Birth Through Perineal Perforation.--Occasionally there is perineal perforation during labor, with birth of the child through the opening.

Brown mentions a case of rupture of the perineum with birth of a child between the v.a.g.i.n.al opening and the a.n.u.s. Ca.s.sidy reports a case of child-birth through the perineum. A successful operation was performed fifteen days after the accident. Dupuytren speaks of the pa.s.sage of an infant through a central opening of the perineum. Capuron, Gravis, and Lebrun all report accouchement through a perineal perforation, without alteration in the sphincter ani or the fourchet. In his "Diseases of Women" Simpson speaks of a fistula left by the pa.s.sage of an infant through the perineum. Wilson, Toloshinoff, Stolz, Argles, Demarquay, Harley, Hernu, Martyn, Lamb, Morere, Pollock, and others record the birth of children through perineal perforations.

Birth Through the Abdominal Wall.--Hollerius gives a very peculiar instance in which the abdominal walls gave way from the pressure exerted by the fetus, and the uterus ruptured, allowing the child to be extracted by the hand from the umbilicus; the mother made a speedy recovery. In such cases delivery is usually by means of operative interference (which will be spoken of later), but rarely, as here, spontaneously. Farquharson and Ill both mention rupture of the abdominal parietes during labor.

There have been cases reported in which the recto-v.a.g.i.n.al septum has been ruptured, as well as the perineum and the sphincter ani, giving all the appearance of a birth by the a.n.u.s.

There is an account of a female who had a tumor projecting between the v.a.g.i.n.a and r.e.c.t.u.m, which was incised through the intestine, and proved to be a dead child. Saviard reported what he considered a rather unique case, in which the uterus was ruptured by external violence, the fetus being thrown forward into the abdomen and afterward extracted from an umbilical abscess.

Birth of the Fetus Enclosed in the Membranes.--Harvey says that an infant can rest in its membranes several hours after birth without loss of life. Schurig eventrated a pregnant b.i.t.c.h and her puppies lived in their membranes half an hour. Wrisberg cites three observations of infants born closed in their membranes; one lived seven minutes; the other two nine minutes; all breathed when the membranes were cut and air admitted. Willoughby recorded the history of a case which attracted much comment at the time. It was the birth of twins enclosed in their secundines. The sac was opened and, together with the afterbirth, was laid over some hot coals; there was, however, a happy issue, the children recovering and living. Since Willoughby's time several cases of similar interest have been noticed, one in a woman of forty, who had been married sixteen years, and who had had several pregnancies in her early married life and a recent abortion. Her last pregnancy lasted about twenty-eight or twenty-nine weeks, and terminated, after a short labor, by the expulsion of the ovum entire. The membranes had not been ruptured, and still enclosed the fetus and the liquor amnii. On breaking them, the fetus was seen floating on the waters, alive, and, though very diminutive, was perfectly formed. It continued to live, and a day afterward took the breast and began to cry feebly. At six weeks it weighed 2 pounds 2 ounces, and at ten months, 12 pounds, but was still very weak and ill-nourished. Evans has an instance of a fetus expelled enveloped in its membranes entire and unruptured. The membranes were opaque and preternaturally thickened, and were opened with a pair of scissors; strenuous efforts were made to save the child, but to no purpose. The mother, after a short convalescence, made a good recovery. Forman reports an instance of unruptured membranes at birth, the delivery following a single pain, in a woman of twenty-two, pregnant for a second time. Woodson speaks of a case of twins, one of which was born enveloped in its secundines.

Van Bibber was called in great haste to see a patient in labor. He reached the house in about fifteen minutes, and was told by the midwife, a woman of experience, that she had summoned him because of the expulsion from the womb of something the like of which she had never seen before. She thought it must have been some variety of false conception, and had wrapped it up in some flannel. It proved to be a fetus enclosed in its sac, with the placenta, all having been expelled together and intact. He told the nurse to rupture the membranes, and the child, which had been in the unruptured sac for over twenty minutes, began to cry. The infant lived for over a month, but eventually died of bronchitis.

Cowger reports labor at the end of the seventh month without rupture of the fetal sac. Macknus and Rootes speak of expulsion of the entire ovum at the full period of gestation. Roe mentions a case of parturition with unruptured membrane. Slusser describes the delivery of a full-grown fetus without rupture of the membrane.

"Dry Births."--The reverse of the foregoing are those cases in which, by reason of the deficiency of the waters, the birth is dry. Numerous causes can be stated for such occurrences, and the reader is referred elsewhere for them, the subject being an old one. The Ephemerides speaks of it, and Rudolph discusses its occurrence exhaustively and tells of the difficulties of such a labor. Burrall mentions a case of labor without apparent liquor amnii, delivery being effected by the forceps. Strong records an unusual obstetric case in which there was prolongation of the pregnancy, with a large child, and entire absence of liquor amnii. The case was also complicated with interst.i.tial and subserous fibroids and a contracted pelvis, combined with a posterior position of the occiput and nonrotation of the head. Lente mentions a case of labor without liquor amnii; and Townsend records delivery without any sanguineous discharge. Cosentino mentions a case of the absence of liquor amnii a.s.sociated with a fetal monstrosity.

Delivery After Death of the Mother.--Curious indeed are those anomalous cases in which the delivery is effected spontaneously after the death of the mother, or when, by manipulation, the child is saved after the maternal decease. Wegelin gives the account of a birth in which version was performed after death and the child successfully delivered.

Bartholinus, Wolff, Schenck, Horstius, Hagendorn, Fabricius Hilda.n.u.s, Valerius, Rolfinck, Cornarius, Boener, and other older writers cite cases of this kind. Pinard gives a most wonderful case. The patient was a woman of thirty-eight who had experienced five previous normal labors. On October 27th she fancied she had labor pains and went to the Lariboisiere Maternite, where, after a careful examination, three fetal poles were elicited, and she was told, to her surprise, of the probability of triplets. At 6 P.M., November 13th, the pains of labor commenced. Three hours later she was having great dyspnea with each pain. This soon a.s.sumed a fatal aspect and the midwife attempted to resuscitate the patient by artificial respiration, but failed in her efforts, and then she turned her attention to the fetuses, and, one by one, she extracted them in the short s.p.a.ce of five minutes; the last one was born twelve minutes after the mother's death. They all lived (the first two being females), and they weighed from 4 1/4 to 6 1/2 pounds.

Considerable attention has been directed to the advisability of accelerated and forced labor in the dying, in order that the child may be saved. Belluzzi has presented several papers on this subject.

Csurgay of Budapest mentions saving the child by forced labor in the death agonies of the mother. Devilliers considers this question from both the obstetric and medicolegal points of view. Hyneaux mentions forcible accouchement practised on both the dead and the dying.

Rogowicz advocates artificial delivery by the natural channel in place of Cesarian section in cases of pending or recent death, and Thevenot discussed this question at length at the International Medico-Legal Congress in 1878. Duer presented the question of postmortem delivery in this country.

Kelly reports the history of a woman of forty who died in her eighth pregnancy, and who was delivered of a female child by version and artificial means. Artificial respiration was successfully practised on the child, although fifteen minutes had elapsed from the death of the mother to its extraction. Driver relates the history of a woman of thirty-five, who died in the eighth month of gestation, and who was delivered postmortem by the v.a.g.i.n.a, manual means only being used. The operator was about to perform Cesarean section when he heard the noise of the membranes rupturing. Thornton reports the extraction of a living child by version after the death of the mother. Aveling has compiled extensive statistics on all varieties of postmortem deliveries, collecting 44 cases of spontaneous expulsion of the fetus after death of the mother.

Aveling states that in 1820 the Council of Cologne sanctioned the placing of a gag in the mouth of a dead pregnant woman, thereby hoping to prevent suffocation of the infant, and there are numerous such laws on record, although most of them pertain to the performance of Cesarean section immediately after death.

Reiss records the death of a woman who was hastily buried while her husband was away, and on his return he ordered exhumation of her body, and on opening the coffin a child's cry was heard. The infant had evidently been born postmortem. It lived long afterward under the name of "Fils de la terre." Willoughby mentions the curious instance in which rumbling was heard from the coffin of a woman during her hasty burial. One of her neighbors returned to the grave, applied her ear to the ground, and was sure she heard a sighing noise. A soldier with her affirmed her tale, and together they went to a clergyman and a justice, begging that the grave be opened. When the coffin was opened it was found that a child had been born, which had descended to her knees. In Derbyshire, to this day, may be seen on the parish register: "April ye 20, 1650, was buried Emme, the wife of Thomas Toplace, who was found delivered of a child after she had lain two hours in the grave."

Johannes Matthaeus relates the case of a buried woman, and that some time afterward a noise was heard in the tomb. The coffin was immediately opened, and a living female child rolled to the feet of the corpse. Hagendorn mentions the birth of a living child some hours after the death of the mother. Dethardingius mentions a healthy child born one-half hour after the mother's death. In the Gentleman's Magazine there is a record of an instance, in 1759, in which a midwife, after the death of a woman whom she had failed to deliver, imagined that she saw a movement under the shroud and found a child between its mother's legs. It died soon after. Valerius Maximus says that while the body of the mother of Gorgia Epirotas was being carried to the grave, a loud noise was heard to come from the coffin and on examination a live child was found between the thighs,--whence arose the proverb: "Gorgiam prius ad funus elatum, quam natum fuisse."

Other cases of postmortem delivery are less successful, the delivery being delayed too late for the child to be viable. The first of Aveling's cases was that of a pregnant woman who was hanged by a Spanish Inquisitor in 1551 While still hanging, four hours later, two children were said to have dropped from her womb. The second case was of a woman of Madrid, who after death was shut in a sepulcher. Some months after, when the tomb was opened, a dead infant was found by the side of the corpse. Rolfinkius tells of a woman who died during parturition, and her body being placed in a cellar, five days later a dead boy and girl were found on the bier. Bartholinus is accredited with the following: Three midwives failing to deliver a woman, she died, and forty-eight hours after death her abdomen swelled to such an extent as to burst her grave-clothes, and a male child, dead, was seen issuing from the v.a.g.i.n.a. Bonet tells of a woman, who died in Brussels in 1633, who, undelivered, expired in convulsions on Thursday. On Friday abdominal movements in the corpse were seen, and on Sunday a dead child was found hanging between the thighs. According to Aveling, Herman of Berne reports the instance of a young lady whose body was far advanced in putrefaction, from which was expelled an unbroken ovum containing twins. Even the placenta showed signs of decomposition.

Naumann relates the birth of a child on the second day after the death of the mother. Richter of Weissenfels, in 1861, reported the case of a woman who died in convulsions, and sixty hours after death an eight months' fetus came away. Stapedius writes to a friend of a fetus being found dead between the thighs of a woman who expired suddenly of an acute disease. Schenk mentions that of a woman, dying at 5 P.M., a child having two front teeth was born at 3 A.M. Veslingius tells of a woman dying of epilepsy on June 6, 1630, from whose body, two days later, issued a child. Wolfius relates the case of a woman dying in labor in 1677. Abdominal movements being seen six hours after death, Cesarean section was suggested, but its performance was delayed, and eighteen hours after a child was spontaneously born. Hoyer of Mulhausen tells of a child with its mouth open and tongue protruding, which was born while the mother was on the way to the grave. Bedford of Sydney, according to Aveling, relates the story of a case in which malpractice was suspected on a woman of thirty-seven, who died while pregnant with her seventh child. The body was exhumed, and a transverse rupture of the womb six inches long above the cervix was found, and the body of a dead male child lay between the thighs. In 1862, Lanigan tells of a woman who was laid out for funeral obsequies, and on removal of the covers for burial a child was found in bed with her. Swayne is credited with the description of the death of a woman whom a midwife failed to deliver. Desiring an inquest, the coroner had the body exhumed, when, on opening the coffin, a well-developed male infant was found parallel to and lying on the lower limbs, the cord and placenta being entirely unattached from the mother.

Some time after her decease Harvey found between the thighs of a dead woman a dead infant which had been expelled postmortem. Mayer relates the history of a case of a woman of forty-five who felt the movement of her child for the fourth time in the middle of November. In the following March she had hemoptysis, and serious symptoms of inflammation in the right lung following, led to her apparent death on the 31st of the month. For two days previous to her death she had failed to perceive the fetal movements. She was kept on her back in a room, covered up and undisturbed, for thirty-six hours, the members of the family occasionally visiting her to sprinkle holy water on her face. There was no remembrance of cadaveric distortion of the features or any odor. When the undertakers were drawing the shroud on they noticed a half-round, bright-red, smooth-looking body between the genitals which they mistook for a prolapsed uterus. Early on April 2d, a few hours before interment, the men thought to examine the swelling they had seen the day before. A second look showed it to be a dead female child, now lying between the thighs and connected with the mother by the umbilical cord. The interment was stopped, and Mayer was called to examine the body, but with negative results, though the signs of death were not plainly visible for a woman dead fifty-eight hours.

By its development the body of the fetus confirmed the mother's account of a pregnancy of twenty-one weeks. Mayer satisfies himself at least that the mother was in a trance at the time of delivery and died soon afterward.

Moritz gives the instance of a woman dying in pregnancy, undelivered, who happened to be disinterred several days after burial. The body was in an advanced state of decomposition, and a fetus was found in the coffin. It was supposed that the pressure of gas in the mother's body had forced the fetus from the uterus. Ostmann speaks of a woman married five months, who was suddenly seized with rigors, headache, and vomiting. For a week she continued to do her daily work, and in addition was ill-treated by her husband. She died suddenly without having any abdominal pain or any symptoms indicative of abortion. The body was examined twenty-four hours after death and was seen to be dark, discolored, and the abdomen distended. There was no sanguineous discharge from the genitals, but at the time of raising the body to place it in the coffin, a fetus, with the umbilical cord, escaped from the v.a.g.i.n.a. There seemed to have been a rapid putrefaction in this ease, generating enough pressure of gas to expel the fetus as well as the uterus from the body. This at least is the view taken by Hoffman and others in the solution of these strange cases.

Antepartum Crying of the Child.--There are on record fabulous cases of children crying in the uterus during pregnancy, and all sorts of unbelievable stories have been constructed from these reported occurrences. Quite possible, however, and worthy of belief are the cases in which the child has been heard to cry during the progress of parturition--that is, during delivery. Jonston speaks of infants crying in the womb, and attempts a scientific explanation of the fact.

He also quotes the following lines in reference to this subject:--

"Mirandum foetus nlaterna clausus in alvo Dicitur insuetos ore dedisse sonos. Causa subest; doluit se angusta sede telleri Et cupiit magnae cernere moliis opus. Aut quia quaerendi studio vis fessa parentum Aucupii aptas innuit esse ma.n.u.s."

The Ephemerides gives examples of the child hiccoughing in the uterus.

Cases of crying before delivery, some in the v.a.g.i.n.a, some just before the complete expulsion of the head from the os uteri, are very numerous in the older writers; and it is quite possible that on auscultation of the pregnant abdomen fetal sounds may have been exaggerated into cries.

Bartholinus, Borellus, Boyle, Buchner, Paullini, Mezger, Riola.n.u.s, Lentillus, Marcellus Donatus, and Wolff all speak of children crying before delivery; and Mazinus relates the instance of a puppy whose feeble cries could be heard before expulsion from the b.i.t.c.h. Osiander fully discusses the subject of infants crying during parturition.

McLean describes a case in which he positively states that a child cried l.u.s.tily in utero during application of the forceps. He compared the sound as though from a voice in the cellar. This child was in the uterus, not in the v.a.g.i.n.a, and continued the crying during the whole of the five minutes occupied by delivery.

Cesarean Section.--Although the legendary history of Cesarean section is quite copious, it is very seldom that we find authentic records in the writings of the older medical observers. The works of Hippocrates, Aretxeus, Galen, Celsus, and Aetius contain nothing relative to records of successful Cesarean sections. However, Pliny says that Scipio Africa.n.u.s was the first and Manlius the second of the Romans who owed their lives to the operation of Cesarean section; in his seventh book he says that Julius Caesar was born in this way, the fact giving origin to his name. Others deny this and say that his name came from the thick head of hair which he possessed. It is a frequent subject in old Roman sculpture, and there are many delineations of the birth of Bacchus by Cesarean section from the corpse of Semele. Greek mythology tells us of the birth of Bacchus in the following manner: After Zeus burnt the house of Semele, daughter of Cadmus, he sent Hermes in great haste with directions to take from the burnt body of the mother the fruit of seven months. This child, as we know, was Bacchus. Aesculapius, according to the legend of the Romans, had been excised from the belly of his dead mother, Corinis, who was already on the funeral pile, by his benefactor, Apollo; and from this legend all products of Cesarean sections were regarded as sacred to Apollo, and were thought to have been endowed with sagacity and bravery.

Old records tell us that one of the kings of Navarre was delivered in this way, and we also have records of the birth of the celebrated Doge, Andreas Doria, by this method. Jane Seymour was supposed to have been delivered of Edward VI by Cesarean section, the father, after the consultation of the physicians was announced to him, replying: "Save the child by all means, for I shall be able to get mothers enough."

Robert II of Scotland was supposed to have been delivered in this way after the death of his mother, Margery Bruce, who was killed by being thrown from a horse. Shakespere's immortal citation of Macduff, "who was from his mother's womb untimely ripped," must have been such a case, possibly crudely done, perchance by cattle-horn. Pope Gregory XIV was said to have been taken from his mother's belly after her death.

The Philosophical Transactions, in the last century contain accounts of Cesarean section performed by an ignorant butcher and also by a midwife; and there are many records of the celebrated case performed by Jacob Nufer, a cattle gelder, at the beginning of the sixteenth century.

By the advent of antisepsis and the improvements of Porro and others, Cesarean section has come to be a quite frequent event, and a record of the successful cases would hardly be considered a matter of extraordinary interest, and would be out of the province of this work, but a citation of anomalous cases will be given. Baldwin reports a case of Cesarean section on a typical rachitic dwarf of twenty-four, who weighed 100 pounds and was only 47 1/2 inches tall. It was the ninth American case, according to the calculation of Harris, only the third successful one, and the first successful one in Ohio. The woman had a uniformly contracted pelvis whose anteroposterior diameter was about 1 1/4 inches. The hygienic surroundings for the operation were not of the best, as the woman lived in a cellar. Tait's method of performing the operation was determined upon and successfully performed. Convalescence was prompt, and in three weeks the case was dismissed. The child was a female of 7 1/2 pounds which inherited the deformities of its mother.

It thrived for nine and a half months, when it died of angina Ludovici.

Figure 15 represents the mother and child.

Harris gives an account of an operation upon a rachitic dwarf who was impregnated by a large man, a baby weighing 14 pounds and measuring 20 inches being delivered by the knife. St. Braun gives the account of a Porro-Cesarean operation in the case of a rachitic dwarf 3 feet 10 inches tall, in which both the mother and child recovered. Munde speaks of twins being delivered by Cesarean section. Franklin gives the instance of a woman delivered at full term of a living child by this means, in whom was also found a dead fetus. It lay behind the stump of the amputated cervix, in the culdesac of Douglas. The patient died of hemorrhage.

Croston reports a case of Cesarean section on a primipara of twenty-four at full term, with the delivery of a double female monster weighing 12 1/2 pounds. This monster consisted of two females of about the same size, united from the sternal notch to the navel, having one cord and one placenta. It was stillborn. The diagnosis was made before operation by v.a.g.i.n.al examination. In a communication to Croston, Harris remarked that this was the first successful Cesarean section for double monstrous conception in America, and added that in 1881 Collins and Leidy performed the same operation without success.

Instances of repeated Cesarean section were quite numerous, and the pride of the operators noteworthy, before the uterus was removed at the first operation, as is now generally done. Bacque reports two sections in the same woman, and Bertrandi speaks of a case in which the operation was successfully executed many times in the same woman.

Rosenberg reports three cases repeated successfully by Leopold of Dresden. Skutsch reports a case in which it was twice performed on a woman with a rachitic pelvis, and who the second time was pregnant with twins; the children and mother recovered. Zweifel cites an instance in which two Cesarean sections were performed on a patient, both of the children delivered being in vigorous health. Stolz relates a similar case. Beck gives an account of a Cesarean operation twice on the same woman; in the first the child perished, but in the second it survived.

Merinar cites an instance of a woman thrice opened. Parravini gives a similar instance. Charlton gives an account of the performance carried out successfully four times in the same woman; Chisholm mentions a case in which it was twice performed. Michaelis of Kiel gives an instance in which he performed the same operation on a woman four times, with successful issues to both mother and children, despite the presence of peritonitis the last time. He had operated in 1826, 1830, 1832, and 1836. Coe and Gueniot both mention cases in which Cesarean section had been twice performed with successful terminations as regards both mothers and children. Rosenberg tabulates a number of similar cases from medical literature.

Cases of Cesarean section by the patient herself are most curious, but may be readily believed if there is any truth in the reports of the operation being done in savage tribes. Felkin gives an account of a successful case performed in his presence, with preservation of the lives of both mother and child, by a native African in Kahura, Uganda Country. The young girl was operated on in the crudest manner, the hemorrhage being checked by a hot iron. The sutures were made by means of seven thin, hot iron spikes, resembling acupressure-needles, closing the peritoneum and skin. The wound healed in eleven days, and the mother made a complete recovery. Thomas Cowley describes the case of a negro woman who, being unable to bear the pains of labor any longer, took a sharp knife and made a deep incision in her belly--deep enough to wound the b.u.t.tocks of her child, and extracted the child, placenta and all. A negro horse-doctor was called, who sewed the wound up in a manner similar to the way dead bodies are closed at the present time.

Barker gives the instance of a woman who, on being abused by her husband after a previous tedious labor, resolved to free herself of the child, and slyly made an incision five inches long on the left side of the abdomen with a weaver's knife. When Barker arrived the patient was literally drenched with blood and to all appearance dead. He extracted a dead child from the abdomen and bandaged the mother, who lived only forty hours. In his discourses on Tropical Diseases Moseley speaks of a young negress in Jamaica who opened her uterus and extracted therefrom a child which lived six days; the woman recovered. Barker relates another case in Rensselaer County, N.Y., in which the incision was made with the razor, the woman likewise recovering. There is an interesting account of a poor woman at Prischtina, near the Servian frontier, who, suffering greatly from the pains of labor, resolved to open her abdomen and uterus. She summoned a neighbor to sew up the incision after she had extracted the child, and at the time of report, several months later, both the mother and child were doing well.

Madigan cites the case of a woman of thirty-four, in her seventh confinement, who, while temporarily insane, laid open her abdomen with a razor, incised the uterus, and brought out a male child. The abdominal wound was five inches long, and extended from one inch above the umbilicus straight downward. There was little or no bleeding and the uterus was firmly contracted. She did not see a physician for three hours. The child was found dead and, with the placenta, was lying by her side. The neighbors were so frightened by the awful sight that they ran away, or possibly the child might have been saved by ligature of the funis. Not until the arrival of the clergyman was anything done, and death ultimately ensued.

A most wonderful case of endurance of pain and heroism was one occurring in Italy, which attracted much European comment at the time.

A young woman, illegitimately pregnant, at full term, on March 28th, at dawn, opened her own abdomen on the left side with a common knife such as is generally used in kitchens. The wound measured five inches, and was directed obliquely outward and downward. She opened the uterus in the same direction, and endeavored to extract the fetus. To expedite the extraction, she drew out an arm and amputated it, and finding the extraction still difficult, she cut off the head and completely emptied the womb, including the placenta. She bound a tight bandage around her body and hid the fetus in a straw mattress. She then dressed herself and attended to her domestic duties. She afterward mounted a cart and went into the city of Viterbo, where she showed her sister a cloth bathed in blood as menstrual proof that she was not pregnant. On returning home, having walked five hours, she was seized with an attack of vomiting and fainted. The parents called Drs. Serpieri and Baliva, who relate the case. Thirteen hours had elapsed from the infliction of the wound, through which the bulk of the intestines had been protruding for the past six hours. The abdomen was irrigated, the toilet made, and after the eighteenth day the process of healing was well progressed, and the woman made a recovery after her plucky efforts to hide her shame.

Cases like the foregoing excite no more interest than those on record in which an abdominal section has been accidental, as, for instance, by cattle-horns, and the fetus born through the wound. Zuboldie speaks of a case in which a fetus was born from the wound made by a bull's horn in the mother's abdomen. Deneux describes a case in which the wound made by the horn was not sufficiently large to permit the child's escape, but it was subsequently brought through the opening. Pigne speaks of a woman of thirty-eight, who in the eighth month of her sixth pregnancy was gored by a bull, the horn effecting a transverse wound 27 inches long, running from one anterior spine to the other. The woman was found cold and insensible and with an imperceptible pulse. The small intestines were lying between the thighs and covered with coagulated blood. In the process of cleansing, a male child was expelled spontaneously through a rent in the uterus. The woman was treated with the usual precautions and was conscious at midday. In a month she was up. She lived twenty years without any inconvenience except that due to a slight hernia on the left side. The child died at the end of a fortnight.

In a very exhaustive article Harris of Philadelphia has collected nearly all the remaining cases on record, and brief extracts from some of them will be given below. In Zaandam, Holland, 1647, a farmer's wife was tossed by a furious bull. Her abdomen was ripped open, and the child and membranes escaped. The child suffered no injuries except a bruised upper lip and lived nine months. The mother died within forty hours of her injuries. Figure 19 taken from an engraving dated 1647, represents an accouchement by a mad bull, possibly the same case. In Dillenberg, Germany, in 1779, a multipara was gored by an ox at her sixth month of pregnancy; the horn entered the right epigastric region, three inches from the linea alba, and perforated the uterus. The right arm of the fetus protruded; the wound was enlarged and the fetus and placenta delivered. Thatcher speaks of a woman who was gored by a cow in King's Park, and both mother and child were safely delivered and survived.

In the Parish of Zecoytia, Spain, in 1785, Marie Gratien was gored by an ox in the superior portion of her epigastrium, making a wound eight inches long which wounded the uterus in the same direction. Dr. Antonio di Zubeldia and Don Martin Monaco were called to take charge of the case. While they were preparing to effect delivery by the v.a.g.i.n.a, the woman, in an attack of singultus, ruptured the line of laceration and expelled the fetus, dead. On the twenty-first day the patient was doing well. The wound closed at the end of the sixteenth week. The woman subsequently enjoyed excellent health and, although she had a small ventral hernia, bore and nursed two children.

Marsh cites the instance of a woman of forty-two, the mother of eight children, who when eight months pregnant was horned by a cow. Her clothes were not torn, but she felt that the child had slipped out, and she caught it in her dress. She was seen by some neighbors twelve yards from the place of accident, and was a.s.sisted to her house. The bowels protruded and the child was separated from the funis. A physician saw the woman three-quarters of an hour afterward and found her pulseless and thoroughly exhausted. There was considerable but not excessive loss of blood, and several feet of intestine protruded through the wound.

The womb was partially inverted through the wound, and the placenta was still attached to the inverted portion. The wound in the uterus was Y-shaped. The mother died in one and a half hours from the reception of her injuries, but the child was uninjured.

Scott mentions the instance of a woman thirty-four years old who was gored by an infuriated ox while in the ninth month of her eighth pregnancy. The horn entered at the anterior superior spinous process of the ilium, involving the parietes and the uterus. The child was extruded through the wound about half an hour after the occurrence of the accident. The cord was cut and the child survived and thrived, though the mother soon died. Stalpart tells the almost incredible story of a soldier's wife who went to obtain water from a stream and was cut in two by a cannonball while stooping over. A pa.s.sing soldier observed something to move in the water, which, on investigation, he found to be a living child in its membranes. It was christened by order of one Cordua and lived for some time after.

Postmortem Cesarean Section.--The possibility of delivering a child by Cesarean section after the death of the mother has been known for a long time to the students of medicine. In the olden times there were laws making compulsory the opening of the dead bodies of pregnant women shortly after death. Numa Pompilius established the first law, which was called "les regia," and in later times there were many such ordinances. A full description of these laws is on record. Life was believed possible after a gestation of six months or over, and, as stated, some famous men were supposed to have been born in this manner.

Francois de Civile, who on great occasions signed himself "trois fois enterre et trois fois par le grace de Dieu ressucite," saw the light of the world by a happy Cesarean operation on his exhumed mother.

Fabricius Hilda.n.u.s and Boarton report similar instances. Bourton cites among others the case of an infant who was found living twelve hours after the death of his mother. Dufour and Mauriceau are two older French medical writers who discuss this subject. Flajani speaks of a case in which a child was delivered at the death of its mother, and some of the older Italian writers discuss the advisability of the operation in the moribund state before death actually ensues. Heister writes of the delivery of the child after the death of the mother by opening the abdomen and uterus.

Harris relates several interesting examples. In Peru in 1794 a Sambi woman was killed by lightning, and the next day the abdomen was opened by official command and a living child was extracted. The Princess von Swartzenberg, who was burned to death at a ball in Paris in 1810, was said to have had a living child removed from her body the next day.

Like all similar instances, this was proved to be false, as her body was burned beyond the possibility of recognition, and, besides, she was only four months pregnant. Harris mentions another case of a young woman who threw herself from the Pont Neuf into the Seine. Her body was recovered, and a surgeon who was present seized a knife from a butcher standing by and extracted a living child in the presence of the curious spectators. Campbell discusses this subject most thoroughly, though he advances no new opinions upon it.

Duer tabulates the successful results of a number of cases of Cesarean section after death as follows:--

Children extracted between 1 and 5 minutes after death of the mother, 21 " " 10 and 15 " " " " " " 13 " " 15 and 30 " " " " " " 2 " " 1 hour " " " " " " 2 " " 2 hours " " " " " " 2