Chaussier also attributes the accident to gan grene as the cause which would most obviously account for its production, though it does not appear from his account that there were present any of the pathological evidences of that con dition ; and in the case first related the child was born alive, and it is expressly mentioned that neither the stump of the limb nor the part amputated spewed any symptom of disorganiza tion or disease, not being even discoloured.
The next case was one occurring in my own practice, and appears to me of great importance as exhibiting the amputation absolutely in pro gress, under the influence of the agent which I believe to be the general, and, most probably, the invariable cause of its occurrence.
About eight years since I attended a patient under circumstances of considerable danger from htemorrhage attending abortion in the fifth month, and on the expulsion of the firms its singular conformation fortunately attracted my attention strongly, and induced me to examine it with care. The head was misshapen and monstrous, the brain covered only by integu ment, and towering upwards like a helmet over the head; but the circumstance deserving of especial notice was the appearance of com plete ligaments surrounding the limbs, and on examining them closely I found that they con sisted of distinct threads, passing from both hands downwards to the legs (seefig.155); at one end, Chaussiert mentions having examined two cases in which separation of a part of the fore arm had taken place before birth, and in a third case he found the separated portion of the arm and hand lying apart, and the stump of the limb healed.
each of these threads or fine cords had formed a complete ligature round the middle of each hand, causing a distinct depression where it passed, the part of the hand below it being almost completely undeveloped. From the hands those cords descended towards the legs, which were crossed, and surrounding them in this position just above the ankles, compressed them so tightly that fully two-thirds of their whole thickness were thereby divided, without, howecer, causing any breach in the skin ; nor was there the slightest appearance of disease or even discolouration of any of the parts, but the feet were, like the hands, imperfectly deve loped and misshapen. The mother was about
twenty-five years of age, and was at the time labouring under fever, but had been previously in perfectly good health, and had not met with any accident either in the way of bodily injury or mental agitation.
About four years after the occurrence of the case just detailed, another was brought under my observation through the kindness of Dr. J. Labatt.
A healthy woman gave birth to a still-born child in the eighth month of gestation ; it was affected with an umbilical hernia of great size, formed by the protrusion of the liver, stomach, and small intestines, but the state of the limbs is the point of interest connected with our inquiry : both were misshapen, and, as hap pened in Mr. Watkinson's case, the left exhibits this remarkable pathological lesion, and exactly in the same situation. Just above the ankle there is a deep depression all around the limb, and sinking to such a depth as to leave only the hones and skin unaffected by it, the diameter of the undivided part being less than half an inch, while that of the leg, just above the depression, is an inch and a quarter. The appearance of the groove is exactly such as would be made by tying a string very tight round the plump limb of a child, and in my opinion could not have been produced in any other way. The part had been very much handled and examined by several before I saw it, so that I was not surprised at not finding any ligature on the limb, but the mark of it was so distinct in the bottom of the depression as to leave no doubt of its previous existence there having produced the constriction of the part. It is important also to observe, as con firmatory of this view of this matter, that the integuments arc not at all broken or divided, but are merely carried inwards with the con stricting agent, so that, had the separation of the limb been completed, each stump would appear skinned over, except at the ends of the bones, and so present the appearance of being partially healed, as described by both Watkin son and Chaussier: the foot was a little swollen and somewhat discoloured ; it seemed turgid with blood, but was without any appearance whatever of gangrene.