[]THE SINGULAR CASE OF A LADY, WHO HAD THE SMALL-POX DURING PREGNANCY; AND WHO COMMUNICATED THE SAME DISEASE TO THE FOETUS.
BY W. LYNN, SURGEON.
AS READ AT THE ROYAL SOCIETY IN FEBRUARY 1786.
LONDON: PRINTED BY C. MACRAE, ORANGE STREET.
A SINGULAR CASE.
[]EVERY circumſtance which tends to elucidate any doubtful point in the animal oeconomy, as it adds to the ſtore of our knowledge, muſt of courſe contribute to ſettle the practice of phyſic and ſurgery upon more certain and rational principles.
[4]Whether a foetus can receive the infection of the ſmall-pox, or any other contagious diſtemper, from its mother in the womb, is a queſ⯑tion which appears not to have been ſatisfactorily ſolved. Many eminent phyſiologiſts have been divided in their opinions upon this ſubject.
In the caſe publiſhed by Mr. John Hunter, in 1777, the point is far from being aſcertained, to the full conviction of that celebrated teach⯑er's own mind; ſince, after having related the caſe, he collects the beſt authorities on both ſides of the queſtion, and leaves the deciſion to the reader's own judgment.
[5]It is to ſettle this matter beyond the poſſibility of future controverſy, that the following facts are, with all reſpect and deference, ſubmitted to the conſideration of this learned Society.
In November, 1785, the wife of Mr. Eve, a coachmaker in Oxford-ſtreet, being then in the eighth month of her pregnancy, was ſeized with rigors, pain in the back, and other febrile ſymptoms. In two days time, the diſeaſe ſhewed itſelf to be the ſmall-pox; and though the puſtules were of the diſtinct ſort, yet they were uncommonly nume⯑rous. [6]On the eleventh day they began to turn; and on the twenty-ſecond day her labour took place, which, according to her reckoning, was a fortnight before the regular period; that is, when ſhe was ad⯑vanced in her pregnancy eight months and two weeks.
The child, at the time of its birth, was covered with diſtinct puſ⯑tules all over its body: they did not appear to be full of matter till three days after; at which time I took ſome of the pus upon a lancet, from one of the puſtules on the face. With this lancet I afterwards ino⯑culated, [7]on the 2d of December, 1785, a child of Mr. Chaters, in Church-ſtreet, Soho, in both arms. On the 7th the inflammation began to appear in each arm, and conti⯑nued daily increaſing till the 11th of December, when the child ſick⯑ened, and was affected with all the ſymptoms which uſually precede the eruption. On the 12th the ſick⯑neſs and fever abated, the puſtules of the diſtinct ſort of ſmall-pox made their appearance, and the child having regularly gone through the ſeveral ſtages of the diſtemper, was perfectly well in three weeks.
[8]It may be proper to obſerve, that Mr. Findlay, ſurgeon, in Sackville Street, and Mr. Holladay, late ſur⯑geon to Sir Edward Hughes, in the Eaſt-Indies, were preſent, both at the taking of the matter, and at the ſubſequent inoculation of the child.
As no circumſtance can prove the identity of the ſmall-pox more in⯑diſputably, than its being commu⯑nicated, with the uſual ſymptoms and progreſſion of the diſeaſe, from one ſubject to another; ſo it appears to be aſcertained from the above facts, that a child can receive the variolous infection from its mother, in utero.
REMARKS.
[9]ALTHO' the fact of the poſ⯑ſibility of the ſmall-pox being communicated from the mother to the foetus, in utero, be clearly proved in this caſe, yet there may ſtill re⯑main ſome doubt with reſpect to the mode of communication.
It may be urged, that if we ſup⯑poſe the communication of the diſ⯑eaſe [10]from the mother to the child to be effected by means of the circulat⯑ing fluids, then the child would never eſcape the infection, when the mother had the diſeaſe; where⯑as the contrary appears in the in⯑ſtance adduced by Mr. John Hunter from Boerhave, of a lady who hav⯑ing gone through the confluent ſmall-pox in the ſixth month of her pregnancy, brought forth after⯑wards, at the regular period, a child, whoſe body did not ſhew the leaſt veſtige of the diſeaſe.
To this it may be anſwered: It is by no means neceſſary, ſuppoſing [11]the contagion to be conveyed by the circulating fluids, that there ſhould be no poſſibility of the child's eſcap⯑ing the diſeaſe, becauſe this aſſer⯑tion proves too much. For it ap⯑pears, that there muſt always be a certain aptitude or fitneſs in a body to receive any infection offered to it; and that unleſs this fitneſs or aptitude prevails, the infection will not take place. What this fitneſs or aptitude is, we cannot tell; but that it really doth exiſt, is evident from daily and palpable experience; otherwiſe, every perſon expoſed to any contagious diſeaſe would never eſcape. How many are there re⯑ſpecting [12]the diſeaſe in queſtion, who never having had it them⯑ſelves, are caſually or purpoſely ex⯑poſed to infection, and eſcape it ſeveral times, while they ſhall catch it upon another occaſion, when perhaps they leaſt expected it? Nor is there any reaſon which can in⯑duce us to ſuppoſe, that this ap⯑titude or fitneſs for receiving infec⯑tion is not as neceſſary to produce the diſeaſe, when the virus is im⯑mediately conveyed by the circu⯑lating fluids, as when it is previ⯑ouſly to be abſorbed: For in the inſtances alledged, although the virus had not acted upon the conſti⯑tution [13]ſo as to produce the diſeaſe, yet we cannot ſuppoſe the whole abſorbent ſyſtem to be entirely in⯑active, ſo as that no particle of matter, capable of infecting, ſhall be taken up by the body, repeat⯑edly expoſed to it. The action and power of the abſorbent ſyſtem muſt go on; and therefore, when a con⯑tagious diſtemper is not produced in any body expoſed to it, this can only be accounted for, from the inaptitude or unfitneſs of the con⯑ſtitution to produce it at the time, however myſterious that inaptitude or unfitneſs may be.
[14]In the caſe mentioned by Boer⯑have, if the foregoing reaſoning has been well founded, we might ſuppoſe that there was a want of aptitude in the foetus to receive the infection, although it was circulat⯑ing in the fluids of the mother; or there is another way of conſidering it, which is, that the child had really gone through the ſmall-pox in utero, but had been born without any marks. How many are there who go through the diſeaſe, and never bear the leaſt veſtige of it after⯑wards?
In this caſe, there was full time enough for the child to catch the [15]infection, go through the ſeveral ſtages of it, and come into the world without a ſpot; for the lady having had the diſeaſe in the ſixth month, implies, that ſhe had gone through it before the ſix months were com⯑pleted; conſequently there were full three months remaining before the child came into the world.
Suppoſing, therefore, the child to have gone through the diſeaſe before the ſeventh month was ac⯑compliſhed, it had ſtill upwards of two months to get rid of any marks remaining from any previous puſtu⯑les it might have had; and is it not [16]extremely probable, that the cir⯑cumſtance of the child's being en⯑tirely ſecluded from the external air, at that period, may have con⯑tributed much to aboliſh or ſhorten the duration of theſe marks? Again; every one knows from daily expe⯑rience, that becauſe the mother had a confluent ſmall-pox, there was no neceſſity that the child ſhould have one of the ſame kind.
If it be poſſible, then, that the child ſhould have had a mild ſmall-pox, it is on the other hand impoſ⯑ſible to aſcertain the number of puſ⯑tules it might have had. One or two [17]are ſufficient to characteriſe the diſtemper, and many perſons go through it, both in the natural way and by inoculation, with no other external mark. Some eminent phy⯑ſicians indeed, among whom is Boer⯑have, have been of opinion, that the eruption is not abſolutely neceſſary to conſtitute the diſeaſe; and that a perſon may go through the vario⯑lous fever without any apparent eruption, and be as free from future infection as if the eruption had ap⯑peared.
There is nothing, therefore, which militates againſt the ſuppo⯑ſition of the contagion being con⯑veyed [18]from the mother to the foetus in utero, by means of the circulating fluids; even in thoſe inſtances ad⯑duced of the child having caught the diſtemper in the womb of its mother, who had previouſly expe⯑rienced it, and therefore was not herſelf ſuſceptible of it. Can we ſuppoſe the diſeaſe to be conveyed to the child any way, then, through the mother? A ſubject may abſorb, and convey an infection to another, of which it is not itſelf ſuſceptible; and in this caſe, the mother be⯑comes the vehicle of a poiſon, which cannot poſſibly have any ef⯑fect upon herſelf.
[19]But, if the ſmall-pox was con⯑veyed to the child in this caſe, thro' the medium of the circulating flu⯑ids, which indeed appears to be the only way by which it could be con⯑veyed, it follows, that other conta⯑gious diſeaſes may be communi⯑cated from the mother to the foetus in utero, through the ſame channel; and therefore, the poſſibility of the like event extends to the Venereal Diſeaſe.
ST. MARTIN'S LANE, Auguſt 1786.
FINIS.
REMARKS.
[9]ALTHO' the fact of the poſ⯑ſibility of the ſmall-pox being communicated from the mother to the foetus, in utero, be clearly proved in this caſe, yet there may ſtill re⯑main ſome doubt with reſpect to the mode of communication.
It may be urged, that if we ſup⯑poſe the communication of the diſ⯑eaſe [10]from the mother to the child to be effected by means of the circulat⯑ing fluids, then the child would never eſcape the infection, when the mother had the diſeaſe; where⯑as the contrary appears in the in⯑ſtance adduced by Mr. John Hunter from Boerhave, of a lady who hav⯑ing gone through the confluent ſmall-pox in the ſixth month of her pregnancy, brought forth after⯑wards, at the regular period, a child, whoſe body did not ſhew the leaſt veſtige of the diſeaſe.
To this it may be anſwered: It is by no means neceſſary, ſuppoſing [11]the contagion to be conveyed by the circulating fluids, that there ſhould be no poſſibility of the child's eſcap⯑ing the diſeaſe, becauſe this aſſer⯑tion proves too much. For it ap⯑pears, that there muſt always be a certain aptitude or fitneſs in a body to receive any infection offered to it; and that unleſs this fitneſs or aptitude prevails, the infection will not take place. What this fitneſs or aptitude is, we cannot tell; but that it really doth exiſt, is evident from daily and palpable experience; otherwiſe, every perſon expoſed to any contagious diſeaſe would never eſcape. How many are there re⯑ſpecting [12]the diſeaſe in queſtion, who never having had it them⯑ſelves, are caſually or purpoſely ex⯑poſed to infection, and eſcape it ſeveral times, while they ſhall catch it upon another occaſion, when perhaps they leaſt expected it? Nor is there any reaſon which can in⯑duce us to ſuppoſe, that this ap⯑titude or fitneſs for receiving infec⯑tion is not as neceſſary to produce the diſeaſe, when the virus is im⯑mediately conveyed by the circu⯑lating fluids, as when it is previ⯑ouſly to be abſorbed: For in the inſtances alledged, although the virus had not acted upon the conſti⯑tution [13]ſo as to produce the diſeaſe, yet we cannot ſuppoſe the whole abſorbent ſyſtem to be entirely in⯑active, ſo as that no particle of matter, capable of infecting, ſhall be taken up by the body, repeat⯑edly expoſed to it. The action and power of the abſorbent ſyſtem muſt go on; and therefore, when a con⯑tagious diſtemper is not produced in any body expoſed to it, this can only be accounted for, from the inaptitude or unfitneſs of the con⯑ſtitution to produce it at the time, however myſterious that inaptitude or unfitneſs may be.
[14]In the caſe mentioned by Boer⯑have, if the foregoing reaſoning has been well founded, we might ſuppoſe that there was a want of aptitude in the foetus to receive the infection, although it was circulat⯑ing in the fluids of the mother; or there is another way of conſidering it, which is, that the child had really gone through the ſmall-pox in utero, but had been born without any marks. How many are there who go through the diſeaſe, and never bear the leaſt veſtige of it after⯑wards?
In this caſe, there was full time enough for the child to catch the [15]infection, go through the ſeveral ſtages of it, and come into the world without a ſpot; for the lady having had the diſeaſe in the ſixth month, implies, that ſhe had gone through it before the ſix months were com⯑pleted; conſequently there were full three months remaining before the child came into the world.
Suppoſing, therefore, the child to have gone through the diſeaſe before the ſeventh month was ac⯑compliſhed, it had ſtill upwards of two months to get rid of any marks remaining from any previous puſtu⯑les it might have had; and is it not [16]extremely probable, that the cir⯑cumſtance of the child's being en⯑tirely ſecluded from the external air, at that period, may have con⯑tributed much to aboliſh or ſhorten the duration of theſe marks? Again; every one knows from daily expe⯑rience, that becauſe the mother had a confluent ſmall-pox, there was no neceſſity that the child ſhould have one of the ſame kind.
If it be poſſible, then, that the child ſhould have had a mild ſmall-pox, it is on the other hand impoſ⯑ſible to aſcertain the number of puſ⯑tules it might have had. One or two [17]are ſufficient to characteriſe the diſtemper, and many perſons go through it, both in the natural way and by inoculation, with no other external mark. Some eminent phy⯑ſicians indeed, among whom is Boer⯑have, have been of opinion, that the eruption is not abſolutely neceſſary to conſtitute the diſeaſe; and that a perſon may go through the vario⯑lous fever without any apparent eruption, and be as free from future infection as if the eruption had ap⯑peared.
There is nothing, therefore, which militates againſt the ſuppo⯑ſition of the contagion being con⯑veyed [18]from the mother to the foetus in utero, by means of the circulating fluids; even in thoſe inſtances ad⯑duced of the child having caught the diſtemper in the womb of its mother, who had previouſly expe⯑rienced it, and therefore was not herſelf ſuſceptible of it. Can we ſuppoſe the diſeaſe to be conveyed to the child any way, then, through the mother? A ſubject may abſorb, and convey an infection to another, of which it is not itſelf ſuſceptible; and in this caſe, the mother be⯑comes the vehicle of a poiſon, which cannot poſſibly have any ef⯑fect upon herſelf.
[19]But, if the ſmall-pox was con⯑veyed to the child in this caſe, thro' the medium of the circulating flu⯑ids, which indeed appears to be the only way by which it could be con⯑veyed, it follows, that other conta⯑gious diſeaſes may be communi⯑cated from the mother to the foetus in utero, through the ſame channel; and therefore, the poſſibility of the like event extends to the Venereal Diſeaſe.