maternal impression is due to the repetition of certain {66} village
gossip which by no means loses its point or effectiveness passing from
mouth to mouth. On the other hand, maternal impressions have been
exploited by novelists, who have found that the morbid curiosity of
women particularly with regard to this subject may make their stories
more widely read. Lucas Malet, who, in spite of the apparently
masculine pseudonym, is really the late Rev. Charles Kingsley's
daughter, has recently called renewed attention to this subject by her
novel "Sir Richard Calmady." In this the hero is born with both his
lower limbs missing from just below the knees. The author has been
careful, however, with regard to the details of the supposed maternal
impression to which this deformity is attributed. A young married
woman in the early part of her first pregnancy has her husband, whom
she loves very dearly, brought back to her with both his limbs taken
off by a shocking accident which resulted fatally. It is not
impossible, some physicians might think, to consider that so severe a
shock could produce a very deleterious effect upon the foetus. That
the result should so exactly copy the scene which was brought under
the eyes of the young mother is, however, beyond credence.
Occasionally such stories, supposedly on medical authority, find their
way into the newspapers, usually from distant parts of the country.
Certain parts of Texas particularly seem to be a fruitful source of
such stories for newspaper correspondents when there is a dearth of
other news. Farmers in thinly settled parts of the country lose a foot
in a reaping machine or a hand in the hay-cutting machine when there
is no one near to help them but their wives, with the result that the
shock to their wives proves the occasion of a similar deformity in an
as yet unborn child. Careful investigation of such cases, however, has
invariably shown that either they were completely false or that the
details showed that whatever had happened was at most a coincidence
and never a direct causative factor in the subsequent deformity.
The greatest difficulty in the mind of the medical man, with regard to
the possibility of maternal impression being communicated in any way
to the foetus, is, as we have said, his knowledge of the anatomy of
mother and foetus. While it is {67} generally supposed that the mother
is very intimately connected with her child _in utero,_ the actual
connection is by no means so direct as might be expected from the
popular impression. It is usually considered that the mother's blood
flows in the child's veins; but this is absolutely false. The child's
blood is formed independently of the mother's blood quite as is that
of the chick in the egg. At all times the blood of the child remains
quite different in constitution to that of its mother. It contains
many more red cells than does her blood and differs in other very
easily recognisable ways. Mother and child are connected by means of
an organ known as the placenta, which is attached very closely to the
uterine wall and from which through the cord the blood of the foetus
circulates. This placenta constitutes the so-called afterbirth. The
mother's blood flows in one portion of it, that of the child in
another, and they always remain distinct and separate from each other.
The gases necessary for the child's life diffuse through the membrane
which separates the two different bloods, and the salts and soluble
proteids necessary for the child's nutrition, as well as the water
necessary for its vital processes, all pass through this membrane, but
at no time is there any direct blood connection between mother and
child. Indeed, for a large part of the formative period of the foetus
life, that is, during the first two months of its existence, the ovum
is not very closely attached to the uterus at all, but grows by means
of the vital power which it has within itself.
Nor is there any direct nervous connection between mother and child;
indeed, there are no nerves at all in the placenta, and none in the
cord through which all communications between mother and child must
pass. It seems impossible to explain, then, how maternal impressions
can so effectively pass from mother to child; and indeed, the whole
subject, when looked at in this way, is apt to be considered
legendary, and the facts adduced in support of the theory of maternal
impressions are practically sure to be thought mere coincidences. A
little knowledge here might seem to justify many things that more
complete knowledge fails to be able to find any reasons for.
{68}
There is no doubt, however, that the mother's environment during
pregnancy is in general very important for the perfect development of
the intrauterine child. Many more deformed births are reported after
times of stress and trial, as, for example, after the sieges of great
cities, notably the siege of Paris in 1871, and such scenes of
desolation as occurred during the thirty years' war in Germany. These
are, however, not direct, but indirect effects of maternal
impressions. The development of the human being _in utero_ is an
extremely complicated process. Any disturbance of it, however slight,
is sure to be followed by serious consequences. Disturbances of
nutrition, such as are consequent upon the deprivation that has to be
endured in times of war or during sieges, is of itself sufficient
seriously to disturb even the uterine life of the child. In these
cases, however, there will be no traceable connection between the form
of the maternal impression and the type of deformity that occurs. This
is, however, the essence of the old theory of the direct effect of
maternal impressions, and consequently that theory must fall to the
ground.
From all that has been said, however, it becomes very clear that as
far as possible women should be shielded from the effect of various
nervous shocks during their pregnancy, and that they owe it to
themselves and their offspring to be careful with regard to any morbid
manifestations of feeling that they may detect in themselves.
JAMES J. WALSH.
{69}
VI
HUMAN TERATA AND THE SACRAMENTS
Teratology ([Greek text], a monster) is a part of biology that treats
of deviation from a normal development in man and the lower animals.
The name was adopted in 1822 by the elder Saint-Hilaire, who then
attempted to separate the results of modern exact methods of research
from the myths and loose descriptions of monsters found in the
writings of old authors. Cicero (_De Divinatione_) derives the term
monster from the proper preternatural signification looked for in the
occurrence of these abnormal beings: "Monstra, ostenta, portenta,
prodigia appellantur, quoniam monstrant, ostendunt, portendunt et
predicunt."
At the end of the seventeenth century Malpighi and Grew discovered
that plant tissue is entirely made up of microscopic spaces enclosing
fluid; they called these spaces _cells_. Different investigators found
that animal tissue is also composed of cells; and between 1835 and
1839 Schwann and Schleiden formulated the law that every metazoic
organism is made of cells, and starts from a cell.
In 1672 de Graaf discovered the mammalian ovum, in 1675 Ludwig Ham
found spermatozoa, in 1827 von Baer recognised the human ovum, but not
until 1875 was the important fact established that fertilisation is
effected by the fusion of the male and female pronuclei. This was
demonstrated by Oscar Hertwig from observation of the ova of
starfishes.
Mammalian ova, owing to an almost complete lack of yolk, are all
small. The egg of a whale is about the size of a fern-seed, but the
yolked eggs of birds are large--that of the great auk was 7.5 inches
long. In man the ovum is from 0.18 to 0.2 mm. in diameter, scarcely
visible to the {70} naked eye, and the spermatozoon is extremely
minute. The human spermatozoon is only fifty-four thousandths of a
millimetre in length, and from forty-one to fifty-three thousandths of
a millimetre are taken up by its flagellum. The essential part is from
four to six thousandths of a millimetre in length (Dr. L. N. Boston,
_Journ, of Applied Microscopy_, vol. iv. p. 1360). A line of 18 human
spermatozoa would reach only across the head of an ordinary pin. These
spermatozoa have the power of locomotion in alkaline fluid. Henle
found they can travel one centimetre in three minutes.
The human ovum and spermatozoon are single cells, and the principal
parts of a typical cell are the cytoplasm (called also the
protoplasm), and, within this, the nucleus and centrosome. The
centrosome is efficient in the process of cell-division. A few cells
have also an outer envelope or membrane, and this part is well
developed in the ovum.
The nucleus is the centre of activity in a cell. In the resting
state it is surrounded by a membrane, and within the membrane is an
intra-nuclear network made up of chromatin and linin--the chromatin
is an important element. The meshes of this network are probably
filled with fluid.
During the stages preparatory to the mitotic, or indirect, division
of a cell into two cells (one of the methods of reproduction) the
chromatin segregates in typical cases into two groups of loops, and
each group has equal portions of the chromatin. When the chromatin
is in this shape, a loop is called a chromosome.
The chromosomes are very important. They occur in constant definite
numbers in the somatic cells of the various species of many animals
and plants, and it is probable that each species of plant and animal
has its own characteristic number of chromosomes. Wilson (_The Cell
in Development and Inheritance,_ New York, 1890) gives a list of 72
species in which the number has been determined. Man has probably 16
chromosomes in the somatic cell, and the mature male and female germ
cells in man contribute eight chromosomes each to the nucleus of the
impregnated ovum.
The chromosomes transmit the physical bases of heredity from one
generation to the next, and the heritages from the two parents are
equal except in cases of prepotency. Every cell {71} in the human body
is derived from the father and the mother equally. The fact that the
woman carries a child for months in her womb means only that she
employs a peculiar method of feeding and protecting it. After its
birth she feeds it from her breasts, before birth through its
umbilical vessels, but she originally gives only the eight chromosomes
as the father does, and the child's vital principle builds up the body
from this foundation. The popular notion that the foetus in the womb
is formed through some process of literal abstraction from the
maternal tissues is no more true than that the infant is so built up
while it is suckling; both processes are merely different methods of
feeding.
All the chromosomes from the fathers of at least 200 men could fit
simultaneously on the head of one pin, yet virtually, not merely
potentially, half the bodily substance of that multitude, and all the
physical characteristics derived from the 200 fathers, are indubitably
contained in those chromosomes and nowhere else, unless by a special
creation they are infused with the new soul, which seems to be an
altogether unreasonable alternative. This statement concerning the
minuteness of the chromosomes is not speculation--they can readily be
seen and measured with the aid of the microscope.
A human being, then, obtains eight microscopic chromosomes from his
father and eight from his mother, positively nothing more except food;
yet he develops into a man with a body made up of countless millions
of cells which expand into more than 200 bones in the skeleton and
over 200 muscles,--into the fascias, ligaments, tendons, the great and
small glands, the lymph and blood systems, the respiratory and
alimentary tracts, the skin and its appendages, and a nervous system,
which alone furnishes material for years of study if we would learn
its anatomy fully. Not only all this, but the man commonly closely
resembles his father or his mother, or some other ancestor, in
personal appearance, in certain physical tendencies, in graces or
blemishes; and furthermore, he shows inherited racial characteristics.
If a father is prepotent, he may have a greater effect in producing
the formed child than the mother has, and _vice versa,_ as when a son
closely resembles his father or his mother. {72} Prepotency, moreover,
may extend down through generations and centuries. In the streets of
Palermo to-day typical Normans may be seen, despite the intermarriages
of centuries, who are the descendants of those male Normans that went
down to Sicily with Tancred. There are Romans there, too, and
Saracens. When the Belgae--a race of tall, red-bearded men, with
elliptical skulls--went from the continent of Europe to Ireland,
probably six centuries before our era, they conquered the aborigines,
a gentle, brune race of lower stature. These Belgae became the
ancestors of the chieftain class, and their physical type persists
until to-day; so does that of the Pictish aborigines. Daniel O'Connell
had a typical Belgic body. Other big, blond Irishmen are Norse or
Danish in remote origin.
How is the extremely complex human body with its various physical
characteristics built up from the nucleus of a fecundated cell, the
ovum? The endeavour to answer this question has brought out most
ingenious speculation from nearly all the great biologists of modern
times. The question is the foundation of the theories of heredity,
and it is also fundamental in the theories of evolution.
The human ovum is a flattened spherical cell, made up of a very
delicate cell-wall, called the vitelline membrane; outside this is a
comparatively thick membrane, the zona pellucida, which is properly
not a part of the cell. Within the vitelline membrane is a granular
cytoplasm, the vitellus (yolk), and in this lies the nucleus, which
in the old text-books was called the germinal vesicle. This nucleus
contains a nucleolus.
The human spermatozoon consists of a flattened head which has a thin
protoplasmic cap extending down two-thirds of its length. In the
head is the nucleus with the chromatin. Beyond the head is the neck,
which contains the anterior and posterior centrosomes. Behind the
neck is the tail, or flagellum, in three parts,--the middle piece,
the principal part, and the end piece. From the neck to the end of
the tail centrally runs a bundle of fibrils, the axial filament. In
the middle piece these fibrils are wrapped within a single spiral
filament which winds from the neck down to the annulus at the
beginning of the principal part, and lies in a clear fluid. Without
the spiral filament, along the middle piece, is the mitochondria, a
finely granular protoplasmic layer. The principal part of the tail
consists of the axial {73} filament enclosed in an involucrum, and
the end piece is made up of this filament without the involucrum.
The head and neck of the spermatozoon, which contain the nucleus and
centrosomes, are the essential parts, and the middle piece and the
remainder of the tail appear to be used solely for locomotion and
penetration. When the head penetrates the ovum, the tail is detached
and rejected.
Our knowledge of the initial stages in the development of a human
embryo is derived indirectly from the observation of other mammals.
There are nine early human embryos reported, and the average
probable age of these is twelve days. Breuss' specimen was probably
ten days old (_Wiener med. Wochenblatt,_ 1877). Peters (_Einbettung
des mensch. Eies,_ 1899) found a smaller embryo than this. The
Breuss ovum was 5 mm. in length; Peters' was 3 by 1.5 by 1.5 mm.,
but the probable age was not given. There have been numerous embryos
more than twelve days old observed, and since the process after the
twelfth day is identical in man and the higher mammals, there is no
doubt that the first stages are also the same.
The segmentation that makes new cells is complicated, and the
outcome of the division is a ball of cells. In eggs which have a
large yolk, like those of birds, the cells form a round body resting
on the surface of the yolk, but in mammalian ova a hollow ball of
cells, or a _Morula,_ results, which lines the internal surface of
the cellular envelope. The ovum absorbs moisture by osmosis and
enlarges, and about the twelfth day after the germ-nuclei have begun
to divide, the Morula, or hollow ball of cells, called also the
_Blastodermic Vesicle,_ is formed.
The next stage in development is the establishment of two primary
germinal layers, called together the _Gastrula_, The outer layer is
the _Ectoderm_ or the _Epiblast,_ and the inner layer is the
_Endoderm_ or _Hypoblast_. In a Morula the smaller cells, which
contain less yolk-material, gradually grow around the larger
yolk-containing cells to form the Gastrula.
Between the Ectoderm and the Endoderm a layer of cells called the
_Mesoderm_ or _Mesoblast_ is next formed, and from these three layers
all the parts of the embryo are built up. From the outer Ectoderm and
the inner Endoderm those organs arise which are in the body, outer
and inner,--as the nervous system and the outer skin from the
Ectoderm, the inner entrails, the lungs and liver, from the Endoderm.
From the Mesoderm come the inner skin, the bones and muscles.
By this time the embryo is a minute longitudinal streak at the {74}
surface of one pole of the ovum. The "Primitive Trace" is like a
long inverted letter U, the legs of which are in apposition. The
Primitive Trace becomes a circular flattened disc; and it grows into
a cylindrical body by the juncture of the free margins which fold
downward and inward and meet in the median line, and this closes in
the pelvic, abdominal, thoracic, pharyngeal, and oral cavities. The
legs and arms bud from this cylinder later. While the ventral
cylinder is growing, another longitudinal cylinder is formed along
the upper surface of the embryo, which will contain the brain and
the spinal column. The subsequent development of the embryo and
foetus need not be known for an understanding of the material
considered in treating here of terata.
Human terata occur in certain rather definite, types of erroneous
development, and the classification of Hirst and Piersol (_Human
Monstrosities_, Philadelphia, 1891), which is a combination and change
of the classifications of Geoffrey Saint-Hilaire, Klebs, and Foerster,
is the most satisfactory. There are four great groups of abnormally
developed human beings: (1) Hemiteratic; (2) Heterotaxic; (3)
Hermaphroditic; (4) Monstrous.
Hemiterata are giants, dwarfs, persons showing anomalies in shape, in
colour, in closure of embryonic clefts, in absence or excess of
digits, or having other defects. This group does not come under
discussion here, but attention should be called to the fact that women
who are dwarfs are to be warned before marriage that they cannot be
delivered normally,--that the caesarean section or symphyseotomy will
be necessary, or that certain physicians will practise craniotomy in
delivering them.
The Heterotaxic group comprises persons whose left or right visceral
organs are reversed in position through abnormal embryonic
development; the liver is on the left side, the heart points to the
right, and so on.
Of the next group, the Hermaphroditic, it may be said that a true
hermaphrodite, in the full sense of the term, has not been found; but
there have been several examples of individuals who had an ovary and a
testicle, and other rudimentary sexual organs that belonged to both
male and female. Forms of apparent doubling are common, and in case of
doubt as to sex the probability leans toward the {75} masculine side.
As to marriage in such cases, questions may arise that are to be
settled by the anatomist. In dealing with double monsters it is
sometimes difficult or impossible to determine whether we have to do
with one or two individuals, and this difficulty has serious weight,
especially in the administration of baptism. It is improbable that
there is a doubling of personality in hermaphrodites. A striking
characteristic of compound terata is that the individuals are always
of the same sex; moreover, the embryonal development of reproductive
organs in general is such as almost to preclude a question of duality
of personality.
Terata, more properly so called, are divided into single, double, and
triple monsters. Single monsters may be autositic, or independent of
another embryo or foetus; or they may be omphalositic, that is,
dependent upon another embryo or foetus, which is commonly well
developed, and which supplies blood for both through the umbilical
vessels. When an omphalosite exists, the other foetus is called, in
this case also, the autosite.
The first order of autositic single monsters contains four genera with
eight species, and under these species are thirty-four varieties. They
may have imperfect limbs, no limbs, one eye in the middle of the
forehead (_cyclops_), fused lower limbs (_siren_), and so on. Some of
these monsters show a strong resemblance to lower animals, but there
is no record that is in any degree scientific of a hybrid between a
human being and a lower animal.
There are two genera of the omphalositic single monsters, with four
species. One of the twins, the autosite, is commonly a normal child;
the other, the omphalosite, may be as small as a child's fist, and be
very much deformed. Of these omphalosites the _paracephalus_ has an
imperfect head, commonly no heart, and the lungs are absent or
rudimentary. The _acephalus_ has no head, and commonly no arms; the
_asomata_ is a head more or less developed, with a sac below
containing rudiments of the trunk organs. The Acephalus is very
rare--the rarest of all monsters except the Tricephalus. There is a
fourth kind--the _foetus anideus_. This is a shapeless mass of flesh
covered with skin. There may be a {76} slight prominence with a tuft
of hair on it at one end of the mass to indicate the head. In this
monster there are more traces of bodily organs than might be expected.
These four kinds of omphalosites are either dead when born, or they
die as soon as the placental circulation is cut off. If there is any
probability of life, the physician should give them baptism before the
placental circulation is stopped.
Nothing satisfactory is known concerning the etiology of single
monsters. Landau, and other authorities as great as he is, reject
the theory that maternal impressions from fright or exposure to the
sight of hideous deformity are the cause of terata. I think the
father is accountable for terata as often as the mother is. Barnes,
an English physician, and others claim they find that terata are
frequent in consanguineous marriages, but I have not been able to
verify the assertion.
It seems a theory may be offered to explain the single terata. In
1888 Roux of Breslau by puncturing one blastomere of a frog's egg in
the two-cell stage killed the punctured blastomere without affecting
the other. The punctured blastomere remained inactive, but the other
developed into a complete _half_ embryo.
Crampton by separating and isolating the blastomeres in the two-cell
stage obtained a half embryo; and Zoja by isolating blastomeres of
the medusae, Clytia and Laodice, got _dwarfed_ larvae.
Wilson succeeded by the separation through shaking of the
blastomeres in the two-cell and four-cell stages in developing
Amphioxus larvae, which were half the natural size for the two-cell
blastomeres, and commonly half the normal size from the four-cell
blastomeres, yet in the latter some of the larvae were of the normal
size but imperfect From the eight-cell stage he got only _imperfect_.
larvae. Similar results were obtained by other operators with
various eggs.
Driesch and Morgan by removing part of the cytoplasm from a
fertilized egg of the ctenophore, Beroe, produced imperfect larvae
showing certain defects which represent the parts removed.
In these cases of injured and isolated blastomeres we have, it seems
to me, a plausible theory for the etiology of single terata. The
blastomeres in the human ovum may perhaps be injured in part by
toxins from the mother, or they may be defective through disease in
the ovum or the spermatozoon. They also may possibly be displaced
traumatically, but this seems to be doubtful.
There are three theories concerning the origin of omphalositic {77}
terata. Ahlfeld (_Missbildungen des Menschen_, Leipsic, 1882) holds
that the autosite is stronger than the omphalosite, and as a
consequence the foetal circulation in the omphalosite is reversed,
and development is thus checked. Dareste (_Production artificielle
des monstruosites_, Paris, 1876), Panum (_Beitrag zur Kenntniss der
physiol. Bedeut. der angeboren Missbildungen, Virchow's Archiv.,_
1878), Perls (_Lehrbuch der allgem. Pathologie_) and Breus (_Wiener
med. Jahrbuch_, 1882) maintain there is an inherent original defect
in the omphalositic child which prevents development of the
blood-vessels, and that Ahlfeld's theory of an indirect umbilical
connection of the omphalosite to the placenta is not probable; if it
were, omphalosites would be very common, because one of twins is
nearly always stronger than the other. Hirst and Piersol (_op. cit_)
combine these theories. This kind of monster is certainly an
imperfectly developed human individual, and even the Foetus Anideus
should receive at the least conditional baptism.