A treatise on the science and practice of midwifery . ly been observed. Children are occasionally born with one extremity moreor less completely absent, and cases are knownin which the whole four extremities were want-ing (Fig. 93). The mode in which these mal-formations are produced has given rise to muchdiscussion. At one time it was supposed thatthe deficiency of the limb was due to gangreneof the extremity and subsequent separation ofthe sphacelated parts. Reuss, who has studiedthe whole subject very minutely,2 considersgangrene in the unruptured ovum to be animpossibility, for that change
A treatise on the science and practice of midwifery . ly been observed. Children are occasionally born with one extremity moreor less completely absent, and cases are knownin which the whole four extremities were want-ing (Fig. 93). The mode in which these mal-formations are produced has given rise to muchdiscussion. At one time it was supposed thatthe deficiency of the limb was due to gangreneof the extremity and subsequent separation ofthe sphacelated parts. Reuss, who has studiedthe whole subject very minutely,2 considersgangrene in the unruptured ovum to be animpossibility, for that change cannot occurunless there is access of oxygen, and whenportions of the separated extremity are foundin utero, as is often the case, they show evi-dences of maceration, but not of decomposi-tion. The general belief is that these intra-uterine amputations depend on constriction ofthe limb by folds or bands of the amnion—most often met with when the liquor amnii is deficient in quantity— 1 Gazette hebdom., 1860. 2 Scanzonis Beitrage, 1869. Fig. Intra-uterine Amputation ofboth Arms and Legs. PATHOLOGY OF THE BECLDUA AND OVUM. 241 which obstruct the circulation and thus give rise to atrophy of the partbelow the constriction. It has been supposed that the umbilical cordmight, by encircling the limb, produce a like result. It appears doubt-ful, however, whether this cause is sufficient to produce complete sepa-ration of the limb, as any great amount of constriction would interferewith the circulation through the cord. Sometimes, when intra-uterineamputation occurs, the separated portion of the limb is found lying loosein the amniotic cavity, and is expelled after the child. Cases of thiskind have been recorded by Martin, Chaussier, and Watkinson. Moreoften no trace of the separated extremity can be found. The explana-tion probably depends upon the period of utero-gestation at which ampu-tation took place. If it occurred at a very early period of pregnancy,before the third mon
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectobstetrics, bookyear1
