man was tried for manslaughter in 1878 because he made a

similar mistake. He had delivered a woman by means of the forceps, and,

after delivery, brought away what he thought a tumor. This "tumor"

consisted of the uterus, with the placenta attached to the fundus, the

funis, a portion of the lateral ligament, containing one ovary and

about three inches of vagina. The uterus was not inverted. A horrible

case, with similar results, happened in France, and was reported by

Tardieu. A brutal peasant, whose wife was pregnant, dragged out a fetus

of seven months, together with the uterus and the whole intestinal

canal, from within 50 cm. of the pylorus to within 8 cm. of the

ileocecal valve. The woman was seen three-quarters of an hour after the

intestines had been found in the yard (where the brute had thrown

them), still alive and reproaching her murderer. Hoffman cites an

instance in which a midwife, in her anxiety to extract the afterbirth,

made traction on the cord, brought out the uterus, ovaries, and tubes,

and tore the vulva and perineum as far as the anus.

Woodson tells the story of a negress who was four months pregnant, and

who, on being seized with severe uterine pains in a bath, succeeded in

seizing the fetus and dragging it out, but inverting the uterus in the

operation. There is a case recorded of a girl of eighteen, near her

labor, who, being driven from her house by her father, took refuge in a

neighboring house, and soon felt the pains of child-birth. The

accoucheur was summoned, pronounced them false pains, and went away. On

his return he found the girl dying, with her uterus completely inverted

and hanging between her legs. This unfortunate maiden had been

delivered while standing upright, with her elbows on the back of a

chair. The child suddenly escaped, bringing with it the uterus, but as

the funis ruptured the child fell to the floor. Wagner pictures partial

prolapse of the womb in labor.

It would too much extend this chapter to include the many accidents

incident to labor, and only a few of especial interest will be given.

Cases like rupture of an aneurysm during labor, extensive hemorrhage,

the entrance of air into the uterine veins and sinuses, and common

lacerations will be omitted, together with complicated births like

those of double monsters, etc., but there are several other cases that

deserve mention. Eldridge gives an instance of separation of the

symphysis pubis during labor,--a natural symphysiotomy. A separation of

3/4 inch could be discerned at the symphysis, and in addition the

sacroiliac synchondrosis was also quite movable. The woman had not been

able to walk in the latter part of her pregnancy. The child weighed 10

1/2 pounds and had a large head in a remarkably advanced stage of

ossification, with the fontanelles nearly closed. Delivery was

effected, though during the passage of the head the pubes separated to

such an extent that Eldridge placed two fingers between them. The

mother recovered, and had perfect union and normal locomotion.

Sanders reports a case of the separation of the pubic bones in labor.

Studley mentions a case of fracture of the pelvis during instrumental

delivery. Humphreys cites a most curious instance. The patient, it

appears, had a large exostosis on the body of the pubes which, during

parturition, was forced through the walls of the uterus and bladder,

resulting in death. Kilian reports four cases of death from perforation

of the uterus in this manner. Schauta pictures such an exostosis.

Chandler relates an instance in which there was laceration of the liver

during parturition; and Hubbard records a case of rupture of the spleen

after labor.

Symphysiotomy is an operation consisting of division of the pubic

symphysis in order to facilitate delivery in narrow pelves. This

operation has undergone a most remarkable revival during the past two

years. It originated in a suggestion by Pineau in his work on surgery

in 1598, and in 1665 was first performed by La Courvee upon a dead body

in order to save the child, and afterward by Plenk, in 1766, for the

same purpose. In 1777 Sigault first proposed the operation on the

living, and Ferrara was the one to carry out, practically, the

proposition,--although Sigault is generally considered to be the first

symphysiotormist, and the procedure is very generally known as the

"Sigaultean operation." From Ferrara's time to 1858, when the operation

had practically died out, it had been performed 85 times, with a

recorded mortality of 33 per cent. In 1866 the Italians, under the

leadership of Morisani of Naples, revived the operation, and in twenty

years had performed it 70 times with a mortality of 24 per cent. Owing

to rigid antiseptic technic, the last 38 of these operations (1886 to

1891) showed a mortality of only 50 per cent, while the

infant-mortality was only 10 2/3 per cent. The modern history of this

operation is quite interesting, and is very completely reviewed by

Hirst and Dorland.

In November, 1893, Hirst reported 212 operations since 1887, with a

maternal mortality of 12.73 per cent and a fetal mortality of 28 per

cent. In his later statistics Morisani gives 55 cases with 2 maternal

deaths and 1 infantile death, while Zweifel reports 14 cases from the

Leipzig clinic with no maternal death and 2 fetal deaths, 1 from

asphyxia and 1 from pneumonia, two days after birth. All the modern

statistics are correspondingly encouraging.

Irwin reports a case in which the firm attachment of the fetal head to

the uterine parietes rendered delivery without artificial aid

impossible, and it was necessary to perform craniotomy. The right

temporal region of the child adhered to the internal surface of the

neck of the uterus, being connected by membranes. The woman was

forty-four years old, and the child was her fourth.

Delay in the Birth of the Second Twin.--In twin pregnancies there is

sometimes a delay of many days in the birth of a second child, even to

such an extent as to give suspicion of superfetation. Pignot speaks of

one twin two months before the other. De Bosch speaks of a delay of

seventeen days; and there were 2 cases on record in France in the last

century, one of which was delayed ten days, and the other showed an

interval of seven weeks between the delivery of the twins. There is an

old case on record in which there was an interval of six weeks between

deliveries; Jansen gives an account of three births in ten months;

Pinart mentions a case with an interval of ten days; Thilenius, one of

thirteen days; and Ephemerides, one of one week. Wildberg describes a

case in which one twin was born two months after the other, and there

was no secretion of milk until after the second birth. A full

description of Wildberg's case is given in another journal in brief, as

follows: A woman, eighteen months married, was in labor in the eighth

month of pregnancy. She gave birth to a child, which, though not fully

matured, lived. There was no milk-secretion in her breasts, and she

could distinctly feel the movements of another child; her abdomen

increased in size. After two months she had another labor, and a fully

developed and strong child was born, much heavier than the first. On

the third day after, the breasts became enlarged, and she experienced

considerable fever. It was noticeable in this case that a placenta was

discharged a quarter of an hour after the first birth. Irvine relates

an instance of thirty-two days' delay; and Pfau one of seven days'.

Carson cites the instance of a noblewoman of forty, the mother of four

children, who was taken ill about two weeks before confinement was

expected, and was easily delivered of a male child, which seemed well

formed, with perfect nails, but weakly. After the birth the mother

never became healthy or natural in appearance. She was supposed to be

dying of dropsy, but after forty-four days the mystery was cleared by

the birth of a fine, well-grown, and healthy daughter. Both mother and

child did well.

Addison describes the case of a woman who was delivered of a healthy

male child, and everything was well until the evening of the fourth

day, when intense labor-pains set in, and well-formed twins about the

size of a pigeon's egg were born. In this strange case, possibly an

example of superfetation, the patient made a good recovery and the

first child lived. A similar case is reported by Lumby in which a woman

was delivered on January 18th, by a midwife, of a full-grown and

healthy female child. On the third day she came down-stairs and resumed

her ordinary duties, which she continued until February 4th (seventeen

days after). At this time she was delivered of twins, a boy and a girl,

healthy and well-developed. The placenta was of the consistency of

jelly and had to be scooped away with the hand. The mother and children

did well. This woman was the mother of ten children besides the product

of this conception, and at the latter occurrence had entire absence of

pains and a very easy parturition.

Pincott had a case with an interval of seven weeks between the births;

Vale 1 of two months; Bush 1 of seventeen days; and Burke 1 with an

interval of two months. Douglas cites an instance of twins being born

four days apart. Bessems of Antwerp, in 1866, mentions a woman with a

bicornate uterus who bore two twins at fifty-four days' interval.