Hamill reports an instance of morning-sickness in a husband two weeks after the appearance of menstruation in the wife for the last time. He had daily attacks, and it was not until the failure of the next menses that the woman had any other sign of pregnancy than her husband's nausea. His nausea continued for two months, and was the same as that which he had suffered during his wife's former pregnancies, although not until both he and his wife became aware of the existence of pregnancy. The Lancet describes a case in which the husband's nausea and vomiting, as well as that of the wife, began and ended simultaneously. Judkins cites an instance of a man who was sick in the morning while his wife was carrying a child. This occurred during every pregnancy, and the man related that his own father was similarly affected while his mother was in the early months of pregnancy with him, showing an hereditary predisposition.

The perverted appetites and peculiar longings of pregnant women furnish curious matter for discussion. From the earliest times there are many such records. Borellus cites an instance, and there are many others, of pregnant women eating excrement with apparent relish. Tulpius, Sennert, Langius, van Swieten, a Castro, and several others report depraved appetites. Several writers have seen avidity for human flesh in such females. Fournier knew a woman with an appetite for the blood of her husband. She gently cut him while he lay asleep by her side and sucked blood from the wounds—a modern "Succubus." Pare mentions the perverted appetites of pregnant women, and says that they have been known to eat plaster, ashes, dirt, charcoal, flour, salt, spices, to drink pure vinegar, and to indulge in all forms of debauchery. Plot gives the case of a woman who would gnaw and eat all the linen off her bed. Hufeland's Journal records the history of a case of a woman of thirty-two, who had been married ten years, who acquired a strong taste for charcoal, and was ravenous for it. It seemed to cheer her and to cure a supposed dyspepsia. She devoured enormous quantities, preferring hard-wood charcoal. Bruyesinus speaks of a woman who had a most perverted appetite for her own milk, and constantly drained her breasts; Krafft-Ebing cites a similar case. Another case is that of a pregnant woman who had a desire for hot and pungent articles of food, and who in a short time devoured a pound of pepper. Scheidemantel cites a case in which the perverted appetite, originating in pregnancy, became permanent, but this is not the experience of most observers. The pregnant wife of a farmer in Hassfort-on-the-Main ate the excrement of her husband.

Many instances could be quoted, some in which extreme cases of polydipsia and bulimia developed; these can be readily attributed to the increased call for liquids and food. Other cases of diverse new emotions can be recalled, such as lasciviousness, dirty habits, perverted thoughts, and, on the other hand, extreme piety, chastity, and purity of the mind. Some of the best-natured women are when pregnant extremely cross and irritable and many perversions of disposition are commonly noticed in pregnancy. There is often a longing for a particular kind of food or dish for which no noticeable desire had been displayed before.

Maternal Impressions.—Another curious fact associated with pregnancy is the apparent influence of the emotions of the mother on the child in utero. Every one knows of the popular explanation of many birth-marks, their supposed resemblance to some animal or object seen by the mother during pregnancy, etc. The truth of maternal impressions, however, seems to be more firmly established by facts of a substantial nature. There is a natural desire to explain any abnormality or anomaly of the child as due to some incident during the period of the mother's pregnancy, and the truth is often distorted and the imagination heavily drawn upon to furnish the satisfactory explanation. It is the customary speech of the dime-museum lecturer to attribute the existence of some "freak" to an episode in the mother's pregnancy. The poor "Elephant-man" firmly believed his peculiarity was due to the fact that his mother while carrying him in utero was knocked down at the circus by an elephant. In some countries the exhibition of monstrosities is forbidden because of the supposed danger of maternal impression. The celebrated "Siamese Twins" for this reason were forbidden to exhibit themselves for quite a period in France.

We shall cite only a few of the most interesting cases from medical literature. Hippocrates saved the honor of a princess, accused of adultery with a negro because she bore a black child, by citing it as a case of maternal impression, the husband of the princess having placed in her room a painting of a negro, to the view of which she was subjected during the whole of her pregnancy. Then, again, in the treatise "De Superfoetatione" there occurs the following distinct statement: "If a pregnant woman has a longing to eat earth or coals, and eats of them, the infant which is born carries on its head the mark of these things." This statement, however, occurs in a work which is not mentioned by any of the ancient authorities, and is rejected by practically all the modern ones; according to Ballantyne, there is, therefore, no absolute proof that Hippocrates was a believer in one of the most popular and long-persisting beliefs concerning fetal deformities.

In the explanation of heredity, Hippocrates states "that the body of the male as well as that of the female furnishes the semen. That which is weak (unhealthy) is derived from weak (unhealthy) parts, that which is strong (healthy) from strong (healthy) parts, and the fetus will correspond to the quality of the semen. If the semen of one part come in greater quantity from the male than from the female, this part will resemble more closely the father; if, however, it comes more from the female, the part will rather resemble the mother. If it be true that the semen comes from both parents, then it is impossible for the whole body to resemble either the mother or the father, or neither the one nor the other in anything, but necessarily the child will resemble both the one and the other in something. The child will most resemble the one who contributes most to the formation of the parts." Such was the Hippocratic theory of generation and heredity, and it was ingeniously used to explain the hereditary nature of certain diseases and malformations. For instance, in speaking of the sacred disease (epilepsy), Hippocrates says: "Its origin is hereditary, like that of other diseases; for if a phlegmatic person be born of a phlegmatic, and a bilious of a bilious, and a phthisical of a phthisical, and one having spleen disease of another having disease of the spleen, what is to hinder it from happening that where the father and mother were subject to this disease certain of their offspring should be so affected also? As the semen comes from all parts of the body, healthy particles will come from healthy parts, and unhealthy from unhealthy parts."

According to Pare, Damascene saw a girl with long hair like a bear, whose mother had constantly before her a picture of the hairy St. John. Pare also appends an illustration showing the supposed resemblance to a bear. Jonston quotes a case of Heliodorus; it was an Ethiopian, who by the effect of the imagination produced a white child. Pare describes this case more fully: "Heliodorus says that Persina, Queen of Ethiopia, being impregnated by Hydustes, also an Ethiopian, bore a daughter with a white skin, and the anomaly was ascribed to the admiration that a picture of Andromeda excited in Persina throughout the whole of the pregnancy." Van Helmont cites the case of a tailor's wife at Mechlin, who during a conflict outside her house, on seeing a soldier lose his hand at her door, gave birth to a daughter with one hand, the other hand being a bleeding stump; he also speaks of the case of the wife of a merchant at Antwerp, who after seeing a soldier's arm shot off at the siege of Ostend gave birth to a daughter with one arm. Plot speaks of a child bearing the figure of a mouse; when pregnant, the mother had been much frightened by one of these animals. Gassendus describes a fetus with the traces of a wound in the same location as one received by the mother. The Lancet speaks of several cases—one of a child with a face resembling a dog whose mother had been bitten; one of a child with one eye blue and the other black, whose mother during confinement had seen a person so marked; of an infant with fins as upper and lower extremities, the mother having seen such a monster; and another, a child born with its feet covered with scalds and burns, whose mother had been badly frightened by fireworks and a descending rocket. There is the history of a woman who while pregnant at seven months with her fifth child was bitten on the right calf by a dog. Ten weeks after, she bore a child with three marks corresponding in size and appearance to those caused by the dog's teeth on her leg. Kerr reports the case of a woman in her seventh month whose daughter fell on a cooking stove, shocking the mother, who suspected fatal burns. The woman was delivered two months later of an infant blistered about the mouth and extremities in a manner similar to the burns of her sister. This infant died on the third day, but another was born fourteen months later with the same blisters. Inflammation set in and nearly all the fingers and toes sloughed of. In a subsequent confinement, long after the mental agitation, a healthy unmarked infant was born.

Hunt describes a case which has since become almost classic of a woman fatally burned, when pregnant eight months, by her clothes catching fire at the kitchen grate. The day after the burns labor began and was terminated by the birth of a well-formed dead female child, apparently blistered and burned in extent and in places corresponding almost exactly to the locations of the mother's injuries. The mother died on the fourth day.

Webb reports the history of a negress who during a convulsion while pregnant fell into a fire, burning the whole front of the abdomen, the front and inside of the thighs to the knees, the external genitals, and the left arm. Artificial delivery was deemed necessary, and a dead child, seemingly burned much like its mother, except less intensely, was delivered. There was also one large blister near the inner canthus of the eye and some large blisters about the neck and throat which the mother did not show. There was no history of syphilis nor of any eruptive fever in the mother, who died on the tenth day with tetanus.

Graham describes a woman of thirty-five, the mother of seven children, who while pregnant was feeding some rabbits, when one of the animals jumped at her with its eyes "glaring" upon her, causing a sudden fright. Her child was born hydrocephalic. Its mouth and face were small and rabbit-shaped. Instead of a nose, it had a fleshy growth 3/4 inch long by 1/4 inch broad, directed upward at an angle of 45 degrees. The space between this and the mouth was occupied by a body resembling an adult eye. Within this were two small, imperfect eyes which moved freely while life lasted (ten minutes). The child's integument was covered with dark, downy, short hair. The woman recovered and afterward bore two normal children.

Parvin mentions an instance of the influence of maternal impression in the causation of a large, vivid, red mark or splotch on the face: "When the mother was in Ireland she was badly frightened by a fire in which some cattle were burned. Again, during the early months of her pregnancy she was frightened by seeing another woman suddenly light the fire with kerosene, and at that time became firmly impressed with the idea that her child would be marked." Parvin also pictures the "turtle-man," an individual with deformed extremities, who might be classed as an ectromelus, perhaps as a phocomelus, or seal-like monster. According to the story, when the mother was a few weeks pregnant her husband, a coarse, rough fisherman, fond of rude jokes, put a large live turtle in the cupboard. In the twilight the wife went to the cupboard and the huge turtle fell out, greatly startling her by its hideous appearance as it fell suddenly to the floor and began to move vigorously.

Copeland mentions a curious case in which a woman was attacked by a rattlesnake when in her sixth month of pregnancy, and gave birth to a child whose arm exhibited the shape and action of a snake, and involuntarily went through snake-like movements. The face and mouth also markedly resembled the head of a snake.

The teeth were situated like a serpent's fangs. The mere mention of a snake filled the child (a man of twenty-nine) with great horror and rage, "particularly in the snake season." Beale gives the history of a case of a child born with its left eye blackened as by a blow, whose mother was struck in a corresponding portion of the face eight hours before confinement. There is on record an account of a young man of twenty-one suffering from congenital deformities attributed to the fact that his mother was frightened by a guinea-pig having been thrust into her face during pregnancy. He also had congenital deformity of the right auricle. At the autopsy, all the skin, tissues, muscles, and bones were found involved. Owen speaks of a woman who was greatly excited ten months previously by a prurient curiosity to see what appearance the genitals of her brother presented after he had submitted to amputation of the penis on account of carcinoma. The whole penis had been removed. The woman stated that from the time she had thus satisfied herself, her mind was unceasingly engaged in reflecting and sympathizing on the forlorn condition of her brother. While in this mental state she gave birth to a son whose penis was entirely absent, but who was otherwise well and likely to live. The other portions of the genitals were perfect and well developed. The appearance of the nephew and the uncle was identical. A most peculiar case is stated by Clerc as occurring in the experience of Kuss of Strasburg. A woman had a negro paramour in America with whom she had had sexual intercourse several times. She was put in a convent on the Continent, where she stayed two years. On leaving the convent she married a white man, and nine months after she gave birth to a dark-skinned child. The supposition was that during her abode in the convent and the nine months subsequently she had the image of her black paramour constantly before her. Loin speaks of a woman who was greatly impressed by the actions of a clown at a circus, and who brought into the world a child that resembled the fantastic features of the clown in a most striking manner.

Mackay describes five cases in which fright produced distinct marks on the fetus. There is a case mentioned in which a pregnant woman was informed that an intimate friend had been thrown from his horse; the immediate cause of death was fracture of the skull, produced by the corner of a dray against which the rider was thrown. The mother was profoundly impressed by the circumstance, which was minutely described to her by an eye-witness. Her child at birth presented a red and sensitive area upon the scalp corresponding in location with the fatal injury in the rider. The child is now an adult woman, and this area upon the scalp remains red and sensitive to pressure, and is almost devoid of hair. Mastin of Mobile, Alabama, reports a curious instance of maternal impression. During the sixth month of the pregnancy of the mother her husband was shot, the ball passing out through the left breast. The woman was naturally much shocked, and remarked to Dr. Mastin: "Doctor, my baby will be ruined, for when I saw the wound I put my hands over my face, and got it covered with blood, and I know my baby will have a bloody face." The child came to term without a bloody face. It had, however, a well-defined spot on the left breast just below the site of exit of the ball from its father's chest. The spot was about the size of a silver half-dollar, and had elevated edges of a bright red color, and was quite visible at the distance of one hundred feet. The authors have had personal communication with Dr. Mastin in regard to this case, which he considers the most positive evidence of a case of maternal impression that he has ever met.

Paternal Impressions.—Strange as are the foregoing cases, those of paternal impression eclipse them. Several are on record, but none are of sufficient authenticity to warrant much discussion on the subject. Those below are given to illustrate the method of report. Stahl, quoted by Steinan, 1843, speaks of the case of a child, the father being a soldier who lost an eye in the war. The child was born with one of its eyes dried up in the orbit, in this respect presenting an appearance like that of the father. Schneider says a man whose wife was expecting confinement dreamt that his oldest son stood beside his bedside with his genitals much mutilated and bleeding. He awoke in a great state of agitation, and a few days later the wife was delivered of a child with exstrophy of the bladder. Hoare recites the curious story of a man who vowed that if his next child was a daughter he would never speak to it. The child proved to be a son, and during the whole of the father's life nothing could induce the son to speak to his father, nor, in fact, to any other male person, but after the father's death he talked fluently to both men and women. Clark reports the birth of a child whose father had a stiff knee-joint, and the child's knee was stiff and bent in exactly the same position as that of its father.

Telegony.—The influence of the paternal seed on the physical and mental constitution of the child is well known. To designate this condition, Telegony is the word that was coined by Weismann in his "Das Keimplasma," and he defines it as "Infection of the Germ," and, at another time, as "Those doubtful instances in which the offspring is said to resemble, not the father, but an early mate of the mother,"—or, in other words, the alleged influence of a previous sire on the progeny produced by a subsequent one from the same mother. In a systematic discussion of telegony before the Royal Medical Society, Edinburgh, on March 1, 1895, Brunton Blaikie, as a means of making the definition of telegony plainer by practical example, prefaced his remarks by citing the classic example which first drew the attention of the modern scientific world to this phenomenon. The facts of this case were communicated in a letter from the Earl of Morton to the President of the Royal Society in 1821, and were as follows: In the year 1816 Lord Morton put a male quagga to a young chestnut mare of 7/8 Arabian blood, which had never before been bred from. The result was a female hybrid which resembled both parents. He now sold the mare to Sir Gore Ousley, who two years after she bore the hybrid put her to a black Arabian horse. During the two following years she had two foals which Lord Morton thus describes: "They have the character of the Arabian breed as decidedly as can be expected when 15/16 of the blood are Arabian, and they are fine specimens of the breed; but both in their color and in the hair of their manes they have a striking resemblance to the quagga. Their color is bay, marked more or less like the quagga in a darker tint. Both are distinguished by the dark line along the ridge of the back, the dark stripes across the forehand, and the dark bars across the back part of the legs." The President of the Royal Society saw the foals and verified Lord Morton's statement.

"Herbert Spencer, in the Contemporary Review for May, 1893, gives several cases communicated to him by his friend Mr. Fookes, whom Spencer says is often appointed judge of animals at agricultural shows. After giving various examples he goes on to say: 'A friend of mine near this had a valuable Dachshund bitch, which most unfortunately had a litter by a stray sheep-dog. The next year the owner sent her on a visit to a pure Dachshund dog, but the produce took quite as much of the first father as the second, and the next year he sent her to another Dachshund, with the same result. Another case: A friend of mine in Devizes had a litter of puppies unsought for, by a setter from a favorite pointer bitch, and after this she never bred any true pointers, no matter what the paternity was.'

"Lord Polwarth, whose very fine breed of Border Leicesters is famed throughout Britain, and whose knowledge on the subject of breeding is great, says that 'In sheep we always consider that if a ewe breeds to a Shrop ram, she is never safe to breed pure Leicesters from, as dun or colored legs are apt to come even when the sire is a pure Leicester. This has been proved in various instances, but is not invariable.'"

Hon. Henry Scott says: "Dog-breeders know this theory well; and if a pure-bred bitch happens to breed to a dog of another breed, she is of little use for breeding pure-bred puppies afterward. Animals which produce large litters and go a short time pregnant show this throwing back to previous sires far more distinctly than others—I fancy dogs and pigs most of all, and probably horses least. The influence of previous sires may be carried into the second generation or further, as I have a cat now which appears to be half Persian (long hair). His dam has very long hair and every appearance of being a half Persian, whereas neither have really any Persian blood, as far as I know, but the grand-dam (a very smooth-haired cat) had several litters by a half-Persian tom-cat, and all her produce since have showed the influence retained. The Persian tom-cat died many years ago, and was the only one in the district, so, although I cannot be absolutely positive, still I think this case is really as stated."

Breeders of Bedlington terriers wish to breed dogs with as powerful jaws as possible. In order to accomplish this they put the Bedlington terrier bitch first to a bull-terrier dog, and get a mongrel litter which they destroy. They now put the bitch to a Bedlington terrier dog and get a litter of puppies which are practically pure, but have much stronger jaws than they would otherwise have had, and also show much of the gameness of the bull-terrier, thus proving that physiologic as well as anatomic characters may be transmitted in this way.

After citing the foregoing examples, Blaikie directs his attention to man, and makes the following interesting remarks:—

"We might expect from the foregoing account of telegony amongst animals that whenever a black woman had a child to a white man, and then married a black man, her subsequent children would not be entirely black. Dr. Robert Balfour of Surinam in 1851 wrote to Harvey that he was continually noticing amongst the colored population of Surinam 'that if a negress had a child or children by a white, and afterward fruitful intercourse with a negro, the latter offspring had generally a lighter color than the parents.' But, as far as I know, this is the only instance of this observation on record. Herbert Spencer has shown that when a pure-bred animal breeds with an animal of a mixed breed, the offspring resembles much more closely the parent of pure blood, and this may explain why the circumstance recorded by Balfour has been so seldom noted. For a negro, who is of very pure blood, will naturally have a stronger influence on the subsequent progeny than an Anglo-Saxon, who comes of a mixed stock. If this be the correct explanation, we should expect that when a white woman married first a black man, and then a white, the children by the white husband would be dark colored. Unfortunately for the proof of telegony, it is very rare that a white woman does marry a black man, and then have a white as second husband; nevertheless, we have a fair number of recorded instances of dark-colored children being born in the above way of white parents.

"Dr. Harvey mentions a case in which 'a young woman, residing in Edinburgh, and born of white (Scottish) parents, but whose mother, some time previous to her marriage, had a natural (mulatto) child by a negro man-servant in Edinburgh, exhibits distinct traces of the negro. Dr. Simpson—afterward Sir James Simpson—whose patient the young woman at one time was, has had no recent opportunities of satisfying himself as to the precise extent to which the negro character prevails in her features; but he recollects being struck with the resemblance, and noticed particularly that the hair had the qualities characteristic of the negro.' Herbert Spencer got a letter from a 'distinguished correspondent' in the United States, who said that children by white parents had been 'repeatedly' observed to show traces of black blood when the women had had previous connection with (i.e., a child by) a negro. Dr. Youmans of New York interviewed several medical professors, who said the above was 'generally accepted as a fact.' Prof. Austin Flint, in 'A Text-book of Human Physiology,' mentioned this fact, and when asked about it said: 'He had never heard the statement questioned.'

"But it is not only in relation to color that we find telegony to have been noticed in the human subject. Dr. Middleton Michel gives a most interesting case in the American Journal of the Medical Sciences for 1868: 'A black woman, mother of several negro children, none of whom were deformed in any particular, had illicit intercourse with a white man, by whom she became pregnant. During gestation she manifested great uneasiness of mind, lest the birth of a mulatto offspring should disclose her conduct.... It so happened that her negro husband possessed a sixth digit on each hand, but there was no peculiarity of any kind in the white man, yet when the mulatto child was born it actually presented the deformity of a supernumerary finger.' Taruffi, the celebrated Italian teratologist, in speaking of the subject, says: 'Our knowledge of this strange fact is by no means recent for Fienus, in 1608, said that most of the children born in adultery have a greater resemblance to the legal than to the real father'—an observation that was confirmed by the philosopher Vanini and by the naturalist Ambrosini. From these observations comes the proverb: 'Filium ex adultera excusare matrem a culpa.' Osiander has noted telegony in relation to moral qualities of children by a second marriage. Harvey said that it has long been known that the children by a second husband resemble the first husband in features mind, and disposition. He then gave a case in which this resemblance was very well marked. Orton, Burdach (Traite de Physiologie), and Dr. William Sedgwick have all remarked on this physical resemblance; and Dr. Metcalfe, in a dissertation delivered before this society in 1855, observed that in the cases of widows remarrying the children of the second marriage frequently resemble the first husband.

"An observation probably having some bearing on this subject was made by Count de Stuzeleci (Harvey, loc. cit.). He noticed that when an aboriginal female had had a child by a European, she lost the power of conception by a male of her own race, but could produce children by a white man. He believed this to be the case with many aboriginal races; but it has been disproved, or at all events proved to be by no means a universal law, in every case except that of the aborigines of Australia and New Zealand. Dr. William Sedgwick thought it probable that the unfruitfulness of prostitutes might in some degree be due to the same cause as that of the Australian aborigines who have had children by white men.

"It would seem as though the Israelites had had some knowledge of telegony, for in Deuteronomy we find that when a man died leaving no issue, his wife was commanded to marry her husband's brother, in order that he might 'raise up seed to his brother.'"

We must omit the thorough inquiry into this subject that is offered by Mr. Blaikie. The explanations put forward have always been on one of three main lines:—

(1) The imagination-theory, or, to quote Harvey: "Due to mental causes so operating either on the mind of the female and so acting on her reproductive powers, or on the mind of the male parent, and so influencing the qualities of his semen, as to modify the nutrition and development of the offspring."

(2) Due to a local influence on the reproductive organs of the mother.

(3) Due to a general influence through the fetus on the mother.

Antenatal Pathology.—We have next to deal with the diseases, accidents, and operations that affect the pregnant uterus and its contents; these are rich in anomalies and facts of curious interest, and have been recognized from the earliest times. In the various works usually grouped together under the general designation of "Hippocratic" are to be found the earliest opinions upon the subject of antenatal pathology which the medical literature of Greece has handed down to modern times. That there were medical writers before the time of Hippocrates cannot be doubted, and that the works ascribed to the "Father of Medicine" were immediately followed by those of other physicians, is likewise not to be questioned; but whilst nearly all the writings prior to and after Hippocrates have been long lost to the world, most of those that were written by the Coan physician and his followers have been almost miraculously preserved. As Littre puts it, "Les ecrits hippocratiques demeurent isoles au milieu des debris de l'antique litterature medicale."—(Ballantyne.)

The first to be considered is the transmission of contagious disease to the fetus in utero. The first disease to attract attention was small-pox. Devilliers, Blot, and Depaul all speak of congenital small-pox, the child born dead and showing evidences of the typical small-pox pustulation, with a history of the mother having been infected during pregnancy. Watson reports two cases in which a child in utero had small-pox. In the first case the mother was infected in pregnancy; the other was nursing a patient when seven months pregnant; she did not take the disease, although she had been infected many months before. Mauriceau delivered a woman of a healthy child at full term after she had recovered from a severe attack of this disease during the fifth month of gestation. Mauriceau supposed the child to be immune after the delivery. Vidal reported to the French Academy of Medicine, May, 1871, the case of a woman who gave birth to a living child of about six and one-half months' maturation, which died some hours after birth covered with the pustules of seven or eight days' eruption. The pustules on the fetus were well umbilicated and typical, and could have been nothing but those of small-pox; besides, this disease was raging in the neighborhood at the time. The mother had never been infected before, and never was subsequently. Both parents were robust and neither of them had ever had syphilis. About the time of conception, the early part of December, 1870, the father had suffered from the semiconfluent type, but the mother, who had been vaccinated when a girl, had never been stricken either during or after her husband's sickness. Quirke relates a peculiar instance of a child born at midnight, whose mother was covered with the eruption eight hours after delivery. The child was healthy and showed no signs of the contagion, and was vaccinated at once. Although it remained with its mother all through the sickness, it continued well, with the exception of the ninth day, when a slight fever due to its vaccination appeared. The mother made a good recovery, and the author remarks that had the child been born a short time later, it would most likely have been infected.

Ayer reports an instance of congenital variola in twins. Chantreuil speaks of a woman pregnant with twins who aborted at five and a half months. One of the fetuses showed distinct signs of congenital variola, although the mother and other fetus were free from any symptoms of the disease. In 1853 Charcot reported the birth of a premature fetus presenting numerous variolous pustules together with ulcerations of the derm and mucous membranes and stomach, although the mother had convalesced of the disease some time before. Mitchell describes a case of small-pox occurring three days after birth, the mother not having had the disease since childhood. Shertzer relates an instance of confluent small-pox in the eighth month of pregnancy. The child was born with the disease, and both mother and babe recovered. Among many others offering evidence of variola in utero are Degner, Derham, John Hunter, Blot, Bulkley, Welch, Wright, Digk, Forbes, Marinus, and Bouteiller.

Varicella, Measles, Pneumonia, and even Malaria are reported as having been transmitted to the child in utero. Hubbard attended a woman on March 17, 1878, in her seventh accouchement. The child showed the rash of varicella twenty-four hours after birth, and passed through the regular coarse of chicken-pox of ten days' duration. The mother had no signs of the disease, but the children all about her were infected. Ordinarily the period of incubation is from three to four days, with a premonitory fever of from twenty-four to seventy-two hours' duration, when the rash appears; this case must therefore have been infected in utero. Lomer of Hamburg tells of the case of a woman, twenty-two years, unmarried, pregnant, who had measles in the eighth month, and who gave birth to an infant with measles. The mother was attacked with pneumonia on the fifth day of her puerperium, but recovered; the child died in four weeks of intestinal catarrh. Gautier found measles transmitted from the mother to the fetus in 6 out of 11 cases, there being 2 maternal deaths in the 11 cases.

Netter has observed the case of transmission of pneumonia from a mother to a fetus, and has seen two cases in which the blood from the uterine vessels of patients with pneumonia contained the pneumococcus. Wallick collected a number of cases of pneumonia occurring during pregnancy, showing a fetal mortality of 80 per cent.

Felkin relates two instances of fetal malaria in which the infection was probably transmitted by the male parent. In one case the father near term suffered severely from malaria; the mother had never had a chill. The violent fetal movements induced labor, and the spleen was so large as to retard it. After birth the child had seven malarial paroxysms but recovered, the splenic tumor disappearing.

The modes of infection of the fetus by syphilis, and the infection of the mother, have been well discussed, and need no mention here.

There has been much discussion on the effects on the fetus in utero of medicine administered to the pregnant mother, and the opinions as to the reliability of this medication are so varied that we are in doubt as to a satisfactory conclusion. The effects of drugs administered and eliminated by the mammary glands and transmitted to the child at the breast are well known, and have been witnessed by nearly every physician, and, as in cases of strong metallic purges, etc., need no other than the actual test. However, scientific experiments as to the efficacy of fetal therapeutics have been made from time to time with varying results.

Gusserow of Strasbourg tested for iodin, chloroform, and salicylic acid in the blood and secretions of the fetus after maternal administration just before death. In 14 cases in which iodin had been administered, he examined the fetal urine of 11 cases; in 5, iodin was present, and in the others, absent. He made some similar experiments on the lower animals. Benicke reports having given salicylic acid just before birth in 25 cases, and in each case finding it in the urine of the child shortly after birth.

At a discussion held in New York some years ago as to the real effect on the fetus of giving narcotics to the mother, Dr. Gaillard Thomas was almost alone in advocating that the effect was quite visible. Fordyce Barker was strongly on the negative side. Henning and Ahlfeld, two German observers, vouch for the opinion of Thomas, and Thornburn states that he has witnessed the effect of nux vomica and strychnin on the fetus shortly after birth. Over fifty years ago, in a memoir on "Placental Phthisis," Sir James Y. Simpson advanced a new idea in the recommendation of potassium chlorate during the latter stages of pregnancy. The efficacy of this suggestion is known, and whether, as Simpson said, it acts by supplying extra oxygen to the blood, or whether the salt itself is conveyed to the fetus, has never been definitely settled.

McClintock, who has been a close observer on this subject, reports some interesting cases. In his first case he tried a mixture of iron perchlorid and potassium chlorate three times a day on a woman who had borne three dead children, with a most successful result. His second case failed, but in a third he was successful by the same medication with a woman who had before borne a dead child. In a fourth case of unsuccessful pregnancy for three consecutive births he was successful. His fifth case was extraordinary: It was that of a woman in her tenth pregnancy, who, with one exception, had always borne a dead child at the seventh or eighth month. The one exception lived a few hours only. Under this treatment he was successful in carrying the woman safely past her time for miscarriage, and had every indication for a normal birth at the time of report. Thornburn believes that the administration of a tonic like strychnin is of benefit to a fetus which, by its feeble heart-beats and movements, is thought to be unhealthy. Porak has recently investigated the passage of substances foreign to the organism through the placenta, and offers an excellent paper on this subject, which is quoted in brief in a contemporary number of Teratologia.

In this important paper, Porak, after giving some historical notes, describes a long series of experiments performed on the guinea-pig in order to investigate the passage of arsenic, copper, lead, mercury, phosphorus, alizarin, atropin, and eserin through the placenta. The placenta shows a real affinity for some toxic substances; in it accumulate copper and mercury, but not lead, and it is therefore through it that the poison reaches the fetus; in addition to its pulmonary, intestinal, and renal functions, it fixes glycogen and acts as an accumulator of poisons, and so resembles in its action the liver; therefore the organs of the fetus possess only a potential activity. The storing up of poisons in the placenta is not so general as the accumulation of them in the liver of the mother. It may be asked if the placenta does not form a barrier to the passage of poisons into the circulation of the fetus; this would seem to be demonstrated by mercury, which was always found in the placenta and never in the fetal organs. In poisoning by lead and copper the accumulation of the poison in the fetal tissues is greater than in the maternal, perhaps from differences in assimilation and disassimilation or from greater diffusion. Whilst it is not an impermeable barrier to the passage of poisons, the placenta offers a varying degree of obstruction: it allows copper and lead to pass easily, arsenic with greater difficulty. The accumulation of toxic substances in the fetus does not follow the same law as in the adult. They diffuse more widely in the fetus. In the adult the liver is the chief accumulatory organ. Arsenic, which in the mother elects to accumulate in the liver, is in the fetus stored up in the skin; copper accumulates in the fetal liver, central nervous system, and sometimes in the skin; lead which is found specially in the maternal liver, but also in the skin, has been observed in the skin, liver, nervous centers, and elsewhere in the fetus. The frequent presence of poisons in the fetal skin demonstrates its physiologic importance. It has probably not a very marked influence on its health. On the contrary, accumulation in the placenta and nerve centers explains the pathogenesis of abortion and the birth of dead fetuses ("mortinatatite") Copper and lead did not cause abortion, but mercury did so in two out of six cases. Arsenic is a powerful abortive agent in the guinea-pig, probably on account of placental hemorrhages. An important deduction is that whilst the placenta is frequently and seriously affected in syphilis, it is also the special seat for the accumulation of mercury. May this not explain its therapeutic action in this disease? The marked accumulation of lead in the central nervous system of the fetus explains the frequency and serious character of saturnine encephalopathic lesions. The presence of arsenic in the fetal skin alone gives an explanation of the therapeutic results of the administration of this substance in skin diseases.

Intrauterine amputations are of interest to the medical man, particularly those cases in which the accident has happened in early pregnancy and the child is born with a very satisfactory and clean stump. Montgomery, in an excellent paper, advances the theory, which is very plausible, that intrauterine amputations are caused by contraction of bands or membranes of organized lymph encircling the limb and producing amputation by the same process of disjunctive atrophy that the surgeons induce by ligature. Weinlechner speaks of a case in which a man devoid of all four extremities was exhibited before the Vienna Medical Society. The amputations were congenital, and on the right side there was a very small stump of the upper arm remaining, admitting the attachment of an artificial apparatus. He was twenty-seven years old, and able to write, to thread a needle, pour water out of a bottle, etc. Cook speaks of a female child born of Indian parents, the fourth birth of a mother twenty-six years old. The child weighed 5 1/2 pounds; the circumference of the head was 14 inches and that of the trunk 13 inches. The upper extremities consisted of perfect shoulder joints, but only 1/4 of each humerus was present. Both sides showed evidences of amputation, the cicatrix on the right side being 1 inch long and on the left 1/4 inch long. The right lower limb was merely a fleshy corpuscle 3/4 inch wide and 1/4 inch long; to the posterior edge was attached a body resembling the little toe of a newly-born infant. On the left side the limb was represented by a fleshy corpuscle 1 inch long and 1/4 inch in circumference, resembling the great toe of an infant. There was no history of shock or injury to the mother. The child presented by the breech, and by the absence of limbs caused much difficulty in diagnosis. The three stages of labor were one and one-half hours, forty-five minutes, and five minutes, respectively. The accompanying illustration shows the appearance of the limbs at the time of report.

Figure 10 represents a negro boy, the victim of intrauterine amputation, who learned to utilize his toes for many purposes. The illustration shows his mode of holding his pen.

There is an instance reported in which a child at full term was born with an amputated arm, and at the age of seventeen the stump was scarcely if at all smaller than the other. Blake speaks of a case of congenital amputation of both the upper extremities. Gillilam a mentions a case that shows the deleterious influence of even the weight of a fetal limb resting on a cord or band. His case was that of a fetus, the product of a miscarriage of traumatic origin; the soft tissues were almost cut through and the bone denuded by the limb resting on one of the two umbilical cords, not encircling it, but in a sling. The cord was deeply imbedded in the tissues.

The coilings of the cord are not limited to compression about the extremities alone, but may even decapitate the head by being firmly wrapped several times about the neck. According to Ballantyne, there is in the treatise De Octimestri Partu, by Hippocrates, a reference to coiling of the umbilical cord round the neck of the fetus. This coiling was, indeed, regarded as one of the dangers of the eighth month, and even the mode of its production is described. It is said that if the cord he extended along one side of the uterus, and the fetus lie more to the other side, then when the culbute is performed the funis must necessarily form a loop round the neck or chest of the infant. If it remain in this position, it is further stated, the mother will suffer later and the fetus will either perish or be born with difficulty. If the Hippocratic writers knew that this coiling is sometimes quite innocuous, they did not in any place state the fact.

The accompanying illustrations show the different ways in which the funis may be coiled, the coils sometimes being as many as 8.

Bizzen mentions an instance in which from strangulation the head of a fetus was in a state of putrefaction, the funis being twice tightly bound around the neck. Cleveland, Cuthbert, and Germain report analogous instances. Matthyssens observed the twisting of the funis about the arm and neck of a fetus the body of which was markedly wasted. There was complete absence of amniotic fluid during labor. Blumenthal presented to the New York Pathological Society an ovum within which the fetus was under going intrauterine decapitation. Buchanan describes a case illustrative of the etiology of spontaneous amputation of limbs in utero Nebinger reports a case of abortion, showing commencing amputation of the left thigh from being encircled by the funis. The death of the fetus was probably due to compression of the cord. Owen mentions an instance in which the left arm and hand of a fetus were found in a state of putrescence from strangulation, the funis being tightly bound around at the upper part. Simpson published an article on spontaneous amputation of the forearm and rudimentary regeneration of the hand in the fetus. Among other contributors to this subject are Avery, Boncour, Brown, Ware, Wrangell, Young, Nettekoven, Martin, Macan, Leopold, Hecker, Gunther, and Friedinger.

Wygodzky finds that the greatest number of coils of the umbilical cord ever found to encircle a fetus are 7 (Baudelocque), 8 (Crede), and 9 (Muller and Gray). His own case was observed this year in Wilna. The patient was a primipara aged twenty. The last period was seen on May 10, 1894. On February 19th the fetal movements suddenly ceased. On the 20th pains set in about two weeks before term. At noon turbid liquor amnii escaped. At 2 P.M., on examination, Wygodzky defined a dead fetus in left occipito-anterior presentation, very high in the inlet. The os was nearly completely dilated, the pains strong. By 4 P.M. the head was hardly engaged in the pelvic cavity. At 7 P.M. it neared the outlet at the height of each pain, but retracted immediately afterward. After 10 P.M. the pains grew weak. At midnight Wygodzky delivered the dead child by expression. Not till then was the cause of delay clear. The funis was very tense and coiled 7 times round the neck and once round the left shoulder; there was also a distinct knot. It measured over 65 inches in length. The fetus was a male, slightly macerated. It weighed over 5 pounds, and was easily delivered entire after division and unwinding of the funis. No marks remained on the neck. The placenta followed ten minutes later and, so far as naked-eye experience indicated, seemed healthy.

Intrauterine fractures are occasionally seen, but are generally the results of traumatism or of some extraordinary muscular efforts on the part of the mother. A blow on the abdomen or a fall may cause them. The most interesting cases are those in which the fractures are multiple and the causes unknown. Spontaneous fetal fractures have been discussed thoroughly, and the reader is referred to any responsible text-book for the theories of causation. Atkinson, De Luna, and Keller report intrauterine fractures of the clavicle. Filippi contributes an extensive paper on the medicolegal aspect of a case of intrauterine fracture of the os cranium. Braun of Vienna reports a case of intrauterine fracture of the humerus and femur. Rodrigue describes a case of fracture and dislocation of the humerus of a fetus in utero. Gaultier reports an instance of fracture of both femora intrauterine. Stanley, Vanderveer, and Young cite instances of intrauterine fracture of the thigh; in the case of Stanley the fracture occurred during the last week of gestation, and there was rapid union of the fragments during lactation. Danyau, Proudfoot, and Smith mention intrauterine fracture of the tibia; in Proudfoot's case there was congenital talipes talus.

Dolbeau describes an instance in which multiple fractures were found in a fetus, some of which were evidently postpartum, while others were assuredly antepartum. Hirschfeld describes a fetus showing congenital multiple fractures. Gross speaks of a wonderful case of Chaupier in which no less than 113 fractures were discovered in a child at birth. It survived twenty-four hours, and at the postmortem examination it was found that some were already solid, some uniting, whilst others were recent. It often happens that the intrauterine fracture is well united at birth. There seems to be a peculiar predisposition of the bones to fracture in the cases in which the fractures are multiple and the cause is not apparent.

The results to the fetus of injuries to the pregnant mother are most diversified. In some instances the marvelous escape of any serious consequences of one or both is almost incredible, while in others the slightest injury is fatal. Guillemont cites the instance of a woman who was killed by a stroke of lightning, but whose fetus was saved; while Fabricius Hildanus describes a case in which there was perforation of the head, fracture of the skull, and a wound of the groin, due to sudden starting and agony of terror of the mother. Here there was not the slightest history of any external violence.

It is a well-known fact that injuries to the pregnant mother show visible effects on the person of the fetus. The older writers kept a careful record of the anomalous and extraordinary injuries of this character and of their effects. Brendelius tells us of hemorrhage from the mouth and nose of the fetus occasioned by the fall of the mother; Buchner mentions a case of fracture of the cranium from fright of the mother; Reuther describes a contusion of the os sacrum and abdomen in the mother from a fall, with fracture of the arm and leg of the fetus from the same cause; Sachse speaks of a fractured tibia in a fetus, caused by a fall of the mother; Slevogt relates an instance of rupture of the abdomen of a fetus by a fall of the mother; the Ephemerides contains accounts of injuries to the fetus of this nature, and among others mentions a stake as having been thrust into a fetus in utero; Verduc offers several examples, one a dislocation of the fetal foot from a maternal fall; Plocquet gives an instance of fractured femur; Walther describes a case of dislocation of the vertebrae from a fall; and there is also a case of a fractured fetal vertebra from a maternal fall. There is recorded a fetal scalp injury, together with clotted blood in the hair, after a fall of the mother: Autenrieth describes a wound of the pregnant uterus, which had no fatal issue, and there is also another similar case on record.

The modern records are much more interesting and wonderful on this subject than the older ones. Richardson speaks of a woman falling down a few weeks before her delivery. Her pelvis was roomy and the birth was easy; but the infant was found to have extensive wounds on the back, reaching from the 3d dorsal vertebra across the scapula, along the back of the humerus, to within a short distance of the elbow. Part of these wounds were cicatrized and part still granulating, which shows that the process of reparation is as active in utero as elsewhere.

Injuries about the genitalia would naturally be expected to exercise some active influence on the uterine contents; but there are many instances reported in which the escape of injury is marvelous. Gibb speaks of a woman, about eight months pregnant, who fell across a chair, lacerating her genitals and causing an escape of liquor amnii. There was regeneration of this fluid and delivery beyond term. The labor was tedious and took place two and a half months after the accident. The mother and the female child did well. Purcell reports death in a pregnant woman from contused wound of the vulva. Morland relates an instance of a woman in the fifth month of her second pregnancy, who fell on the roof of a woodshed by slipping from one of the steps by which she ascended to the roof, in the act of hanging out some clothes to dry. She suffered a wound on the internal surface of the left nympha 1 1/2 inch long and 1/2 inch deep. She had lost about three quarts of blood, and had applied ashes to the vagina to stop the bleeding. She made a recovery by the twelfth day, and the fetal sounds were plainly audible. Cullingworth speaks of a woman who, during a quarrel with her husband, was pushed away and fell between two chairs, knocking one of them over, and causing a trivial wound one inch long in the vagina, close to the entrance. She screamed, there was a gush of blood, and she soon died. The uterus contained a fetus three or four months old, with the membranes intact, the maternal death being due to the varicosity of the pregnant pudenda, the slight injury being sufficient to produce fatal hemorrhage. Carhart describes the case of a pregnant woman, who, while in the stooping position, milking a cow, was impaled through the vagina by another cow. The child was born seven days later, with its skull crushed by the cow's horn. The horn had entered the vagina, carrying the clothing with it.

There are some marvelous cases of recovery and noninterference with pregnancy after injuries from horns of cattle. Corey speaks of a woman of thirty-five, three months pregnant, weighing 135 pounds, who was horned by a cow through the abdominal parietes near the hypogastric region; she was lifted into the air, carried, and tossed on the ground by the infuriated animal. There was a wound consisting of a ragged rent from above the os pubis, extending obliquely to the left and upward, through which protruded the great omentum, the descending and transverse colon, most of the small intestines, as well as the pyloric extremity of the stomach. The great omentum was mangled and comminuted, and bore two lacerations of two inches each. The intestines and stomach were not injured, but there was considerable extravasation of blood into the abdominal cavity. The intestines were cleansed and an unsuccessful attempt was made to replace them. The intestines remained outside of the body for two hours, and the great omentum was carefully spread out over the chest to prevent interference with the efforts to return the intestines. The patient remained conscious and calm throughout; finally deep anesthesia was produced by ether and chloroform, three and a half hours after the accident, and in twenty minutes the intestines were all replaced in the abdominal cavity. The edges were pared, sutured, and the wound dressed. The woman was placed in bed, on the right side, and morphin was administered. The sutures were removed on the ninth day, and the wound had healed except at the point of penetration. The woman was discharged twenty days after, and, incredible to relate, was delivered of a well-developed, full-term child just two hundred and two days from the time of the accident. Both the mother and child did well.

Luce speaks of a pregnant woman who was horned in the lower part of the abdomen by a cow, and had a subsequent protrusion of the intestines through the wound. After some minor complications, the wound healed fourteen weeks after the accident, and the woman was confined in natural labor of a healthy, vigorous child. In this case no blood was found on the cow's horn, and the clothing was not torn, so that the wound must have been made by the side of the horn striking the greatly distended abdomen.

Richard, quoted also by Tiffany, speaks of a woman, twenty-two, who fell in a dark cellar with some empty bottles in her hand, suffering a wound in the abdomen 2 inches above the navel on the left side 8 cm. long. Through this wound a mass of intestines, the size of a man's head, protruded. Both the mother and the child made a good convalescence. Harris cites the instance of a woman of thirty, a multipara, six months pregnant, who was gored by a cow; her intestines and omentum protruded through the rip and the uterus was bruised. There was rapid recovery and delivery at term. Wetmore of Illinois saw a woman who in the summer of 1860, when about six months pregnant, was gored by a cow, and the large intestine and the omentum protruded through the wound. Three hours after the injury she was found swathed in rags wet with a compound solution of whiskey and camphor, with a decoction of tobacco. The intestines were cold to the touch and dirty, but were washed and replaced. The abdomen was sewed up with a darning needle and black linen thread; the woman recovered and bore a healthy child at the full maturity of her gestation. Crowdace speaks of a female pauper, six months pregnant, who was attacked by a buffalo, and suffered a wound about 1 1/2 inch long and 1/2 inch wide just above the umbilicus. Through this small opening 19 inches of intestine protruded. The woman recovered, and the fetal heart-beats could be readily auscultated.

Major accidents in pregnant women are often followed by the happiest results. There seems to be no limit to what the pregnant uterus can successfully endure. Tiffany, who has collected some statistics on this subject, as well as on operations successfully performed during pregnancy, which will be considered later, quotes the account of a woman of twenty-seven, eight months pregnant, who was almost buried under a clay wall. She received terrible wounds about the head, 32 sutures being used in this location alone. Subsequently she was confined, easily bore a perfectly normal female child, and both did well. Sibois describes the case of a woman weighing 190 pounds, who fell on her head from the top of a wall from 10 to 12 feet high. For several hours she exhibited symptoms of fracture of the base of the skull, and the case was so diagnosed; fourteen hours after the accident she was perfectly conscious and suffered terrible pain about the head, neck, and shoulders. Two days later an ovum of about twenty days was expelled, and seven months after she was delivered of a healthy boy weighing 10 1/2 pounds. She had therefore lost after the accident one-half of a double conception.

Verrier has collected the results of traumatism during pregnancy, and summarizes 61 cases. Prowzowsky cites the instance of a patient in the eighth month of her first pregnancy who was wounded by many pieces of lead pipe fired from a gun but a few feet distant. Neither the patient nor the child suffered materially from the accident, and gestation proceeded; the child died on the fourth day after birth without apparent cause. Milner records an instance of remarkable tolerance of injury in a pregnant woman. During her six months of pregnancy the patient was accidentally shot through the abdominal cavity and lower part of the thorax. The missile penetrated the central tendon of the diaphragm and lodged in the lung. The injury was limited by localized pneumonia and peritonitis, and the wound was drained through the lung by free expectoration. Recovery ensued, the patient giving birth to a healthy child sixteen weeks later. Belin mentions a stab-wound in a pregnant woman from which a considerable portion of the epiploon protruded. Sloughing ensued, but the patient made a good recovery, gestation not being interrupted. Fancon describes the case of a woman who had an injury to the knee requiring drainage. She was attacked by erysipelas, which spread over the whole body with the exception of the head and neck; yet her pregnancy was uninterrupted and recovery ensued. Fancon also speaks of a girl of nineteen, frightened by her lover, who threatened to stab her, who jumped from a second-story window. For three days after the fall she had a slight bloody flow from the vulva. Although she was six months pregnant there was no interruption of the normal course of gestation.

Bancroft speaks of a woman who, being mistaken for a burglar, was shot by her husband with a 44-caliber bullet. The missile entered the second and third ribs an inch from the sternum, passed through the right lung, and escaped at the inferior angle of the scapula, about three inches below the spine; after leaving her body it went through a pine door. She suffered much hemorrhage and shock, but made a fair recovery at the end of four weeks, though pregnant with her first child at the seventh month. At full term she was delivered by foot-presentation of a healthy boy. The mother at the time of report was healthy and free from cough, and was nursing her babe, which was strong and bright.

All the cases do not have as happy an issue as most of the foregoing ones, though in some the results are not so bad as might be expected. A German female, thirty-six, while in the sixth month of pregnancy, fell and struck her abdomen on a tub. She was delivered of a normal living child, with the exception that the helix of the left ear was pushed anteriorly, and had, in its middle, a deep incision, which also traversed the antihelix and the tragus, and continued over the cheek toward the nose, where it terminated. The external auditory meatus was obliterated. Gurlt speaks of a woman, seven months pregnant, who fell from the top of a ladder, subsequently losing some blood and water from the vagina. She had also persistent pains in the belly, but there was no deterioration of general health. At her confinement, which was normal, a strong boy was born, wanting the arm below the middle, at which point a white bone protruded. The wound healed and the separated arm came away after birth. Wainwright relates the instance of a woman of forty, who when six months pregnant was run over by railway cars. After a double amputation of the legs she miscarried and made a good recovery. Neugebauer reported the history of a case of a woman who, while near her term of pregnancy, committed suicide by jumping from a window. She ruptured her uterus, and a dead child with a fracture of the parietal bone was found in the abdominal cavity. Staples speaks of a Swede of twenty-eight, of Minnesota, who was accidentally shot by a young man riding by her side in a wagon. The ball entered the abdomen two inches above the crest of the right ilium, a little to the rear of the anterior superior spinous process, and took a downward and forward course. A little shock was felt but no serious symptoms followed. In forty hours there was delivery of a dead child with a bullet in its abdomen. Labor was normal and the internal recovery complete. Von Chelius, quoting the younger Naegele, gives a remarkable instance of a young peasant of thirty-five, the mother of four children, pregnant with the fifth child, who was struck on the belly violently by a blow from a wagon pole. She was thrown down, and felt a tearing pain which caused her to faint. It was found that the womb had been ruptured and the child killed, for in several days it was delivered in a putrid mass, partly through the natural passage and partly through an abscess opening in the abdominal wall. The woman made a good recovery. A curious accident of pregnancy is that of a woman of thirty-eight, advanced eight months in her ninth pregnancy, who after eating a hearty meal was seized by a violent pain in the region of the stomach and soon afterward with convulsions, supposed to have been puerperal. She died in a few hours, and at the autopsy it was found that labor had not begun, but that the pregnancy had caused a laceration of the spleen, from which had escaped four or five pints of blood. Edge speaks of a case of chorea in pregnancy in a woman of twenty-seven, not interrupting pregnancy or retarding safe delivery. This had continued for four pregnancies, but in the fourth abortion took place.

Buzzard had a case of nervous tremor in a woman, following a fall at her fourth month of pregnancy, who at term gave birth to a male child that was idiotic. Beatty relates a curious accident to a fetus in utero. The woman was in her first confinement and was delivered of a small but healthy and strong boy. There was a small puncture in the abdominal parietes, through which the whole of the intestines protruded and were constricted. The opening was so small that he had to enlarge it with a bistoury to replace the bowel, which was dark and congested; he sutured the wound with silver wire, but the child subsequently died.

Tiffany of Baltimore has collected excellent statistics of operations during pregnancy; and Mann of Buffalo has done the same work, limiting himself to operations on the pelvic organs, where interference is supposed to have been particularly contraindicated in pregnancy. Mann, after giving his individual cases, makes the following summary and conclusions:—

(1) Pregnancy is not a general bar to operations, as has been supposed.

(2) Union of the denuded surfaces is the rule, and the cicatricial tissue, formed during the earlier months of pregnancy, is strong enough to resist the shock of labor at term.

(3) Operations on the vulva are of little danger to mother or child.

(4) Operations on the vagina are liable to cause severe hemorrhage, but otherwise are not dangerous.

(5) Venereal vegetations or warts are best treated by removal.

(6) Applications of silver nitrate or astringents may be safely made to the vagina. For such application, phenol or iodin should not be used, pure or in strong solution.

(7) Operations on the bladder or urethra are not dangerous or liable to be followed by abortion.

(8) Operations for vesicovaginal fistulae should not be done, as they are dangerous, and are liable to be followed by much hemorrhage and abortion.

(9) Plastic operations may be done in the earlier months of pregnancy with fair prospects of a safe and successful issue.

(10) Small polypi may be treated by torsion or astringents. If cut, there is likely to be a subsequent abortion.

(11) Large polypi removed toward the close of pregnancy will cause hemorrhage.

(12) Carcinoma of the cervix should be removed at once.

A few of the examples on record of operations during pregnancy of special interest, will be given below. Polaillon speaks of a double ovariotomy on a woman pregnant at three months, with the subsequent birth of a living child at term. Gordon reports five successful ovariotomies during pregnancy, in Lebedeff's clinic. Of these cases, 1 aborted on the fifth day, 2 on the fifteenth, and the other 2 continued uninterrupted. He collected 204 cases with a mortality of only 3 per cent; 22 per cent aborted, and 69.4 per cent were delivered at full term. Kreutzman reports two cases in which ovarian tumors were successfully removed from pregnant subjects without the interruption of gestation. One of these women, a secundipara, had gone two weeks over time, and had a large ovarian cyst, the pedicle of which had become twisted, the fluid in the cyst being sanguineous. May describes an ovariotomy performed during pregnancy at Tottenham Hospital. The woman, aged twenty-two, was pale, diminutive in size, and showed an enormous abdomen, which measured 50 inches in circumference at the umbilicus and 27 inches from the ensiform cartilage to the pubes. At the operation, 36 pints of brown fluid were drawn off. Delivery took place twelve hours after the operation, the mother recovering, but the child was lost. Galabin had a case of ovariotomy performed on a woman in the sixth month of pregnancy without interruption of pregnancy; Potter had a case of double ovariotomy with safe delivery at term; and Storry had a similar case. Jacobson cites a case of vaginal lithotomy in a patient six and a half months pregnant, with normal delivery at full term. Tiffany quotes Keelan's description of a woman of thirty-five, in the eighth month of pregnancy, from whom he removed a stone weighing 12 1/2 ounces and measuring 2 by 2 1/2 inches, with subsequent recovery and continuation of pregnancy. Rydygier mentions a case of obstruction of the intestine during the sixth month of gestation, showing symptoms of strangulation for seven days, in which he performed abdominal section. Recovery of the woman without abortion ensued. The Revue de Chirurgien 1887, contains an account of a woman who suffered internal strangulation, on whom celiotomy was performed; she recovered in twenty-five days, and did not miscarry, which shows that severe injury to the intestine with operative interference does not necessarily interrupt pregnancy. Gilmore, without inducing abortion, extirpated the kidney of a negress, aged thirty-three, for severe and constant pain. Tiffany removed the kidney of a woman of twenty-seven, five months pregnant, without interruption of this or subsequent pregnancies. The child was living. He says that Fancon cites instances of operation without abortion.

Lovort describes an enucleation of the eye in the second month of pregnancy. Pilcher cites the instance of a woman of fifty-eight, eight months in her fourth pregnancy, whose breast and axilla he removed without interruption of pregnancy. Robson, Polaillon, and Coen report similar instances.

Rein speaks of the removal of an enormous echinococcus cyst of the omentum without interruption of pregnancy. Robson reports a multi-locular cyst of the ovary with extensive adhesions of the uterus, removed at the tenth week of pregnancy and ovariotomy performed without any interruption of the ordinary course of labor. Russell cites the instance of a woman who was successfully tapped at the sixth month of pregnancy.

McLean speaks of a successful amputation during pregnancy; Napper, one of the arm; Nicod, one of the arm; Russell, an amputation through the shoulder joint for an injury during pregnancy, with delivery and recovery; and Vesey speaks of amputation for compound fracture of the arm, labor following ten hours afterward with recovery. Keen reports the successful performance of a hip-joint amputation for malignant disease of the femur during pregnancy. The patient, who was five months advanced in gestation, recovered without aborting.

Robson reports a case of strangulated hernia in the third month of pregnancy with stercoraceous vomiting. He performed herniotomy in the femoral region, and there was a safe delivery at full term. In the second month of pregnancy he also rotated an ovarian tumor causing acute symptoms and afterward performed ovariotomy without interfering with pregnancy. Mann quotes Munde in speaking of an instance of removal of elephantiasis of the vulva without interrupting pregnancy, and says that there are many cases of the removal of venereal warts without any interference with gestation. Campbell of Georgia operated inadvertently at the second and third month in two cases of vesicovaginal fistula in pregnant women. The first case showed no interruption of pregnancy, but in the second case the woman nearly died and the fistula remained unhealed. Engelmann operated on a large rectovaginal fistula in the sixth month of pregnancy without any interruption of pregnancy, which is far from the general result. Cazin and Rey both produced abortion by forcible dilatation of the anus for fissure, but Gayet used both the fingers and a speculum in a case at five months and the woman went to term. By cystotomy Reamy removed a double hair-pin from a woman pregnant six and a half months, without interruption, and according to Mann again, McClintock extracted stones from the bladder by the urethra in the fourth month of pregnancy, and Phillips did the same in the seventh month. Hendenberg and Packard report the removal of a tumor weighing 8 3/4 pounds from a pregnant uterus without interrupting gestation.

The following extract from the University Medical Magazine of Philadelphia illustrates the after-effects of abdominal hysteropasy on subsequent pregnancies:—

"Fraipont (Annales de la Societe Medico-Chirurgicale de Liege, 1894) reports four cases where pregnancy and labor were practically normal, though the uterus of each patient had been fixed to the abdominal walls. In two of the cases the hysteropexy had been performed over five years before the pregnancy occurred, and, although the bands of adhesion between the fundus and the parietes must have become very tough after so long a period, no special difficulty was encountered. In two of the cases the forceps was used, but not on account of uterine inertia; the fetal head was voluminous, and in one of the two cases internal rotation was delayed. The placenta was always expelled easily, and no serious postpartum hemorrhage occurred. Fraipont observed the progress of pregnancy in several of these cases. The uterus does not increase specially in its posterior part, but quite uniformly, so that, as might be expected, the fundus gradually detaches itself from the abdominal wall. Even if the adhesions were not broken down they would of necessity be so stretched as to be useless for their original purpose after delivery. Bands of adhesion could not share in the process of involution. As, however, the uterus undergoes perfect involution, it is restored to its original condition before the onset of the disease which rendered hysteropexy necessary."

The coexistence of an extensive tumor of the uterus with pregnancy does not necessarily mean that the product of conception will be blighted. Brochin speaks of a case in which pregnancy was complicated with fibroma of the uterus, the accouchement being natural at term. Byrne mentions a case of pregnancy complicated with a large uterine fibroid. Delivery was effected at full term, and although there was considerable hemorrhage the mother recovered. Ingleby describes a case of fibrous tumor of the uterus terminating fatally, but not until three weeks after delivery. Lusk mentions a case of pregnancy with fibrocystic tumor of the uterus occluding the cervix. At the appearance of symptoms of eclampsia version was performed and delivery effected, followed by postpartum hemorrhage. The mother died from peritonitis and collapse, but the stillborn child was resuscitated. Roberts reports a case of pregnancy associated with a large fibrocellular polypus of the uterus. A living child was delivered at the seventh month, ecrasement was performed, and the mother recovered.

Von Quast speaks of a fibromyoma removed five days after labor. Gervis reports the removal of a large polypus of the uterus on the fifth day after confinement. Davis describes the spontaneous expulsion of a large polypus two days after the delivery of a fine, healthy, male child. Deason mentions a case of anomalous tumor of the uterus during pregnancy which was expelled after the birth of the child; and Daly also speaks of a tumor expelled from the uterus after delivery. Cathell speaks of a case of pregnancy complicated with both uterine fibroids and measles. Other cases of a similar nature to the foregoing are too numerous to mention. Figure 13, taken from Spiegelberg, shows a large fibroid blocking the pelvis of a pregnant woman.

There are several peculiar accidents and anomalies not previously mentioned which deserve a place here, viz., those of the membranes surrounding the fetus. Brown speaks of protrusion of the membranes from the vulva several weeks before confinement. Davies relates an instance in which there was a copious watery discharge during pregnancy not followed by labor. There is a case mentioned in which an accident and an inopportune dose of ergot at the fifth month of pregnancy were followed by rupture of the amniotic sac, and subsequently a constant flow of watery fluid continued for the remaining three months of pregnancy. The fetus died at the time, and was born in an advanced state of putrefaction, by version, three months after the accident. The mother died five months after of carcinoma of the uterus. Montgomery reports the instance of a woman who menstruated last on May 22, 1850, and quickened on September 26th, and continued well until the 11th of November. At this time, as she was retiring, she became conscious that there was a watery discharge from the vagina, which proved to be liquor amnii. Her health was good. The discharge continued, her size increased, and the motions of the child continued active. On the 18th of January a full-sized eight months' child was born. It had an incessant, wailing, low cry, always of evil augury in new-born infants. The child died shortly after. The daily discharge was about 5 ounces, and had lasted sixty-eight days, making 21 pints in all. The same accident of rupture of the membranes long before labor happened to the patient's mother.

Bardt speaks of labor twenty-three days after the flow of the waters; and Cobleigh one of seventeen days; Bradley relates the history of a case of rupture of the membranes six weeks before delivery. Rains cites an instance in which gestation continued three months after rupture of the membranes, the labor-pains lasting thirty-six hours. Griffiths speaks of rupture of the amniotic sac at about the sixth month of pregnancy with no untoward interruption of the completion of gestation and with delivery of a living child. There is another observation of an accouchement terminating successfully twenty-three days after the loss of the amniotic fluid. Campbell mentions delivery of a living child twelve days after rupture of the membranes. Chesney relates the history of a double collection of waters. Wood reports a case in which there was expulsion of a bag of waters before the rupture of the membranes. Bailly, Chestnut, Bjering, Cowger, Duncan, and others also record premature rupture of the membranes without interruption of pregnancy.

Harris gives an instance of the membranes being expelled from the uterus a few days before delivery at the full term. Chatard, Jr., mentions extrusion of the fetal membranes at the seventh month of pregnancy while the patient was taking a long afternoon walk, their subsequent retraction, and normal labor at term. Thurston tells of a case in which Nature had apparently effected the separation of the placenta without alarming hemorrhage, the ease being one of placenta praevia, terminating favorably by natural processes. Playfair speaks of the detachment of the uterine decidua without the interruption of pregnancy.

Guerrant gives a unique example of normal birth at full term in which the placenta was found in the vagina, but not a vestige of the membranes was noticed. The patient had experienced nothing unusual until within three months of expected confinement, since which time there had been a daily loss of water from the uterus. She recovered and was doing her work. There was no possibility that this was a case of retained secundines.

Anomalies of the Umbilical Cord.—Absence of the membranes has its counterpart in the deficiency of the umbilical cord, so frequently noticed in old reports. The Ephemerides, Osiander, Stark's Archives, Thiebault, van der Wiel, Chatton, and Schurig all speak of it, and it has been noticed since. Danthez speaks of the development of a fetus in spite of the absence of an umbilical cord. Stute reports an observation of total absence of the umbilical cord, with placental insertion near the cervix of the uterus.

There is mentioned a bifid funis. The Ephemerides and van der Wiel speak of a duplex funis. Nolde reports a cord 38 inches long; and Werner cites the instance of a funis 51 inches long. There are modern instances in which the funis has been bifid or duplex, and there is also a case reported in which there were two cords in a twin pregnancy, each of them measuring five feet in length. The Lancet gives the account of a most peculiar pregnancy consisting of a placenta alone, the fetus wanting. What this "placenta" was will always be a matter of conjecture.

Occasionally death of the fetus is caused by the formation of knots in the cord, shutting off the fetal circulation; Gery, Grieve, Mastin, Passot, Piogey, Woets, and others report instances of this nature. Newman reports a curious case of twins, in which the cord of one child was encircled by a knot on the cord of the other. Among others, Latimer and Motte report instances of the accidental tying of the bowel with the funis, causing an artificial anus.

The diverse causes of abortion are too numerous to attempt giving them all, but some are so curious and anomalous that they deserve mention. Epidemics of abortion are spoken of by Fickius, Fischer, and the Ephemerides. Exposure to cold is spoken of as a cause, and the same is alluded to by the Ephemerides; while another case is given as due to exposure white nude. There are several cases among the older writers in which odors are said to have produced abortion, but as analogues are not to be found in modern literature, unless the odor is very poisonous or pungent, we can give them but little credence. The Ephemerides gives the odor of urine as provocative of abortion; Sulzberger, Meyer, and Albertus all mention odors; and Vesti gives as a plausible cause the odor of carbonic vapor. The Ephemerides mentions singultus as a cause of abortion. Mauriceau, Pelargus, and Valentini mention coughing. Hippocrates mentions the case of a woman who induced abortion by calling excessively loud to some one. Fabrieius Hildanus speaks of abortion following a kick in the region of the coccyx. Gullmannus speaks of an abortion which he attributes to the woman's constant neglect to answer the calls of nature, the rectum being at all times in a state of irritation from her negligence. Hawley mentions abortion at the fourth or fifth month due to the absorption of spirits of turpentine. Solingen speaks of abortion produced by sneezing. Osiander cites an instance in which a woman suddenly arose, and in doing so jolted herself so severely that she produced abortion. Hippocrates speaks of extreme hunger as a cause of abortion. Treuner speaks of great anger and wrath in a woman disturbing her to the extent of producing abortion.

The causes that are observed every day, such tight lacing, excessive venery, fright, and emotions, are too well known to be discussed here.

There has been reported a recent case of abortion following a viper-bite, and analogues may be found in the writings of Severinus and Oedman, who mention viper-bites as the cause; but there are so many associate conditions accompanying a snake-bite, such as fright, treatment, etc., any one of which could be a cause in itself, that this is by no means a reliable explanation. Information from India an this subject would be quite valuable.

The Ephemerides speak of bloodless abortion, and there have been modern instances in which the hemorrhage has been hardly noticeable.

Abortion in a twin pregnancy does not necessarily mean the abortion or death of both the products of conception. Chapman speaks of the case of the expulsion of a blighted fetus at the seventh month, the living child remaining to the full term, and being safely delivered, the placenta following. Crisp says of a case of labor that the head of the child was obstructed by a round body, the nature of which he was for some time unable to determine. He managed to push the obstructing body up and delivered a living, full-term child; this was soon followed by a blighted fetus, which was 11 inches long, weighed 12 ounces, with a placenta attached weighing 6 1/2 ounces. It is quite common for a blighted fetus to be retained and expelled at term with a living child, its twin.

Bacon speaks of twin pregnancy, with the death of one fetus at the fourth month and the other delivered at term. Beall reports the conception of twins, with one fetus expelled and the other retained; Beauchamp cites a similar instance. Bothwell describes a twin labor at term, in which one child was living and the other dead at the fifth month and macerated. Belt reports an analogous case. Jameson gives the history of an extraordinary case of twins in which one (dead) child was retained in the womb for forty-nine weeks, the other having been born alive at the expiration of nine months. Hamilton describes a case of twins in which one fetus died from the effects of an injury between the fourth and fifth months and the second arrived at full period. Moore cites an instance in which one of the fetuses perished about the third month, but was not expelled until the seventh, and the other was carried to full term. Wilson speaks of a secondary or blighted fetus of the third month with fatty degeneration of the membranes retained and expelled with its living twin at the eighth month of uterogestation.