FCETUS. 



327 



markable phenomenon, the utterly unfounded 

 hypothesis has been formed, that these spon- 

 taneous separations are the result of gangrene, 

 although there are no traces of it to be dis- 

 covered on the stump, it being actually, to 

 a certain extent, healed, and no change of 

 colour to be seen :" and he immediately adds, 

 " a case lately observed by Montgomery of 

 Dublin appears to contribute a natural explana- 

 tion of this remarkable fact, inasmuch as it 

 indicates the cause of this separation." He 

 then repeats the details of my first case, and 

 proceeds to say he " believes that both the 

 formation of these threads, and the amputation 

 of the limbs, which are most probably in all 

 cases produced by them, may be explained 

 by the history of the formation of the fetus." 

 He then enters into a minute detail of facts 

 well known to all who are acquainted with 

 the mode in which the development of the 

 fetus takes place, and observes, " I look upon 

 these threads as prolongations of the egg mem- 

 brane from which the foetus grows, whether 

 this skin (or membrane) be taken as the navel 

 bladder or the amnion :" and he subsequently 

 objects to their being considered as formed by 

 organized lymph, which I considered them 

 to be, and still remain of the same opinion. 



The prolongations of the membrane, Gurlt 

 thinks, are afterwards, by the constant motions 

 of the fetus, twisted into slight but firm cords 

 or threads, which may involve different portions 

 of the fetal limbs, (as we sometimes find the 

 umbilical cord several times round the neck, 

 or other parts of the child's body,) so as to 

 stricture them and cause their separation ; and 

 in this way Professor Gurlt explains the 

 presence of the ligatures concerned in the pro- 

 duction of spontaneous amputation. I dissent 

 from this as a general explanation, for a reason 

 presently to be stated ; but it is only justice 

 to the author to mention that the condition 

 of both the children which I examined was 

 in other respects such as favours his theory, 

 for whenever such unnatural adhesions take 

 place between the amnion and the fetus, they 

 give rise to a monstrosity of a peculiar kind, 

 and this is observable in both these cases, and 

 in others also : in one there is protrusion of 

 the brain and monstrous formation of the head 

 in other respects ; and in the other the liver, 

 stomach, and great part of the intestines were 

 contained in a hernial sac, external to the body. 

 But notwithstanding the support thus derived 

 from analogy, there is one circumstance which 

 appears fatal to the explanation when applied 

 to the first case described by me, which is, 

 that in all cases where these membranous con- 

 nections have been observed giving rise to 

 monstrosity, one end of the cord or thread- 

 like band has always been found attached to 

 the amnion, and the other to the fetus, but 

 here both ends of the cords are attached to 

 the limbs, and afford no evidence of having 

 been connected with the amnion ; and it was 

 for this reason that I abstained at first from 

 offering the explanation now proposed by Pro- 

 fessor Gurlt, which I then thought, and still 

 consider inapplicable to the specimen which 



I was then describing, and equally, or perhaps 

 still more so, to that described by Zagorsky, 

 to be mentioned presently, seefg. 159 ; though, 

 at the same time, I am quite ready to admit 

 that ligamentous bands so formed would be 

 fully adequate to the accomplishment of such 

 an effect : and I now know also that strictures 

 from another source, and which from their 

 nature must possess very little constricting 

 force indeed, are in some instances found 

 sufficient so completely to act on and indent 

 the limb, that, could their action be con- 

 tinued, which, however, is scarcely possible, 

 they might ultimately induce a similar mutila- 

 tion. While I was engaged in committing 

 these observations to writing, I received a most 

 interesting preparation from Dr. W. O'B. 

 Adams, in which the coiling of the umbilical 

 cord round the left leg of the fetus at three 

 months had deeply indented it, as represented 

 in the subjoined Jig. 157. Here, it will be 



Fig. 157. 



observed, at least three-fourths of the thick- 

 ness of the limb are divided by the pressure 

 of the umbilical cord, which was coiled around 

 it, and which, both in this and fg. 158, is 

 removed from the strictured part where it 

 originally lay, in order to show more distinctly 

 the effect produced by it. 



Within the last few months another instance 

 of the same effect produced by the same agent 

 just above the left knee of a fetus at about 

 the same period of growth, occurred with a 

 patient of the writer's, and under his imme- 



