Within the last few months another instance of the same effect produced by the same agent just above the left knee of a fcetus at about the same period of growth, occurred with a patient of the writer's, and under his imme diate observation, as shown in the annexed figure, 158.
I am very much disposed to believe that Morgagni witnessed a fact of this kind ; at least his description of the appearance in a monstrous foetus between the fifth and sixth month, greatly resembles it, of which he says, " All the limbs were in a very bad state, the upper limbs from the elbows downwards ; for to the arms, which were very short and distorted, distorted hands were likewise added. And the inferior limbs terminated, likewise, in distorted feet, but the left leg was either broken from the funieulus umbiliealis having been ap plied round it, or was more distorted than the other parts :"* and he afterwards, with great reason, conjectures that the binding of the cord round the leg may have been the cause of the child's death, by interrupting the circulation through it. It is a very ex traordinary fact, that in every one of these cases, as well as in several others, the injury was sustained by the left extremity.f In the course of the last year Dr. Simpson of Edinburgh published an excellent paper on this subject;/ into which he has collected a vast quantity of curious information and many most important cases from authors, to which he has added not a few from his own obser vation, together with several highly apposite remarks ; and I am happy to find that he also assents to, and, indeed, strongly confirms my view both as to the agent which produces the change and its consisting of organized lymph, sneh as is usually elaborated under the influence of inflammatory action, from which it is well known that several varieties of foetal deformities arise;'" and it is a matter of every day ob servation how completely lymph so effused will be converted into distinct firm threads, uniting opposite serous surfaces, especially those which move freely on each other, as the pleurae and the peritoneal coverings of the ab dominal visceral From the eases referred to by Dr. Simpson, I shall now notice three which appear more particularly illustrative of the true nature of this remarkable lesion, and confirmatory of my original account of it.
Zagorsky has described/ a malformed foetus of the fifth month, which, in addition to several other deformities, was deficient of the right leg, the thigh ending in a rounded and cicatrized stump, in the centre of which was a small projecting point: from this was prolonged a slender thread-like membrane, strong in pro portion to its size, that ran directly across to the left leg, which it encircled, a little above the ankle, like a tightened ligature, see jig. 159, and formed in it a depression of considerable depth, while the portion of the extremity below the ligature was, as well as the appended foot, rather tumefied. From about the middle of the transverse thread-like membrane a small body of an oblong form was suspended, which, on examination, proved to be the right foot perfectly formed, as its general outline and five toes demonstrated, but not larger in size than the foot of a foetus of the tenth or twelfth week.
Beclard mentions§ the case of a very de formed hydrocephalic foetus, whose left leg was divided by a transverse depression that pene trated as deep as the bones, and resembled that which would have been produced by a tight ligature. The two opposite surfaces of this
indentation were both eieatrized, and almost touching one another. " It is evident," says Beclard, " that if this foetus had remained in utero for some time longer, it would have been born with an amputated and cicatrized leg, the remains of which might have been found in the liquor amnii." Albert F. Veld quotes a case from Froriep's Notizen, Bd.xii. p. 26, of a ftetus " whose left foot was separated, during pregnancy, from the bone, and the fore foot was born by itself; quite healed." The following case was recently published in the American Journal of Medical Science, by Dr. F. P. Fitch of New Boston. On the 17th March a healthy woman, then in the seventh month of pregnancy, suddenly discharged the liquor arnnii. On the 21st a substance escaped from the vagina, which proved to be a perfectly well-formed fcetal foot, apparently separated at the ankle-joint, and in a complete state of pre servation. On the 5th April she was delivered of a seven-months' child, which lived about half an hour. At the left side of the centre of the forehead there was a horny protuberance of the size of the middle finger; the face, also, was greatly deformed. Upon the foot, the place of separation was contracted to the size of a small pin's head, and the healing process had apparently been as perfect, and progressed very nearly as far as that on the lower extre mity of the limb.t Within the last few months a child of a month old was brought to me from the county of Westmeath, in consequence of its having been born deprived of the left hand. On exa mination I found the forearm of that side pre senting, a little above the wrist, the appearance of a perfectly well-formed stump, as it would be found after amputation by the surgeon's knife; with this difference, however, that the mark of cicatrix did not extend across the stump, but was confined to a small circular depression In Its centre; the child was other wise quite perfect and healthy. Unfortunately I could not obtain any information as to whe ther the hand had been found at the time of delivery or not, the poor woman having been attended only by an ignorant country midwife. Three cases, very similar to the above, are de scribed by Dr. Simpson.* I feel almost convinced that the removal of limbs in this way is by no means so uncommon an occurrence as the paucity of eases hitherto recorded would, at first sight, lead us to con clude ; but the reason appears to me to be this, when the separated portion of limb was not accidentally discovered, the imperfection seems to have been considered quite as a matter of course, and without further examination, as arising from imperfect development or monstro sity, and, consequently, no search was made for the deficient part ; and, even if search was made, the amputated member might have been so small as to escape undiscovered, involved in the membranes, or buried in coagula ; even though the child to which it belonged had at tained considerable size, because its separation may, as we have seen, take place a consider able time previous to birth; this is noticed in Mr. Watkinson's case, and is still more stri kingly exemplified in that described by Zagors ky, see fig. 159.