按键盘上方向键 ← 或 → 可快速上下翻页，按键盘上的 Enter 键可回到本书目录页，按键盘上方向键 ↑ 可回到本页顶部！
————未阅读完？加入书签已便下次继续阅读！
requency and serious character of saturnine encephalopathic lesions。 The presence of arsenic in the fetal skin alone gives an explanation of the therapeutic results of the administration of this substance in skin diseases。
Intrauterine amputations are of interest to the medical man； particularly those cases in which the accident has happened in early pregnancy and the child is born with a very satisfactory and clean stump。 Montgomery； in an excellent paper； advances the theory； which is very plausible； that intrauterine amputations are caused by contraction of bands or membranes of organized lymph encircling the limb and producing amputation by the same process of disjunctive atrophy that the surgeons induce by ligature。 Weinlechner speaks of a case in which a man devoid of all four extremities was exhibited before the Vienna Medical Society。 The amputations were congenital； and on the right side there was a very small stump of the upper arm remaining； admitting the attachment of an artificial apparatus。 He was twenty…seven years old； and able to write； to thread a needle； pour water out of a bottle； etc。 Cook speaks of a female child born of Indian parents； the fourth birth of a mother twenty…six years old。 The child weighed 5 1/2 pounds； the circumference of the head was 14 inches and that of the trunk 13 inches。 The upper extremities consisted of perfect shoulder joints； but only 1/4 of each humerus was present。 Both sides showed evidences of amputation； the cicatrix on the right side being 1 inch long and on the left 1/4 inch long。 The right lower limb was merely a fleshy corpuscle 3/4 inch wide and 1/4 inch long； to the posterior edge was attached a body resembling the little toe of a newly…born infant。 On the left side the limb was represented by a fleshy corpuscle 1 inch long and 1/4 inch in circumference； resembling the great toe of an infant。 There was no history of shock or injury to the mother。 The child presented by the breech； and by the absence of limbs caused much difficulty in diagnosis。 The three stages of labor were one and one…half hours； forty…five minutes； and five minutes； respectively。 The accompanying illustration shows the appearance of the limbs at the time of report。
Figure 10 represents a negro boy； the victim of intrauterine amputation； who learned to utilize his toes for many purposes。 The illustration shows his mode of holding his pen。
There is an instance reported in which a child at full term was born with an amputated arm； and at the age of seventeen the stump was scarcely if at all smaller than the other。 Blake speaks of a case of congenital amputation of both the upper extremities。 Gillilam a mentions a case that shows the deleterious influence of even the weight of a fetal limb resting on a cord or band。 His case was that of a fetus； the product of a miscarriage of traumatic origin； the soft tissues were almost cut through and the bone denuded by the limb resting on one of the two umbilical cords； not encircling it； but in a sling。 The cord was deeply imbedded in the tissues。
The coilings of the cord are not limited to compression about the extremities alone； but may even decapitate the head by being firmly wrapped several times about the neck。 According to Ballantyne； there is in the treatise De Octimestri Partu； by Hippocrates； a reference to coiling of the umbilical cord round the neck of the fetus。 This coiling was； indeed； regarded as one of the dangers of the eighth month； and even the mode of its production is described。 It is said that if the cord he extended along one side of the uterus； and the fetus lie more to the other side； then when the culbute is performed the funis must necessarily form a loop round the neck or chest of the infant。 If it remain in this position； it is further stated； the mother will suffer later and the fetus will either perish or be born with difficulty。 If the Hippocratic writers knew that this coiling is sometimes quite innocuous； they did not in any place state the fact。
The accompanying illustrations show the different ways in which the funis may be coiled； the coils sometimes being as many as 8。
Bizzen mentions an instance in which from strangulation the head of a fetus was in a state of putrefaction； the funis being twice tightly bound around the neck。 Cleveland； Cuthbert； and Germain report analogous instances。 Matthyssens observed the twisting of the funis about the arm and neck of a fetus the body of which was markedly wasted。 There was complete absence of amniotic fluid during labor。 Blumenthal presented to the New York Pathological Society an ovum within which the fetus was under going intrauterine decapitation。 Buchanan describes a case illustrative of the etiology of spontaneous amputation of limbs in utero Nebinger reports a case of abortion； showing commencing amputation of the left thigh from being encircled by the funis。 The death of the fetus was probably due to compression of the cord。 Owen mentions an instance in which the left arm and hand of a fetus were found in a state of putrescence from strangulation； the funis being tightly bound around at the upper part。 Simpson published an article on spontaneous amputation of the forearm and rudimentary regeneration of the hand in the fetus。 Among other contributors to this subject are Avery； Boncour； Brown； Ware； Wrangell； Young； Nettekoven； Martin； Macan； Leopold； Hecker； Gunther； and Friedinger。
Wygodzky finds that the greatest number of coils of the umbilical cord ever found to encircle a fetus are 7 （Baudelocque）； 8 （Crede）； and 9 （Muller and Gray）。 His own case was observed this year in Wilna。 The patient was a primipara aged twenty。 The last period was seen on May 10； 1894。 On February 19th the fetal movements suddenly ceased。 On the 20th pains set in about two weeks before term。 At noon turbid liquor amnii escaped。 At 2 P。M。； on examination； Wygodzky defined a dead fetus in left occipito…anterior presentation； very high in the inlet。 The os was nearly completely dilated； the pains strong。 By 4 P。M。 the head was hardly engaged in the pelvic cavity。 At 7 P。M。 it neared the outlet at the height of each pain； but retracted immediately afterward。 After 10 P。M。 the pains grew weak。 At midnight Wygodzky delivered the dead child by expression。 Not till then was the cause of delay clear。 The funis was very tense and coiled 7 times round the neck and once round the left shoulder； there was also a distinct knot。 It measured over 65 inches in length。 The fetus was a male； slightly macerated。 It weighed over 5 pounds； and was easily delivered entire after division and unwinding of the funis。 No marks remained on the neck。 The placenta followed ten minutes later and； so far as naked…eye experience indicated； seemed healthy。
Intrauterine fractures are occasionally seen； but are generally the results of traumatism or of some extraordinary muscular efforts on the part of the mother。 A blow on the abdomen or a fall may cause them。 The most interesting cases are those in which the fractures are multiple and the causes unknown。 Spontaneous fetal fractures have been discussed thoroughly； and the reader is referred to any responsible text…book for the theories of causation。 Atkinson； De