Fractures of the long bones have been ob served sometimes as the result of injuries sustained by the mother, but in other instances independent of any such cause, and apparently depending on some defect in their composition. I saw an instance in which a woman, when eight months pregnant, was precipitated from the second story of a house into the street, by which the hip-joint was dislocated, and she was otherwise much injured; she fell on her face, yet the uterus was not ruptured; labour came on that night, and the child was born dead with several of its bones broken : the woman recovered well. A case is quoted by Dugs on the authority of Carus, in which a woman fell on her belly and caused a fracture in the leg of the child, which was born with the fracture complicated with wounds in the soft parts ; gangrene supervened and detached entirely the fractured Marc/ relates a case, in which all the bones of the limbs and several others were found fractured, the mother nut having met with any accident, and having had an easy and quick labour ; the child was born alive and lived for some days : on examination after death the number of fractures were found to amount to forty-three, some of them just beginning to unite, and others almost com pletely consolidated.
In a case which occurred to Chaussier, in which also the labour was quick and easy, and the mother had not sustained any previous acci dent, the child was born alive and survived twenty-four hours; its limbs were malformed, and after death no less than one hundred and thirteen fractures were discovered in different conditions, some of them being already quite consolidated, while others were apparently quite recent.* Fractures independent of any external injury or defect of nutrition are supposed by some to be produced by violent spasmodic contractions of the fcetal muscles, which are capable of very energetic efforts, at a time when the fcetal bones have very little power of resistance. It appears reasonable to believe, that such spasmodic action of the muscles might be induced by causes violently disturbing the nervous system of the mother, since we know that such in fluences acting on a nurse will cause spasmodic and convulsive affections in the child at her breast ; and we further know, that even in the adult a quick muscular effort has been followed by fracture of a bone, but how far such analo gies are applicable to explain the lesion in question I would not pretend to determine.
A similar explanation has been supposed applicable to the instances of dislocations which have been discovered in the fcetus, and one in particular related by Chaussier appears to correspond to such a supposition. A young, delicate, and nervous lady, in the ninth month of pregnancy, suddenly felt such violent and rapid movements of the child that she was near fainting; these tumultuous motions were three times repeated in the course of ten minutes, and then there succeeded a perfect calm; the remainder of the pregnancy passed on well, the labour was easy, the child was pale and weak, and had a complete dislocation of the left fore-arm.t In another instance mentioned
by Marc there were found, in addition to congenital dislocation of both hip-joints, no less than seven other luxations.
But by far the most remarkable pathological lesion to which the fcetus in utero is subject, is that in which portions of its limbs are removed by a process which has been with propriety denominated spontaneous amputation.
This singular fact has been mentioned by several authors of credit, as Richerand,§ Desor ineaux,11 13illard,If and Murat,* though none of them appear to have witnessed any case of the kind themselves ; but they all agree in regarding it as simply the result of inflamma tion and gangrene. Haller evidently was not aware of any such case, for although he gives a long list of extraordinary mutilations of the foetus, he considers them aS the result of im perfect development or malformation, and not of separation or removal if parts alreadyformed ; for he expressly objects to the authors who have furnished such descriptions, that they cannot even quote one instance in which " mantis truncata, aliusve artus, in membranis icons seorsim a corpore, repertus sit.• I laving sought with diligence through authors, the only cases which I have been able to find are those which I shall now briefly mention.
In the 54th volume of the Loud. Med. Phys. Joum. Mr. Vatkinson states, that being in attendance on a lady twenty years of age in her first labour, which was natural and easy, he discovered, on the birth of the child, that the left foot had been amputated a little above the ankle, and the part was nearly but not quite healed, the bones protruding a little. The child was alive, but survived only a few minutes; on making further search the ampu tated foot was found in utero, and it, also, was nearly healed. There did not appear to have been any haemorrhage from the limb; the sepa rated foot was much smaller than the other ; it skewed no mark of putrefaction, but appeared to be in a state of perfect preservation, not being even discoloured. The mother had not met with any accident nor any particular mental emotion, and she was sufficiently independent to render unnecessary any over-exertion on her part. Mr. \Vatkinson offers no opinion on the nature or cause of the accident. The annexed sketch represents the condition of the parts.