Paper - A study of the causes underlying the origin of human monsters 20

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Mall FP. A study of the causes underlying the origin of human monsters. (1908) Jour, of Morphol., 19:

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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

Embryos or the Eighth Week and Older

There are but two specimens of the eighth week (Nos. 79 and 152), one about 56 and the other 57 days old. Both are strangulated embryos imbedded in a mass of granular magma with the chorion more or less infiltrated with leucocytes. No. 152 is from a woman suffering with endometritis, this being her third successive abortion, each of which took place during the third month of pregnancy. In this specimen the umbilical cord is thin and very much twisted, a condition which might also interfere with the nutrition of the embryo.

The bodies of the two embryos are more or less altered, the greatest change being found in the central nervous system, as found in so many of the younger specimens. The vascular system is dilated and there are clumps of blood cells in the surrounding tissues. In No. I 52 the connective tissue appears to be more fibrous than is normal, the cutis being more or less hypertrophied.

The remaining specimens may be considered in two groups: (1) Those with a tendency towards club-foot, the most common malformation, and (2) those tending towards partial destruction of the central nervous system, also a very common malformation. At the present time, I cannot do better than to describe these specimens in regular order, for there are not enough specimens to allow following the changes from one to the other with any degree of certainty. Table XVII shows, however, that the placenta: are involved in all cases in which they were studied. The villi are more or less fibrous or hyaIline, usually infiltrated with leucocytes, and sometimes attacked by syncytial masses. The umbilical cord is usually thin and much twisted. It appears as if the beginning of the trouble lay in the chorion or placenta, which was gradually poisoned by the products of inflammation in the uterus, and in the course of time this resulted in fibrous degeneration of its villi, main wall of the chorion and finally the cord. As a result of malnutrition, the tissues of the embryo grew in an irregular fashion, the central nervous system and extremities suffering most, as is the case in numerous younger specimens. Later the heart stopped, and then the most resistant cells of the body continued to grow for a time until everything came to a standstill.

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TABLE XVI. NORMAL EMBRYO or 1111: EIGHTH WEEK AND OLDER. w r - '3 . ‘Bi ‘3 _ o . Specimen E Chorion. 1% go Specimen. E Chorion. g 3: E 5‘ E *3‘ ‘*3 2 Ir: 2 mm. mm. days mm. mm, days.

No.118.. 25 94 No.315.. 47 63 His (D12) 25 45 x 40 No. 105 . . 48 83 No.99. . 27 4o 75 No. 184 . 5o 6ox55x55 No. 192 . 27 7ox6ox5o No. 151.. 52 8ox6ox6o No. 403 . 27 64 No.169.. 52 11:: No.45. . 28 4ox35x2o No. 139.. 55 8ox65x4o 79 No. 2o3 . 28 4ox3ox3o No. 326.. 55 77 No. 26.. . 3o 75 No. 267. 59 84 No. 155 . 30 50x40 No.30... 6o 77 No. 2o2 . 3o 71 No. 171. 60 7o x 5o 2: 5o 56 No. 227 . 30 6o x.45x2o No. 92.. 7o 98 No. 274 . 31 57 No. 23.. 7o 6 No. 373 . 31 50 x 35 69 No. 3oo.. 73 14 w s Mmot.. . 32 68 No. 34. 80 104 No.129 . 32 66 No. 172 80 103 No. 145 . 33 6o x 50 x 4o 78 No. 125 83 84 No.52. . 33 4ox3ox15 No. 308. 84 1o: No. 211 . 33 9 wks No. 337. go 64 No. 178.. 35 61 No. 146. ' 95 .115 No. 269.. 35 77 No. 392. 95 101 No.213.. 37 7ox6ox5o No.117 me 111 No. 176.. 38 7ox7ox7o No.394. 105 125 No. 329.. 39 82 No. 138. 112 127 No. 140.. 4o 72 No. 355. 113 14 wks No. 206.. 40 89 No. 126. 125 125 No. 224.. 40 6ox5ox4o 78 No. 149 130 126 No. 362.. 40 44 No.46. 135 140 No. 282.. 42 36 No. 356 150 130 No. 96.. . 44 84 No.98. 160 125 No. 301.. 44 6ox4ox3o No. 359 160 156 No. 217.. 45 8ox6ox6o 78 No. 354. 190 178 No. 259.. 45 65x50 No. 121.. 210 190 No.95... 46 68x5ox5o 83

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TABLE XVII. Length of Dimensions of Menstrual . No' Embryo. the Chotion. Age. chorion’ 152 3r 70 x 42 x 38 ' 7o Fibrous and invaded by leucocytes and syncytium. Cord thin. 79 32 50 x 50 x so 9; Invaded _by leucocytes and syncytium. 124 35 90 x 75 x so 126 Abscesses in the placenta Cord thin and twisted. 3 16 44 I Cord thin and fibrous. 230 57 75x6ox5ol 7 mos. _ _ _ 286 6o 100 x 50 x 4oj 225 Hyahne and infiltrated with leucocytes and syncytium. 5 Cord thin and twisted. 308 84 101 Fibrous (2) Muco-purulent substance between villi. Cord twisted. 261 go I2OX 7ox 7oi Very fibrous.

These changes are beautifully illustrated in specimen No. I24, which is also described and .well pictured in my first paper upon this subject. This embryo is of the nine weeks’ stage, with a chorion twice too large and a menstrual history five weeks too long. This means that after the ninth week of pregnancy the embryo ceased to grow, but the chorion continued to expand Qt the same rate as the normal one grows, until the fourteenth. week, when it aborted. What is also noteworthy is that the amnion did not keep pace with the growth of the chorion, leaving between them a large exocoelom. The placenta is more or less diseased, that is, infiltrated with leucocytes, which at points produce small abscesses. The embryo itself has atrophic ears, club-hands and club-feet. After the embryo had been i11 my possession for seven years it was cut into sagittal sections, which, unfortunately, did not stain-well. However, they show that the skin is more fibrous than normal, being infiltrated with round cells, especially in the deformed extremities, where all of the structures are involved, forming syndactyly.

Changes similar to the ones found in No. 124 are seen again in No. 316. Unfortunately, I failed to obtain the membranes or any history of this specimen, so its story must be told by its form and structure alone. The feet and one hand are club—shaped, and the other hand is spread out and is attached to the side of the head. The skin is thickened and much of the epidermis has fallen off. At points the epithelial cells form mounds without any tendency towards horny changes in them. The muscles, blood-vessels and nerves of the extremities are converted into one fibrous mass of spindleshaped cells, giving much the appearance of myomatous tissue infiltrated with round cells. The cartilages are hyaline, and bone has formed in the center of the calcaneum. The hand has grown to the side of the head, the epithelial coverings having united. The true skin is composed of a mass of round cells.

No. 230 shows about the same changes, with additional “records” in the chorion, including the menstrual age. Together they show that the pathological process must have been under way for at least three months. There are some leucocytes in the chorion and the cord is thin and twisted. The tissues of the embryo appear normal, but they do not stain well, and the changes in the hands and feet appear to have been caused by mechanical twisting after the death of the embryo.

No. 286 is a similar specimen. The chorion is hyaline, infiltrated with leucocytes, and is attacked by syncytial cell masses. However, sections of different portions of the embryo show that its tissues are practically normal, which indicates that its death must have been sudden and not gradual.

The oldest specimen of this group is No. 261, which must also have been dead for a considerable time. The villi of the placenta have undergone fibrous degeneration and are devoid of syncytium. The cord is twisted, is of normal size. and at its attachment to the placenta is somewhat fibrous. Its blood-vessels are filled with blood. The decidua is composed of large sinuses, which are well filled with round cells.

At this place it may be well to introduce the description of a specimen (No. 308) which may prove to be of unusual value. In every respect it appeared to be a normal one about 100 days old, but the amniotic cavity was found filled completely with a mass of granular magma which was easily brushed aside to expose the embryo. The umbilical cord was found wrapped around both of the arms like a pair of shoulder braces, as the figure shows. Sections from the middle of placenta, at the point of the attachment of the cord, show that there is a muco—purulent mass between its villi, which contain many fragmented nuclei.

It may be that the poisonous condition of the uterus stimulated the embryo unduly, which in its gyrations got well wrapped up in its own cord. This naturally affected its nutrition, the first sign of which is the presence of granular magma. Had it not been aborted it would probably have ended like some of the others just described.

In numerous younger embryos a destruction of the brain and cord were noticed, and in a few of them the brain was extruding from the head. Yet all these changes were by far too severe to end in anencephalic monsters at full term. In nearly all of these specimens the changes in the central nervous system followed the cessation of the heart beat, and naturally such embryos could not continue their development; at best they formed moles. At any rate, the changes in these embryos show in a most radical way the reactions of the various tissues when the circulation is gradually stopped.

However, development cannot continue long if the infection of the chorion is severe, and, therefore, we find but few older specimens of pathological embryos in a relatively large collection. Usually these appear to be uninteresting, are misplaced or are thrown away. This has not been the case with my collection, and in it there are but few older pathological embryos. If a variety of merosomatous monsters are due to endometritis, we should expect to find them in diminished number as pregnancy proceeds, for it is likely that changes which arrest the circulation in the embryo, or foetus, will soon end in abortion. Therefore it is to be expected that a small number of pathological embryos develop into wellformed monsters.

In specimen No. 293 we have, however, conditions which might end in a typical spina bifida, for the tissues over the spinal cord are infiltrated with embryo’s blood and are being destroyed. The epidermis is intact. Had this embryo not been aborted the injury in it is sufficient to permit of an irregular growth of the cord to_ form spina bifida occulta.

In specimens Nos. 201 and 226 the changes in the central nervous system are very pronounced, and had they not been quite so severe it is easy to imagine their growth, at full term, into a cyclops foetus in the first case and into anencephalus in the second case.

Specimen No. 295 has in it changes which, if extended, could affect the cerebrum, and I am inclined to the belief that most cases of anencephaly begin in these later stages rather than in very young ones, for if they did not how could :1 relatively normal base of the skull develop in them? In this foetus correlated development has given form to all the bones of the skull, and the proportion of those of the base would not change very much in case the vault and brain. were destroyed, as is found in typical anencephalic monsters at birth. Questions like these are open to investigation and will give us the key by which we may determine at what time in development anencephaly begins, or whether the time is at all constant.