In both the instances here before us, from the condition of the limbs and the impossibility of the parts under the ligatures continuing their growth under such circumstances, it could scarcely be made subject of doubt that had the children continued to live and grow, the parts of the limbs below the constriction would have separated, and so undergone spontaneous am putation.
The next case to which my attention was drawn was one very politely communicated to me by Dr. Tyson West, of Alford, Lincolnshire, in consequence of his becoming acquainted with my account of this matter. Dr. West attended a patient at the Westminster Lying-in Hospital in t805, who, after a natural and easy labour, gave birth to a still-born child which had but one leg, the other limb exhibit ing positive proof of having been spontaneously amputated some time before, the stump being partially healed and nicely rounded, about an inch and a half below the knee : the unhealed portion of the stump was about this size.
Ile accounts for the amputated portion of the limb not being found in conse quence of the occurrence of a most dangerous accident which threw all the parties concerned into great alarm and confusion ; hut lie adds that it struck him at the time, and lie is still of the same opinion, that the division of the limb was effected by some stricture round it.* When first announcing the discovery of this fact, in 1832,t I stated that the origin of these ligatures, and still more their application so as to stricture the limbs, were circumstances nn which I did not feel prepared to pronounce an opinion with any reasonable probability of its being satisfactory, and I am sorry that five years' additional consideration of the matter has not enabled me to solve the difficulty com pletely; but I am happy to find that, so far as I have ventured to point out a proximate cause of this singular phenomenon, my views have been assented to, and my explanation adopted, by all who have subsequently ex pressed their opinions on the subject, and especially by Professor Gurlt, of the Royal School of Medicine at Berlin, author of a work on pathological anatomy, (whose investi gations render him peculiarly qualified to form an opinion on such a subject,) who has written a commentary on my original paper,t in which lie adopts, as correct, my explanation of this curious fact, and, in addition, undertakes to account for the formation and application of the ligatures.
He commences his observations by rejecting in toto the notion of the agency of gangrene : his words are : " To explain this most re markable phenomenon, the utterly unfounded hypothesis has been formed, that these spon taneous separations are the result of gangrene, although there are no traces of it to be dis covered on the stump, it being actually, to a certain extent, healed, and no change of colour to be seen :" and he immediately adds, " a case lately observed by Montgomery of Dublin appears to contribute a natural explana tion of this remarkable fact, inasmuch as it indicates the cause of this separation." Ile then repeats the details of my first case, and proceeds to say lie " believes that both the formation of these threads, and the amputation of the limbs, which are most probably in all cases produced by them, may be explained by the history of the formation of the foetus." Ile then enters into a minute detail of facts well known to all who are acquainted with the mode in which the development of the iletus takes place, and observes, " I look upon these threads as prolongations of the egg mem brane from which the foetus grows, whether this skin (or membrane) be taken as the navel bladder or the amnion :" and he subsequently objects to their being considered as formed by organized lymph, which I considered them to be, and still remain of the same opinion.
The prolongations of the membrane, Gurlt thinks, are afterwards, by the constant motions of the foetus, twisted into slight but firm cords or threads, which may involve different portions of the foetal limbs, (as we sometimes find the umbilical cord several times round the neck, or other parts of the child's body,) so as to stricture them and cause their separation ; and in this way Professor Gurlt explains the presence of the ligatures concerned in the pro duction of spontaneous amputation. I dissent from this as a general explanation, for a reason presently to be stated ; but it is only justice to the author to mention that the condition of both the children which I examined was in other respects such as favours his theory, for whenever such unnatural adhesions take place between the amnion and the foetus, they give rise to a monstrosity of a peculiar kind, and this is observable in both these cases, and in others also : in one there is protrusion of the brain and monstrous formation of the head in other respects ; and in the other the liver, stomach, and great part of the intestines were contained in a hernial sac, external to the body. But notwithstanding the support thus derived from analogy, there is one circumstance which appears final to the explanation when applied to the first case described by me, which is, that in all cases where these membranous con nections have been observed giving rise to monstrosity, one end of the cord or thread like band has always been found attached to the amnion, and the other to the foetus, but here both ends of the cords are attached to the limbs, and afford no evidence of having been connected with the amnion ; and it was for this reason that I abstained at first from offering the explanation now proposed by Pro fessor Gurlt, which I then thought, and still consider inapplicable to the specimen which I was then describing, and equally, or perhaps still more so, to that described by Zagorsky, to be mentioned presently, see fig. 159 ; though, at the same time, I am quite ready to admit that ligamentous bands so formed would be fully adequate to the accomplishment of such an effect : and I now know also that strictures from another source, and which from their nature must possess very little constricting force indeed, are in some instances found sufficient so completely to act on and indent the limb, that, could their action be con tinued, which, however, is scarcely possible, they might ultimately induce a similar mutila tion. While I was engaged in committing these observations to writing, I received a most interesting preparation from Dr. \V. 0'11. Adams, in which the coiling of the umbilical cord round the left leg of the foetus at three months had deeply indented it, as represented in the subjoined fig. 157. here, it will be observed, at least three-fourths of the thick ness of the limb are divided by the pressure of the umbilical cord, which was coiled around it, and which, both in this and fig. 158, is removed from the strictured part where it originally lay, in order to show more distinctly the effect produced by it.