Bauhaus-Universität Weimar

Titel:
The Cyclopaedia of Anatomy and Physiology, vol. 2: Dia-Ins
Person:
Todd, Robert Bentley
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit25760/332/
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.
        

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