Umbilical Cord

Anomalies and Curiosities of Medicine
by George M. Gould, M.D., Walter L. Pyle, M.D.

(Page 22 of 39)

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.

There was a case at Riga in 1839 of a robust girl who conceived in February, and in consequence her menses ceased. In June she aborted, but, to her dismay, soon afterward the symptoms of advanced pregnancy appeared, and in November a full-grown child, doubtless the result of the same impregnation as the fetus, was expelled at the fourth month. In 1860 Schuh reported an instance before the Vienna Faculty of Medicine in which a fetus was discharged at the third month of pregnancy and the other twin retained until full term. The abortion was attended with much metrorrhagia, and ten weeks afterward the movements of the other child could be plainly felt and pregnancy continued its course uninterrupted. Bates mentions a twin pregnancy in which an abortion took place at the second month and was followed by a natural birth at full term. Hawkins gives a case of miscarriage, followed by a natural birth at full term; and Newnham cites a similar instance in which there was a miscarriage at the seventh month and a birth at full term.

Worms in the Uterus. Haines speaks of a most curious case - that of a woman who had had a miscarriage three days previous; she suffered intense pain and a fetid discharge. A number of maggots were seen in the vagina, and the next day a mass about the size of an orange came away from the uterus, riddled with holes, and which contained a number of dead maggots, killed by the carbolic acid injection given soon after the miscarriage. The fact seems inexplicable, but after their expulsion the symptoms immediately ameliorated. This case recalls a somewhat similar one given by the older writers, in which a fetus was eaten by a worm. Analogous are those cases spoken of by Bidel of lumbricoides found in the uterus; by Hole, in which maggots were found in the vagina and uterus; and Simpson, in which the abortion was caused by worms in the womb - if the associate symptoms were trustworthy.

We can find fabulous parallels to all of these in some of the older writings. Pare mentions Lycosthenes' account of a woman in Cracovia in 1494 who bore a dead child which had attached to its back a live serpent, which had gnawed it to death. He gives an illustration showing the serpent in situ. He also quotes the case of a woman who conceived by a mariner, and who, after nine months, was delivered by a midwife of a shapeless mass, followed by an animal with a long neck, blazing eyes, and clawed feet. Ballantyne says that in the writings of Hippocrates there is in the work on "Diseases", which is not usually regarded as genuine, a some what curious statement with regard to worms in the fetus. It is affirmed that flat worms develop in the unborn infant, and the reason given is that the feces are expelled so soon after birth that there would not be sufficient time during extrauterine life for the formation of creatures of such a size. The same remark applies to round worms. The proof of these statements is to be found in the fact that many infants expel both these varieties of parasites with the first stool. It is difficult to know what to make of these opinions; for, with the exception of certain cases in some of the seventeenth and eighteenth century writers, there are no records in medicine of the occurrence of vermes in the infant at birth. It is possible that other things, such as dried pieces of mucus, may have been erroneously regarded as worms.