Paper - A study of the causes underlying the origin of human monsters 10

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Mall FP. A study of the causes underlying the origin of human monsters. (1908) J Morphol. 19: 3-368.

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1908 Mall TOC: Historical | Double Monster | Lithium embryos | Salts of potassium and heart | Spina bifida and anencephaly | Cyclopia and club-foot | Pathological ova | Twin pregnancies | Unruptured tubal pregnancies | Ruptured tubal pregnancies | Amnion Destruction | Moles | Pathological ova umbilical cord and amnion | Second week | Third week | Fourth week | Fifth week | Sixth week | Seventh week | Eighth week and older | Specimens and figures | Plates | Historic Papers | Franklin Mall

A Study Of The Causes Underlying The Origin Of Human Monsters

Ruptured Tubal Pregnancies

According to Williams,‘ most of the ova in tubal pregnancy are extruded through the internal opening into the abdonimal cavity, producing a condition known as tubal abortion. He collected the cases published by various authorities, and found that in 289 cases that were carefully reported 78 per cent ended by abortion and 22 per cent by rupture of the tube. Among these there is a small per cent of normal embryos, and the fate of them has recently been studied by Von Winckel.2 Before considering Von Winckel’s report it is necessary to collect some data regarding the frequency of abortions of pathological ova and of monsters in uterine pregnancies.

Williams states that “a conservative estimate would indicate that every fifth or sixth pregnancy in private practice ends in abortion, and the percentage would be increased considerably were the early cases taken into account, in which there is a profuse loss of blood following the retardation of the menstrual period for a few weeks.” I also find that Marchand3 has collected the per cent of monsters from a number of writers; his figures are as follows:

‘““*°*- i§?;a‘i§. m‘Y.i’;s€§a. Chaussier . . . . . . . . . . . . . . . . . . . . 22,293 132

Peuch . . . . . . . . . . . . . . . . . . . . . . 772 7

Schworer . . . . . . . . . . . . . . . . . . . . 39,917 88

Winckel . . . . . . . . . . . . . . . . . . . .. 10,056 : 56

VVinckel . . . . . . . . . . . . . . . . . . . . . 8,149 232 81,187 615

‘Williams, Obstetrics, p, 539, New York, 1903.

‘Von Winckel, Ueber die Missbildung von ektopisch entwickelten Friichten, Wiesbaden, I902.

“Marchand, Missbildungen, Eulenburg’s Real-Encyclopedia, Bd. 15, p. 439, I897. 66 MALL. [VoL. XIX.

It is noticed that these data, which are given in chronological order, give an increasing per cent of monsters, indicating that the more recent ones are collected with greater care. Taken together they give pretty well, I think, an average, for no doubt slight anomalies are included only in the records given by Von Winckel. If we assume that the number of

births represent only four-fifths of the pregnancies, the figures will read about as follows:

Abortions Abortions

Pregnancies. Births. Normal Pathological Monsters

Embryos. Ova. at term. Number . . . .. 100,000 80,572 11,765 7,048 615 In per cent .. 100 80 12 7 .6

I find in my own records of 434‘ embryos (Catalogue Nos. 1 to 404) that 163 of them are pathological, which, when raised to the number of abortions given in the table above, gives 7,048 as the number of pathological embryos in every 100,000 pregnancies. For the present this is as near as I can

First Month.

Nos. I to 208- 26 normal and 33 pathological: 56 % of pathological Nos. 209 to 404-— 18 normal and 45 patho1ogical:71*% of pathological Nos. 1 to 404-— 44 normal and 78 pathological: 59 % of pathological

Second Month.

Nos. 1 to 208- 59 normal and 32 pathological=35 % of pathological Nos. 209 to 404-— 46 normal and 28 patho1ogical=38 % of pathological Nos. 1 to 404-107 normal and 60 pathologica1=36 % of pathological

First and Second Months.

Nos. I to 208- 85 normal and 65 pathological=43 % of pathological Nos. 209 to 404- 66 normal and 73 pathological: 53 % of pathological Nos. 1 to 404-151 normal and 138 pathological=48 % of pathological

Total Number: of All Months. Nos. 1 to 404-27: normal and 163 path0logical=38 % of pathological

‘Total number of specimens (434) catalogued under 404 numbers.

The per cent has been fully up to 70 from Nos. 127 to 404. The low per cent (44) up to No. 127 is due to the fact that only normal embryos were at first collected. No. 1.] ORIGIN OF HUMAN MONSTERS. 67

approach the proper number and per cent, but it will do for the sake of making comparisons. It appears, therefore, that in every 100 pregnancies in cities there are seven abortions and about one monster is born at term. It may be less in country districts.

I have made no special effort to collect foetal monsters, but find that my collection contains seven monsters which are not included in the 163 pathological specimens mentioned above.

I have been unable to collect any good data regarding the frequency of monsters in tubal pregnancy, but, according to Joachimsthal, they are very rare, and according to Leopold they are rare, while Martin and Orthmann, Ruge, Olshausen and Veit state that they are more common than in uterine pregnancies. It may be that the latter gynecologists confused early pathological embryos with older monsters, while the former did not, a line between them being difficult to draw, and, therefore, it is not frequently recognized.

Von Winckel has done us a service in collecting those foetuses from tubal pregnancies which continued to live and were removed alive from the abdominal cavity. The foetuses which he considers must have been derived from the 4 per cent of normal embryos I have found in unruptured tubes removed in Dr. Kelly’s clinic. Ninety—six of the specimens were so markedly pathological and so far destroyed that they could not possibly have lived until the end of pregnancy. Von Winckel’s cases are especially valuable to determine the fate of the embryos that must have been normal before the tube ruptured, that is, during the first weeks of pregnancy.

Von Winckel first gives the cases that have been published by others, as follows:

Date. Author. No. Monsters. 1876. Henning . . . . . . .. I 50 2 and 6 compressed foetuses. I894. Orillard . . . . . . . . 6 (alive) 6 1893. Schelling 257 25

I891. Kiichenmeister 43 7 5 68 MALL. [Vox.. XIX.

Date. Author. No. Monsters. . Harris . . . . . . . . . . 45 II I9OI. Sittner . . . . . . . . .. 126 (alive) 36 1902. V. Winckel . . . . .. 13 (alive) 13 . Kehrer . . . . . . . .. 93 (uterus

bicornis) 7

It is seen in the table from Von Winckel that the number of monsters increases in per cent from year to year. However, he thinks that it is safe to say that one—half of the foetuses in ectopic pregnancy are deformed, the most common deformity being that of the hands and feet. Von Winckel further collected 87 cases (14 his own) and found that 57 of them were much deformed and I2 were markedly monstrous. Among these there were six cases of hydrocephalus and one each of hydromeningocele, encephalocele, anencephalus, omphalocele, spina bifida, and hypospadia. In addition, the head was found deformed, 57; legs, 44; arms, 35 times; with club—feet in 12 and amniotic bands in 4 cases. The placenta was usually deformed, sometimes multiple, broad and thin or short and thick, and often very hemorrhagic.

In general, then, it is the poles of the body that suffer most, the head being deformed in 75, legs in 50, arms in 40 and the trunk in 4 per cent of the cases. It is clear that 3 good share of the difficulty is due to ordinary mechanical causes, but the I2 cases that were markedly monstrous could not be due to such causes alone. For them we must hold the hemorrhagic placenta responsible, which could be included under what I have termed faulty implantation. Therefore, I4 per cent of the 87 cases become monstrous, while in normal pregnancies it is but .6 per cent. However, in all of I00 total pregnancies the per cent would be as follows:

pregna,-,c;e5_ I\I§3°i;::T}‘1:] Pathological. Monsters.

Uterine . . . . . . .. I00 80 7 .6 Tubal . . . . . . . . .. I00 3 96 .56

The proper per cent of real monsters was obtained .from the 4_per cent of normal embryos. The 14 per cent of monsters were obtained from the 4. per I00 of normal embryos in tubal pregnancy, the remaining 96-having become pathological at a very early stage. This gives, as is shown in the table, .56 per cent of monsters for the full 100, which is only a coincidence and an improper comparison. Three of the four embryos that remain, that is, those that produce normal foetuses, are by no means so according to Von Winckel.

I have given the data obtained from tubal pregnancy at some length on account of their bearing upon the etiology of teratogenesis. No matter how these data are considered. they all point in one direction—the number of pathological embryos and monsters is greatly increased in tubal pregnancy.