ANTE-NATAL INJURIES

1905 The Lancet  
University of London with a view to giving the medical student in London advantages equal to those enjoyed by the students in large provincial universities. Judging from the applause with which the exposition of both schemes was greeted it would seem that each had the hearty approval of the audience. ___ THE HEALTH OF THE KING. ON Saturday, the llth inst., His Majesty received a chill, probably when driving in his motor car. Some bronchial catarrh with a slight rise of temperature and increase
more » ... ature and increase in the pulse-rate ensued so that it was found necessary by his medical attendants to advise him to remain indoors in an equable temperature. We are glad to say that His Majesty has progressed satisfactorily and on Wednesday was able to go out. A VERY interesting question was raised in a case before the Exeter magistrates when a woman, in applying for a separation order said that her last child had been born with black ey(s and a discoloured face as the result of her husband's violence. The medico-legal question involved is one of much interest. What is the usual effect on the foetus in utero of traumatism applied Lo the abdomen of the mother ? The amount of injury which a pregnant woman may sustain and yet give birth at full term to a healthy child is astonishing. One of the most remarkable cases is that recorded by Corey. The patient, a woman three months pregnant, was tossed by a cow. There was an abdominal wound through which protruded the great omentum, the descending and transverse colon, most of the small intestine, and the pylori end of the stomach. Three and a half hours after the accident the viscera were replaced under an anoesthetic and the edges of the wound were pared and sutured. The woman made a perfect recovery and gave birth at full term to a healthy and uninjured child. Tiffany, who has collected a number of such cases, quotes one of a woman who at the eighth month of pregnancy was almost buried by the fall of a clay wall and received a number of wounds on the head, 32 stitches having to be inserted. In spite of this the pregnancy continued to full term and the patient gave birth to a healthy female child. The escape of the foetus from injury in such cases is no doubt to be explained by its protected position in the mother's abdomen and by the presence of the liquor amnii. Unhappily in many instances of severe abdominal injuries the outcome is not so fortunate and that such injuries may result in serious damage to the child is only too certain. Neugebauer, for instance, relates the case of a woman who, when near full term, committed suicide by jumping from a second-floor window. She ruptured her uterus and a dead foetus with a fracture of the parietal bone was found lying free in the abdominal cavity. A great many of the recorded cases, however, especially in the older literature, in which various injuries, for example, fractures and dislocations of the foetal bones, are described, must be received with scepticism, as such conditions are more often due to defects of development than to direct injury to the foetus in utero. An instance of this kind is no doubt the case recorded of a woman who at the seventh month of pregnancy fell and struck her abdomen against a tub. She was delivered at full term of a child who had a deep cleft in the cheek involving the anterior part of the helix and antihelix of the left pinna and extending forwards as far as the nose. The external auditory meatus was also obliterated. This was in all probability not a case of injury at all but an example of an intermaxillary fissure of the face. Such a fissure usually starts at the angle of the mouth and ,pursues an outward and, upward course towards the ear. It is most commonly met with on the left side, as in this case, and is often associated with various deformities of the external ear. It is usually asserted that intra-uterine fractures are due to external violence but this is far from always the case. Numerous examples of fractures involving the long bones and the cranial bones can be collected, especially from the older literature. Gurlt has recorded a large number of such cases and his paper proves that they are by no means uncommon. Their explanation, however, is not EO simple. In many instances they are met with in association with other deformities or complete or partial absence of some of the other bones. The view put forward by Ballantyne with regard to these conditions is probably the correct one-namely, that the great majority are really due not to external violence but to the result of amniotic adhesions. Further support is given to this view by the fact that not infrequently a cicatrix has been found over the site of the fracture and this is explained by the supposition that a band of the amnion was attached at this point and produced by its traction distortion of the oft cartilage of the developing bone and as a result the appearance of a healed fracture. In the same way it is probable that most of the recorded cases of intra-uterine dislocations are also not the result of direct trauma but are due to anomalies of growth from the pressure exercised by an ill-developed and unseparated amnion. The curious cases of so-called recent wounds of the skin which are met with from time to time in newly born babies, and which have always been the cause of a great deal of curious speculation, must be explained in the same way and are in reality due to the rupture of an amniotic adhesion during parturition. The tearing through of such an adhesion close to the skin would give rise to a raw area. The Exeter magistrates apparently believed the story of the woman who applied for their assistance and it is possible that they took a correct view of the case. That severe injuries inflicted upon the mother may affect the foetus in utero is certain and it would be rash to assert that in certain circumstances, as, for example, a deficiency of the liquor amnii, even comparatively slight violence could not cause damage to the unborn child. At the same time in considering such cases the medical man must always remember that a very large number of so-called injuries are in reality faults of development and are due to trauma it is true, but to trauma produced by the pressure of an undeveloped amnion and not to trauma the result of external violence.
doi:10.1016/s0140-6736(01)45918-6 fatcat:ia35ieq3ujev5lkvezvjopq75i