324
FŒTUS.
of the pelvis : in one case where the labour
required version of the child, the arm got be¬
tween the side of the head and the pubes and
produced so much difficulty in the delivery,
that the left parietal bone was completely
depressed. Siebold has reported a case in his
journal, in which the labour was painful and
tedious, and the child was born dead : a large
bloody tumour was found over the right parietal
bone ; and on exposing the bone, it was tra¬
versed by three distinct fissures passing in
different directions : no instruments had been
used.* But I have reason to know that these
injuries of the cranial bones may occur, not
only independently of contracted pelvis, but
even of slow or difficult labour. I some time
since attended a lady in her second labour, and
after about three hours from its commencement,
she gave birth to a healthy boy, but with a
depression in the left temporal bone which
would readily have contained an almond in its
shell ; by degrees the depression disappeared,
and at the end of a few months no trace of it
remained ; the lady’s first labour was easy, as
were also those that succeeded the birth of this
child, and no such injury was observable in
any other of the children. More recently I
was informed by Mr. Mulock, of a case in
which, on the subsidence of a cranial tumour,
a spicula of bone was felt distinctly projecting
under the integuments; the labour had been
slow but natural. When these injuries of the
fœtal head were first observed, they were attri¬
buted to violence by Haller, Rosa, and others,
the error of which opinion was first perceived
by Rœderer and Baudelocque, and it is need¬
less to say how important is the distinction,
especially in a medico-legal point of view.
Fractures of the long bones have been ob¬
served sometimes as the result of injuries
sustained by the mother, but in other instances
independent of any such cause, and apparently
depending on some defect in their composition.
I saw an instance in which a woman, when
eight months pregnant, was precipitated from
the second story of a house into the street, by
which the hip-joint was dislocated, and she was
otherwise much injured; she fell on her face,
yet the uterus was not ruptured ; labour came
on that night, and the child was born dead
with several of its bones broken : the woman
recovered well. A case is quoted by Dugés on
the authority of Carus, in which a woman fell
on her belly and caused a fracture in the leg of
the child, which was born with the fracture
complicated with wounds in the soft parts;
gangrene supervened and detached entirely the
fractured limb.f MarcJ relates a case, in
which all the bones of the limbs and several
others were found fractured, the mother not
having met with any accident, and having had
an easy and quick labour ; the child was born
alive and lived for some days : on examination
after death the number of fractures were found
* See Med. Chir. Review, No. 37, July 1833,
p. 211.
t Diet, de Méd. et de Chirurgie Prat. tom. vin.
P- 293.
| Diet, des Sc. Méd. tom. xvi. p, 63.
to amount to forty-three, some of them just
beginning to unite, and others almost com¬
pletely consolidated.
In a case which occurred to Chaussier, in
which also the labour was quick and easy, and
the mother had not sustained any previous acci¬
dent, the child was born alive and survived
twenty-four hours ; its limbs were malformed,
and after death no less than one hundred and
thirteen fractures were discovered in different
conditions, some of them being already quite
consolidated, while others were apparently
quite recent.*
Fractures independent of any external injury
or defect of nutrition are supposed by some to
be produced by violent spasmodic contractions
of the fœtal muscles, which are capable of very
energetic efforts, at a time when the fœtal bones
have very little power of resistance. It appears
reasonable to believe, that such spasmodic
action of the muscles might be induced by
causes violently disturbing the nervous system
of the mother, since we know that such in¬
fluences acting on a nurse will cause spasmodic
and convulsive affections in the child at her
breast ; and we further know, that even in the
adult a quick muscular effort has been followed
by fracture of a bone, but how far such analo¬
gies are applicable to explain the lesion in
question I would not pretend to determine.
A similar explanation has been supposed
applicable to the instances of dislocations which
have been discovered in the fœtus, and one in
particular related by Chaussier appears to
correspond to such a supposition. A young,
delicate, and nervous lady, in the ninth month
of pregnancy, suddenly felt such violent and
rapid movements of the child that she was near
fainting ; these tumultuous motions were three
times repeated in the course of ten minutes,
and then there succeeded a perfect calm ; the
remainder of the pregnancy passed on well,
the labour was easy, the child was pale and
weak, and had a complete dislocation of the
left fore-arm.f In another instance mentioned
by MarcJ there were found, in addition to
congenital dislocation of both hip-joints, no
less than seven other luxations.
But by far the most remarkable pathological
lesion to which the fœtus in utero is subject, is
that in which portions of its limbs are removed
by a process which has been with propriety
denominated spontaneous amputation.
This singular fact has been mentioned by
several authors of credit, as Richerand,§ Desor-
meaux,|| Billard,1[ and Murat,** though none
of them appear to have witnessed any case of
the kind themselves; but they all agree in
* For a full account of the dissection, see
Bullet, de la Fac. de la Soc. de Méd. de Paris,
1813, No. 3.
f Discours prononcé à la Maternité, Juin 1812.
t Diet, des Sei. Méd. t. xvi. p. 66. See also
une Mémoire sur un déplacement originel ou con¬
genital de la tête des femurs, par M. le Baron Du¬
puytren; Repertoire d’Anatomie, t. ii. partie 1.
5 Elemens de Physiologie, p. 477.
I Diet, de Méd. t. xv. p. 404.
^ Maladies des Enfans, p. 623.
** Diet, des Sei. Méd. t. xvi. p. 70.
