MRS.-, age, twenty-eight, years, American, large and strong, came to my clinic February, 1893, and asked this question: “Why is it that I cannot give birth to a living child?” The history she grave was as follows: She had been married eight years; had always had perfect health, never having employed a physician except as an accoucheur; never had taken any medicine, and says that she is in perfect health now. Except at confinements she had never been ill, and had recovered promptly and perfectly from four labors. She looked the picture of health, but her misfortune had caused a deep melancholy. She returned three times, and with all the quizzing I could give or examinations I could make, I could not find any cause for her unnatural labors.
Turning my attention to the possibility of the husband’s health as a factor in the child’s death, I could not discover that he had ever had any disease that could have accounted for parental influence causing immature children. In detail, let me say that the mother had conceived and carried without inconvenience, up to the time of the foetal death in a perfectly natural manner.
She never had shown a sign of: 1. Syphilis; 2. Anaemia; 3. Uterine disease or of any of its appendages; 4. Uterine displacement; 5. Cellulitis or peritonitis; 6. Laceration of the cervix; 7. Fevers; 8. Chorea; 9. Bright’s disease; 10. Tumors; 11. Poisoning from lead, arsenic, etc.; 12. Icterus or liver disease; 13. Traumatisms; 14. Overwork; 15. Reflex, as headaches, nausea; 16. Intemperance; 17. Narcotics or opiates; 18; Heredity did not influence her case, as all of her sisters are mothers; 19. Abortions at an early date; 20. Kidney lesions, non-inflammatory. Any one of these causes have been deemed sufficient to cause foetal death.
On the husband’s side, he had never suspicioned that he had in any way had: 1. Syphilis; 2. Nephritis; 3. Diabetes; 4. Phthisis; 5. Cancer; 6. He was in the prime of life, never had been intemperate; 7. No eruptive diseases; 8. Brothers were fathers; 9. No malaria; 10. No tobacco or lead poisoning. In fact, it was difficult to obtain a single clue to any physical defect through indiscretions or disease.
We next turned attention to the cause of death of the foetus, as each miscarriage was due to the presence of a dead foetus in utero. This first child she carried during eight months of gestation. When born, it had been dead several days. The second child was born at the fifth month, the third at the seventh month, and the fourth at the eighth month. All the children seemed perfectly formed, were not macerated, and, so far as the patient could tell, there were never any marks of syphilis. Once the attending physician said that there was something the matter with the cord, but she never had any explanation given her, and renewed the question fervently: “Why can I not have a living child?”.
These cases, so far as the aggregate in literature is concerned, are not especially rare, but they do not occur frequently in individual practice. Each practitioner could probably narrate one or more cases, but taken as a class of cases they are rare. Two pertinent questions arise here: What are the causes? What can be done?.
The answer to the first question, as found in the recent literature, is very briefly condensed in the following list of causes of death of the foetus: A. The premature detachment of the placenta-1. Through traumatism; 2. Violent exertions; 3. Infective fevers; 4. Nephritis. B. Diseases of the placenta-1. Syphilitic; 2. Infective fevers; 3. Tuberculosis; 4. Apoplexy; 5. Infarct; 6. Torsions; 7. Inflammatory changes; 8. Fibrous bands. C. Diseases of the foetus-1. Torsion of the cord; 2. Obliteration of the blood vessels of the cord; 3. Partial or incomplete development of the cord; 4. Irregularities or abnormalities in its placental attachments; 5. Thrombus; 6. Mummified fibrous cords; 7. Fatty degeneration of the cotyledons.
When can be done? The answer is plain. The majority of these cases will trace out to be either syphilitic or else to be accounted for by the velamentous insertion of the cord. The former is recognized best by microscopical examination. This examination should be made immediately after the expulsion of the placenta. The presence of gumma or syphilitic nodules is the true test. Fraencle has never been able to demonstrate syphilis of the placenta earlier than the sixth month.
The marginal attachment of the cord and the white infarct of the placenta or the various torsions are beyond the power of the diagnostician or of any form of medical interference. In the cases where the lesion exists, as in the nerve-centres or circulatory system, hygienic conditions and constitutional treatment is the only form of treatment that promises any measure of success. In the cases similar to the one I refer to, there being no lesions, I would try the treatment usually known as the anti-syphilitic, using Mer. cor., 6x trit., once daily for some months.
In case the lesion is syphilitic, repeated pregnancies have been known to have the effect of elimination, and the mother may finally give birth to a child viable and full of promise.
I have condensed my paper to a mere outline, but as there is little likelihood of a discussion, it will not have taken long to have mentioned the outlines of this subject.
DISCUSSION.
DR. LUDLAM: Ladies and Gentlemen, I inquired of the professor whether my colleague mentioned mental shock as a cause of abortion. We all know, i think, that this is a cause. There is such a long list of causes he overlooked this, I think. Mental shock often induces this result, but that there are causes that might accidentally have the effect there is no doubt. Dr. Bailey’s subject is, however, as I understand it, the habitual abortion that occurs over and over again in the same patient.
The impossibility of the woman, such as he cited, giving birth to a living child-the affection which she must undergo under those circumstances in not becoming a mother-is surely terrible. Surely, if there is anything we can do in such a case or anything we can suggest as a means of preventing such an experience, we ought to study such a question very carefully. For my part, I think there are times in cases not having gone quite so far as these where I have induced early labor, and the mothers have been blessed with living children. I suggest that we might think of this thing a little oftener than, perhaps, we have been inclined to do, because it is expedient and is more justifiable now than it ever was before.
DR. FOSTER: I would like to offer a suggestion or two with reference to such a case. It would seem that all of the well- known causes of the death of the child utero have been pretty well considered, and were well considered, I think, in the paper read by Dr. Bailey.
There is another possible cause, however, to which I would like to call attention. Perhaps it might be valuable. Perhaps I might put it in this way: I would say that the woman would, perhaps, have a better chance of giving birth to a living child if she had another husband. There have been such instances on record. Where either parent is not fruitful, he or she is likely to be in a subsequent marriage.
We see a similar state of facts oftentimes in the vegetable world, where we will find a little piece of ground that will always fail to ripen its fruit. It will permit a certain kind of fruit to grow until before it has reached maturity. Other kinds of fruit it will mature. I am under the impression that this case of Dr. bailey’s comes somewhere in that line.
ARTHUR FISHER, M.D., Montreal, Can.: To me there would be a suspicion of constitutional conditions, and if I could not do anything else, I would be strongly inclined to treat with sulphur and perhaps with other remedies.
