Before the advent of antenatal screening, birth abnormalities were far commoner than they are today. Early medical journals had a particular fascination with these ‘monstrosities’, printing regular reports of children born without limbs or with anomalous or absent internal organs. Reading these reports today, there is often little sense that they were printed for any inherent scientific interest, but to satisfy readers’ fascination with the bizarre and grotesque.
I found this report from the Provincial Medical and Surgical Journal of 1842 interesting, because it seems to have been printed at the very end of this era: the editor cannot resist using the headline ‘Monstrosity’, but the article reports a successful operation to correct a major congenital deformity – a useful surgical intervention on a helpless patient.
The subject of this case, at the time of birth, presented the following appearances. The head, chest, and spine were perfectly well-formed. The right lower extremity was much smaller than the left, but the bones of the limb did not seem to be affected. On a level with the edge of the ribs, on the right side, near the region of the gall-bladder, there was a third lower extremity, composed of a foot, leg, thigh, and iliac bone; the foot and leg of this supernumerary limb were much smaller in proportion than the thigh; its different articulations were immovable. From the play of the ribs it was impossible to ascertain whether the iliac bone was merely placed over or intimately connected with them; nor could it be ascertained with what parts the inner surface of the bone was in contact. The functions of respiration, &c., however, were not disturbed in any way. From the lower edge of the iliac bone there projected a large hernial tumour, which appeared to contain at least one half of the abdominal viscera, and a small, firm body, of the consistence of the spleen. At the point where the edge of the hernial tumour joined the root of the supernumerary limb there was a small empty scrotum, with a small penis, furnished with a glans, but no prepuce; from the extremity of this penis urine was occasionally discharged, and hence it was concluded that the hemial tumour contained a kidney with a supernumerary bladder.
The surgeons attending the infant decided that they could do something to help the child:
The circumstances just related induced the surgeon (M. Bonnefoux, of Rhodez) who attended the infant, not to attempt the removal of the iliac bone, but merely remove the supernumerary limb from its joint. This was done when the child had attained the age of six weeks.
This being 1842, there was no possibility of anaesthesia. It is to be hoped that a six-week-old baby would quickly forget the experience.
All the vessels were tied as they were divided, and the limb disarticulated before the femoral artery was cut through; very little blood was thus lost. Since the operation the right lower extremity increased rapidly, and is now exactly similar in appearance to the left. The hernial tumour has manifestly diminished in size. M. Delmas attributes the success of this operation, the performance of which he had recommended, to the circumstance that surgical operations on infants generally turn out well. The normal urinary apparatus of the child now performs all its functions in the usual way. From the small supernumerary penis, however, the urine generally passes drop by drop; when the child cries it is forced out in a stream. The supernumerary limb was never observed to execute any independent movements; besides, the muscular tissue was almost completely atrophied, but the nerves of the limb were well developed.