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causes favored its spread. Average temperature of springs about 60° F I can say nothing of post-mortem appearances, as I know of no post obit inspections.
From what I saw, and what I learned of the results of practice in the hands of others, I am satisfied the disease was more fatal with females than males.
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Three of my cases died from other causes; one from bronchial irritation supervening, two others from being complicated with whoopingcough and consequent debility.
Of the sixty-four cases here reported, fifty-five were attended by me as principal physician. Of this number six died. Of the nine others, only seen as consulting physician, six died.
III. CONGENITAL MALFORMATION.
By F. E. H. STEGER, A. M., M. D.
DURING the summer of 1855 I was requested to visit a lady, Mrs. P., who had been married about twelve months. She was of middle stature, about nineteen years of age, sanguine-nervous temperament, and her health before marriage had been uniformly good. She had been accustomed to take a good deal of exercise, which had rendered her system vigorous and healthy. Her husband, while on my way to visit his wife, informed me that she was advanced in pregnancy about eight months; that she had become much emaciated, and was much depressed in spirits. He informed me that a most distressing circumstance had occurred to her some months previous to my visit, which had produced a mental shock, from the effect of which she could not rally. She being alone one evening, looked out from their little cottage, and saw a sow bringing forth a litter of pigs, surrounded by other hogs, which had eaten several,
and had begun to tear them away and eat, before fully born. She ran out and attempted to relieve the sow, by driving her to a place of secu rity, but failed, became much fatigued, and returned to the house to witness a repetition of the same occurrence, until the unfortunate animal became so lacerated by her tormentors that she died in a few hours, and shared in part the fate of her offspring. This circumstance, he assured me, had effected a great change in the mental condition of his wife, and he expressed his fears of the ultimate result.
I found his wife emaciated, pale, and exceedingly nervous, not disposed to talk; would answer my questions in monosyllables; had lost her appetite; sleep disturbed by frightful dreams, in which she saw the most horrible images passing in ghastly array before her; and her physical system had become so feeble, that she could with difficulty walk about the yard.
I continued to question her, until she declared most emphatically that the occurrence related to me by her husband was the cause of her present unfortunate condition; that she deeply regretted it, having produced so much physical suffering and mental anguish, and was fully persuaded that it must finally terminate in the death of her infant, and probably her own.
She assured me that it always hung as an incubus upon her; during the day it was never absent from her mind, and at night, in her dreams, it assumed the most horrid forms, from which she often awoke trembling and exhausted. She said she had sought the company of her former companions, with whom "the charmed hours had fled uncounted," but now their converse only tended to make her more melancholy, for in her mind brooded one continued apprehension of impending evil.
I attempted to quiet her perturbation of mind, by assuring her that her fears were not well founded, for within the whole country around, as far as she knew, scarcely one woman in a hundred is so unfortunate as to lose her life or that of her infant in delivery, and in a great majority of cases neither difficulty, danger, nor delay need be apprehended. I assured her that it was usual for melancholic persons to look on the dark side of every picture presented, of occurrences in real or imaginary life, and our imaginary troubles are more difficult to bear with fortitude than our real, being infinitely more numerous. I ordered her to take moderate exercise daily in the open air, with cheerful and agreeable company, a more generous diet, occasionally an aperient, and Sulph. Morph. at night, to induce sleep.
There was but slight improvement in her general condition during the period that elapsed until I was summoned to attend her, about twelve
o'clock at night, and found her in labor. She gave birth to a child about sunrise, and her former gloomy apprehensions were but too well founded.
The perineum of the infant was cleft from the symphysis pubes to the os coccygis, in nearly a direct line, and the greater portion of the bowels protruding, surrounded by the peritoneal sac. I attempted to return. them, but adhesions were so firm that I found it impossible. Otherwise the child was well formed, and from physical signs I was satisfied that it could not have been a premature birth. It continued to breathe about two hours.
Was this deformity purely accidental, or was it the result of the circumstances which I have detailed? We too frequently place in the chapter of accidents (merely for convenience' sake,) what is difficult of solution, as though the world would be materially enlightened by our very sage classification. I apprehend that in the moral, intellectual, or physical world, such an occurrence as an accident is impossible, as whatever happens must be the result of some cause, whether known or shrouded in impenetrable mystery. Every thing above us and beneath us moves on in harmony, governed by unchanging laws. The raindrop, descending from the clouds, reaches the earth, having described its curve through the air, marked out for it by the opposing forces, wind and gravitation, as unerringly as the earth performs its circuit around the sun. Every drop of water that leaps over the falls of Niagara is bound by laws to fall at a destined spot; and so the beautiful harmony that regulates and governs our complex system, the waste and replenishing of tissues and organs, are not the results of chance, but of causation.
An ovum, quickened by spermatozoa, and protected by the admirably arranged uterine organs of the mother, under the action of the vital laws, will ordinarily in nine months attain such a perfectibility of organization as to enable it to maintain an independent existence; but the beauty, health, and conditions absolutely necessary to its future life may be greatly modified by a thousand external circumstances that may affect the mother during the period of gestation.
Dr. Pritchard says, "The opinion which formerly prevailed, and which has been entertained by some modern writers, among whom is Dr. Darwin, that at the period when organization commences in the ovum, that is, at or soon after the time of conception, the structure of the fœtus is capable of undergoing modification from impressions on the mind or senses of the parent, is contradicted at least by no fact in physiology. It is an opinion of very ancient prevalence, and may be traced to so
remote a period that its rise cannot be attributed to the speculations of philosophers; and it is difficult to account for the origin of such a persuasion, unless we ascribe it to facts which happened to be observed." (Vide Pritchard, Researches, etc., vol. ii., p. 556.) This position of Dr. Pritchard appears to me to be sustained by evidence sufficient to place it beyond doubt, if we examine the gradual development of the foetus in utero alone.
The microscope plainly shows us that at first the embryo is not like the adult animal in any respect; the resemblance grows as development goes on; the presence of one organ determines the presence of another; and in the earlier stages we cannot tell whether the embryo is that of a fish, a reptile, a bird, or a mammal, much less what kind of fish, reptile, bird, or mammal.
Wolff demonstrated the great law of epigenesis, by which the parts of an animal are made one after another, and out of the other, so that each organ may be considered as a secreting organ with respect to the others. Treviranus subsequently adopted this idea of each organ having, as it were, a secretory function with respect to the others; and Mr. Paget has luminously expounded it in his masterly Lectures on Pathology.
The first discoverable organs formed from the ovum are the result of organized material derived from the mother, themselves a nucleus around which adjacent organs must similarly form, until the foetus becomes entire in its organization. Thus we see the little tiny human being dependent on its mother for material for enlargement, while the quality and quantity of that material are regulated by impressions made on the mother, and often the impress of her sensitive nerves is stamped unmistakably on the undeveloped foetus.
A talented and finely educated young gentleman of my acquaintance, speaking of this subject, assured me that, some months before his birth, his father had a rencontre with a gentleman, was dangerously stabbed, and was near dead from loss of blood, when his mother, not aware of his critical condition, approached him. She was greatly shocked, yet continued her unremitting attentions to her husband until he recovered, and could not after banish from her mind his pale and languid appearance. She assured him that she feared it would affect her child, and often repeated the apprehension. This young gentleman from infancy, enjoying good health, has been exceedingly pale and colorless.
Plutarch speaks of a family in Thebes, every member of which was born with the mark of a spear-head on his body. Dr. Combe relates the following case which fell under his own observation: "W. B., a shoemaker in Portsburgh, called and showed him his son, aged 18, who
is in a state of idiocy. He is simple and harmless, but never could do any thing for himself. His father said that his wife was sound in mind; that he has other three children, all sound; and that the only account he could ever give of the condition of this son was, that he kept a publichouse, and some months before the birth of this boy, an idiot lad came round with a brewer's drayman, and helped him to lift the casks off the cart; that that idiot made a strong impression on his wife; that she complained that she could not get his appearance removed from her mind, and that she kept out of the way when he came to the house afterward; that the son was weak in body from birth, and silly in mind, and had the slouched and slovenly appearance of the idiot." (Vide Combe, 373.)
Sir Everard Home mentions a case, fully establishing the position assumed, that of a thorough-bred English mare, who, in the year 1816, had a mule by a quagga, the mule bearing unmistakable quagga marks. In the years 1817, 1818, and 1823, this mare again foaled, and although she had not seen the quagga since 1816, her three foals were all marked with the curious quagga marks.
Meckel, Blumenbach, and Orton, have given similar and striking cases. I know a lady, Mrs. who several years ago, while at church, pregnant with her first-born, saw a lady whose features are very striking and peculiar. Mrs. continued to gaze upon her as though mesmerized, and after she returned home, the image had so fixed itself on her mind, she could not for a moment evade it; during the solitary hours of night it was daguerreotyped in her mental vision, distorted and frightful, and for months continued to afflict her. Mrs. 's first-born had the features of the lady caricatured, yet a striking resemblance, which has become yet more striking with age. The ladies alluded to are very unlike, no resemblance in complexion or feature, and no relationship existing between the families.
The following quotation from the London Medical Gazette, September, 1832, affords an example of the effect on the children of unfavorable physical circumstances operating on the parents previous to birth. "There is about Paris a number of beggars, twelve or thirteen of them at least, all deformed in various ways, and all born at Lille, in certain dark caverns under the fortifications. The effect of these places, from their want of light, producing malformed births, is so notorious, that the magistrates of Lille have issued orders to prohibit the poor from taking up their abodes in them."
From a careful investigation of the subject under consideration, I come to the conclusion, that circumstances affecting the mother greatly affect the foetus in utero, and determine its beauty, perfection, health, and