only capable of producing a constriction; but also in some circumstances an elongation of the limb; as seen in Schaeffer's case (Fig. 34, c). Upon the right foot of the foetus described by Zagorsky, an interesting effect has been produced apparently by this same cause. The pseudo-membrane attached to it seems to have been originally affixed along the inner side of the heel, and is stated to have stretched from thence as far forward as the little toe. In its course to the opposite extremity it had passed round the outer and across the fore part of the leg; and when stretched, had, in consequence of its connections and course, produced the effect of turning the included portion of leg and foot half round upon its axis, so as to bring the inner ankle to the situation of the outer, and to invert the surfaces of the foot in the manner before mentioned. (See Case II. and Fig. 36.) Both in the child described by Mr. Watkinson, and in Dr. Montgomery's second case, the foot which was not the seat of the amputating process was turned partially inwards. The sketch given in Fig. 36 of the left leg in Zagorsky's case, may serve also to illustrate a remark make by Dr. Montgomery, as to how it happens that in cases of amputation of the foetal limbs, the surface of the stump, and even of the amputated portion of the extremity, seem nearly or entirely cicatrized; for, it is evident, that by the constricting ligature gradually carrying in before it, at the point where it encircles or compresses the limb, a duplicature or process of the cutaneous texture, and from this texture constituting (as it certainly appears to do) one of the last that is removed by the disjunctive atrophy, both sides of the deep indentation or furrow, formed at the seat of constriction, must be found regularly covered over by the elongated and depressed integuments as far almost, in most cases, as the bone itself; and even the small portion of the stump which is left raw by the division of the last parts, may be observed in some instances invested with a true cicatrix at the time of birth; provided the separation of the limb has taken place at such a period before the expulsion of the child from the uterus, as to allow of this cicatrization being completed. The view that has been taken of the disjunctive action which we have attributed in the preceding remarks to the forcible and gradually increasing constriction of the bands of pseudo-membrane upon the fœtal limbs, seems confirmed, in no inconsiderable degree, by what is occasionally observed to occur when the same kind of conPlouquet, and recommended by the latter as more particularly adapted to the case of êmaciated and timid subjects.—(See Sprengel's Histoire de la Médecine, tom. vii. pp. 313 and 333; Cooper's Dictionary of Surgery.) During last year, in the experimental rooms of M. Amussat at Paris, I had an opportunity of seeing M. Mayor, the distinguished surgeon of Lausanne, attempt to cut off the limbs of dogs by forcibly tightening around them a circular ligature of strong wire. striction is exercised upon any part of the fœtus by the Umbilical Cord. From the facility with which the smooth surface of the cord moves over that of the fœtus, it is of extremely rare occurrence that the convolutions of the former around the neck, body, and extremities of the latter, ever come to act as a constricting or compressing agent upon the parts over which they pass, although such an effect has been occasionally observed, while the surface of the cord still remained healthy, when its coils have accidentally become so very firmly entangled and knotted with one another, or with the fœtal limbs, as to prevent its own motions, as seen in a remarkable case represented and described by Van de Laar,' in which the arms of an aborted fœtus were curiously displaced and distorted, from having been thrown transversely across the back and twisted in that position, by some duplicatures of the navel-string. When the surface of the cord, however, becomes, as occasionally occurs, morbidly adherent at some point to the surface of the foetus, the state of matters is necessarily much changed; the portion of cord between the umbilicus and point of adhesion is, as it were, fixed, and the parts which it happens to be stretched over and encircle in its course are liable to become compressed and constricted by it, during the progress of the natural enlargement of the body, in the same manner as we have already seen them to be by the ligatures or bands of pseudo-membrane. Thus Meckel' mentions the case of an aborted fœtus of the third month, whose umbilical cord, after being imbedded to the depth of half an inch in the parts of the right scapular region, stretched from thence downwards to the right thigh and leg, to which it was intimately united by morbid adhesions. Wrisberg has delineated, and very minutely described, a case which is still more in point, in reference to the present subject. In a deformed fœtus of the fourth month, the umbilical cord, on leaving the abdomen, ran first over the left shoulder, and around the back of the neck, and then came to encircle completely the right upper extremity immediately below the shoulder. To all these different parts it was morbidly adherent, and at the point where it encircled the right arm, it imbedded itself deeply in the subjacent soft parts (carnes subjacentes valde stringit). In its subsequent course the cord, after running again over the left shoulder, returned a second time to the right arm, and crossed over it above the elbow, impressing another furrow or indentation upon it at the point of contact. In this case we have an example of the process which produces the spontaneous amputation of the limbs of the fœtus, going on at two 'Observationes Obstetrico-Medicæ, p. 41, and Tab. ii. Sandifort's Thesaurus, tom. iii. p. 235, Tab. ii. fig. 5. different points in the same arm, and it differs from the instances. previously detailed in this respect only, that the constricting and dividing agent was not, as in them, a band of false membrane, but a portion of the umbilical cord. At one time I was inclined to believe that spontaneous amputation of the limbs of the fœtus might be occasionally produced in another mode, namely, by previous Fracture of the bone; and this opinion was suggested by the following case. In 1834, a boy, at that time seven years of age, was exhibited in Edinburgh, wanting both arms and hands. From the right shoulder, one finger, containing four phalanges, and from the left two other shorter fingers protruded. The two fingers attached to the left shoulder were situated vertically over one another, and the inferior presented at one point in the course of its first or proximal phalanx, a great and sudden narrowing or contraction. On making some further inquiries, it appeared that this last finger had been fractured some years before by a fall, and had gradually from that time become more and more atrophied at the fractured part, so much so, that if the same process continued much longer, it seemed not improbable that the pedicle or neck of integuments attaching the finger, might ultimately come to be completely divided, and consequently all the portion of the member anterior to it be allowed to drop off. The circumstances of this case readily suggested the idea that the similar constricted appearance, and occasional complete amputation, of the limbs of the fœtus, might possibly in some instances originate in the same cause. We know from various accurately recorded instances, that fractures do occur in the bones of the fœtus in utero, as an effect of physical injury, and also spontaneously, if we may trust to the cases observed by Chaussier and Baudelocque, and it seems possible, at least, that under some circumstances this fracture may be attended with such lesions of the surrounding soft tissues, as may give rise to a kind of disjunctive atrophy or absorption similar in its nature and effects to that which had occurred in the finger of the boy, and, perhaps, in the textures of the fœtal limb, still more active and speedy in its operation. At the same time it must be admitted, that in none of the instances hitherto recorded of fractures of the bones of the fœtal limbs, does such an atrophy of the surrounding soft parts appear to have been observed, if we may not be allowed to except the case given by Amand, who found in a fœtus of the fourth or fifth month the bones of the forearm, thigh, and leg separated and mobile, as if they had been fractured by design, and the parts seemingly held attached by the medium of the integuments only. 'Nouvelles Observations sur la Pratique des Accouchemens, p. 92, obs. viii. In his first communication,' Dr. Montgomery has referred to a pas sage in Haller's Elementa Physiologiæ, in which that author casually alludes to some expressions of Roederer, in such a way as led Dr. Montgomery to suppose, that this last writer might have described the compression of the limbs of the fœtus by cords of organized lymph. Having access to the work of Roederer referred to by Haller, I beg to subjoin the passage alluded to, only remarking that the language of the author is not so definite as to leave the matter entirely without doubt. It is contained in an essay, "De vi Imaginationis in Fætum negatá." After speaking of the supposed resemblance of certain deformed human foetuses to apes, he observes, that the comparison is not so far fetched, for "femora abdomini applicantur, reflectuntur crura, ad faciem eriguntur manus, retractis cubitis. Inquirens in structuram corpusculi ligamenta strictiora notavi, artusque compressos. Since the first publication of the preceding essay, in 1836, there have been many additions to the literature of spontaneous amputation, and various instances of the three preceding modes of its production adduced. 1. Cases in which the umbilical cord acted, as suggested, as the amputating agent, have been recorded by Drs. Montgomery, Schwabe, Buchanan, &c. 2. Instances in which bands of coagulable lymph formed the constricting agents, have been published by Smith, Nettekoven, Dubois, and others; some years ago, I showed a recent example of this kind to the Obstetric Society. 3. Martin has lately described and figured a case, proving the truth of the suggestion offered above, that spontaneous amputation may some. times originate in fracture and injury of the extremity of the fœtus. In his case, the mother had fallen from a ladder eight weeks before delivery, and the child was born with the left arm amputated near the shoulder, and the wound still not entirely closed. The sepa rated, but nearly full-sized arm was expelled with the placenta. ON THE RUDIMENTARY REPRODUCTION OF EXTREMITIES AFTER THEIR SPONTANEOUS AMPUTATION. On the stumps of limbs that have seemingly undergone an early spontaneous amputation in utero, there is often seen a species of anormal structure, which has not yet, so far as I am aware, been described in any existing work on the subject of monstrosities. I ' Dublin Journ. of Medical Science, vol. i. p. 143. 9 Loc. cit. tom. viii. p. 135. * Opuscula Medica, p. 120. 4 See details regarding this case in Monthly Journal for 1848, p. 891. See Monthly Journal for July, 1841, p. 537, and for June, 1848, p. 891, &c.. allude to the appearance on the end of many such stumps of a projecting mass or nodule, varying in size from a small cutaneous ridge to the bulk of a walnut, and having protruding from its surface one, two, or more, still smaller fleshy divisions or projections, which are provided at their extreme points with nails. This variety of anormal structure is by no means rare. Several years ago, when searching for instances of it, I found five or six living examples in Edinburgh and its neighborhood; and I have seen some, and heard of many more, living in different parts of Scotland and England. It is interesting, however, not so much from the frequency with which it is met with, as from the nature of the anormal structure itself, consisting, as I believe it does, of a tendency in the human subject to the reproduction of a lost extremity. As a general law, the power of repairing and reproducing lost parts decreases as we ascend from the lower to the higher parts of the animal scale. In the lowest and simplest forms of animal life, as in polyps, not only are separated parts or segments rapidly restored but the separated segments themselves sometimes become developed into whole and perfect individuals. A hydra was cut at different times into various portions by Trembley, and fifty separate individuals of the species were developed from the segments of one. Johnstone and Duges have shown that animals with much higher organization—namely, the Planaria-could in the same way be multiplied by artificial subdivision; and Lyonnet and Bonnet found the same true of the Nais. As we ascend upwards in the scale of life, all power of self-development in separated parts or segments disappears, but the power of regenerating these lost parts or segments is retained to a greater or less degree by the general body of the animal. When the arms or rays of Star-fish are broken off artificially, or when they are thrown off, as they sometimes are, in the Lingthorn or Luidia, &c., by a true "spontaneous amputation" on the part of the animal, the lost arms are betimes entirely restored. In the Crustacea a separated or amputated limb is also rapidly renovated. The head or anterior rings of the earth-worm and other Annelida are generally regenerated after their decapitation; and the power of reproduction is still so great in the Mollusca, that the snail, according to Schweigger, has sometimes its head and antennæ restored after they are removed by amputation, provided the cephalic ganglion lying above the œsophagus be left uninjured. In the lower divisions of the Vertebrata we have the salamander still capable of reproducing an entire leg or tail, or even of forming a new under jaw; and the triton can regenerate, as in Blumenbach's experiment, a complete and perfect eye. But in the higher and warm-blooded vertebrata this power of repairing and restoring lost compound parts and organs seems totally or almost entirely wanting. In man |