Page images
PDF
EPUB

The patient was enormously large and I ap. prehended twins. She was like the teutonic gentleman, whose abdomen was so gross that he was obliged to ask the boot black if his shoes needed polishing, not being able to see over his ponderous belly.

Several hours having elapsed and the pains becoming almost incessant, I ruptured the water bag and was surprised at the great flow of amniotic fluid. The patient said, "I am wet up to my shoulders." There must have been two or three times the normal quantity. Now the abdomen became unusually small and she was enabled to see her feet; also the fear of twins vanished.

[blocks in formation]

discharging a large mass of dark clots, evidently blood.

For the reader to form a correct idea how the monstrosity looked I refer him to Fig. No. 1.

This represents the exact manner that it came into the world. A face presentation, changed to this by the blades of the forceps and manipulation from the presentation previously described. The appearance was most hideous when it came into view, as the reader can appreciate by examination of the accompanying cuts. I carefully guarded the monstrosity that the mother should not see it, and had the husband carry it out of the room wrapped in a towel. I never allowed her to see it, though she much desired to do so. Careful examination revealed that there were

[graphic]

side of the vagina, appearing to the touch like the placenta. I carefully explored and found that the growth was attached to the back of the neck. I now examined further and found that my finger passed into the mouth on the left side of the soft parts directly opposite the tumor. I could find no sutures or fontanelles, and having outlined the gums and felt the tongue, I explained to the family, aside from the patient, that I feared a deformity or monstrosity, and that I should advise the application of forceps, as there seemed no progress in the labor. I had no difficulty in applying the forceps, but was obliged to labor long and patiently before the fetus could be forced down low enough to unlock the forceps. Fearing rupture of the perineum, I did this, and three or four powerful pains brought the "imp" away, the large sack previously rupturing, and

no perfect vertebræ, no parietal bones, no frontal bone, except a narrow portion in the forehead; no occipital, except a rudimentary portion at the base of the skull; very small portion of temporal; rudimentary ears (pinnæ and auditory canal); No perceptible brain matter; no membranes of the brain; open spinal canal down to the last lumbar vertebra, this vertebra being the only one that could be detected, and that with no processes. This vertebra was not covered with integument; the ribs and chest bones were all pushed into a heap, and the sternum and upper chest wall was continuous with the inferior maxilla, throwing the face upward; the eyes were not formed, i. e., the globes, not the lids, only two sockets, covered by thin membranes. See Fig. 1.

Before I had the photograph taken I stuffed the spina bifida sack with cotton, but could

not make it appear as large as it should have done, owing to the walls of the tumor being so frail. By examining Fig. 2 you will discover a talipes of the left foot, also, non development of the soft tissues of the left leg. The absence of the spine is shown in Fig. 2; also the concavity covered by the membranous sack.

From a careful estimate of the time, I conclude that the mother carried this "imp" for at least ten months and a half.

I was engaged to attend her by the husband at least two months prior to the time she was confined, and he told me the time would be up in two weeks. Thus the mother's calculation, dating from the time her menstrua ceased,

born and she saw the tumor she exclaimed, "Oh! the intestines of the goat?" The tumor was an encephalocele.

Dr. W. E. Ground, of Wisconsin, further corroborates my position by the following statement in the Medical Standard: He says, "There was a large amount of amniotic fluid, but no other item of special importance in the case of labor." The Doctor's case was like mine in this particu'ar. His "imp weighed about five pounds," about the weight of the one above described. "The meninges and a small amount of brain matter occupied the cavity of the cranium."

"The monster was temporarily placed in the

[graphic]

must have been three hundred and fifteen days. I learned from the mother of the lady con. fined that her husband took home an artifici. 1 rubber snake about two months after she became pregnant, and playfully sprang the reptile in her face, frightening her nearly into convulsions. I believe that this was the cause of the malformation. They had been married seven years, and this was the only time she had become pregnant. The sex of the fetus was

female.

[ocr errors]

Maternal impressions are, no doubt, well proven. Dr. Spitzka strongly maintains this view; he says: "There is a potency to produce aberrant development." A case is recorded in point in the May number of the Medical Standard by Dr. S. R. Thompson: "The mother, when five months pregnant, saw her husband dive his knife into the abdomen of a goat, which had been slaughtered, and the sight of the suddenly protruding visceral mass so shocked her, that she fell back, clutching the nape of her neck. The impression haunted her for some time, and when the child was

[graphic]

Jacob was a genius of no mean order, as it is said of him in the Book of Genesis, xxx chapter, beginning at the 37th verse, "And Jacob took him rods of green poplar, and of the hazel and chestnut tree, and pilled white strakes in them, and made the white appear which was in the rods.

"And he set the rods which he had pilled before the flocks in the gutters in the watering troughs when the flocks came to drink, that they should conceive when they came to drink. And the flocks conceived when they came to drink before the rods, and brought fourth cattle ringstraked, speckled and spotted."

It would seem that if animals which are much duller than the human being could be influenced by such influences as above detailed, certainly the intense shock given to pregnant women could but interfere with the process of fetal development, which all know is carried. on in such a delicate manner, through nerve and blood forces, so intimately related to the parent in every way.

The student of embryology, no doubt, has read the work of Ambrose Pare, translated by Tho. Johnson, 1579, of monsters and prodigies. Many, no doubt, have read the opinion of more modern embroyologists, viz., Reaumer, Dareste, Panum, Schroke, Symkiewicz, Schenck, Hunking and Marion Humes. These authors, These authors, or contributors to science, have shown many interesting facts relative to abnormal development brought about by interfering with nature's laws, of the procreation of certain of the animal species. If mental and moral peculiarities are transmitted to children through three or four generations, why not admit the possibility of interference of the development of the physical, knowing that the mind so impressed the body through the passions, anger, sorrow, joy, etc, even to cause death. The fear of some fatal disease, such as cholera, has caused the disease and death. Men have died from sup. posed hemorrhage; only water trickling upon their arms and their minds impressed with the dea that a vein had been opened, caused them to gradually pass into unconsciousness and inal dissolution.

[blocks in formation]

An Interesting Case of Laparotomy. EDITOR MEDICAL WORLD:-On the 18th of February, 1892, I was called to see a patient with Dr. A. S. Reever, of Belleville. The patient had applied to Dr. R. on the 15th complaining of belly ache. Dr. R. gave him an opiate for immediate relief of his pain. This was vomited up, as were also medicines given to move his bowels; and the only relief obtained was from the hypodermic use of morphine. This plan of treatment with enemata was pursued for several days; at first there was little or no constitutional disturbance, but each day the bowels became more and more tender and swollen, with a more and more frequent pulse, and corresponding rise in temperature, but with no motion from his bowels.

When I saw him on the afternoon of the 18th the temperature had fallen to about 95°, his pulse was about 170 per minute, his skin was cold and clammy, and he complained of feeling too hot, and he wanted to be constantly fanned. The abdomen was very much swollen, but not tympanitic except over the epigastric region; elsewhere it was dull on percussion, and very tender everywhere, but with no special point of tenderness. His condition was certainly very unpromising. He was an unusually well-developed boy of sixteen years, with strongly marked vitality. He had for some days before his sickness been eating very freely of dried grapes, which was supposed to have caused the obstruction of his bowels. Feeling satisfied that in his present condition he could live but a short time, with the consent of his family, I decided to give him the benefit of the chance of laparotomy. Not having any very clear idea as to what I should find, or what I should do, I opened the abdomen by an incision in the median line, from the umbilicus to the pubis. Upon opening the cavity there was a gush of fluid of the appearance and consistency of pea soup, but with a decided fecal smell. In this there were small particles of a brownish matter floating, which upon being squeezed between my fingers seemed to be fecal matter. After cleansing the abdominal cavity as well as possible, the wound was closed with a drainage tube in the lower edge of the cut, for drainage and washing out the cavity. The wound was closed by three rows of stitches; a deep row of silver stitches, the peritoneum closed with a continuous cat gut suture, and a spherical row of silk stitches in the skin. The wound was dressed with iodoform and a compress and bandage around the body. The boy rallied from the operation nicely, and progressed favorably toward recovery until the 25th, when against orders, and in the absence of the nurse, he got out of bed, and used a chamber pot by sitting on it to have a move

ment from his bowels. I should have said before that his bowels moved freely the day after the operation, and continued to act freely. The bandage around his body had become loose, and in his straining at stool the stitches all tore loose, the wound gaped open and the bowels protruded. He was seen not long after this by Dr. Keever, who replaced the bowels, and brought the edges together, and secured it as well as he could with adhesive plaster. I saw the boy again on the morning of the 25th. At that time the wound was gaping wide open, the adhesive plaster having slipped. The bowels were fully exposed lying in the bottom of the wound; they had formed pretty firm adhesions to the side of the cut. He was again put under the influence of chloroform, and the edges freshened by the knife and scissors, the adhesions between the cut and the intestines torn loose by my fingers. I then sewed it up again, putting in deep silver sutures, which I entered about an inch from the edge of the cut, and bringing them out about the same distance on the other side. I applied these as quilled sutures and took everything in their grasp. For the quills I used bone crotchet needles, twisting the wire around these needles so that if they should cut the tissues the wire could be loosened. I then brought the deep tissues, including the peritoneum, together, with a continuous cat gut suture, and closed the wound with superficial silk sutures, putting the drainage tube in again. The wound was again dressed with iodoform, covered with a large compress of absorbent cotton, and a firm abdominal bandage placed over all. The boy was put to bed in a better condition than after the first operation. He reacted well, and again made steady recovery for ten days, when I was informed by Dr. Keever that he had again ruptured the stitches, and that he did not think anything more could be done . for him. Several days thereafter, when I was expecting to hear of his death, I learned from Dr. Keever that not being willing to "let him die with his guts out" he had sewed him up again, and that he was doing very well, with a fair chance of recovery. The sequel of the case is that the boy continued to do well and finally recovered. The boy was a very intractable subject, and there was a continued tendency of the stitches to cut out. The tendency of the wound to reopen was met by the use of adhesive plaster placed on opposite sides of the cut, with eyes, (such as are used in ladies dresses) sewed to the sides and laced with rubber bands (such as are used for binding letters or bundles of papers) across the wound, and this reinforced by a firm abdominal bandage. The drainage tube was kept in and used for several weeks to wash out the abdominal cavity from which

there was a continuous discharge of pus, which in a few days after the first operation lost its fecal odor. The abdominal cavity was washed out several times a day with a saturated solution of boracic acid. With the movement of his bowels the day after the first operation his temperature came a little above normal and remained so, except that there was a sharp rise at each successive reopening of the wound. His appetite was good-too good, for there was difficulty in restraining it.

His recovery under all the circumstances is remarkable, and is largely due to the care and attention given him by Dr. Keever, under most discouraging circumstances. As to the pathol gy, it is hard to say just what was the condition of things. The intestines were all cov ered with a fibrinous effusion and glued to gether. The peritoneum was deeply congested and inflamed. I did not think it prudent to make a thorough search. What was the meaning of the small brownish particles found floating in the foul pea-soup like effusion which filled the cavity? Upon mashing them they looked, felt and smelled like feces. If they were fecal particles where did they come from? I suspected an ulcerative perforation of the vermiform appendix, but did not think it best to press the search under the circumstances, preferring to trust to the general reparative powers of nature, rather than to turn out the bowels, break up all the adhesions, and find the leak, (which, if I were correct in my hypothesis, nature had already closed), especially in the almost collapsed condition of the boy.

Parkersburg, W. Va.

T. A. HARRIS, M. D.

Practical List of Forty-Eight Remedies Suitable for the Pocket Case.

Being aware that the Philadelphia Dosimetric Company had offered a prize for the best list of forty-eight remedies, in the granule form for the pocket case, we obtained the privilege of placing some of the best of these lists before our readers, as they convey a great deal of interesting and useful information.

We give first the list sent by Dr. Wesselowski, of Kansas. We shall publish in subsequent numbers the lists prepared by Dr. Hardwick, of Kentucky, and Dr. Dumas, of Arkansas.

[blocks in formation]
[blocks in formation]
[blocks in formation]

EDITOR MEDICAL WORLD:-In answer to your "Problem" on page 33; Quiz Dept, I would say as follows:

Dr. B. sends in his bill for all he has done, and a consultation fee.

Drs. A. and B. both should consult together as to the cause, &c. of death, and then Dr. A. make out the death certificate, and his own bill regardless of Dr. B's. bill. Each man should make out his own bill. Dr. A., having been the physician who treated the case, has not lost his control of the case. Dr. B. was called in emergency, and should collect his bill, and let Dr. A. make the death certificate.

Bedford, Iowa. M. C. CONNETT, M. D.

« PreviousContinue »