gestation is seldom attained, but it is generally terminated at the seventh or eighth month. Defective nutrition is probably due to spastic action and to the cause giving rise to it, namely, irritation or disease of the nervous centres.

Mental emotion, whether fear, anger, intense joy, or grief, is probably one of the causes of the spastic affections of the fœtus in utero. The changes which are induced in the blood and secretions of the foetus, by emotion in the mother, or any continued derangement in the system of the mother, are probably sufficient causes to induce convulsive action in the embryo.

An example is related by Tourtual of emotion causing the maternal secretions to become prejudicial to, and occasioning the death of, her infant.

"During Easter, 1821, a carpenter of this place (Munster) quarrelled with a soldier, who was billeted on him, when the latter fell upon him with his drawn sword. The carpenter's wife, at first, trembled with fear and horror; then, suddenly throwing herself between the combatants, she wrested the sword out of the soldier's hands, broke it, and flung it away. Some neighbours, attracted by the noise, hastened to the spot, and separated the men. The mother, thus violently excited, and while this mad uproar still continued, took up her child from the cradle where it was playing, and gave it the breast. The infant was in perfect health, and had never had a moment's illness. After some minutes it became restless, and left off sucking; it panted, and sank dead in its mother's lap. A quarter of a hour had scarcely elapsed when I saw the child. It was as though sleeping undisturbed in its cradle, and the body had not yet lost its natural heat. I immediately applied all the resources of my art (although I could not understand why death should take place so rapidly from such a cause), but in vain.”1

1 'Praktische Beiträge zur Therapie der Kinderkrankheiten,' Münster, p. 94,

1829.

came under

my own ob

Again, the following case

servation :

E. B., æt. 17. When nine months old was being suckled by her mother, at the time that intelligence was received of the sudden death of her father at sea. The mother was naturally much affected on receiving this unexpected and sad intelligence. Two or three days later she was alarmed by her child shuddering and fainting in her arms without any apparent cause. These attacks were repeated, returning at short intervals, and terminated in convulsions; the toes were drawn downwards and the feet inwards, and the hands were clenched. At two years of age, these fits became less frequent, and assumed the ordinary character of epileptic attacks. The extensors and adductors of the feet, and the flexors of the fingers were slightly but permanently retracted. At seventeen years of age she was robust and healthy in appearance; but the memory had suffered, and the temper was irritable. The epileptic attacks had assumed a periodical character, and preceded the catamenia; the pronators of the right forearm were spasmodically contracted, and the flexors of the fingers; the gastrocnemius, soleus, and tibialis posticus were also affected in the same manner.

And it cannot be doubted that, during the more intimate relationship which exists between the parent and embryo, a less cause even may produce a similar effect. It is impossible not to believe that, while the relation between the two is so intimate that the fœtus is to all intents a part of the maternal body, a comparatively slight cause may induce a diseased action.

It is scarcely necessary to mention, that the siege of Landau, and the explosion of the arsenal, was, as we are assured by most credible witnesses, followed by the most. dire effects on both mothers and children. Of ninety-two children who were born soon after, fifty-nine died at birth, or were born dead, or survived only some few months;

and some were idiotic, and some were born with fractures of the bones.

I have known so many instances in which emotion has been the cause of derangement in the system of the foetus, and cause and effect been recognised and acknowledged in some at the time of their occurrence, and without waiting for demonstration of the effect until the termination of gestation, that I cannot doubt its influence.

For instance, the wife of a shopkeeper, a highly respectable and intelligent person, had occasion to take her child to a surgeon for his opinion of some slight ailment with which it was affected. She was at the time in the sixth month of pregnancy. On entering the room in which the consultation was held, she observed several casts of club-feet and other distortions, and was immediately seized with a sensation of disgust, followed by sickness and general malaise. She was removed home, when she expressed her conviction that she should give birth to a child with clubbed feet, in consequence of what had occurred. She did not entirely recover from the impression which had been produced until after the child was born, namely, one month after the occurrence, i. e., at the seventh month of utero-gestation. The child was born with double varus of the third degree.

One of the worst forms of club-hand and club-foot that I have ever seen, unconnected with monstrosity, was believed by the mother to have arisen in the following

manner :

During the sixth month of pregnancy, the wife of a substantial Lincolnshire farmer, early in 1852, had a narrow escape from falling into a deep dyke, in which were eight or nine feet of water. She saved herself by dint of a great muscular effort, and sustained, at the same time, a very severe fright. Until this occurrence, she had felt the ordinary movements of the foetus, but from this moment they ceased entirely, so that she expressed her belief that the child was dead. Until the fourth day no movement could be distinguished; but on that day a slight fluttering or tremulous motion was felt, which increased, until in time it was similar to that which had been

felt before the accident. The child was born at the eighth month with talipes varus and talipo-manus, and was small and unhealthy in appearance.

The hands remained distorted long after the feet had been restored to their normal shapes.

The following case was under the care of Mr. Tamplin, at the Orthopædic Hospital, to whom I am indebted for it:

"During the sixth month of pregnancy, a robust woman fell, in the dusk of the evening, into an opening which had been left uncovered in the road. She was much alarmed and somewhat hurt by the fall. The child was born at the eighth month, with the hands and feet as shown in the accompanying engravings."

I could mention many cases in which the mother remembered to have been particularly struck by the appearance of a club-foot during her pregnancy, and which she believed, from the impressions it had occasioned, was the cause of distortion in her own child. In one case, an unfortunate beggar, whose feet where distorted into varus; in another, a boy with club-foot beating her child, were mentioned by the parents as the probable causes of distortion of the infants of which they were at the time pregnant. Or again, an injury to the foot of the parent is occasionally assigned as the cause of distortion in the foetus.

Again, many cases occur for which causes cannot be with any degree of certainty assigned; and it is probable that in hysterical and highly sensitive persons, a cause, which, under ordinary circumstances might be insufficient, may in these prove sufficient to induce convulsive action in the fœtus, or to induce spasm of individual muscles or of groups of muscles. Although much obscurity must veil this part of the subject, it is generally accorded that the poor and the uneducated-those who are exposed to care and want, or to brutal treatment, intoxication and vice, are more subject to these affections than those differently circumstanced. Mental impressions, unrestrained and violent passions, brutal treatment involving personal injury and creating fear, are, I believe, common causes of these affections.

In

Congenital distortions are sometimes hereditary. 1853, I operated on a child for talipes varus of both feet, who had three brothers, all of whom were born with double varus; and in 1855, a fifth boy was born in this family, also with varus of both feet, who also was under my care, and on whom I operated. There were three girls in this family born intermediately with the boys. None of