324 



FCETUS. 



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 

 foetal head were first observed, they were attri- 

 buted to violence by Haller, Rosa, and others, 

 the error of which opinion was first perceived 

 by Rcederer 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 slory 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 Duges 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 Med. et de Chirurgie Prat. torn. viii. 

 p. 293. 



J Diet, dee Sc. Med. torn. 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 foetal muscles, which are capable of very 

 energetic efforts, at a time when the foetal 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 foetus, 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 foetus 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- 

 raeaux,|| Billard,^ 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 Med. de Paris, 

 1813, No. 3. 



t Discours prononce a la Maternite, Juin 1812. 



J Diet, des Sci. Med. t. xvi. p. 66. See also 

 une Memoire sur un deplacement originel ou con- 

 genital de la tete des femurs, par M. le Baron Du- 

 puytren; Repertoire d'Anatomie, t. ii. partie 1. 



Elemens de Physiologic, p. 477. 



\\ Diet, de Med. t. xv. p. 404. 



1 Maladies des Enfans, p. 623. 



** Diet, dea Sci. Med. t. xvi. p. 70. 



