Anomalies and Curiosities of Medicine [52]
of the fetus possess only a potential activity. The storing up of poisons in the placenta is not so general as the accumulation of them in the liver of the mother. It may be asked if the placenta does not form a barrier to the passage of poisons into the circulation of the fetus; this would seem to be demonstrated by mercury, which was always found in the placenta and never in the fetal organs. In poisoning by lead and copper the accumulation of the poison in the fetal tissues is greater than in the maternal, perhaps from differences in assimilation and disassimilation or from greater diffusion. Whilst it is not an impermeable barrier to the passage of poisons, the placenta offers a varying degree of obstruction: it allows copper and lead to pass easily, arsenic with greater difficulty. The accumulation of toxic substances in the fetus does not follow the same law as in the adult. They diffuse more widely in the fetus. In the adult the liver is the chief accumulatory organ. Arsenic, which in the mother elects to accumulate in the liver, is in the fetus stored up in the skin; copper accumulates in the fetal liver, central nervous system, and sometimes in the skin; lead which is found specially in the maternal liver, but also in the skin, has been observed in the skin, liver, nervous centers, and elsewhere in the fetus. The frequent presence of poisons in the fetal skin demonstrates its physiologic importance. It has probably not a very marked influence on its health. On the contrary, accumulation in the placenta and nerve centers explains the pathogenesis of abortion and the birth of dead fetuses ("mortinatatite") Copper and lead did not cause abortion, but mercury did so in two out of six cases. Arsenic is a powerful abortive agent in the guinea-pig, probably on account of placental hemorrhages. An important deduction is that whilst the placenta is frequently and seriously affected in syphilis, it is also the special seat for the accumulation of mercury. May this not explain its therapeutic action in this disease? The marked accumulation of lead in the central nervous system of the fetus explains the frequency and serious character of saturnine encephalopathic lesions. The presence of arsenic in the fetal skin alone gives an explanation of the therapeutic results of the administration of this substance in skin diseases.
Intrauterine amputations are of interest to the medical man, particularly those cases in which the accident has happened in early pregnancy and the child is born with a very satisfactory and clean stump. Montgomery, in an excellent paper, advances the theory, which is very plausible, that intrauterine amputations are caused by contraction of bands or membranes of organized lymph encircling the limb and producing amputation by the same process of disjunctive atrophy that the surgeons induce by ligature. Weinlechner speaks of a case in which a man devoid of all four extremities was exhibited before the Vienna Medical Society. The amputations were congenital, and on the right side there was a very small stump of the upper arm remaining, admitting the attachment of an artificial apparatus. He was twenty-seven years old, and able to write, to thread a needle, pour water out of a bottle, etc. Cook speaks of a female child born of Indian parents, the fourth birth of a mother twenty-six years old. The child weighed 5 1/2 pounds; the circumference of the head was 14 inches and that of the trunk 13 inches. The upper extremities consisted of perfect shoulder joints, but only 1/4 of each humerus was present. Both sides showed evidences of amputation, the cicatrix on the right side being 1 inch long and on the left 1/4 inch long. The right lower limb was merely a fleshy corpuscle 3/4 inch wide and 1/4 inch long; to the posterior edge was attached a body resembling the little toe of a newly-born infant. On the left side the limb was represented by a fleshy corpuscle 1 inch long and 1/4 inch in circumference, resembling the great toe of an infant. There was no history of shock or injury to the mother. The child presented
Intrauterine amputations are of interest to the medical man, particularly those cases in which the accident has happened in early pregnancy and the child is born with a very satisfactory and clean stump. Montgomery, in an excellent paper, advances the theory, which is very plausible, that intrauterine amputations are caused by contraction of bands or membranes of organized lymph encircling the limb and producing amputation by the same process of disjunctive atrophy that the surgeons induce by ligature. Weinlechner speaks of a case in which a man devoid of all four extremities was exhibited before the Vienna Medical Society. The amputations were congenital, and on the right side there was a very small stump of the upper arm remaining, admitting the attachment of an artificial apparatus. He was twenty-seven years old, and able to write, to thread a needle, pour water out of a bottle, etc. Cook speaks of a female child born of Indian parents, the fourth birth of a mother twenty-six years old. The child weighed 5 1/2 pounds; the circumference of the head was 14 inches and that of the trunk 13 inches. The upper extremities consisted of perfect shoulder joints, but only 1/4 of each humerus was present. Both sides showed evidences of amputation, the cicatrix on the right side being 1 inch long and on the left 1/4 inch long. The right lower limb was merely a fleshy corpuscle 3/4 inch wide and 1/4 inch long; to the posterior edge was attached a body resembling the little toe of a newly-born infant. On the left side the limb was represented by a fleshy corpuscle 1 inch long and 1/4 inch in circumference, resembling the great toe of an infant. There was no history of shock or injury to the mother. The child presented