326 



FOETUS. 



was there the slightest appearance of disease 

 or even discolouration of any of the parts, but 

 the feet were, like the hands, imperfectly deve- 

 loped and mis-shapen. The mother was about 

 twenty-five years of age, and was at the time 

 labouring under fever, but had been previously 

 in perfectly good health, and had not met with 

 any accident either in the way of bodily injury 

 or mental agitation. 



About four years after the occurrence of the 

 case just detailed, another was brought under 

 my observation through the kindness of Dr. J. 

 Labatt. 



A healthy woman gave birth to a still-bom 

 child in the eighth month of gestation; it was 

 affected with an umbilical hernia of great size, 

 formed by the protrusion of the liver, stomach, 

 and small intestines, but the state of the limbs 

 is the point of interest connected with our 

 inquiry : both were mis-shapen, and, as hap- 

 pened in Mr. Watkinson's case, the left exhibits 

 this remarkable pathological lesion, and exactly 

 in the same situation. Just above the ankle 

 there is a deep depression all around the limb, 

 and sinking to such a depth as to leave only 

 the bones and skin unaffected by it, the 

 diameter of the undivided part being less than 

 half an inch, while that of the leg, just above 

 the depression, is an inch and a quarter. The 

 appearance of the groove is exactly such as 

 would be made by tying a string very tight 

 round the plump limb of a child, and in my 

 opinion could not have been produced in any 

 other way. The part had been very much 

 handled and examined by several before I saw 

 it, so that I was not surprised at not finding 

 any ligature on the limb, but the mark of it 

 was so distinct in the bottom of the depression 

 as to leave no doubt of its previous existence 

 there having produced the constriction of the 

 part. It is important also to observe, as con- 

 fig. 156. 



finnatory of this view of this matter, that the 

 integuments are not at all broken or divided, 

 but are merely carried inwards with the con- 

 stricting agent, so that, had the separation of 

 the limb been completed, each stump would 

 appear skinned over, except at the ends of the 

 bones, and so present the appearance of being 

 partially healed, as described by both Watkin- 



son and Chaussier: the foot was a little swollen 

 and somewhat discoloured ; it seemed turgid 

 with blood, but was without any appearance 

 whatever of gangrene. 



In both the instances here before us, from 

 the condition of the limbs and the impossibility 

 of the parts under the ligatures continuing their 

 growth under such circumstances, it could 

 scarcely be made subject of doubt that had the 

 children continued to live and grow, the parts 

 of the limbs below the constriction would have 

 separated, and so undergone spontaneous am- 

 putation. 



The next case to which my attention was 

 drawn was one very politely communicated to 

 me by Dr. Tyson West, of Alford, Lincolnshire, 

 in consequence of his becoming acquainted 

 with my account of this matter. Dr. West 

 attended a patient at the Westminster Lying-in 

 Hospital in 1805, who, after a natural and 

 easy labour, gave birth to a still-born child 

 which had but one leg, the other limb exhibit- 

 ing positive proof of having been spontaneously 

 amputated some time before, the stump being 

 partially healed and nicely rounded, about an 

 inch and a half below the knee : the unhealed 

 portion of the stump was about this size. 

 He accounts for the amputated portion/ ,\\ 

 of the limb not being found in conse-i 

 quence of the occurrence of a most 

 dangerous accident which threw all the parties 

 concerned into great alarm and confusion ; but 

 he adds that it struck him at the time, and he 

 is still of the same opinion, that the division 

 of the limb was effected by some stricture 

 round it.* 



When first announcing the discovery of this 

 fact, in 1832,f I stated that the origin of these 

 ligatures, and still more their application so as 

 to stricture the limbs, were circumstances on 

 which I did not feel prepared to pronounce 

 an opinion with any reasonable probability of 

 its being satisfactory, and I am sorry that five 

 years' additional consideration of the matter has 

 not enabled me to solve the difficulty com- 

 pletely ; but I am happy to find that, so 

 far as I have ventured to point out a proximate 

 cause of this singular phenomenon, my views 

 have been assented to, and my explanation 

 adopted, by all who have subsequently ex- 

 pressed their opinions on the subject, and 

 especially by Professor Gurlt, of the lloyal 

 School of Medicine at Berlin, author of a 

 work on pathological anatomy, (whose investi- 

 gations render him peculiarly qualified to form 

 an opinion on such a subject,) who has written 

 a commentary on my original paper,! in which 

 he adopts, as correct, my explanation of this 

 curious fact, and, in addition, undertakes to 

 account for the formation and application of 

 the ligatures. 



He commences his observations by rejecting 

 in toto the notion of the agency of gangrene : 

 his words are : " To explain this most re- 



* A notice of this case was inserted by Dr. West 

 in the Lond. Med. and Surg, Jotirn. for 1832, vol. i. 

 p. 741. 



t See Dublin Medical Journal, vol. i. p. 140. 



J See Medicinische Zeitung, 1833, N. 3, p. 13. 



