MATERNAL IMPRESSIONS, BY DE J. W. BALLANTYNE. 99 4. A SERIES OF THIRTEEN CASES OF ALLEGED MATERNAL IMPRESSION. By J. W. Ballantynk, M.D., F.R.C.P.E., F.R.S.E., Lecturer on Diseases of Infancy and Childhood, Minto House, and on Midwifery and Gynaecology, Medical College for Women, Edinburgh; Secretary to the Edinburgh Obstetrical Society. During last winter I ventured to lay before this Society the records of some cases in which a maternal impression was the alleged cause of a foetal defect or malformation, and I endeavoured to point out what seemed to me to be the rational way of studying this subject. I believed then, and I believe now, that we are not concerned at present with the questions, How are maternal impressions effective ? or, How can their action be physiologically and reasonably explained ? but rather with the preliminary inquiry whether, in conjunction with certain definite circum- stances, certain clearly marked phenomena occur so frequently and so persistently as to compel the belief that there is more than the element of_ chance or coincidence in their association. Do foetal anomalies follow maternal impressions so frequently as to warrant the statement that they stand in the relationship of effect and cause ? It would have been futile to have spent time in discussing the possible explanations of the phenomenon of atavism in heredity before it was proven that this curious method of the transmission of diseases or peculiarities really existed; but now that atavism is an accepted fact, biologists and physiologists are rightly busying themselves with the inquiry into its meaning and causes. When it has been demonstrated that maternal impressions occur so frequently as the forerunners of foetal bodily or mental defects as to warrant the assertion that the former are potent in producing the latter, then, and' only then, it will be wise to adduce theories to explain such a relationship. In the above-mentioned paper it was also pointed out that each alleged case of maternal impression must be most carefully scrutinized, and that in every instance certain facts must be ascertained. Seven questions were stated which were considered as of vital importance. These were?(1.) What was the age of the pregnancy when the impression occurred ? (2.) What was the character of the impression ? (3.) Was the object causing the impression similar to the defect produced ? (4.) What was the channel or channels through which the impression was received ? (5.) Was the mother conscious of the impression, and did she anticipate a defect in her child ? (6.) What was the duration and strength of the impression ? and (7.) Was there any evidence that the defect might have been hereditary ? Since the publication of my paper (.Edinburgh Medical Journal, January 1891), I have received from medical friends records of cases observed by them in which all the above-named questions 100 MATERNAL IMPRESSIONS, BY DR J. W. BALLANTYNE. were thoroughly investigated. To these observers I now tender my thanks for the time and care which they have expended upon the inquiries they have made for me. I shall narrate the cases in the order in which they were received, and shall thereafter give a summary of the results obtained from their study. Case I.?Mrs M., a patient under the care of Dr Arthur Wilson, gave the following account of the circumstances which she believes led to the production of a peculiar mark on her child's chest. In October 1883, when she was 20 years of age, and had borne one healthy child, she was at work in the hold of a vessel, and during the meal-hour a fellow-worker^ threw an apple at her, which struck her on the left side between* the waist and the breast. At the time when this happened she believed herself to be about one month pregnant, as she had seen nothing during October, and had always been regular previously, save during her first pregnancy. Subsequent events showed that her calculation was correct. At the time when she received the blow she did not experience any feeling of fear, anger, or horror; the circumstance did not impress her much at all, and she did not anticipate that any harm would result to the child. On July 2nd, 1884, she gave birth to a full- time male child, on whose chest there was a peculiar mark, similar in size to the apple which was thrown at the patient, but rather paler in colour. She then remembered the above-mentioned circumstance, and connected the impression and the mark together as cause and effect. Dr Wilson has described the mark as an oval patch 2| inches long and 2 inches broad, situated above and to the inner side of the left nipple, which is included in its lower and outer margin, and of a bluish-brown mottled appearance, slightly darker in colour at the circumference than at the centre. Over the patch coursed several dilated veins lying immediately below the skin. It was not a nsevus in the usual acceptation of the term, but rather a hyperaemic pqtch with a blush which dis- appeared on pressure, leaving a general mottling. The mother is now 28 years of age, and has borne four children, one girl and three boys, all of whom, save the boy above mentioned, who was her second child, are free from any mark or bodily defect. The boy is now 7 years old, and the mark on his chest has not irtcreased or decreased in size, although from the relatively small size of the chest at the time of birth it then appeared larger. There is no other mark on his body. Such were the statements which Dr Wilson elicited at his first interview; but on a second occasion, when he carefully cross-examined the woman, he found that in certain points she contradicted herself,?for instance, at the first interview she said the apple hit her on the left side, but at the second she affirmed that it was on the right side. There was no history of such marks being hereditary in the woman's ante- MATERNAL IMPRESSIONS, BY DR J. W. BALLANTYNE. 101 cedents, but there was a curious fact in her own history, which will be mentioned immediately. I do not consider that this case affords strong evidence in support of the potency of a maternal impression; but it is interesting as an example of perhaps the commonest variety uf such histories. Case II.?The same patient, Mrs M., exhibited in her own person an abnormality which had been ascribed by her mother to a maternal impression which she (the mother) had received when pregnant. The anomaly consisted in the presence of a patch of gray hair on the left temple, which had existed ever since the first growth of hair took place. Her mother said that when pregnant she was one day in company with her husband and her sister. The husband said1 he would give his wife's sister a penny for every gray hair she pulled out of his head; she pulled out several and threw them at her sister, hitting her (she thinks) on the head. The infant born soon afterwards developed the gray patch which is mentioned above, and which still exists. The above case is not of much value for the purpose we have in view, for it has not been verified and scrutinized; but I have narrated it to show that in this family maternal impressions were evidently believed in, and that anything suggesting such a circum- stance would not be likely to be overlooked. Case III.?It is to Dr W. Iverach Robertson that I am indebted for the history of the third case of supposed maternal impression now to be narrated. His patient was pregnant for the seventh time, and had arrived at the second month of gestation when she was very much impressed by a circumstance told her by a friend. This friend said that a child had been born in her house about whose sex there was some doubt. So far as Dr Robertson can make out, it was a case of absence of the penis. The patient had never heard of such a thing before; she was much impressed " " by the strangeness" of the story, and wondered" if such a condition had ever been heard of previously. She told Dr Robertson that she had heard of other wonderful things, but that they had not kept so much in her mind as this; for several nights she could not get to sleep through thinking about it. She most distinctly states that she did not anticipate any defect in her own child. She never saw the deformed infant, and therefore received the impression entirely through hearing of the circumstance. She was delivered at the full time of an infant, the subject of ectopia vesicae and epispadias. All her previous children, six in number, had been" healthy, and had not been deformed in any way, and there was no family history of extroversion of the bladder or of any other malformation. It is impossible in this case to say whether or not the object causing the impression closely resembled the defect produced; but there must have been some similarity 102 MATERNAL IMPRESSIONS, BY DR J. W. BALLANTYNE. ? ? between the two conditions, for epispadias at first sight certainly suggests absence of the penis. Case IV.?Dr Robertson has also sent me the notes of a case which occurred in his father's (Dr W. B. Robertson's) practice, and in which he attributed the idiocy of the child to a mental shock which the mother received during her pregnancy.