A ludicrous mistake

Every experienced midwife will have a story about the patient who didn’t even realise she was pregnant until she went into labour. So-called cryptic pregnancies are fairly common – a spectacular example occurred a few years ago when a British soldier on active duty in Afghanistan suddenly went into labour and gave birth at the infirmary of Camp Bastion.

In 1852 several medical journals related an unusual variation on this theme.  In The Lancet the case history, written by a Dr Buzzell, was given the headline ‘A Ludicrous Mistake’.  The young mother was 20, and described as ‘stupid’; in a scandalous plot twist she was unmarried.  When she started to experience severe abdominal pain, her friends realised she must be in labour, and called for the elderly woman who served as midwife to the area:

She made an examination, felt “the child’s head low down,” and the “ waters had broke,” etc. She advised that a physician be sent for forthwith. A young physician was sent for, who, being informed on his arrival that she had been in “great pain by spells,” and that the “waters had broke,” the “ child’s head had been felt,” etc., made a slight examination, and not having a very good opportunity of examination, as the patient was very restless, he concluded that the old lady was right, and that the girl was surely in travail. Her pains, however, seemed to abate after the arrival of the Doctor, and that was not regarded as anything very strange for a young woman, having a young physician present.

So far, so medically conventional. But then the case began to display a few unexpected quirks.

The waters came away periodically about once in six or eight hours. This rather perplexed the physician, and after spending the night waiting for the “pains to come on,” the physician thought, as it seemed to be rather a peculiar case, that it might be advisable to have counsel. I was sent for; but as the messenger was informed, when he arrived in the village, that I was not at home, another physician was sent for, who visited the patient. Upon an examination of the patient, this consulting physician pronounced it to be a case of superfoetation… 

Superfoetation, an extremely rare event, is the simultaneous gestation of two foetuses conceived on different occasions.  In 2007 a woman in Essex gave birth to two babies (not twins!) which had been conceived three weeks apart.

…and after explaining the case to the family and attending physician, he proposed to send for a surgeon, in order to make an incision in the patient’s side, and extract the foetus therefrom.”

Caesarian section, although an extremely perilous business, was not unknown at this date.  There now remained the problem of the baby’s paternity. It is not clear where precisely these events took place, but it seems that local law required the mother to reveal (on oath) the name of the father.  A justice of the peace was called for:

The justice came in due time, and, as suspicion naturally rested upon the man at whose house the patient had lived…she was made to swear the baby on this man—though the justice was not disposed, from the vagueness or indefiniteness of her answers to his question, to proceed to issue a warrant for the arrest of the father of the child. The case had now assumed a very serious aspect. The character of the patient, and of a hitherto respectable man, was “down,” and the news flew on the wings of the wind, as might be expected in this noisy world.

The following day Dr Buzzell was summoned, with a message informing him that he would be required to perform a caesarean. He had quite a surprise when he arrived:

On making an examination of the patient, I found that, instead of its being a case of superfoetation, it was nothing but a large accumulation of faeces in the rectum, so large that it occupied nearly the whole of the inferior portion of the pelvic cavity, merging forwards hard on the pubic bones and against the bladder. This explains the reason why the old lady supposed that the “ waters had broke.” The urine escaped, of course, at different periods, and then “ with a rush.” I directed the old lady, who had the priority in the call, to oil her fingers and cautiously to deliver the patient of her burden.

Oh my. Quite a punishment for incompetence! In the nineteenth century, when several doctors might attend the same patient, those late to arrive would typically concede ‘priority’ to those who had answered the call first. Dr Buzzell neatly turns this convention to his advantage.  He also had some good news for the purported ‘father’:

I advised the father to stay process legally, until the child was born and named, and concluded myself that I should consider it a hard case to be the alleged father of such a child.

The patient is, I believe, as “comfortable as could be expected” under the circumstances. I advised that her bowels might be kept pervious, and I believe she has not had occasion to “send out” again…Such a case should admonish young practitioners to be cautious and thorough in their examinations, and not to let modesty prevent them from discriminating between a large accumulation of faeces in the rectum and a child’s head.

Now that’s a maxim to live by. Medical students, take note.