gewichts)" long. This child lived ten days. In the Jour. d'Accouchements for February, 1895, there is a discussion of a case reported to be a fifth-month fetus, which was still living at the time the paper was written, two years and a half after birth. The analysis of the evidence as to the age of the child there gone into leads to the probability that the child was a few days over six months in utero, about 180 days after the last menses. In that article are references to six other cases of six months and a few days intrauterine life. In the Lancet, April, 1852, there is the record of a case born on the 179th day of pregnancy, that lived four months, and then died of an epidemic disease. Dr. Barker describes a case born on the 158th day; weight, one pound, length, 11 inches; three years and a half afterwards it was still living. 66. Conclusions as to limits of variation.-From the foregoing facts we can but come to the conclusion that, though the normal period of gestation is 275 to 282 days from the end of the last menses, or 270 days from a single coition, the pregnancy may be protracted to 334 days after coitus, or 344 days after the menses; while, on the other hand, the shortest recorded pregnancy where the child has been carried through an existence of more than a few hours is Home's case, in the eighteenth week, 126 days, where the infant lived more than eight years CHAPTER IV. SUPERFETATION. 67. Definition. 68. Ovulation during pregnancy. 69. Possibility of conception. 70. Evidence from alleged superfetation in normal cases, in general. 71. Twins with different fathers. 72. Simultaneous birth of two fetuses of different ages. 73. Two viable fetuses born within nine months. 74. Interpretation of this evidence; twin compression. 75. Evidence from superfetation in abnormal cases; double uterus. 76. Coincident extra- and intra-uterine pregnancy. 77. Conclusions. 67. Definition. In connection with the question of the duration of pregnancy, treated in the previous chapter, the question arises as to how soon after the end of one pregnancy another may begin. And as there have been a number of cases reported in which the time between the birth of two infants at term has been recorded as less than nine solar months, we are confronted with the problem as to whether one pregnancy can begin before another has come to term. If one pregnancy can be superimposed upon the other, we have the condition known as superfetation. And directly allied hereto comes the question as to whether the two infants of a twin birth may have different fathers. 68. Ovulation during pregnancy. In order for two pregnancies to be superimposed, not only must there be two inseminations, but there must also be two ovules set free from the ovaries of the woman, and the spermatozoa must meet and fertilize the ovules. The question as to whether ovulation continues during pregnancy has not much evidence to settle it. The prevalent opinion is that ovulation is suspended while the uterus is functionating. The only positive evidence of ovulation is the finding of the ovule or the ruptured Graafian follicle in the ovary. (The unimpregnated ovule would be extremely hard to find.) The ovaries in the majority of cases during pregnancy certainly show no traces of ovulation since the date of impregnation. But in the cat one case has been reported in which, during pregnancy, Christopher1 found a follicle on the point of rupture, and Auvard says that Slavyansky, in a woman who died from rupture of a tubal pregnancy, found a follicle in the left ovary which was tense, as if about to rupture. This is rather scanty evidence, but it tends towards the view that in exceptional cases, ovulation may be possible during pregnancy. 69. Possibility of conception.- That insemination may take place is unquestioned; but then the possibility of the semen meeting the ovule remains to be settled. Our present views as to the changes that take place in the lining membrane of the uterus are to the effect that during the first three months of gestation, there is a certain amount of space between the decidua reflexa, which covers the ovum, and the decidua vera, which lines the uterus; but that during the third month the two decidual surfaces fuse. Hence, during the first three months it is possible, from an a priori point of view, for the spermatozoa to meet the ovum, if by any chance there be one in the tube, and a preg nancy may follow. 70. Evidence from alleged superfetation in normal cases, in general. The cases upon which superfetation has been argued may be divided into three classes: 1. Twin pregnancies, in which the children, by certain physical peculiarities, prove that they had different fathers; as where one is a white child and one a mulatto. 2. Birth almost simultaneously of two fetuses of unequal development. 3. Birth of two living children at a longer interval, but less than that required for the development of the second infant after the birth of the first. 71. Twins with different fathers.- Instances of the first class are not uncommon. In animals, instances of a bitch giving birth to a litter of pups, some of which resemble one dog and some another dog, are common. Instances where a mare has been covered by a stallion, and within a short period by an ass, and has brought forth twins bearing the marks of the two fathers, are also on record in the veterinary annals. And there are a number of cases on record where a negress has borne twins, one a mulatto and one a pure black.3 Buf 'Amer. Journ. Obstet., May, 1886. 472. 'Amer. Jour. Med. Sci., Oct., 1841, p. 315. For a large number of similar cases, see references in Beck's Med. Jurisprudence, Vol. I., p. 265; also Phil. Med. Exam. 1849, p. 523; and another in Am. Jour. Med. Sci., July, 1854, p. 290. Also, Mosely, Diseases of Tropical Climates, p. 111; and Casper's Wochenschrift, Jan. 8th, 1842; and Amer. Jour. Med. Sci., April, 1849, p. 549. fon cites the case of a white woman who, after having intercourse with a white and a negro, at an interval of a few hours, gave birth at term to a mulatto and a white child. And Bouillon," after reporting a case where a negress bore a black and a mulatto, both equally developed, at a single birth, cites the case of a negress belonging to M. Bertodiere, a landowner in Morne à l'Eau, "Qui mit à monde trois enfans, dont un mulâtre, le second noir, et le troisième câbre; la mère et les enfans vivent encore, et ne laissent aucune incertitude sur la superfétation." Analogous to these births of twins with evident different fathers" are the more common cases of twins from the fertilization of two ovules at one insemination, such as are represented by those that have separate amniotic and chorionic membranes, with two distinct or fused placentæ: the majority of cases of twins (977 cases out of 1,159 examined by Ahlfeld). 72. Simultaneous birth of two fetuses of different ages.- Instances of the second class are also not rare. Sunderland reports a case where a woman, at an interval of two hours, gave birth to two fetuses, one of the fifth month and one of the third month. Carpenter' reports the case of a woman who, within an interval of a few days, gave birth to a three weeks' ovum (embryo not seen), and a carneous mole 4 inches in diameter, which was reckoned as of about the third month. Tyler Smith reports a case of a miscarriage of an 'Buffon, cited by Auvard. Bull. Fac. de Med. de Paris, 1820, VII., p. 512: "Who gave birth to three infants: the first a mulatto, the second a black, and the third a creole; the mother and the children are still living and allow no uncertainty as to the superfetation." For a similar case, see also Tyler Smith, Lancet, April, 1856, p. 388. As incidentally bearing upon the question of a mulatto child from two white parents, the question of "teleg ony," or the effect of a previous sire upon children of a second father, should be mentioned. The condition in animals is well recognized, under the term of "throwing back." (See the paper read at Royal Med. Soc. Edinburgh, on March 1st, 1895; "Teratologia," July, 1895.) In man the condition seems to be equally accepted. Gould, Anomalies and Curiosities, p. 88, says that a white woman pregnant by a black man and later by a white man will always show the An taint of the black husband in the children of both white parents. He also says that children born in adultery resemble the legal father more than the real father, and children by the second husband resemble the first husband. instance of this kind, or, as the author considers it, of maternal impression, is described by Clerc (Bull. Soc. Med. Suisse Romande, July 7, 1873) from the experience of Kuss in Strassburg. A white woman had a negro paramour with whom she had had sexual connection several times while in America. Returning to Europe she spent two years in a convent, and then married a white man. The result of the union was a dark-skinned child. Maternal impression is substantianted by several other apparently authentic cases. (See Gould and Pyle's Anomalies and Curiosities of Medicine, p. 81.) 'Carpenter, Amer. Journ. Obstet., Vol. XX.. 1887, p. 200. "Tyler Smith, quoted by Carpenter. ovum of the fifth month, and one of the first month. This woman had menstruated regularly during her pregnancy. Gauthereaux9 de scribes a case in which there was a birth of twins each about 5 inches long (four and a half months), and then a few hours later a single birth of an infant 15 inches long (about seven and a half months). Godfrey1o describes a case where, four days after the birth of a three and a half months' fetus, there was delivered a seven months' child, weighing four and a quarter pounds. Giles11 reports the case of a dead child at half term and a seven and a half months' child, born three hours apart. Sinard12 reports recently a very interesting case of birth on the same date of a six months' fetus, length 32.5 cms., that lived fifty-four hours, and a full term or somewhat over-developed child with slight hydrocephalus, that lived twenty-four hours. In connection with this case Sinard quotes a case cited by Nagele13 of a woman who gave birth to a large girl infant, and a half hour later to a small girl infant, too weak to suck, that lived only two weeks. This second infant was 16 inches long and weighed two and a half pounds; it was estimated at seven months. Perhaps the most evident case of this class is that reported by Dufrènois11 of the delivery, in the same day, of one child at full term and a fetus one inch long, in which the eyes and the rudiments of the extremities could be seen, and of which the age was estimated at six to seven weeks. The fetus was not dried up or changed in any way to cause suspicion of decomposition, but was in a small amniotic sac of its own. The woman admitted coitus in the fourth month, in the sixth month, and again towards the end of the seventh or beginning of the eighth month. After the last connection the woman felt nausea and the derangement of appetite common in the early months of pregnancy. Another very possible case is that of Addison,15 where a woman was delivered of a healthy male child, and four days later, twins, the size of a pigeon's egg, were born. 73. Two viable fetuses born within nine months.-As instances of the third class, where fully developed infants are born at intervals less than that required for their development, we may quote 'from Genahl's thesis (University of Paris), of 1867, "Considerations sur Gauthereaux, N. Orleans Med. Surg. Journ., N. S., Vol. XVIII., 1890-91, pt. 1, P. 426. Godfrey, Lancet, Lond., 1887, Vol. II., p. 959. "Giles, Lancet, 1887, Vol. II., p. 565. "Sinard, Le Bull. Méd. de Quebec, 1900, I., 463. "Negalé, Le Bull. Méd. de Quebec, 1900, Ĭ., 463. "Dufrènois, J. de Méd. et de Chir. Prat., Paris, 1833, IV., p. 65. 15 Addison, Lancet, London, 1886, Vol. I., p. 477. |