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.
Whether a foetus can receive the infection of the small-pox, or any other contagious distemper, from its mother in the womb, is a question 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 teacher'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.
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 numerous. 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 advanced in her pregnancy eight months and two weeks.
The child, at the time of its birth, was covered with distinct pustules 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 inoculated, 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 continued daily increasing till the 11th of December, when the child sickened, and was affected with all the symptoms which usually precede the eruption. On the 12th the sickness 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.
It may be proper to observe, that Mr. Findlay, surgeon, in Sackville Street, and Mr. Holladay, late surgeon 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 indisputably, than its being communicated, 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.
ALTHO' the fact of the possibility of the small-pox being communicated from the mother to the foetus,
in utero,
be clearly proved in this case, yet there may still remain some doubt with respect to the mode of communication.
It may be urged, that if we suppose the communication of the disease from the mother to the child to be effected by means of the circulating fluids, then the child would never escape the infection, when the mother had the disease; whereas the contrary appears in the instance adduced by Mr. John Hunter from Boerhave, of a lady who having gone through the confluent small-pox in the sixth month of her pregnancy, brought forth afterwards, 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 the contagion to be conveyed by the circulating fluids, that there should be no possibility of the child's escaping the disease, because this assertion proves too much. For it appears, 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 respecting the disease in question, who never having had it themselves, are casually or purposely exposed 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 induce us to suppose, that this aptitude or fitness for receiving infection is not as necessary to produce the disease, when the virus is immediately conveyed by the circulating fluids, as when it is previously to be absorbed: For in the instances alledged, although the virus had not acted upon the constitution so as to produce the disease, yet we cannot suppose the whole absorbent system to be entirely inactive, so as that no particle of matter, capable of infecting, shall be taken up by the body, repeatedly exposed to it. The action and power of the absorbent system must go on; and therefore, when a contagious distemper is not produced in any body exposed to it, this can only be accounted for, from the inaptitude or unfitness of the constitution to produce it at the time, however mysterious that inaptitude or unfitness may be.
In the case mentioned by Boerhave, 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 circulating 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 afterwards?
In this case, there was full time enough for the child to catch the 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 completed; 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 accomplished, it had still upwards of two months to get rid of any marks remaining from any previous pustules it might have had; and is it not extremely probable, that the circumstance of the child's being entirely secluded from the external air, at that period, may have contributed much to abolish or shorten the duration of these marks? Again; every one knows from daily experience, 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 impossible to ascertain the number of pustules it might have had. One or two 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 physicians indeed, among whom is Boerhave, have been of opinion, that the eruption is not
absolutely
necessary to constitute the disease; and that a person may go through the variolous fever without any apparent eruption, and be as free from future infection as if the eruption had appeared.
There is nothing, therefore, which militates against the supposition of the contagion being conveyed from the mother to the
foetus in utero,
by means of the circulating fluids; even in those instances adduced of the child having caught the distemper in the womb of its mother, who had previously experienced 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 becomes the vehicle of a poison, which cannot possibly have any effect upon herself.
But, if the small-pox was conveyed to the child in this case, thro' the medium of the circulating fluids, which indeed appears to be the only way by which it could be conveyed, it follows, that other contagious diseases may be communicated 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.