CORNELL UNIVERSITY LIBRARY Cornell University Library R 706.G69 1897 Anomalies and curiosities of medicine :b 3 1924 005 713 957 Cornell University Library The original of tiiis book is in tine Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924005713957 PREFATORY AND UNTTRODUCTORY. Since the time when man's mind first busied itself with subjects beyond his own self-preservation and the satisfaction of his bodily appetites, the anoma- lous and curious have been of exceptional and persistent fascination to him ; and especially is this true of the construction and functions of the human body. Possibly, indeed, it was the anomalous that was largely instrumental in arous- ing in the savage the attention, thought, and investigation that were finally to develop into the body of organized truth which we now call Science. As by the aid of collected experience and careful inference we to-day endeavor to pass our vision into the dim twilight whence has emerged our civilization, we find abundant hint and even evidence of this truth. To the highest type of philosophic minds it is the usual and the ordinary that demand investigation and explanation. But even to such, no less than to the most naive-minded, the strange and exceptional is of absorbing interest, and it is often through the extraordinary that the philosopher gets the most searching glimpses into the heart of the mystery of the ordinary. Truly it has been said, facts are stranger than fiction. In monstrosities and dermoid cysts, for example, we seem to catch forbidden sight of the secret work-room of JSTature, and drag out into the light the evidences of her clumsiness, and proofs of her lapses of skill, — evidences and proofs, moreover, that tell us much of the methods and means used by the vital artisan of Life, — the loom, and even the silent weaver at work upon the mysterious garment of corporeality. " La premiere ohose qui s'offre d, F Homme quand il se regarde, c'est son corps," says Pascal, and looking at the matter more closely we find that it was the strange and mysterious things of his body that occupied man's earliest as well as much of his later attention. In the beginning, the organs and functions of generation, the mysteries of sex, not the routine of digestion or of locomotion, stimulated his curiosity, and in them he recognized, as it were, an unseen hand reaching down into the world of matter and the workings of bodily organiza- tion, and reining them to impersonal service and far-off ends. All ethnolo- gists and students of primitive religion well know the role that has been played in primitive society by the genetic instincts. Among the older naturalists, such as Pliny and Aristotle, and even in the older historians, whose scope included natural as well as civil and political history, the atypic and bizarre, and especially the aberrations of form or function of the generative organs, 1 2 PREFATORY AND INTRODUCTORY. caught the eye most quickly. Judging from the records of early writers, when Medicine began to struggle toward self-consciousness, it was again the same order of facts that was singled out by the attention. The very names applied by the early anatomists to many structures so widely separated from the organs of generation as were those of the brain, give testimony of the state of mind that led to and dominated the practice of dissection. In the literature of the past centuries the predominance of the interest in the curious is exemplified in the almost ludicrously monotonous iteration of titles, in which the conspicuous words are curiosa, rara, monstruosa, memor- abilia, prodigiosa, selecta, exotica, miraculi, lusibus naturae, occultis naturae, etc., etc. Even when medical science became more strict, it was largely the curious and rare that were thought worthy of chronicling, and not the estab- lishment or illustration of the common, or of general principles. With all ■ his sovereign sound sense, Ambrose Par6 has loaded his book with references to impossibly strange, and even mythologic cases. In our day the taste seems to be insatiable, and hardly any medical jour- nal is without its rare or " unique " case, or one noteworthy chiefly by reason of its anomalous features. A curious case is invariably reported, and the inser- tion of such a report is generally productive of correspondence and discus- sion with the object of finding a parallel for it. In view of all this it seems itself a curious fact that there has never been any systematic gathering of medical curiosities. It would have been most natural that numerous encyclopedias should spring into existence in response to such a persistently dominant interest. The forelying volume appears to be the first thorough attempt to classify and epitomize the literature of this nature. It has been our purpose to briefly summarize and to arrange in order the records of the most curious, bizarre, and abnormal cases that are found in medical literature of all ages and all languages — a tlmumatographia medica. It will be readily seen that such a collection must have a function far beyond the satisfaction of mere curiosity, even if that be stigmatized with the word " idle." If, as we believe, reference may here be found to all such cases in the literature of Medicine (including Anatomy, Physiology, Surgery, Obstet- rics, etc.) as show the most extreme and exceptional departures from the ordinary, it follows that the future clinician and investigator must have use for a handbook that decides whether his own strange case has already been paralleled or excelled. He will thus be aided in determining the truth of his statements and the accuracy of his diagnoses. Moreover, to know ex- tremes gives directly some knowledge of means, and by implication and inference it frequently does more. Remarkable injuries illustrate to what extent tissues and organs may be damaged without resultant death, and thus the surgeon is encouraged to proceed to his operation with greater confidence and more definite knowledge as to the issue. If a mad cow may blindly play the part of a successful obstetrician with her horns, certainly a skilled PREFATORY AND INTRODUCTORY. 3 surgeon may hazard entering the womb with his knife. If large portions of an organ, — the lung, a kidney, parts of the liver, or the brain itself, — may be lost by accident, and the patient still live, the physician is taught the lesson of nil desperandum, and that if possible to arrest disease of these organs before their total destruction, the prognosis and treatment thereby acquire new and more hopeful phases. Directly or indirectly many similar examples have also clear medicolegal bearings or suggestions ; in fact, it must be acknowledged that much of the im- portance of medical jurisprudence lies in a thorough comprehension of the anomalous and rare cases in Medicine. Expert medical testimony has its chief value in showing the possibilities of the occurrence of alleged extreme cases, and extraordinary deviations from the natural. Every expert witness should be able to maintain his argument by a full citation of parallels to any remarkable theory or hypothesis advanced by his clients ; and it is only by an exhaustive knowledge of extremes and anomalies that an authority on medical jurisprudence can hope to substantiate his testimony beyond question. In every poisoning case he is closely questioned as to the largest dose of the drug in question that has been taken with impunity, and the smallest dose that has killed, and he is expected to have the cases of reported idiosyncrasies and tolerance at his immediate command. A widow with a child of ten months' gestation may be saved the loss of reputation by mention of the authentic cases in which pregnancy has exceeded nine months' duration ; the proof of the viability of a seven months' child may alter the disposition of an estate ; the proof of death by a blow on the epigastrium without external marks of violence may convict a murderer ; and so it is with many other cases of a medicolegal nature. It is noteworthy that in old-time medical literature — sadly and unjustly neglected in our rage for the new — should so often be found parallels of our most wonderful and peculiar modern cases. We wish, also, to enter a mild protest against the modern egotism that would set aside with a sneer as myth and fancy the testimonies and reports of philosophers and physicians, only because they lived hundreds of years ago. We are keenly appreciative of the power exercised by the myth-making faculty in the past, but as ap- plied to early physicians, we suggest that the suspicion may easily be too active. When Par6, for example, pictures a monster, we may distrust his art, his artist, or his engraver, and make all due allowance for his primitive knowledge of teratology, coupled with the exaggerations and inventions of the wonder-lover; but when he describes in his own writing what he or his confrlres have seen on the battle-field or in the dissecting room, we think, within moder- ate limits, we owe him credence. For the rest, we doubt not that the modern reporter is, to be mild, quite as much of a myth-maker as his elder brother, especially if we find modern instances that are essentially like the older cases reported in reputable journals or books, and by men presumably honest. In 4 PREFATORY AND INTRODUCTORY. our collection we have endeavored, so far as possible, to cite similar cases from the older and from the more recent literature. This connection suggests the question of credibility in general. It need hardly be said that the lay-journalist and newspaper reporter have usually been ignored by us, simply because experience and investigation have many times proved that a scientific fact, by presentation in most lay-journals, becomes in some mysterious manner, ipso faeto, a scientific caricature (or worse !), and if it is so with facts, what must be the eifect upon reports based upon no fact whatsoever ? It is manifestly impossible for us to guarantee the credibility of chronicles given. If we have been reasonably certain of unreliability, we may not even have mentioned the marvelous statement. Obviously, we could do no more with apparently credible cases, reported by reputable medi- cal men, than to cite author and source and leave the matter there, where our responsibility must end. But where our proper responsibility seemed likely never to end was in carrying out the enormous labor requisite for a reasonable certainty that we had omitted no searching that might lead to undiscovered facts, ancient or modern. Choice in selection is always, of course, an affair de gustibus, and especially when, like the present, there is considerable embarrassment of riches, coupled with the purpose of compressing our results in one handy volume. In brief, it may be said that several years of exhaustive research have been spent by us in the great medical libraries of the United States and Europe in collecting the material herewith presented. If, despite of this, omissions and errors are to be found, we shall be grateful to have them pointed out. It must be remembered that limits of space have forbidden satisfactory discussion of the cases, and the prime object of the whole work has been to carefully collect and group the anomalies and curiosities, and allow the reader to form his own conclusions and make his own deductions. As the entire labor in the preparation of the forelying volume, from the inception of the idea to the completion of the index, has been exclusively the jDersonal work of the authors, it is with full confidence of the authenticity of the reports quoted that the material is presented. Complete references are given to those facts that are comparatively un- known or unique, or that are worthy of particular interest or further investi- gation. To prevent unnecessary loading of the book with foot-notes, in those instances in which there are a number of cases of the same nature, and a descrip- tion has not been thought necessary, mere citation being sufficient, references are but briefly given or omitted altogether. For the same reason a biblio- graphic index has been added at the end of the text. This contains the most important sources of information used, and each journal or book therein has its own number, which is used in its stead all through the book (thus, 476 signifies The Lancet, London ; 597, the New York Medical Journal • etc.). These bibliographic numbers begin at 100. PREFATORY AND INTRODUCTORY. 5 Notwithstanding that every effort has been made to conveniently and satis- factorily group the thousands of cases contained in the book (a labor of no small proportions in itself), a complete general index is a practical necessity for the full success of what is essentially a reference-volume, and conse- quently one has been added, in which may be found not only the subjects under consideration and numerous cross-references, but also the names of the authors of the most important reports. A table of contents follows this preface. We assume the responsibility for innovations in orthography, certain abbreviations, and the occasional substitution of figures for large numerals, fractions, and decimals, made necessary by limited space, and in some cases to more lucidly show tables and statistics. From the variety of the reports, uniformity of nomenclature and numeration is almost impossible. As we contemplate constantly increasing our data, we shall be glad to receive information of any unpublished anomalous or curious cases, either of the past or in the future. For many courtesies most generously extended in aiding our research- work we wish, among others, to acknowledge our especial gratitude and in- debtedness to the officers and assistants of the Surgeon-General's Library at Washington, D. C, the Library of the Royal College of Surgeons of Lon- don, the Library of the British Museum, the Library of the British Medical Association, the Biblioth^que de Faculty de Medecine de Paris, the Biblio- thgque Nationale, and the Library of the College of Physicians of Phila- delphia. George M. Gould. Philadelphia, October, 1896. Walter L. Pyle. TABLE OF CONTENTS. CHAPTEE I. GENETIC ANOMALIES 17^49 Menstruation, 17 — Vicarious aud compensatory, 18 — From the skin, 18 — From the breasts, 19 — From the eyes, 23— From the ears, 24— From the mouth, 24 — From the extremities, 25 — From old ulcers, wounds, or cicatrices, 25 — From the rectum or urinary tract, 26 — After removal of the uterus or ovaries, 26 — Hematemesis as a means of, 27 — Migratory, 27— Postmortem, 27 — Black, 27 — Suppression of, 27 — In man, 27 — Vicarious, in the male, 28— During preg- nancy and lactation, 28 — Child-bearing after cessation of, 29 — Precocious, 29 — Protracted, 32 — Late establishment of, 33 — Precocious impregnation, 34 — Twins born to a child mother, 38 — Pregnancy before the appearance of menstru- ation, 38 — Fecundity in the old, 38 — Multiple births in the aged, 40 — Impreg- nation without completion of the copulative act, 40 — Artificial impregnation, 42 — Unconscious impregnation, 45 — Conception with deficient organs, 45 — Concep- tion soon after a preceding pregnancy, 46 — Superfetation, 46 — Children of differ- ent colors, 48. CHAPTEK II. PRENATAL ANOMALIES 50-112 Extrauterine pregnancy, 50 — Termination of, 51 — Abortion by the mouth, 52 — Discharge of fetal bones by the rectum, 52 — By the urinary passages, 53— Discharge of the fetus through the abdominal walls, 53 — Combined intrauterine and extrauterine gestation, 54 — Triple ectopic gestation, 57 — Delivery of a viable extrauterine fetus, 57 — Ultimate fate of viable ectopic children, 62 — Long reten- tion of extrauterine pregnancy, 62— Long retention of uterine pregnancy, 63 — Long continuation of fetal movements, 64 — Duration of pregnancy, 65 — Short pregnancies, 65 — The incubator, 68 — Prolonged pregnancies, 68 — Unconscious pregnancy, 72— Pseudocyesis, 73 — Sympathetic male nausea of pregnancy, 79 — Perverted appetites of pregnant women, 80 — Maternal impressions, 81 — Paternal impressions, 85 — Telegony, 86 — Antenatal pathology, 89 — Transmission of con- tagious diseases to the fetus in utero, 90 — Small-pox, 90 — Varicella, measles, pneumonia, and malaria, 91 — Effects on the fetus in utero of medicine adminis- tered to the pregnant mother, 92 — Intrauterine amputations, 94 — Intrauterine fractures, 97 — Multiple fetal fractures, 97 — Results to the fetus of injuries to the pregnant mother, 98 — Injuries about the genitalia, 98 — Injuries from cattle-horns, 99 — Major accidents in pregnant women, 100 — Operations during pregnancy, 103 — After-effects of abdominal hysteropaxy on subsequent pregnancies, 106 — Coex- istence of an extensive tumor of the uterus with pregnancy, 106 — Protrusion of the membranes from the vulva several weeks before confinement, 107 — Anomalies of the umbilical cord, 109— Anomalous causes of abortion, 109 — Abortion of one twin, 110 — Worms in the pregnant uterus, 111. 7 TABLE OF CONTENTS. CHAPTEK III. PAGES OBSTETEIC ANOMALIES 113-143 General considerations, 113 — Painless births, 113 — Birth during intoxication, 114— During hypnotism, 114— During sleep, lethargies, trances, etc., 114 — Eapid parturition without usual symptoms, 116 — Unusual places of birth, 119 — Birth by the rectum, 120— Through perineal perforation, 121— Through the abdominal wall, 122— Ofthe fetus enclosed in the membranes, 122— Dry births, 123— Post- mortem delivery, 123— Antepartum crying of the fetus, 127— Cesarean section, 128 — Repeated Cesarean section, 130 — Cesarean section by the patient herself, 131 — Abdominal section and delivery by cattle-horns, 133 — Delivery by a can- , nonball, 134— Postmortem Cesarean section, 135 — Rupture of the uterus during pregnancy, 137 — Spontaneous rupture of the vagina, 138 — Sloughing of the geni- tals after parturition, 138 — Accidental extraction of the prolapsed pelvic organs, 139 — Accidents incident to labor, 140— Symphysiotomy, 141 — Delay in the birth of the second twin, 142. CHAPTER IV. PROLIFICITY 144-160 General historic observations, 144 — General law, and influence of war, 144 — Influence of rural and urban life, 145 — Effect of climate and race, 145 — Ancient and modern prolificity, 146 — Legal encouragement, 146 — Old explanations of prolificity, 146 — Greatest number of children at a single birth, 147 — Proportion of multiple births, 147 — Examples of multiple births, 148 — Twins and triplets, 148 — Quadruplets, 148 — Quintuplets, 150 — Sextuplets, 152 — Multiple births over six, 152— Seven, 152— Eight, 153— Nine, 153— Eleven, 153— Twelve, 154— Thirteen, 154 — Fifteen, 154 — Repetition of multiple births, 154 — Father of 87 children by two wives, 156 — Extreme prolificity by single births, 157 — Possibil- ities of paternity, 157 — Multimarriages, 159 — Possible number of descendants, 159 — Animal prolificity, 160. CHAPTER V. MAJOR TERATA 161-212 Monstrosities, 161 — ^Ancient explanations, 161 — Early teratology, 164 — Double hermaphroditic terata, 165 — Scientific teratology, 165 — Artificial produc- ' tion of monsters, 166 — ^Animal teratology, 166 — Classification of monsters, 167 — Triple monsters, 167 — Double monsters, 167 — Hindoo sisters, 168— Siamese twins, 168 — Radlca-Doddica, 171 — Operations on conjoined twins, 172 — -Cranio- pagi, 173 — Pygopagi, 174— Biddenden maids, 174 — Helen and Judith, 177 — Millie-Christine, 179 — Rosa-Josepha Blazek, 179 — Tynberg's case, 180 — Ischi- opagi, 181 — Louis and Louise, 181 — Marie-Louise and Hortense-Honorine, 182 — Minna and Minnie Finley, 183 — Jones twins, 183 — Scottish brothers, 184 — Ritta-Christina, 184 — Tocci brothers, 186 — Marie-Rosa Drouin, 186 — Bicephalic monsters, 187— Edward Mordake, 188 — Fantastic monsters, 189 — Parasitic terata, 189 — Lazarus-Joannes Baptista Colloredo, 191 — Louise L , 192 — "Laloo," 192— "A-Ke," 193— Duplication ofthe lower body, 193— Blanche Dumas, 194 — Mrs. B , 194 — Diphallic terata, 194 — Jean Baptista dos Santos, 196— Fetus in fetu, 199— Dermoid cysts, 202 — Multiple dermoids^ 205 — Herma- phroditism, 206 — Interesting instances of, 206— Catherine or Charles Hoffman, 207 — Marie Madeline Lefort, 207 — Spurious hermaphroditism, 211^Law of evolution in hermaphroditism, 211 — Neuter hermaphrodites, 212 — Maiie Doro- th6e, 212 — Legal aspect of hermaphroditism, 212. TABLE OF CONTENTS. CHAPTER VI. MINOR TERATA 213I323 Ancient ideas relative to minor terata, 213— Teratoscopy, 213— Congenital defect of the epidermis, 217— Elasticity of the skin, 217— "Elastic-Skin Man," 217— Dermatolysis, 217— Abnormal development of the scalp, 218— Impervious skin, 219— Albinism, 220— Partial albinism, 221— Melanism, 222— Human horns, 222— Anomalies of the hair, 226— Congenital alopecia, 226— Sexualism and hair- growth, 228— Bearded vs'omen, 228— Hypertrichosis, 230— "Dog-face men," 231 — Nsevus pilosus, 232— Hair and beard of great length, 234— Accidental growths of hair, 235— Anomalies of the color of the hair, 235— Sudden canities, 235— Temporary and partial canities, 238 — Anomalous color-changes of the hair, 239 — Chemic colorations of the hair, 240 — Curious causes of alopecia, 241— Anoma- lies of the nails, 241 — Anomalies of dentition, 242 — Triple dentition, 243— Eden- tulousness, 243— Excessive dentition, 244— Supernumerary teeth, 244— Extraoral dentition, 244 — Anomalies of the head, 245 — Life without a cerebrum, 246— Defective development of the cerebellum, 246 — Microcephaly, 247 — Artificial microcephaly, 248 — Macrocephaly, 248 — Largest healthy brains on record, 249 — Hydrocephaly, 250 — Deficiency of the cranial bones, 250 — Anomalies of the maxillary bones, 251— Congenital absence of the nose, 252 — Large and small noses, 252 — Congenital division of the nose, 252— Macrostoma, 253 — Microstoma, 252 — Congenital atresia of the mouth, 253 — Anomalies of the lips, 254 — Hare-lip, 254 — Congenital absence of the tongue, 2^4 — Bifid and supernumerary tongues, 255 — Large and small tongues, 256 — Anomalies of the palate and uvula, 256 — Of the epiglottis, 256 — Double epiglottis and double voice, 257 — Anomalies of eyes, 257 — Absence of the eyes, 257 — Living cyclopia, 258 — "Pour-eyed man of Cricklade," 258 —Anomalies of lids, 259— Of the iris, 259— Of the lens,'260— Heredity in the causation of congenital defects of the eye, 260 — Anomalie8;',of the ears, 261 — Absence of the limbs, 263 — Supernumerary limbs, 269 — A;no,inalies of the feet, 270— Of the hand, 270 — Absence of the digits, 271— SuperriSinjerary digits, 273 — Hypertrophy of the digits, 276— Talipes, 276 — Anomalies of thei' vertebrae, 277 — Human tails, 277 — Vestigial remains, 279 — Anomalies of the spinal canal and contents, 280 — Supernumerary ribs',' 281 — Fispure of the ster- num, 282 — Other thoracic defects, 284 — Branchial fissui-es, 284 — Anomalies of the esophagus, 284 — Anomalies of the lungs, 285 — Of the diaphragm, 285 — Of the stomach, 286 — Of the intestines, 287 — Dilatation of the colon, 287 — "Bal- loon-man," 287 — Imperforate anus, 288 — Anomalies of the liver, 290 — Of the spleen, 290 — Transposition of the viscera, 291 — Congenital extroversion or even- tration, 292 — Anomalies of kidney, 293 — Of the ureters, 294 — Of the bladder, 295 — Exstrophy of the bladder, 295 — Anomalies of the heaft and vascular system, 296— Of the breast, 297— Amazia, 297— Micromazia, 298— Polymazia, 298— Anomalies of the hymen, 302 — Of the female exteriial 'genitals, 303 — Absence of the vagina, 303 — Duplex vagina, 304 — Transverse septa of the vagina, 305 — Anomalous openings of the vagina, 305 — Anomalies of the labia, 306 — Absence of the nymphsB, 306 — Enlarged nymphse, 306 — Hottentot women, 307 — Ceremo- nial enlargement of the nymphae, 307 — Anomalies of the clitoris, 307 — Circum- cision of the clitoris in Egypt, 308 — Absence of the ovaries, 309 — Prolapse of the ovaries, 310 — Supernumerary ovaries, 310 — Anomalies of the Fallopian tubes, 311 — Of the uterus, 311 — Absence of the uterus, 31 1— Double uterus, 311 — Preg- nancy with double uterus, 311— Triple uterus, 313 — Hernia of the uterus, 313 — Absence of the penis, 314 — Rudimentary development of the penis, 315 — Penis palme, 316 — Torsion of the penis, 316— Ossification of the penis, 316 — Absence of the frenum and prepuce, 317 — Anomalies of the urethra, 317 — Duplication of the urethra, 317 — Hypospadias and epispadias, 318 — Artificial penis, 318 — An- 10 TABLE OF CONTENTS. PAGES orcnism, 319— Monorchism, 319— Polyorchism, 320— Cryptorchism, 321— Anom- alous position of the testicles, 322— Inversion of the testicle, 323— Anomalies of the seminal vesicles, 323. CHAPTEK VII. ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT 324-364 Giants, 324— Ancient giants, 324— Discoveries of giants' bones, 325— Gen- eral opinions, 326— Association of acromegaly with gigantism, 327— Celebrated giants, 328— Giants of history, 333— Dwarfs, 333— Pygmies, 333— Artificial pro- duction of dwarfs, 335— Ancient popularity of dwarfs, 336— Intellectual dvyarfs, 337 — Women predisposed to give birth to dwarfs, 337 — Species of dwarfs, 338 — Celebrated dwarfs, 338— Geoffrey Hudson, 338— Gibson, 338— B6b§, 339— Borwi- 'laski, 339— Great age in dwarfs, 339— Robert Skinner, 340—" Tom Thumb," 342 —Lucia Zarete, 343— Precocious development, 343— " Man-boys," 343— Small new-born infants, 347 — Large new-born infants, 348 — Congenital asymmetry and hemihypertrophy, 350— Obesity, 352 — Fat children, 352 — General remarks on obesity, 354 — Treatment of obesity, 356 — Remarkable instances of obesity, 356 — Simulation of obesity , 360—' ' Adiposis dolorosa, ' ' 360— Abnormal leanness, 363 — "Living skeletons," 364 — Extreme muscular atrophy, 364. CHAPTER VIII. LONGEVITY 365-382 Scope of the article, 365 — General opinions, 365 — Testimony of statistics, 365 — Natural term of life, 366 — Censuses of centenarians, 366 — Effect of class-influ- ences, occupation, etc., 367 — Longevity in ancient times, 368 — Difference in chronology, 368 — Alchemy and the "elixir of life," 368 — Longevity in Jewish history, 369 — In Egypt, 370 — Among the ancient Chinese, 370 — Among the Greeks, 370 — Among the Romans, 370 — Among hermits and ecclesiastics, 370 — Among the Brahmin priests of India, 371 — Influence of mental culture, 371 — Compatibility of mental and physical activity with longevity, 371— Longevity among the Royalty, 372 — Influence of personal habits, 372 — Remarkable in- stances of longevity, 373 — Henry Jenkins, 373 — Thomas Parr, 373 — Jean Korin, 373— Setrasch Czarten, 373 — Sundry instances of great age, 374 — Generative ability in old age, 376 — Influence of stimulants, 377 — Rejuvenescence of the senses in age, 378 — Heredity in longevity, 379 — Longevity among physicians, 381 — Recent instances of longevity, 382. CHAPTER IX. PHYSIOLOGIC AND FUNCTIONAL ANOMALIES 383-526 Anomalies of the secretions, 383 — Colored saliva, 383 — Abnormalities of uri- nation, 383 — Metastasis of tears, 384 — Anomalies of the semen, 384 — Blue bile, 385 — Chroraidrosis, 385 — Hyperidrosis, 386 — Unilateral and localized sweating, 387 — Bloody sweat or "stigmata," 388 — Louise Lateau, 389 — Postmortem sweating, 391 — Anomalies of lactation, 391 — Milk-metastasis, 391 — Lactation in the new-born, 392 — In children, 392 — In the aged, 393— Prolonged lactation and galactorrhea, 394 — Gynecomazia, 394 — Men suckling infants, 397 — Human odors, 397 — Individual odors, 398— Modifying causes, 398— Odors •of races, 399— Odor of the breath after coitus, 399 — Influence of the emotions, 399 — Odors associated ■with mental and nervous diseases, 401 — The odor of insanity, 400 — Odors of some diseases, 401 — Odor of the hair, 401 — Sexual influence of odors, 401 — Fetichism, 401 — Sexual influence of the olfactory sense in animals, 402 — Bulimia, 403 — TABLE OF CONTENTS. 11 PAGES Polydipsia, 404 — Polydipsia among glass-blowers, 405 — Hydroadipsia, 405 — Perverted appetites, 405 — Anthropophagy, 406 — Cannibals, 407 — Ancient cus- toms, 409 — Depraved appetite for human flesh in civilization, 409 — Further ex- amples of depraved appetites, 411 — Pica, 412 — Chalk-eating, 412 — Arsenic eating, 413 — Fasting, 413 — Older instances, 414— "Fasting girls," 418 — Modern in- stances of fasting, 419 — Fasting exhibitionists, 420 — Anomalies of temperature, 421--Hyperthermy reaching 148° F., 423 — Endurance of external heat, 424 — "Human Salamanders," 424 — Fire-worship, 425 — Spontaneous combustion of the human body, 426 — Magnetic, phosphorescent, and electric anomalies, 429 — Effects of cold, 431 — Effects of working in compressed air, 433 — Remarkable development of the remaining senses when one or more are lost, 432 — Examples of compensatory sense-development, 433— Laura Dewey Bridgman, 43 — Helen Kellar, 435 — Edith Thomas, 437— Remarkable blind savants, 439 — Feats of memory, 439 — Boy calculators, etc., 439 — Jacques luaudi, 439 — Oscar Moore, 439 — "Wolf-childreu, 444 — Artificial manufacture of " wild boys," 448 — Equilibrists, 449 — Rope-walkers, 449 — Blondin, 450 — Human pyramids, 450 — Jugglers, 451 — Marksmen, 452 — Ventriloquists, 453 — Athletic feats, 455 — Public contests of Greece, 455 — Runners, 455 — Couriers, 456 — Indian runners, 457 — Jinrickisha- men, 457 — Letter-carriers of India, 458 — "Go-as-you-please" pedestrians, 458 — Modern records for running, 459 — Long-distance traversing, 459 — Riders, 460 — Influence of the spleen in running, 461 — Swimming, 461 — Jumpers and acro- batic tumblers, 462 — Extraordinary physical development and strength, 463 — Modern Hercules, 464 — Strong women, 468 — Strength of the jaws, 468 — Strength in the hands, 470 — Fraudulent "strong men," 470 — Officially recorded feats of strength, 470 — Contortionists, 473— Dislocationists, 473— Endurance of pain, 475 — Aissaoui, 476 — Malingerers, 478 — Hypersensitiveness to pain, 480 — Relation of pain to shock, 480 — Morbid desire for pain, 480 — Pain as a means of sexual enjoyment, 480 — Masochism, 480 — Flagellation, 480 — Fatal flogging, 481 — Idio- syncrasies, 481 — Idiosyncrasies in relation to the sense of smell, 482 — Of the sense of hearing, 484 — To music, 485 — Therapeutic value of music, 485 — Idiosyn- crasies as to vision, 487 — Of the sense of touch, 488 — Idiosyncrasies to foods, 489 — Eggs, 490— Parsley, 491— Rice, 491— Figs, 491— Wheat-flour, 492— Food su- perstitions, 493 — "Totemism," 494— Idiosyncrasies to drugs, 496 — Acids, 497 — Antimony, 499— Arsenic, 500— Belladonna, 500— Digitalis, 502— Ergot, 502— Epsom salts, 503 — lodin, 503 — Iodoform, 503 — Lead-poisoning, 503 — Mercury, 504 — Croton oil, 504 — Castor oil, 504 — Opium and its derivatives, 505 — Chronic opium-eating, 506 — Phosphorous, 508— Pilocarpin, 508 — Quinin, 509 — Strych- nin, 510 — Idiosyncrasies in coitus, 511 — Death in coitus, 513 — Suspended anima- tion, 513 — Prolonged submersion, 513 — Divers, 514 — Suspension of the cardiac movements at will, 516 — Hibernation, 517 — Human hibernation, 517 — Fakirs of India, 517 — Recovery after asphyxia from hanging and strangling, 519 — Prema^ tare burial, 519 — Postmortem anomalies, 522 — Movements of a corpse, 522 — Postmortem priapism, 523 — Retardation of putrefaction, 523 — Postmortem growth of hair and nails, 523 — Untoward effects of the emotions on the vital functions, 523— Death from joy and laughter, 524— Death from grief and sorrow, 524 — Death from fear, 525 — Death from shock alone following blows that cause no visible injury, 525 — Death from the "wind of the cannon-ball," 526. CHAPTER X. SURGICAL ANOMALIES OF THE HEAD AND NECK 527-587 Injuries to the eye, 527— Exophthalmos, 527— Avulsion of the eye, 527— Rupture of the eyeball, 528— Serious sequels of orbital injuries, 528— Gunshot injuries of the orbit, 529— Foreign bodies in the orbit, 531— Foreign bodies in the eyeball, 532— Dislocation of the lens, 533— Injury to the eyeball by birds, 12 TABLE OF CONTENTS. PAGES 533— Rare accident to the eye, 533— Epistaxis through the eyes, 534— Late res- toration of sight, 535— Sight spontaneously restored, 536— Nyctalopia, 536— Hemeralopia, 536— Snow-blindness, 537— Eetiual injury from exposure to intense light, 537— Electric-light injuries of the eye, 537— Injuries to the ear, 537— Boxing the ears, 537— Rupture of the tympanum, 537— Perforation of the tym- panum, 538— Objective tinnitus aurium, 538— Insects in the ear, 539— Other foreign bodies in the ear, 539— Scalp-injuries, 542— Cerebral injuries, 545— Pene- tration and transfixion of the brain, 545 — Gunshot injuries of the brain, 549 — Study of gunshot injuries of the brain, 551 — Head-injuries with loss of cerebral substance, 551 — "American Crow-bar Case," 551 — Loss of brain-substance from cerebral tumor, 557 — Extensive fractures of the cranium, 558— Diving into shallow water, 559 — Fracture of the internal table of the cranium, 559 — Fracture of the cranial base, 559 — Foreign bodies in the brain, 559 — Injuries of the nose, 661 — Nose-making, 561 — Deformities of the nose, 563— Insects iu the nose, 563 — Foreign bodies in the nose, 564^Tongue-swallowing, 565 — Tongue-sucking, 565 — Injuries to the tongue, 565 — Regeneration of a severed tongue, 565 — Artic- ulation without a tongue, 566 — Hypertrophy of the tongue, 566 — Macroglossia, 567 — Living fish in the pharynx, 567 — Leech in the pharynx, 569 — Foreign bodies in the pharynx and esophagus, 570 — Migration of foreign bodies from the esophagus, 571 — Abscess or ulceration into neighboring blood-vessels, consequent upon lodgment of foreign bodies in the esophagus, 571 — Esophagotomy, 574 — • Injuries of the neck, 574 — Ligature of the common carotid artery, 575 — Nonfatal perforating wounds of the trachea and esophagus, 575 — Self-decapitation, 576 — Cases of nonfatal cut- throat, 577 — Injuries of the cervical vertebrae, 578 — Foreign bodies in the larynx and trachea, 580 — Impaction of artificial teeth in the larynx, 582 — Excision of the larynx, 584 — Injuries destroying great portions of the face or jaw, but not causing death, 585 — A curious accident, 587. CHAPTER XI. SURGICAL ANOMALIES OF THE EXTREMITIES 588-605 Reunion of severed digits, 588 — Reproduction and accidental production of nails, 588 — Avulsion of a finger with the entire tendon, 589 — Avulsion of the arm, 590 — Avulsion of the leg, 592 — Injuries to the sciatic nerve, 592 — Recovery of an injured member after extensive severance and loss of substance, 593 — Rup- ture of the quadriceps tendon, 594 — Spontaneous fractures, 594 — Evolution of the treatment of dislocations, 594 — Anomalous dislocations, 594 — Congenital dislocations, 595 — Major amputations, 596 — Multiple amputations, 596 — Sponta- neous amputation, 597 — Artificial limbs, 598 — Dismembered athletes, 598 — Foreign bodies in the extremities, 599 — Osteomalacia, 600 — Rachitis, 601 — Achondroplasia, 602 — Osteitis deformans, 603 — Deformities of the articulations, 603 — "Camel-boy," 603 — Deformities from infantile spinal paralysis, 604 — Anomalous growth of bones of the extremities, 605. CHAPTER XII. SURGICAL ANOMALIES OF THE THORAX AND ABDOMEN 606-666 Injuries of the lung and bronchus, 606 — Loss of lung-tissue, 607 — Surgery of the lung, 608 — Excision of diseased portions of the lung, 608 — Rupture of the lung without fracture of the rib, 608 — Spontaneous rupture of the lung, 609 — Penetration and transfixion of the thoracic cavity, 610 — Recovery after major thoracic wounds, 611 — Wounds of the diaphragm, 612 — Diaphragmatic hernia, 612 — Peritonitis in the thoracic cavity, 613 — Foreign bodies in the thoracic cavity, 613— Foreign bodies in the bronchi, 614 — Cardiac injuries, 616— Instances TABLE OF CONTENTS. 13 PAGES of survival after cardiac injuries, 617— Nonfatal cardiac injuries, 620 — Foreign bodies in the heart, 624 — Injuries to the pericardium, 624 — Rupture of the heart, 625— Displacement of the heart, 626— Hypertrophy of the heart, 626— Wounds of the aorta, 626 — Sundry cases of vascular injuries, 627 — Rupture of the esoph- agus, 628— Rupture of the stomach, 629— Voluntary vomiting, 630 — Wounds of the stomach, 630— Alexis St. Martin, 630— Gastric fistulse, 631— Gastrotomy performed on knife-swallowers, 633— Sword-swallovping, 633— Swallovping knives, pebbles, glass, etc., 635 — Living animals in the alimentary canal, 636 — Other foreign bodies in the alimentary canal, 637 — Hair-swallowing, 641 — Foreign bodies in the intestines, 641 — Foreign bodies in the vermiform appendix, 642 — Intestinal injuries, 642 — Successful intestinal resection, 643 — Sloughing of the intestines following intussusception, 643 — Rupture of the intestines, 644 — Operations upon the gaatro-intestinal tract, 644 — Gastrostomy, 644 — Pyloro- plasty, 644 — Pylorectomy, 644 — Gastrectomy, 644— Enterostomy, 645 — Colos- tomy, 645 — Intestinal anastomosis, 645 — Foreign bodies in the rectum, 645 — Transfixion of the abdomen, 648 — Evisceration, 650 — Nonfatal perforating gun- shot wounds of the abdomen, 651 — Bullets voided from the bowel and bladder, 651 — Wounds of the liver, 652— Surgery of the liver, 652 — Resection of the liver, 654 — Floating liver, 655 — Hypertrophy of the liver, 655— Rupture of the gall- bladder, 655 — Cholecystotomy and cholecystectomy, 655 — Rupture of the spleen, 656— Wounds of the spleen, 656 — Splenectomy, 656 — Hypertrophy of the spleen, 657 — Inj uries of the thoracic duct, 657 — Ligation of the abdominal aorta, 658 — Ligation of the common iliac artery, 658 — Foreign bodies loose in the abdominal cavity, 658 — Foreign bodies in the skin and muscles of the back, 659 — Fracture of the lower spine, 659 — Laminectomy, 660 — Injuries to the spinal cord, 661 — Hernia, 662— Spontaneous rupture of the abdominal walls, 666. CHAPTER XIII. SURGICAL ANOMALIES OF THE GENITOURINARY SYSTEM 667-696 Wounds of the kidney, 667 — Operations on the kidney, 668 — Rupture of the ureter, 668 — Operations on the ureter, 669 — Stricture of the ureter, 669 — Rupture of the bladder, 670 — Gunshot wounds of the bladder, 671 — Penetration of the bladder through the anus, vagina, or buttocks, 671 — Arrow-wound of the bladder through the buttocks, 672 — Wounds of the bladder followed by calculi, 673 — Fistulse of the bladder, 675 — Worms in the bladder, 676 — Foreign bodies in the bladder, 676 — Hair in the bladder, 678 — Foreign bodies in the pelvis, 678 — Rup- ture of the urethra, 679 — Fracture of the penis, 679 — Urethral stricture, 680 — Sundry injuries to the penis, 680 — Amputation of the penis, 680 — Gunshot wounds of the penis, 681 — Luxation of the penis, 681 — Spontaneous retraction of the penis, 681 — Spontaneous gangrene of the penis, 682 — Prolonged priapism, 683 — -Theories of priapism, 684 — Injuries of the testicles and scrotum, 685 — Avulsion of the male external genitalia, 686 — Preservation of sexual power after injuries of the genitals, 687— Atrophy of the testicles, 687 — Retraction of the testicles, 688 — Ectopia of the testicles, 688— Rupture of the spermatic vessels, 689 — Hydrocele, 689— Separation of an ovary, 689— Injuries of the vagina, 689 — Rupture of the clitoris, 691— Discharge of the vaginal parietes, 691— Injuries during coitus, 691 — Foreign bodies in the vagina, 692 — Long retention of pessa- ries, etc., 693 — Leech in the vagina, 694 — Foreign bodies in the uterus, 695. CHAPTER XIV. MISCELLANEOUS SURGICAL ANOMALIES 697-758 Marvelous recoveries from multiple injuries, 697 — Recoveries after injuries by machinery, with multiple fractures, etc., 699— Miscellaneous multiple frac- 14 TABLE OF CONTENTS. PAGES tures, 701— Recoveries from high falls, 703— High dives, 704— Resistance of children to injuries, 705— Instances of infant- vitality, 706— Operations on the extreme young and old, 706— Repeated operations, 707— Billroth's marvelous operation, 708— Self-performed surgical operations, 708— Instances of extensive loss of blood, with recovery, 709— Extensive venesection, 709— Spontaneous hemorrhages, 709— Arrow-wounds, 710— Arrow-poison, 711— Multiple arrow- wounds, 711— Serious iusect-stings, 713— Syphilis from a flea-hite, 714 — Snake- bites, 715— Hydrophobia, 719— Shark-bites, 721— Leprosy from a fish-bite, 721— Alligator-bites, 722— Animal-bites, 722— Injuries from lightning-stroke, 722— Eecoveryfrom lightning-stroke, 723— Therapeutic eflfectof lightning-stroke, 726— Grafting, 728— Tooth-replantation, 728— Muscle-transplantation, 729— Tendon- transplantation, 729— Nerve-grafting, 729— Bone-grafting, 729— Skin-grafting, 729 — Self-mutilatioDS, 731— Self-castration, 732 — Miscellaneous mutOations, 735— ' ' Needle-girls, "etc. ,735 — Wanderings of pins and needles in the body, 736 — Prick of a pin causing death, 737 — Manufacture of crippled beggars, 737 — Chinese foot- binding, 737 — Professional leg-breaker, 741 — Anomalous suicides, 742 — Religions and ceremonial mutilations, 743 — Self-bleeding, 745 — Exhibition of scars, 745 — Cosmetic mutilations, 746 — Manufacture of dimples, 746 — Amputation of the fingers, 746 — Knocking out the front teeth, 747 — Depilatory customs, 747 — Bor- ing the ear, 749 — Tattooing, 749 — Infection from tattooing, 751 — Infibulation, 752 — Chastity-girdles, 753 — Infibulation to prevent masturbation, 754— Slitting the urethra, 754— Mutilations of the genital organs to prevent conception, 754 — Circumcision, 754 — Ceremonial ovariotomy, 755 — Castration, 755 — Eunuch- makers, 756 — Castration because of excessive cupidity, 756 — Castration as a re- ligious rite, 756 — The Skoptzies, 757. CHAPTER XV. ANOMALOUS TYPES AND INSTANCES OF DISEASE 759-822 Tumors, 759 — Adenoma of the breast, 759 — Diffuse hypertrophy of the breast, 759— Goiter, 761— Extirpation of the thyroid gland, 762 — Fibromata, 762— Multiple fibromata of the skin, 762— Keloids, 764— Lipomata, 764— Chon- dromata, 766 — Benign bone-tumors, 768 — Exostoses, 768— Gros-nez, 769 — Neu- romata, 770 — Carcinomata, 772 — Sarcomata, 772— Osteosarcoma, 772 — Varicose veins, 778— Aneurysmal varix, 778— Aneurysm, 779 — Large uterine tumors, 780 — Ovarian cysts, 782 — Enormous dropsies, 786— Ankylosis of the articula- tions, 787—" Ossified man," 787— Petrefaction, 788— Calculi, 788— Large vesical calculi, 788— Vesical calculi in very young children, 790— Multiple vesical cal- culi, 790 — Renal calculi, 790— Other extravesical calculi, 791 — Retention and suppression of urine, 792— Persistent constipation, 794— Elephantiasis arabum, 795 — Elephantiasis of the lower extremities, 795— Elephantiasis of the upper extremities, 798 -Elephantiasis of the face and scalp, 798— Elephantiasis of the breast, 800 — Elephantiasis of the scrotum, 800— Statistics of operations on ele- phantoid scroti, 803— Acromegaly, 803— Chiromegaly, 805— Megalocephaly, 805 — Cretinism, 805— Sporadic cretinism, 806 — Myxedema, 807 — Cagots, 808 — Per- sistent hiccough, 811 -Anomalous sneezing, 813 — " Ear sneezing, " 815-Hemo- philia, 815— Hemophilic purpura of the retina, 816— Hemorrhagic diseases of the new-born, 816— Syphilis haemorrhagica neonatorum, 816— Winckel's disease 816— Barlow's disease, 817— Tetanus neonatorum, 817 — Human parasites 818 Tapeworms, 818— Ascarides, 819— Trichinosis, 820— Ecchinococcus, 820— Pila- ria sanguinis hominis, 820 — "Eaten of worms," 821— Bot-fly, 821 Peenash 822. TABLE OF CONTENTS. 15 CHAPTER XVI. PAGES ANOMALOUS SKIN-DISEASES 823-851 Icthyosis, 823—" Porcupine-man," 823— "Biped Armadillo," 823— "Alli- gator-boy," 824^Harlequin fetus, 825— Contagions follicular keratosis, 825— Keratodermia, 825 — "Hide- bound disease," 826 — Morphea, 826— Scleroderma neonatorum, 826 — " Elephant-man," 827 — Aiuhum, 828— Sclerodactylia annu- laris ainhumoides, 832 — Skin-shedding, 832 — "Snake-boy," 835 — Dermatitis exfoliativa neonatorum, 835 — Epidemic exfoliative dermatitis, 835 — Sphacelo- derma, 836 — Raynaud's disease, 836 — Spontaneous gangrene of the skin. 837 — Neuroses of the skin, 837 — Neuroma cutis dolorosum, 839 — Yaws, 839 — Furun- culosis orientalis, 840 — Pigmentary anomalies, 841 — Chloasma uterinum, 841 — Acanthosis nigricans, 841 — Xeroderma pigmentosum, 842 — Nigrities, 842 — • Anomalous discolorations of the skin, 843 — Metallic discolorations of the skin, 845 — Melasma, 845 — Leukoderma, 845 — "Leopard-boy," 845 — Canities un- guium, 847 — Plica polonica, 848 — Tinea nodosa, 849 — "Hair-eaters," 849 — My- cosis fungoides, 850 — Universal dermatitis, 851. CHAPTBE XVII. ANOMALOUS NERVOUS AND MENTAL DISEASES 852-890 Anomalous types of epilepsy, 853— The dancing mania, 853 — ■" Tarantism," 854 — Palmus, 855 — Athetosis, 857 — Paramyclouus multiplex, 859 — Saltatoric spasm, 859 — Progressive muscular atrophy, 859 — Facial hemiatrophy, 859 — Lin- gual hemiatrophy, 860 — Astasia-abasia, 860 — M6nifere's disease, 861 — Mery- cism, 862 —Wakefulness, 863 — Somnambulism, 863 — Pathognomonic dreams, 867 — Catalepsy, trance, and lethargy, 867 — Hypnotism, 870 — African sleep sick- ness, 872 —Aphasia, 872— Aphasia after snake-bites, 874 — Anosmia, 874 — Hyper- osmia, 875 — Parosmia, 875 — Perversion of the tactile sense, 875 — Nostalgia, 876 — Hypochondria, 876 — Fear-psychoses, 877 — Aichmophobia, 877 — Agoraphobia, 877 — Acrophobia, 877 — Thalassophobia, 877 — Claustrophobia, 878 — Astrophobia, 878 — Mysophobia, 878— Hematophobia, 878 — Anthropophobia and monophobia, 879 — Bacillophobia, 879 — Kleptomania and kleptophobia, 879— Folie de doute, 879— Other rare fear-psychoses, 880 — Demonomania, 880 — Particular aversions, 880 — Circular insanity, 881 — Katatonia, 882 — A modern Pygmalion, 882 — Double consciousness, 883 — Morbid sympathy of twins as illustrated in the " Corsican brothers, 887 — Automatism, 887 — Presentiment of approaching death, 889. CHAPTER XVIII. HISTORIC EPIDEMICS . . 891-914 Preliminary remarks on the great plagues, 891 — The black death, 892 — Mortality of, 893— Moral effect of, 894— The great plague of London, 895— Modern bubonic plague in China, 896— Sweating sickness, 896— Mortality of, 897 —Chronologic table of the principal plagues, 898— Small-pox, 903— Inoculation, 905 — Lady Montagu, 905— Vaccination, 906— Edward Jenner, 906— Asiatic cholera, 908— Typhus fever, 910— Yellow fever, 910- Leprosy, 911— Syphilis, 912 — Tuberculosis, 913 — Modern mortality from infectious diseases, 913. BIBLIOGRAPHIC INDEX 915-929 INDEX 931-968 ANOMALIES AND CURIOSITIES OF MEDICINE. CHAPTEE I. GENETIC AI^OMALIES. Menstruation has always been of interest, not only to the student of medicine, but to the lay-observer as well. In olden times there were many opinions concerning its causation, all of which, until the era of physiologic investigation, were of superstitious derivation. Believing menstruation to be the natural means of exit of the feminine bodily impurities, the ancients always thought a menstruating woman was to be shunned ; her very presence was deleterious to the whole animal economy, as, for instance, among the older writers we find that Pliny '^ remarks : " On the approach of a woman in this state, must will become sour, seeds which are touched by her become sterile, grass withers away, garden plants are parched up, and the fruit will fall from the tree beneath which she sits." He also says that the menstruating women in Cappadocia were perambulated about the fields to preserve the vegetation from worms and caterpillars. According to Flem- ming,^ menstrual blood was believed to be so powerful that the mere touch of a menstruating woman would render vines and all kinds of fruit-trees sterile. Among the indigenous Australians, menstrual superstition was so intense that one of the native blacks, who discovered his wife lying on his blanket during her menstrual period, killed her, and died of terror himself in a fortnight. Hence, Australian women during this season are forbidden to touch anything that men use." Aristotle said that the very look of a men- struating woman would take the polish out of a mirror, and the next person looking in it would be bewitched. Frommann ^ mentions a man who said he saw a tree in Goa which withered because a catamenial napkin was hung on it. Bourke remarks that the dread felt by the American Indians in this respect corresponds with the particulars recited by Pliny. Squaws at the time of menstrual purgation are obliged to seclude themselves, and in most instances to occupy isolated lodges, and in all tribes are forbidden to a 636, L. xxviii., cap. 23. b de Eemediis, 16 and 17. c Frazer, "The Golden Bough." * " Tractatus de Fascinatione," Nuremberg, 1675. 2 17 18 GENETIC ANOMALIES. prepare food for anyone save themselves. It was believed that, were a men- struating woman to step astride a rifle, a bow, or a lance, the weapon would have no utility. Medicine men are in the habit of making a " protective " clause whenever they concoct a " medicine," which is to the eifect that the " medicine " will be effective provided that no woman in this condition is allowed to approach the tent of the official in chai'ge. Empiricism had doubtless taught the ancient husbands the dangers of sexual intercourse during this period, and the after-results of many such con- nections were looked upon as manifestations of the contagiousness of the evil excretions issuing at this period. Hence at one time menstruation was held in much awe and abhorrence. On the other hand, in some of the eastern countries menstruation was regarded as sacred, and the first menstrual discharge was considered so valua- ble that premenstrual marriages were inaugurated in order that the first ovum might not be wasted, but fertilized, because it was supposed to be the purest and best for the purpose. Such customs are extant at the present day in some parts of India, despite the efforts of the British Government to sup- press them, and descriptions of child-marriages and their evil results have often been given by missionaries.. As the advances of physiology enlightened the mind as to the true nature of the menstrual period, and the age of superstition gradually disappeared, the intense interest in menstruation vanished, and now, rather than being held in fear and awe, the physicians of to-day constantly see the results of copulation during this period. The uncontrollable desire of the husband and the mercenary aims of the prostitute furnish examples of modern disregard. The anomalies of menstruation must naturally have attracted much attention, and we find medical literature of all times replete with examples. While some are simply examples of vicarious or compensatory menstrua- tion, and were so explained even by the older writers, there are many that are physiologic curiosities of considerable interest. Lh6ritier ^^ furnishes the oft-quoted history of the case of a young girl who suffered from suppression of menses, which, instead of flowing through the natural channels, issued periodically from vesicles on the leg for a period of six months, when the seat of the discharge changed to an eruption on the left arm, and con- tinued in this location for one year ; then the discharge shifted to a sore on the thumb, and at the end of another six months again changed, the next location being on the upper eyelid ; here it continued for a period of two years. Brierre de Boismont and Meisner describe a case apparently identical with the foregoing, though not quoting the source. Haller, *"" in a collection of physiologic curiosities covering a period of a century and a half, cites 18 instances of menstruation from the skin. Parrot has also mentioned several cases of this nature. Chambers " speaks a 476, 1861, i., 207. MENSTRUATION FROM THE SKIN. 19 of bloody sweat occurring periodically in a woman of twenty-seven ; the intervals, however, were occasionally but a week or a fortnight, and the exu- dation was not confined to any one locality. Van Swieten '^^ quotes the history of a case of suppression of the menstrual function in which there were convulsive contractions of the body, followed by paralysis of the right arm. Later on, the patient received a blow on the left eye causing amaurosis ; swelling of this organ followed, and one month later blood issued from it, and subsequently blood oozed from the skin of the nose, and ran in jets from the skin of the fingers and from the nails. D'Andrad6 * cites an account of a healthy Parsee lady, eighteen years of age, who menstruated regularly from thirteen to fifteen and a half years ; the catamenia then became irregular and she suffered occasional hemorrhages from the gums and nose, together with attacks of hematemesis. The men- struation returned, but she never became pregnant, and, later, blood issued from the healthy skin of the left breast and right forearm, recurring every month or two, and finally additional dermal hemorrhage developed on the fore- head. Microscopic examination of the exuded blood showed usual constituents present. There are two somewhat similar cases spoken of in French literature.'' The first was that of a young lady, who, after ten years' suppression of the menstrual discharge, exhibited the flow from a vesicular eruption on the finger. The other case was quite peculiar, the woman being a prostitute, who menstruated from time to time through spots, the size of a five-franc piece, developing on the breasts, buttocks, back, axilla, and epigastrium. Barham " records a case similar to the foregoing, in which the menstru- ation assumed the character of periodic purpura. Duchesne * mentions an instance of complete amenorrhea, in which the ordinary flow was replaced by periodic sweats. Parrot speaks of a woman who, when seven months old, suffered from strumous ulcers, which left cicatrices on the right hand, from whence, at the age of six years, issued a sanguineous discharge with associate convulsions. One day, while in violent grief, she shed bloody tears. She menstruated at the age of eleven, and was temporarily improved in her condition ; but after any strong emotion the hemorrhages returned. The subsidence of the bleed- ing followed her first pregnancy, but subsequently on one occasion, when the menses were a few days in arrears, she exhibited a blood-like exudation from the forehead, eyelids, and scalp. As in the case under D'AndradS's obser- vation, the exudation was found by microscopic examination to consist of the true constituents of blood. An additional element of complication in this case was the occurrence of occasional attacks of hematemesis. Menstruation from the Breasts. — Being in close sympathy with the generative function, we would naturally expect to find the female mammse a 772, 1862. ^ 162, 1829, 212, 236. Mead, " and Acta Eruditorum ^ all mention instances. Forel " saw menstruation in a man. Gloninger^ tells of a man of thirty-six, who, since the age of seventeen years and five months, had had lunar manifestations of menstrua- tion. Each attack was accompanied by pains in the back and hypogastric region, febrile disturbance, and a sanguineous discharge from the urethra, which resembled in color, consistency, etc., the menstrual flux. King ^ re- lates that while attending a course of medical lectures at the University of Louisiana he formed the acquaintance of a young student who possessed the normal male generative organs, but in whom the simulated function of men- struation was periodically performed. The cause was inexplicable, and the unfortunate victim was the subject of deep chagrin, and was afflicted with melancholia. He had menstruated for three years in this manner : a fluid exuded from the sebaceous glands of the deep fossa behind the corona glandis ; this fluid was of the same appearance as the menstrual flux. The quantity was from one to two ounces, and the discharge lasted from three to six days. At this time the student was twenty-two years of age, of a lymphatic temperament, not particularly lustful, and was never the victim of any venereal disease. The author gives no account of the after-life of this man, his whereabouts being, unfortunately, unknown or omitted. Vicarious Menstruation in the Male. — This simulation of menstrua- tion by the male assumes a vicarious nature as well as in the female. Van Swieten,'' quoting from Benivenius, relates a case of a man who once a month sweated great quantities of blood from his right flank. Pinel mentions a case of a captain in the army (M. Regis), who was wounded by a bullet in the body and who afterward had a monthly discharge from the urethra. Pinel calls attention particularly to the analogy in this case by mentioning that if the captain were exposed to fatigue, privation, cold, etc., he exhibited the ordinary symptoms of amenorrhea or suppression. Fournier' speaks of a man over thirty years old, who had been the subject of a menstrual evacua- tion since puberty, or shortly after his first sexual intercourse. He would experience pains of the premenstrual type, about twenty-four hours before the appearance of the flow, which subsided when the menstruation began. He was of an intensely voluptuous nature, and constantly gave himself up to sexual excesses. The flow was abundant on the first day, diminished on the second, and ceased on the third. Halliburton,J Jouilleton, and Rayman also record male menstruation. Cases of menstruation during pregnancy and lactation are not rare. a 706, cent, iii., obs. 47. ^ 803, L. v., cap. ]5. c 515^ 369. a 106, ann. 1688, 228. e 239, 1869. f I29', 1819. 8 251,1867. !> 755, vol. xiii., sect. 1286. i 302, iv., 192. j Weekly Med. Rev., Chicago, 1884, xii., 392. PRECOCIOUS MENSTRUATION. 29 It is not uncommon to find pregnancy, lactation, and menstruation coexist- ing. No careful obstetrician will deny pregnancy solely on the regular occurrence of the menstrual periods, any more than he would make the diag- nosis of pregnancy from the fact of the suppression of menses. Blake " reports an instance of catamenia and mammary secretion during pregnancy. Denaux de Breyne mentions a similar case. The child was born by a face- presentation. De Saint-Moulin ^ cites an instance of the persistence of men- struation during pregnancy in a woman of twenty-four, who had never been regular; the child was born at term. Gelly speaks of a case in which menstruation continued until the third month of pregnancy, -when abortion occurred. Post," in describing the birth of a two-pound child, mentions that menstruation had persisted during the mother's pregnancy. Rousset ^ reports a peculiar case in which menstruation appeared during the last four months of pregnancy. There are some cases on record of child-bearing after the menopause, as, for instance, that of Pearson,^ of a woman who had given birth to nine children up to September, 1836 ; after this the menses appeared only slightly until July, 1838, when they ceased entirely. A year and a half after this she was delivered of her tenth child. Other cases, somewhat similar, will be found under the discussion of late conception. Precocious menstruation is seen from birth to nine or ten years. Of course, menstruation before the third or fourth year is extremely rare, most of the cases reported before this age being merely accidental sanguineous discharges from the genitals, not regularly periodical, and not true catamenia. However, there are many authentic cases of infantile menstruation on record, which were generally associated with precocious development in other parts as well. Billard says that the source of infantile menstruation is the lining membrane of the uterus ; but Camerer explains it as due to ligature of the umbilical cord before the circulation in the pulmonary vessels is thoroughly established. In the consideration of this subject, we must bear in mind the influence of climate and locality on the time of the appearance of menstruation. In the southern countries, girls arrive at maturity at an earlier age than their sisters of the north. Medical reports from India show early puberty of the females of that country. Campbell remarks that girls attain the age of puberty at twelve in Siam, while, on the contrary, some observers report the fact that menstruation does not appear in the Esquimaux women until the age of twenty-three, and then is very scanty, and is only present in the summer months. Cases of menstruation commencing within a few days after birth and exhibiting periodical recurrence are spoken of by Penada,^ Neues Han- a218, 1856-7, Iv., 508. b Jour, d'accouch., Li6ge, 1888, ix., 205. « 286, 1885-6, i., 543. d Jour, de m6d. de Bordeaux, 1856. e 476, 1836. f Saggio d'osservazioni, iii. 30 GENETIC ANOMALIES. noverisches Magazin,^ Drummond,'' Buxtorf," Arnold/ The Lancet/ and the British Medical Journal. '' Cecil s relates an instance of menstruation on the sixth day, continuing for five days, in which six or eight drams of blood were lost. Peeples^ cites an instance in Texas in an infant at the age of five days, which was associated with a remarkable development of the genital organs and breasts. Van Swieten offers an example at the first month ; the British Medical Journal ' at the second month ; Conarmond at the third month. Ysabel, a young slave girl belonging to Don Carlos Pedro of Havana, J began to menstruate soon after birth, and at the first year was regular in this function. At birth her mammae were well developed and her axillae were slightly cov- ered with hair. At the age of thirty-two months she was three feet ten inches tall, and her genitals and mammae resembled those of a girl of thir- teen. Her voice was grave and sonorous ; her moral inclinations were not known. Deever^^^ records an instance of a child two years and seven months old who, with the exception of three months only, had menstruated regularly since the fourth month. Harle ^ speaks of a child, the youngest of three girls, who had a bloody discharge at the age of five months which lasted three days and recurred every month until the child was weaned at the tenth month. At the eleventh month it returned and continued periodically until death, occasioned by diarrhea at the fourteenth month. The necropsy showed a uterus If inches long, the lips of which were congested ; the left ovary was twice the size of the right, but displayed nothing strikingly abnormal. Baillot and the British Medical Journal ' cite instances of men- struation at the fourth month. A case is on record ■" of an infant who menstru- ated at the age of six months, and whose menses returned on the twenty- eighth day exactly. Clark, Wall, and the Lancet" give descriptions of cases at the ninth month. Naegele has seen a case at the eighteenth month, and Schmidt and Colly " in the second year. Another case p is that of a child, nineteen months old, whose breasts and external genitals were fully de- veloped, although the child had shown no sexual desire, and did not exceed other children of the same age in intellectual development. This prodigy was symmetrically formed and of pleasant appearance. "Warner i speaks of Sophie Gantz, of Jewish parentage, born in Cincinnati, July 27, 1865 whose menses began at the twenty-third month and had continued regularly up to the time of reporting. At the age of three years and six months she was 38 inches tall, 38 pounds in weight, and her girth at the hip was 33J inches. The pelvis was broad and well shaped, and measured lOJ » 586, xvii., 1519. b 224, 1879, ii., 47. c 107, vol vii 107 a 494, 1876, ii., 42. <= 476, 1871, i., 366. i 224, 1879, i.,'841. g 494, 1885. h 597, March, 1895. i 224, 1881, ii., 682 J 599, 1829. k224, 1880, i., 848. I 224, 1883, ii., 1141. m224' 1879,' i.,'801 n 476, 1827. 548,1864,382. P 516, 1828. q 459^ 1869. PRECOCIOUS MENSTRUATION. 31 inches from the anterior surface of the spinous process of one ilium to that of the other, being a little more than the standard pelvis of Churchill, and, in consequence of this pelvic development, her legs were bowed. The mammae and labia had all the appearance of established puberty, and the pubes and axilla were covered with hair. She was lady-like and maidenly in her demeanor, without unnatural constraint or effrontery. A case some- what similar, though the patient had the appearance of a little old woman," was a child of three whose breasts were as well developed as in a girl of twenty, and whose sexual organs resembled those of a girl at puberty. She had menstruated regularly since the age of two years. Woodruff'' describes a child who began to menstruate at two years of age and continued regularly thereafter. At the age of six years she was still menstruating, and exhibited beginning signs of puberty. She was 118 cm. tall, her breasts were devel- oped, and she had hair on the mons veneris. Van der Veer " mentions an infant who began menstruating at the early age of four months and had continued regularly for over two years. She had the features and develop- ment of a child ten or twelve years old. The external labia and the vulva in all its parts were well formed, and the mons veneris was covered with a full growth of hair. Sir Astley Cooper, Mandelshof, the Ephemerides, Rause, Geoffroy-Saint-Hilaire, and several others'^ report instances of menstruation occurring at three years of age. Le Beau ® describes an infant- prodigy who was born with the mammae well formed and as much hair on the mons veneris as a girl of thirteen or fourteen. She menstruated at three and continued to do so regularly, the flow lasting four days and being copious. At the age of four years and five months she was 42 J inches tall ; her features were regular, the complexion rosy, the hair chestnut, the eyes blue-gray, her mammae the size of a large orange, and indications that she would be able to bear children at the age of eight. Prideaux cites a case at five, and Gaugirau Casals, a doctor of Agde, ^ has seen a girl of six years who suffered abdominal colic, hemorrhage from the nose, migraine, and neu- ralgia, all periodically, which, with the association of pruritus of the genitals and engorged mammae, led him to suspect amenorrhea. He ordered baths, and shortly the menstruation appeared and became regular thereafter. Brierre de Boismont records cases of catamenia at five, seven, and eight years ; and Skene s mentions a girl who menstruated at ten years and five months. She was in the lowest grade of society, living with a drunken father in a tenement house, and was of wretched physical constitution, quite ignorant, and of low moral character, as evinced by her specific vaginitis. Occurring from nine years to the ordinary time of puberty, many cases are recorded. » 476, Jan. 29, 1848, 137. b 538, March 7, 1896. <= 125, 1883. 458, T. xxxvii., 542. i 538, Nov. 16, 1895. 36 GENETIC ANOMALIES. existence (as it only lived a week) by its grandmother, who had a child only a few months old. The parents of this child were prosperous, intelligent, and worthy people, and there was no doubt of the child's age. " Annie is now well and plays about with the other children as if nothing had happened." Harris refers to a Kentucky woman, a mother at ten years, one in Massachu- setts a mother at ten years, eight months, and seventeen days, and one in Phila- delphia at eleven years and three months. The first case was one of infantile precocity, the other belonging to a much later period, the menstrual function having been established but a few months prior to conception. All these girls had well-developed pelves, large mammae, and the general marks of womanhood, and bore living children. It has been remarked of 3 verj-- markedly precocious cases of pregnancy that one was the daughter of very humble parents, one born in an almshouse, and the other raised by her mother in a house of prostitution. The only significance of this statement is the greater amount of vice and opportunity for precocious sexual intercourse to which they were exposed ; doubtless similar cases under more favorable con- ditions would never be recognized as such. The instance in the Journal deS^avans is reiterated in 1775,^ which is but such a repetition as is found all through medical literature — " new friends with old faces," as it were. Haller observed a case of impregnation in a girl of nine, who had menstruated several years, and others who had become pregnant at nine, ten, and twelve years respectively. Hewlett,^ whose case is mentioned by Harris, saw a child who had menstruated the first year and regularly thereafter, and gave birth to a child weighing 7f pounds when she was only ten years and thirteen days old. At the time of delivery she measured 4 feet 7 inches in height and weighed 100 pounds. Curtis," who is also quoted by Harris, relates the history of Elizabeth Drayton, who became pregnant before she was ten, and was delivered of a full-grown, living male child weighing 8 pounds. She had menstruated once or twice before conception, was fairly healthy during gestation, and had a rather lingering but natural labor. To complete the story, the father of this child was a boy of fifteen. One of the faculty of Montpellier ■* has reported an instance at New Orleans of a young girl of eleven, who became impregnated by a youth who was not yet sixteen. Maygrier ® says that he knew a girl of twelve, living in the Faubourg Saint^Germain, who was confined. Harris ^ relates the particulars of the case of a white girl who began to menstruate at eleven years and four months, and who gave birth to an over- sized male child on January 21, 1872, when she was twelve years and nine months old. She had an abundance of milk and nursed the child ; the labor was of about eighteen hours' duration, and laceration was avoided. He also speaks of a mulatto girl, born in 1848, who began to menstruate at eleven » 280, 3775. b 783, vol. vii. c 218, Feb. 19, 1863. d 302, xxxii., 394. e Ibid. f 125, 1874. PRECOCIOUS IMPREGNATION. 37 years and nine months, and gaA^e birth to a female child before she reached thirteen, and bore a second child when fourteen years and seven months old. The child's father was a white boy of seventeen. The following are some Indian statistics : * 1 pregnancy at ten, 6 at eleven, 2 at eighteen, 1 at nineteen.'' Chevers "^^ speaks of a mother at ten and others at eleven and twelve ; and Green, at Dacca, performed craniotomy upon the fetus of a girl of twelve. Wilson " gives an account of a girl thirteen years old, who gave birth to a full-grown female child after three hours' labor. She made a speedy convalescence, but the child died four weeks afterward from bad nursing. The lad who acknowledged paternity was nineteen years old. King ^ reports a well- verified case of confinement in a girl of eleven. Both the mother and child did well. Robertson of Manchester describes a girl, working in a cotton factory, who was a mother at twelve ; de La Motte *'* mentions pregnancy before twelve ; Kilpatrick " in a negress, at eleven years and six months ; Fox,' at twelve ; Hall,^ at twelve ; Kinney,'' at twelve years, ten months, and sixteen days ; Herrick,' at thirteen years and nine months ; Murillo,'' at thirteen years ; Philippart,'^ at fourteen years ; Stallcup, at eleven years and nine months ; Stoakley,' at thirteen years ; Walker,"" at the age of twelve years and eight months ; another case," at twelve years and six months ; and Williams," at eleven. » An editorial article in the Indian Medical Gazette of Sept., 1890, says : — "The appearance of menstruation is held by the great majority of natives of India to be evidence and proof of marriageability, but among the Hindu community it is considered disgraceful that a girl should remain unmarried until this function is established. The con- sequence is that girls are married at the age of nine or ten years, but it is understood or pro- fessed that the consummation of the marriage is delayed until after the first menstrual period. There is, however, too much reason to believe that the earlier ceremony is very frequently, perhaps commonly, taken to warrant resort to sexual intercourse before the menstrual flux has occurred : it may be accepted as true that premenstrual copulation is largely practised under the cover of marriage in this country. " From this practice it results that girls become mothers at the earliest possible period of their lives. A native medical witness testified that in about 30 per cent, of marriages children were born by wives of from twelve to thirteen years of age. Cases of death caused by the first act of sexual intercourse are by no means rare. They are naturally concealed, but ever and anon they come to light. Dr. Chevers mentioned some 14 cases of this sort in the last edition of his 'Handbook of Medical Jurisprudence for India,' and Dr. Harvey found 5 in the medicolegal returns submitted by the Civil Surgeons of the Bengal Presidency during the years 1870-71-72. " Eeform must come from conviction and effort, as in every other case, but meantime the strong arm of the law should be put forth for the protection of female children from the degradation and hurt entailed by premature sexual intercourse. This can easily be done by raising the age of punishable intercourse, which is now fixed at the absurd limit of ten years. Menstruation very seldom appears in native girls before the completed age of twelve years, and if the ' age of consent ' were raised to that limit, it would not interfere with the preju- dices and customs which insist on marriage before menstruation." b 434, Feb., 1845. <= 318, 1861-2. d 476, 1868, ii., 618. e 545, 1873. f 286, 1889. g 729, 1859. ^ 538, 1885. i 593, 1873. J 668, 1875. k 143, 1875. 1 526, 1855, xi., 203. °'218, 1846-7. ^ 822, 1876. o 131, 1874. 38 GENETIC ANOMALIES. In 1816 some girls were admitted to the Paris Maternity as young as thirteen, and during the Eevolution several at eleven, and even younger. Smith " speaks of a legal case in which a girl, eleven years old, being safely delivered of a living child, charged her uncle with rape. Allen >> speaks of a girl who became pregnant at twelve years and nine months, and was delivered of a healthy, 9-pound boy before the physician's arrival ; the placenta came away afterward, and the mother made a speedy recovery. She was thought to have had " dropsy of the abdomen," as the parents had lost a girl of about the same age who was tapped for ascites. The father of the child was a boy only fourteen years of age. Marvelous to relate, there are on record several cases of twins being born to a child mother. Kay reports a case of twins in a girl of thirteen ; Montgomery, at fourteen ; and Meigs reports the case of a young girl, of Spanish blood, at Maracaibo, who gave birth to a child before she was twelve and to twins before reaching fourteen years. In the older works, the folloAving authors have reported cases of preg- nancy before the appearance of menstruation : Ballonius, Vogel, Mor- gagni, the anatomist of the kidney, Schenck, Bartholinus, Bierling, Zacchias, Charleton, Mauriceau, Ephemerides, and Fabricius Hildanus. In some cases this precocity seems to be hereditary, being transmitted from mother to daughter, bringing about an almost incredible state of affairs, in which a girl is a grandmother about the ordinary age of maternity. Kay says that he had reported to him, on " pretty good " authority, an instance of a Damascus Jewess who became a grandmother at twenty-one years. In France " they record a young grandmother of twenty-eight. Ketchum ^ speaks of a negress, aged thirteen, who gave birth to a well-developed child which began to menstruate at ten years and nine months and at thirteen became pregnant ; hence the negress was a grandmother at twenty-five years and nine months. She had a second child before she was sixteen, who began to menstruate at seven years and six months, thus proving the inheritance of this precocity, and leaving us at sea to figure what degree of grandmother she may be if she lives to an advanced age. Another interesting case of this nature is that of Mrs. 0.,"= born 1854, married in 1867, and who had a daughter ten months after. This daughter married in 1882, and in March, 1883, gave birth to a 9-pound boy. The youthful grandmother, not twenty- nine, was present at the birth. This case was remarkable, as the children were both legitimate. Fecundity in the old seems to have attracted fully as much attention among the older observers as precocity. Pliny ^^^ speaks of Cornelia, of the family of Serpios, who bore a son at sixty, who was named Volusius Saturnius ; and Marsa, a physician of Venice, was deceived in a pregnancy a 490, 1848. b 224, 1885, ii., 913. c 365, 1867, No. 291. d 770, 1849. e 494, June 9, 1883. FECUNDITY IN THE OLD. 39 in a woman of sixty, his diagnosis being " dropsy." Tarenta records the history of the case of a woman who menstruated and bore children when past the age of sixty. Among the older reports are those of Blanchard " of a woman who bore a child at sixty years ; Fielitz,!"" one at sixty ; Ephemerides, one at sixty-two ; Rush,^ one at sixty ; Bernstein,2°i one at sixty years ; Schoepfer, at seventy years ; and, almost beyond belief, Debes'^ cites an instance as tak- ing place at the very advanced age of one hundred and three. Wallace <• speaks of a woman in the Isle of Orkney bearing children when past the age of sixty. We would naturally expect to find the age of child-bearing prolonged in the northern countries where the age of maturity is later. Capuron cites an example of child-birth in a woman of sixty ; Haller, cases at fifty-eight, sixty-three, and seventy ; Dewees,- at sixty-one ; and Thibaut de Chauvalon, in a woman of Martinique aged ninety years. There was a woman delivered in Germany, in 1723, at the age of fifty-five ; one at fifty-one in Kentucky ; " and one in Russia at fifty .^ Depasse^ speaks of a woman of fifty-nine years and five months old who was delivered of a healthy male child, which she suckled, weaning it on her sixtieth birthday. She had been a widow for twenty years, and had ceased to menstruate nearly ten years before. In St. Peter's Church, in East Oxford, is a monument bearing an inscription re- cording the death in child-birth of a woman sixty-two years old. Cachot'' relates the case of a woman of fifty-three, who was delivered of a living child by means of the forceps, and a year after bore a second child without instrumental interference. She had no milk in her breasts at the time and no signs of secretion. This aged mother had been married at fifty-two, five years after the cessation of her menstruation, and her husband was a young man, only twenty-four years old. Kennedy' reports a delivery at sixty-two years, and the Cincinnati Enquirer, January, 1863, says : " Dr. W. McCarthy was in attendance on a lady of sixty-nine years, on Thursday night last, who gave birth to a fine boy. The father of the child is seventy-four years old, and the mother and child are doing well." Quite recently there died in Great Britain a Mrs. Henry of Gortree at the age of one hundred and twelve, leaving a daughter of nine years. May ham J saw a woman seventy-three years old who recovered after delivery of a child. A most peculiar case is that of a widow, seventy years old, a native of Garches.'' She had been in the habit of indulging freely in wine, and, during the last six months, to decided excess. After an unusually prolonged libation she found herself unable to walk home ; she sat down by the roadside waiting until she could proceed, and was so found by a young man who knew her and who proposed helping her home. By the time her a 213, cent, iv., n. 71. b 696, ii. <= 290, 248. a 629, vol. xxii., 543. " 133, 1872, vi., 138. f 811, 1881, vi. g 364, Oct. 1, 1891. k 616, 1883-4, xxvi., 394. 1769,1881. J 542, Jan., 1891. k 789, Dec. 3, 1881. 40 GENETIC ANOMALIES. house was reached night was well advanced, and she invited him to stop over night ; finding her more than affable, he stopped at her house over four nights, and the result of his visits was an ensuing pregnancy for Madame. Multiple births in the aged have been reported from authentic sources. The Lancet " quotes a rather fabulous account of a lady over sixty-two years of age who gave birth to triplets, making her total number of children 13. Montgojnery, Colomb, and Knehel, each, have recorded the birth of twins in women beyond the usual age of the menopause, and there is a case '' recorded of a woman of fifty-two who was delivered of twins. Impregnation without completion of the copulative act by reason of s®me malformation, such as occlusion of the vagina or uterus, fibrous and unruptured hymen, etc., has been a subject of discussion in the works of medical jurisprudence of all ages ; and cases of conception without entrance of the penis are found in abundance throughout medical literature, and may have an important medicolegal bearing. There is little doubt of the possibility of spermatozoa deposited on the genitalia making progress to the seat of fer- tilization, as their power of motility and tenacity of life have been well dem- onstrated. Percy " reports an instance in which semen was found issuing from the os uteri eight and one-half days after the last intercourse ; and a microscopic examination of this semen revealed the presence of living as well as dead spermatozoa. We have occasional instances of impregnation by rectal coitus, the semen finding its way into an occluded vaginal canal by a fistulous communication. Guillemeau,^ the surgeon of the French king, tells of a girl of eighteen, who was brought before the French officials in Paris, in 1607, on the cita- tion of her husband of her inability to allow him completion of the marital function. He alleged that he had made several unsuccessful attempts to enter her, and in doing so had caused paraphimosis. On examination by the surgeons she was found to have a dense membrane, of a fibrous nature, entirely occluding the vagina, which they incised. Immediately afterward the woman exhibited morning sickness and the usual signs of pregnancy, and was delivered in four months of a full-term child, the results of an impreg- nation occasioned by one of the unsuccessful attempts at entrance. Such instances are numerous in the older literature, and a mere citation of a few is considered sufficient here. Zacchias,^ Amand, Fabricius Hildanus, Graaf the discoverer of the follicles that bear his name, Borellus, Blegny, Blanchard ^ Diemerbroeck,g Duddell, Mauriceau, h Reyes, Riolan,^ Harvey, the discoverer of the circulation of the blood,* Wolfius, Walther, Rongier,J Ruysch, For- estus, Ephemerides)'' and Schurig all mention cases of conception with intact » 476, 1867, i., 727. b 538, 1889. c 130, March 9, 1861. d 389, L. ii., chap. 8, fol. 108. e 830, n. 42. f 213 cent. iii. g 303, L. i., c. 23. h 686, L. ii., c. 37. i 405^ L. ii., c. 11. J 462, T. xlix., 358. kl04, Dec. 1, ann. iii., obs. 273. IMPREGNATION AFTER INCOMPLETE COPULATION. 41 hymen, and in which there was no entrance of the penis. Tolberg '^^^ has an example of hymen integrum after the birth of a fetus five months old, and there is recorded* a case of tubal pregnancy in which the hymen was intact. Gilbert ^ gives an account of a case of pregnancy in an unmarried woman, who successfully resisted an attempt at criminal connection and yet became impregnated and gave birth to a perfectly formed female child. The hymen was not ruptured, and the impregnation could not have preceded the birth more than thirty-six weeks. Unfortunately, this poor woman was infected with gonorrhea after the attempted assault. Simmons of St. Louis "^ gives a curious peculiarity of conception, in which there was complete closure of the vagina, subsequent conception, and delivery at term. He made the patient's acquaintance from her application to him in regard to a malcondi- tion of her sexual apparatus, causing much domestic infelicity. Lawson'^ speaks of a woman of thirty-five, who had been married ten months, and whose husband could never effect an entrance ; yet she became pregnant and had a normal labor, despite the fact that, in addition to a tough and unruptured hymen, she had an occluding vaginal cyst. Hickinbotham of Birmingham ^ reports the history of two cases of labor at term in females whose hymens were immensely thickened. H. Grey Edwards has seen a case of imperforate hymen which had to be torn through in labor ; yet one single act of copulation, even with this obstacle to entrance, sufficed to impregnate. Champion speaks of a woman who became pregnant although her hymen was intact. She had been in the habit of having coitus by the urethra, and all through her pregnancy continued this practice. Houghton^ speaks of a girl of twenty-five into whose vagina it was impossible to pass the tip of the first finger on account of the dense cicatricial membrane in the orifice, but who gave birth, with comparative ease, to a child at full term, the only interference necessary being a few slight incisions to permit the passage of the head. Tweedies saw an Irish girl of twenty- three, with an imperforate os uteri, who had menstruated only scantily since fourteen and not since her marriage. She became pregnant and went to term, and required some operative interference. He incised at the point of usual location of the os, and one of his incisions was followed by the flow of liquor amnii, and the head fell upon the artificial opening, the diameter of which proved to be one and a half or two inches ; the birth then progressed promptly, the child being born alive. Guerard ^ notes an instance in which the opening barely admitted a hair ; yet the patient reached the third month of pregnancy, at which time she induced abortion in a manner that could not be ascertained. Roe gives a a Collect. Acad, de M6d., Paris, 1756, xli., 151. b 218, 1872, 298. • 218, 1859-60, Ixi., 295. s Northwest Med. and Surg. Jour., St. Paul, 1870-71, i., 183. t 363, 1849, i., 451. " Morgagni, Napoli, 1875, xvii., 747. ^ 368, 1831. w Western Lancet, San Francisco, 1873-4, ii., 705. x 176, 1874-5, xii., 457. ARTIFICIAL IMPREGNATION. 43 hearsay, it has been demonstrated as a practical and useful method in those cases in which, by reason of some unfortunate anatomic malformation on either the male or the female side, the marriage is unfruitful. There are many cases constantly occurring in which the birth of an heir is a most desirable thing in a person's life. The historic instance of Queen Mary of England, whose anxiety and efforts to bear a child were the subject of public comment and prayers,^ is but an example of a fact that is occurring every day, and doubtless some of these cases could be righted by the pursuance of some of the methods suggested. There have been rumors from the beginning of the century of women being impregnated in a bath, from contact with cloths containing semen, etc., and some authorities in medical jurisprudence have accepted the possibility of such an occurrence. It is not in the province of this work to speculate on what may be, but to give authoritative facts, from which the reader may draw his own deductions. Fertilization of plants has been thought to have been known in the oldest times, and there are some who believe that the library at Alexandria must have contained some information relative to it. The first authentic account that we have of artificial impregnation is that of Schwammerdam, who in 1680 attempted it without success by the fecunda- tion of the eggs of fish. Eoesel, his scholar, made an attempt in 1690, but also failed ; and to Jacobi, in 1700, belongs the honor of success. In 1780, Abbe Spallanzani, following up the success of Jacobi, artificially impreg- nated a bitch, who brought forth in sixty-two days 3 puppies, all resembling the male. The illustrious John Hunter advised a man afilicted with hypospadias to impregnate his wife by vaginal injections of semen in water with an ordinary syringe, and, in spite of the simplicity of this method, the attempt was followed by a successful issue. Since this time, Nicholas of Nancy and Lesueur have practised the simple vaginal method ; while Gigon, d'Angouleme (14 cases), Girault (10 cases), Marion Sims, Thomas, Salmon, Pajot, Gfillard, Courty, Eoubaud, Dehaut, and others have used the more modern uterine method with success. A dog-breeder,* by syringing the uterus of a bitch, has succeeded in im- pregnating her. Those who are desirous of full information on this subject, as regards the modus operandi, etc., are referred to Girault j*" this author reports in full several examples. One case was that of a woman, aged twenty-five, afflicted with blenorrhea, who, chagrined at not having issue, made repeated forcible injections of semen in water for two months, and finally succeeded in impregnating herself, and was delivered of a living child. Another case was that of a female, aged twenty-three, who had an extra long vaginal canal, probably accounting for the absence of pregnancy. She made injec- tions of semen, and was finally delivered of a child. He also reports the case of a distinguished musician who, by reason of hypospadias, had never a 806, 1884. '' 100, 1868, 409. 44 GENETIC ANOMALIES. impregnated his wife, and had resorted to injections of semen with a favor- able result. This latter case seems hardly warranted when we consider that men afflicted with hypospadias and epispadias have become fathers. Percy " gives the instance of a gentleman whom he had known for some time, whose urethra terminated a little below the frenum, as in other persons, but whose glans bulged quite prominently beyond it, rendering urination in the forward direction impossible. Despite the fact that this man could not perform the ejaculatory function, he was the father of three children, two of them inheriting his penile formation. The fundamental condition of fecundity being the union of a spermato- zoid'and an ovum, the object of artificial impregnation is to further this union by introducing semen directly to the fundus of the uterus. The operation is quite simple and as follows : The husband, having been found perfectly healthy, is directed to cohabit with his wife, using a condom. The semen ejaculated is sucked up by an intrauterine syringe (Fig. 1) which has been properly disinfected and kept warm. The os uteri is now exposed and wiped off with some cotton which has been dipped in an antiseptic fluid ; the nozzle of the syringe is introduced to the fundus of the uterus, and some drops of the fluid slowly expressed into the uterus. The woman Fig. 1.— Apparatus for artificial impregnation. 1^ then kept in bed OU her back. This operation is best carried out immediately before or immediately after the menstrual epoch, and if not successful at the first attempt should be repeated for several months. At the present day artificial impregnation in pisciculture is extensively used with great success.^ a 130, 1861. i" The followiDg extraordinary incident of accidental impregnation, quoted from the American Medical "Weekly 1 by the Lancet,^ is given in brief, not because it bears any sem- blance of possibility, but as a curious example from the realms of imagination in medicine. L. G. Capers of Vicksburg, Miss., relates an incident during the late Civil War, as fol- lows : A matron and her two daughters, aged fifteen and seventeen years, filled witli the enthusiasm of patriotism, stood ready to minister to the wounds of their countrymen in their fine residence near the scene of the battle of E , May 12, 1863, between a portion of Grant's army and some Confederates. During the fray a gallant and noble young friend of the narrator staggered and fell to the earth ; at the same time a piercing cry was heard in the house near by. Examination of the wounded soldier showed that a bullet had passed through the scrotum and carried away the left testicle. The same bullet had apparently penetrated the left side of the abdomen of the elder young lady, midway between the umbilicus and the anterior superior spinous process of the ilium, and had become lost in the abdomen. This 1 131, Nov. 7, 1874. 2 476, 1875, i., 85. CONCEPTION WITH DEFICIENT ORGANS. 45 Interesting as are all the anomalies of conception, none are more so than those of unconscious impregnation ; and some well-authenticated cases can be mentioned. Instances of violation in sleep, with subsequent preg- nancy as a result, have been reported in the last century by Valentini,"'^ Gen- selius," and Schurig. Reports by modern authorities seem to be quite scarce, though there are several cases on record of rape during anesthesia, followed by impregnation. Capuron *• relates a curious instance of a woman who was raped during lethargy, and who subsequently became pregnant, though her condition was not ascertained until the fourth month, the peculiar abdominal sensation exciting suspicion of the true nature of the case, which had pre- viously been thought impossible. There is a record of a case "^ of a young girl of great moral purity who became pregnant without the slightest knowledge of the source ; although, it might be remarked, such cases must be taken " cum grano satis." Cases of conception without the slightest sexual desire or pleasure, either from fright, as in rape, or naturally deficient constitution, have been recorded ; as well as conception during intoxication and in a hypnotic trance, which latter has recently assumed a much mooted legal aspect. As far back as 1680,^'' Duverney speaks of conception without the slightest sense of desire or pleasure on the part of the female. Conception with Deficient Organs. — Having spoken of conception with some obstructive interference, conception with some natural or acquired deficiency of the functional, organic, or genital apparatus must be considered. It is a well-known fact that women exhibiting rudimentary development of the uterus or vagina are still liable to become pregnant, and many such cases have been recorded ; but the most peculiar cases are those in which pregnancy has appeared after removal of some of the sexual apparatus. Pregnancy going to term with a successful delivery frequently follows the performance of ovariotomy with astonishing rapidity. Olier ^ cites an daughter suffered an attack of peritonitis, but recovered in two months under the treatment administered. Marvelous to relate, just two hundred and seventy-eight days after the reception of the minie-ball, she was delivered of a fine boy, weighing 8 pounds, to the surprise of herself and the mortification of her parents and friends. The hymen was intact, and the young mother strenu- ously insisted on her virginity and innocence. About three weeks after this remarkable birth Dr. Capers. was called to see the infant, and the grandmother insisted that there was something wrong with the child's genitals. Examination showed a rough, swollen, and sensitive scrotum, containing some hard substance. He operated, and extracted a smashed and battered minie- ball. The doctor, after some meditation, theorized in this manner : He concluded that this was the same ball that had carried away the testicle of his young friend, that had penetrated the ovary of the young lady, and, with some spermatozoa upon it, had impregnated her. With this conviction he approached the young man and told him the circumstances ; the soldier appeared skeptical at first, but consented to visit the young mother ; a friendship ensued which soon ripened into a happy marriage, and the pair had three children, none resembling, in the same degree as the first, the heroic pater familias. a 104, 1715. b 254, 86. <= 525, 1855. d 363, xlv., 1140. 46 GENETIC ANOMALIES. instance of ovariotomy with a pregnancy of twins three months afterward, and accouchement at term of two well-developed boys. Polaillon " speaks of a pregnancy consecutive to ovariotomy, the accouchement being normal at term. Crouch'' reports a case of successful parturition in a patient who had previously undergone ovariotomy by a large incision. Parsons " mentions a case of twin pregnancy two years after ovariotomy attended with abnormal development of one of the children. Cutter '^ speaks of a case in which a woman bore a child one year after the performance of ovariotomy, and Pippingskold ^ of two cases of pregnancy after ovariotomy in which the stump as well as the remaining ovary were cauterized. Brown ^ relates a similar instance with successful delivery. Bixby,^ Harding,'' Walker (1878-9), and Mears' all report cases, and others are not at all rare. In the cases following shortly after operation, it has been suggested that they may be explained by the long retention of the ova in the uterus, deposited there prior to operation. In the presence of such facts one can but wonder if artificial fecundation of an ovum derived from another woman may ever be brought about in the uterus of a sterile woman ! Conception Soon After a Preceding Pregnancy. — Conception some- times follows birth (or abortion) with astonishing rapidity, and some women seem for a period of their lives either always pregnant or with infants at their breasts. This prolificity is often alluded to, and is not confined to the lower classes, as often stated, but is common even among the nobility. Illustrative of this, we have examples in some of the reigning families in Europe to-day. A peculiar instance is given by SparkmanJ in which a woman conceived just forty hours after abortion. Rice'' mentions the case of a woman who was confined with her first child, a boy, on July 31, 1870, and was again delivered of another child on June 4, 1871. She had become pregnant twenty-eight days after delivery. He also mentions another case of a Mrs. C, who, at the age of twenty-three, gave birth to a child on September 13, 1880, and bore a second child on July 2, 1881. She must have become pregnant twenty-one days after the delivery of her first child. Superf etation has been known for many centuries ; the Romans had laws prescribing the laws of succession in such cases, and many medical writers have mentioned it. Hippocrates and Aristotle wrote of it, the former at some length. Pliny speaks of a slave who bore two infants, one resembling the master, the other a man with whom she had intercourse, and cites the case as one of super- fetation. Schenck ' relates instances, and Zacchias, Yelchius, and Sinibaldus mention cases. Par6 seemed to be well conversant with the possibility as well as the actuality of superfetation ; and Harvey ^ reports that a certain a 168, 1879, vi., 243. b 550, xxxv., 71. - 476, 1866, i., 284. d 538, 1867-8. e 321, 1880. f 548, 1854, ix., 566. g 476, I88I. h476, 1880, i., 93. i 547, 1879. J 264, 1876. ^Vid, 1881, 206. • L. iv., De Superfetation, 617. m404 fol. 479. SUPERFETATION. 47 maid, gotten with child by her master, in order to hide her knavery came to London in September, where she lay in by stealth, and being recovered, returned home. In December of the same year she was unexpectedly deliv- ered of another child, a product of superfetation, which proclaimed the crime that she had so cui^ningly concealed before. Marcellus Donatus, Goret, Schacher, '^^ and Mauriceau " mention super- fetation. In the Acad6mie des Sciences, at Paris, in 1702, there was men- tioned the case of a woman who was delivered of a boy ; in the placenta was discovered a sort of bladder which was found to contain a female fetus of the age of from four to five months ; and in 1729, before the same society, there was an instance in which two fetuses were born a day apart, one aged forty days and the other at full term. From the description, it does not seem pos- sible that either of these were blighted twin pregnancies. -Ruysch'' gives an account of a surgeon's wife at Amsterdam, in 1686, who was delivered of a strong child which survived, and, six hours after, of a small embryo, the funis of which was full of hydatids and the placenta as large and thick as one of three months. Euysch accompanies his description with an illustrative figure. At Lyons, in 1782, Benoite Franquet was unexpectedly delivered of a child seven months old ; three weeks later she experienced symptoms indicative of the existence of another fetus, and after five months and six- teen days she was delivered of a remarkably strong and healthy child. Baudeloque" speaks of a case of superfetation observed by Desgranges in Lyons in 1780. After the birth of the first infant the lochia failed to flow, no milk appeared in the breasts, and the belly remained large. In about three weeks after the accouchement she had connection with her hus- band, and in a few days felt fetal movements. A second child was born at term, sixty-eight days after the first; and in 1782 both children were living. A woman of Aries'* was delivered on November 11, 1796, of a child at term ; she had connection with her husband four days after ; the lochia stopped, and the milk did not flow after this intercourse. About one and a half months after this she felt quickening again, and naturally sup- posed that she had become impregnated by the first intercourse after confine- ment ; but five months after the first accouchement she was delivered of another child at term, the result of a superfetation. Milk in abundance made its appearance, and she was amply able to nourish both children from the breasts. Lachausse "^ speaks of a woman of thirty who bore one child on April 30, 1748, and another on September 16th in the same year. Her breasts were full enough to nourish both of the children. It might be remarked in comment on this case that, according to a French authority, the woman died in 1755, and on dissection was found to have had a double uterus. a 513, app. i., 65. ^ 698, Tome i., obs. 14. c Trait6 de I'Art des Accouchemens, ii. d 302, iv., 181. ^ De superfetation vera in utero simplici, Argentor., 1755. 48 GENETIC ANOMALIES. A peculiar instance of superfetation was reported by Langmore" in which there was an abortion of a fetus between the third and fourth months, appar- ently dead some time, and thirteen hours later a second fetus ; an ovum of about four weeks and of perfect formation was found adherent near the fundus. Tyler Smith*' mentions a lady pregnant for the first time who miscarried at five months and some time afterward discharged a small clot containing a perfectly fresh and healthy ovum of about four weeks' forma- tion. There was no sign of a double uterus, and the patient menstruated regularly during pregnancy, being unwell three weeks before the abortion. Harley and Tanner '^ speak of a woman of thirty-eight who never had borne twiiis, and who aborted a fetus of four months' gestation ; serious hemorrhage accompanied the removal of the placenta, and on placing the hand in the uter- ine cavity an embryo of five or six weeks was found inclosed in a sac and floating in clear liquor amnii. The patient was the mother of nine children, the youngest of which was three years old. Young ^ speaks of a woman who three months previously had aborted a three months' fetus, but a tumor still remained in the abdomen, the auscultation of which gave evidence of a fetal heart-beat. Vaginal examination revealed a dilatation of the os uteri of at least one inch and a fetal head pressing out ; subsequently a living fetus of about six months of age was delivered. Se- vere hemorrhage complicated the case, but was controlled, and convales- cence speedily ensued. Huse '^ cites an instance of a mother bearing a boy on November 4, 1834, and a girl on August 3, 1835. At birth the boy looked premature, about seven months old, which bemg the case, the girl must have been either a superfetation or a seven months' child also. Van Bibber of Baltimore says he met a young lady who was born five months after her sister, and who was still living. The most curious and convincing , examples of superfetation are those in which children of different colors, either twins or near the same age, are born to the same woman, — similar to that exemplified in the case of the, mare who was covered first by a stallion and a quarter of an hour later by an ass, and gave birth at one parturition to a horse and a mule. ^ Parsons ^ speaks of a case at Charleston, S. C, in 1714, of a white woman who gave birth to twins, one a mulatto and the other white. She confessed that after her husband left her a negro servant came to her and forced her to comply with his wishes by threatening her life. Smellie mentions the case of a black woman who had twins, one child black and the other almost white. She confessed having had intercourse with a white overseer immediately after her husband left her bed. Dewees^ reports a similar case. Newlin of Nashville ' speaks of a negress who bore twins, one distinctly black with the a 778, iv., 135. b 476, April 12, 1856. c 778^ Lond., 1863, iv., 165-169 d 124, 1868. e 218, 1856, liv. 294. f Acad, de M6d., Aug., 1825. g 629, Oct., 1745. h 301, 1805, T. clxxiv. i Quoted in 300, Sept., 1887. CHILDREN OF DIFFERENT COLORS. 49 typical African features, while the other was a pretty mulatto exhibiting the distinct characters of the Caucasian race. Both the parents were perfect types of the black African negro. The mother, on being questioned, frankly acknowledged that shortly after being with her husband she had lain a night with a white man. In this case each child had its own distinct cord and placenta. Archer'' gives facts illustrating and observations showing : " that a white woman, by intercourse with a white man and negro, may conceive twins, one of which shall be white and the other a mulatto ; and that, vice versa, a black woman, by intercourse with a negro and a white man, may conceive twins, one of which shall be a negro and the other a mulatto." Wight "^ narrates that he was called to see a woman, the wife of an East Indian laborer on the Isle of Trinidad, who had been delivered of a fetus 6 inches long, about four months old, and having a cord of about 18 inches in length. He removed the placenta, and in about half an hour the woman was delivered of a full-term white female child. The first child was dark, like the mother and father, and the mother denied any possibility of its being a white man's child ; but this was only natural on her part, as East Indian husbands are so intensely jealous that they would even kill an un- faithful wife. Both the mother and the mysterious white baby are doing well. Bouillon" speaks of a negress in Guadeloupe who bore twins, one a negro and the other a mulatto. She had sexual congress with both a negro and a white man. Delmas,'^ a surgeon of Eouen, tells of a woman of thirty-six who was delivered in the hospital of his city on February 26, 1806, of two children, one black and the other a mulatto. She had been pregnant eight months, and had had intercourse with a negro twice about her fourth month of preg- nancy, though living with the white man who first impregnated her. Two placentae were expelled some time after the twins, and showed a mem- branous junction. The children died shortly after birth. Pregnancy often takes place in a unicorn or bicorn uterus, leading to sim- ilar anomalous conditions. Galle, Hoffman, Massen, and Sanger give inter- esting accounts of this occurrence, and Eoss" relates an instance of triple pregnancy in a double uterus. Cleveland^ describes a discharge of an anomalous deciduous membrane during pregnancy which was probably from the unimpregnated half of a double uterus. a 541, 1809-10. b 124, July 6, 1895, 14. = Bull, de la Socl6t6 de M6d., 1821. d 302, iv., 181. e M6dicin, Paris, 1879, v., No. 43. f 778, 1884, xxvi., 117. CHAPTEK II. PRENATAL AE'OMALIES. Extrauterine Pregnancy. — In the consideration of prenatal anomalies, the iirst to be discussed will be those of extrauterine pregnancy. This abnormalism has been known almost as long as there has been any real knowledge of obstetrics. In the writings of Albucasis,"^ during the eleventh century, extrauterine pregnancy is discussed, and later the works of N. Polinus and Cordseus, about the sixteenth century, speak of it ; in the case of Cordseus the fetus was converted into a lithopedion and carried in the abdomen twenty-eight years. Horstius in the sixteenth century relates the history of a woman who conceived for the third time in March, 1547, and in 1563 the remains of the fetus were still in the abdomen. Israel Spach, in an extensive gynecologic work published in 1557, fig- ures a lithopedion drawn in situ in the case of a woman with her belly laid open. He dedicated to this calcified fetus, which he regarded as a reversion, the following curious epigram, in allusion to the classical myth that after the flood the world was repopulated by the two survivors, Deucalion and Pyrrha, who walked over the earth and cast stones behind them, which, on striking the ground, became people. Roughly translated from the Latin, this epigram read as follows : " Deucalion cast stones behind him and thus fashioned our tender race from the hard marble. How comes it that nowadays, by a reversal of things, the tender body of a little babe has limbs nearer akin to stone ? " * Many of the older writers mention this form of fetation as a curiosity, but oifer no explanation as to its cause. Mauriceau ^'^ and de Graaf '** discuss in full extrauterine pregnancy, and Salmuth, Hannseus, and Bartholinus describe it. From the beginning of the eighteenth century this subject always demanded the attention and interest of medical observers. In more modern times, Campbell and Geoffroy-Saint-Hilaire, who named it " Grossesse Path- ologique," have carefully defined and classified the forms, and to-day every text-book on obstetrics gives a scientific discussion and classification of the different forms of extrauterine pregnancy. The site of the conception is generally the wall of the uterus, the Fallo- pian tube, or the ovary, although there are instances of pregnancy in the vagina, as for example when there is scirrhus of the uterus ; *> and again, cases =* 844, 274. b 462, T. li.. 55. 50 TERMINATION OF EXTRAUTERINE PREGNANCY. 51 supposed to be only extrauterine have been instances simply of double uterus, with single or concurrent pregnancy. Eoss -^ speaks of a woman of thirty- three who had been married fourteen years, had borne six children, and who on July 16, 1870, miscarried with twins of about iive months' develop- ment. After a week she declared that she was still pregnant with another child, but as the physician had placed his hand in the uterine cavity after the abortion, he knew the fetus must be elsewhere or that no pregnancy existed. We can readily see how this condition might lead to a diagnosis of extra- uterine pregnancy, but as the patient insisted on a thorough examination, the doctor found by the stethoscope the presence of a beating fetal heart, and by vaginal examination a double uterus. On introducing a sound into the new aperture he discovered that it opened into another cavity ; but as the woman was pregnant in this, he proceeded no further. On October 31st she was delivered of a female child of full growth. She had menstruated from this bipartite uterus three times during the period between the miscarriage of the twins and the birth of the child. Both the mother and child did well. In most cases there is rupture of the fetal sac into the abdominal cavity or the uterus, and the fetus is ejected into this location, from thence to be removed or carried therein many years ; but there are instances in which the conception has been found in situ, as depicted in Figure 2. A sturdy woman ^ of thirty was executed on January 16, 1735, for the murder of her child. It was ascertained that she had passed her catamenia about the first of the month, and thereafter had sexual intercourse with one of her fellow-prisoners. On dissection both Fallopian tubes were found distended, and the left ovary, which bore signs of conception, was twice as large as the right. Campbell ^** quotes another such case in a woman of thirty-eight who for twenty years had practised her vocation as a Cyprian, and who unexpectedly conceived. At the third month of pregnancy a hard extrauterine tumor was found, which was gradually increasing in size and extending to the left side of the hypogastrium, the associate symptoms of pregnancy, sense of pressure, pain, tormina, and dysuria, being unusually severe. There was subsequently an attack of inflammatory fever, followed by tumefaction of the abdomen, con- vulsions, and death on the ninth day. The fetus had been contained in the peritoneal coat of the ovary until the fourth month, when one of the feet passed through the cyst and caused the fatal result. Signs of acute peritonitis were seen postmortem, the abdominal cavity was full of blood, and the ovary much lacerated. The termination of extrauterine pregnancy varies ; in some cases the fetus is extracted by operation after rupture ; in others the fetus has been delivered alive by abdominal section ; it may be partially absorbed, or carried many years in the abdomen ; or it may ulcerate through the confining walls, enter the bowels or bladder, and the remnants of the fetal body be discharged. a 476, 1871, ii., 189. 1^527, vol. v., 277. 52 PRENATAL ANOMALIES. The curious cases mentioned by older writers, and called abortion by the mouth, etc., are doubtless, in many instances, remnants of extra- uterine pregnancies or dermoid cysts. Maroldus ^"^ speaks in full of such cases ; Bartholinus, Salmuth,* and h Eeyes ^ speak of women vomiting remnants of fetuses. In Germany," in the seventeenth century, there lived a woman who on three different occasions is said to have vomited a fetus. The last miscarriage in this manner was of eight months' growth and was accom- Fig. 2. -Pregnant Fallopian tube laid open, showing the fetus killed by hemorrhage into Its membranes but without the escape of the fetus from the tube {Xuttle and Cragin). panied by its placenta. The older observers thought this woman must have had two orifices to her womb, one of which had some connection with the stomach, as they had records of the dissection of a female in whom was found a conformation similar to this. Discharge of the fetal bones or even the whole of an extrauterine fetus by the rectum is not uncommon. There are two early cases mentioned i in ^"A IV., 180. d629, 1748, 1015. DISCHARGE OF FETUS FROM ABDOMINAL WALLS. 53 which the bones of a fetus were discharged at stool, causing intense pain. Armstrong * describes an anomalous case of pregnancy in a syphilitic patient who discharged fetal bones by the rectum. Bubendorf ^ reports the sponta- neous elimination of a fetal skeleton by the rectum after five years of reten- tion, with recovery of the patient. Butcher " speaks of delivery through the rectum at the fourth month, with recovery. Depaul mentions a similar ex- pulsion after a pregnancy of about two months and a half. Jackson <* reports the dissection of an extrauterine sac which communicated freely with the large intestine. Peck ® has an example of spontaneous delivery of an extra- uterine fetus by the rectum, with recovery of the mother. Skippon, ^ in the early part of the last century, reports the discharge of the bones of a fetus through an " imposthume " in the groin. Other cases of anal discharge of the product of extrauterine conception are recorded by Winthrop, Woodbury, Tuttle, Atkinson, Browne, Weinlechner, Gibson, Littre, Magruder, Gilland, and many others. De Brun du Bois-Noir s speaks of the expulsion of extra- uterine remains by the anus after seven years, and Heyerdahl ^ after thirteen years. Benham ' mentions the discharge of a fetus by the rectum ; there was a stricture of the rectum associated with syphilitic patches, necessitating the performance of colotomy. Bartholinus ^^" and Rosseus ^^^ speak of fetal bones being discharged from the urinary passages. Ebersbach, in the Ephemerides of 1717, describes a necropsy in which a human fetus was found contained in the bladder. In 1878 WhiteJ reported an instance of the discharge of fetal remains through the bladder. Discharge of the Fetus through the Abdominal Walls. — Margaret Parry of Berkshire"^ in 1668 voided the bones of a fetus through the flesh above the os pubis, and in 1684 she was alive and well, having had healthy children afterward. Brodie ' reports the history of a case in a negress who voided a fetus from an abscess at the navel about the seventeenth month of conception. Modern instances of the discharge of the extrauterine fetus from the walls of the abdomen are frequently reported. Algora ™ speaks of an abdominal pregnancy in which there was spontaneous perforation of the anterior abdominal parietes, followed by death. Bouzal ° cites an extraor- dinary case of ectopic gestation in which there was natural expulsion of the fetus through abdominal walls, with subsequent intestinal strangulation.. An artificial anus was established and the mother recovered. Brodie, Dunglison, Erich, Rodbard, Fox, and Wilson are among others reporting the expulsion of remnants of ectopic pregnancies through the abdominal parietes. Camp- bell quotes the case of a Polish woman, aged thirty-five," the mother of nine a 490, 1835, xvi., 51. b 140, 1886, xxvi., 269. <= Am. Med. Jour., St. Louis, 1886. d 218, 1865. e 218, 1870, Ixxxiii., 22. f 629, 1731. S 242, 1883. ^ 603, 1847. i 224, 1876. J 764 (1878), 1879, iii., 101. k 629, 1700, 219. ' Ibid. mClinica, Zaragoza, 1878, ii., 221, o 497, 1884, 513. » 504, vol. xix.. No. 3. 54 PRENATAL ANOMALIES. children, most of whom were stillborn, who conceived for the tenth time, the gestation being normal up to the lying-in period. She had pains followed by extraordinary effusion and some blood into the vagina. After various protracted complaints the abdominal tumor became painful and inflamed in the umbilical region. A breach in the walls soon formed, giving exit to purulent matter and all the bones of a fetus. During this process the patient received no medical treatment, and frequently no assistance in dressing the opening. She recovered, but had an artificial anus all her life. Sarah McKinna" was married at sixteen and menstruated for the first time a month thereafter. Ten months after marriage she showed signs of preg- nancy and was delivered at full term of a living child ; the second child was born ten months after the first, and the second month after the second birth she again showed signs of pregnancy. At the close of nine months these symptoms, with the exception of the suppression of menses, subsided, and in this state she continued for six years. During the first four years she felt discomfort in the region of the umbilicus. About the seventh year she suffered tumefaction of the abdomen and thought she had conceived again. The abscess burst and an elbow of the fetus protruded from the wound. A butcher enlarged the wound and, fixing his finger under the jaw of the fetus, extracted the head. On looking into the abdomen he perceived a black object, whereupon he introduced his hand and extracted piecemeal an entire fetal skeleton and some decomposed animal-matter. The abdomen was bound up, and in six weeks the woman was enabled to superintend her domestic affairs ; excepting a ventral hernia she had no bad after-results. Kimura,^ quoted by Whitney, speaks of a case of extrauterine pregnancy in a Japanese woman of forty-one similar to the foregoing, in which an arm protruded through the abdominal wall above the umbilicus and the remains of a fetus were removed through the aperture. The accompanying illustra- tion (Fig. 3) shows the appearance of the arm in situ before extraction of the fetus and the location of the wound. Bodinier" and Lusk '^ report instances of the delivery of an extrauterine fetus by the vagina ; and Mathieson " relates the history of the delivery of a living ectopic child by the vagina, with recovery of the mother. Gordon ^ speaks of a curious case in a negress, six months pregnant, in which an extra- uterine fetus passed down from the posterior culdesac and occluded the uterus. It was removed through the vagina, and two days later labor-pains set in, and in two hours she was delivered of a uterine child. The placenta was left beliind and drainage established through the vagina, and the woman made complete recovery. Combined Intrauterine and Extrauterine Gestation. — Many well- authenticated cases of combined pregnancy, in which one of the products of a 629, viii., 517. b 791, 1893. o 616, v., 79. d 125, xix., 242. e 224, 1884, i., 99. f 8I7' October, 1848. COMBINED ECTOPIC AND UTERINE GESTATION. 55 conception was intrauterine and the other of extrauterine gestation, have been recorded. Clark and Ramsbotham'^, report instances of double conception, one fetus being born alive in the ordinary manner and the other located extrauterine. Chasser'' speaks of a case in which there was concurrent pregnancy in both the uterus and the Fallopian tube. Smith" cites an instance of a woman of twenty-three who became pregnant in August, 1870. In the following December she passed fetal bones from the rectum, and a month later gave birth to an intrauterine fetus of six months' growth. McGee '^ mentions the case of a woman of twenty-eight who became pregnant in July, 1872, and on October 20th and 21st passed several fetal bones by the rectum, and about four months later expelled some from the uterus. From this time she rapidly recovered her strength and health. Devergie® quotes an instance of a woman of thirty who had several children, but who died sud- Fig. 3.— A, protrusion of an arm In ectopic gestation ; B, after operation (Kimura). denly, and being pregnant was opened. In the right iliac fossa was found a male child weighing 5 pounds and 5 ounces, 8 J inches long, and of about five months' growth. The uterus also contained a male fetus of about three months' gestation. Figure 4 shows combined intrauterine and extra- uterine gestation. Hodgen ^ speaks of a woman of twenty-seven, who was regular until November, 1872 ; early in January, 1873, she had an attack of pain with peritonitis, shortly after which what was apparently an extra- uterine pregnancy gradually diminished. On August 17, 1873, after a labor of eight hours, she gave birth to a healthy fetus. The hand in the uterus detected a tumor to the left, which was reduced to about one-fourth the former size. In April, 1874, the woman still suffered pain and tenderness » 548, 1856, 591. d 681, March, 1875. b 463, Aout., 1812, 415. e M6decine L6gale, i., 508. c 481, February, 1873. f 703, August, 1874. 56 PRENATAL ANOMALIES. in the tumor. Hodgen believed this to have been originally a tubal preg- nancy, which burst, causing much heniorrhage and the death of the fetus, together with a limited peritonitis. Beach"- has seen a twin compound pregnancy in which after connection there was a miscarriage in six weeks, and four years after delivery of an extrauterine fetus through the abdominal walls. Cooke cites an example of intrauterine and extrauterine pregnancy progressing simultaneously to full period of gestation, with resultant death. Rosset'^ reports the case of a woman of twenty-seven, who menstru- ated last in November, 1878, and on August 5, 1879, was delivered of a well-developed dead female child weighing seven pounds. The uterine contractions were feeble, and the attached placenta was removed only with difficulty; there was considerable hemorrhage. The hemorrhage continued to occur at intervals of two weeks, and an extrauterine tumor re- mained. Two weeks later septicemia supervened and life was despaired of. On the 15th of October a portion of a fetus of five months' growth in an ad- vanced stage of decomposition protruded from the vulva. After the escape of this putrid mass her health returned, and in four months she was again robust and healthy. Whinery " speaks of a young woman who at the time of her second child-birth observed a tumor in the ab- domen on her right side and felt motion in it. In about a month she was seized with severe pain which continued a week and then ceased. Health soon improved, and the woman afterward gave birth to a third child ; subsequently she noticed that the tumor had enlarged since the first birth, and she had a recur- rence of pain and a slight hemorrhage every three weeks, and distinctly felt motion in the tumor. This continued for eighteen months, when, after a most violent attack of pain, all movement ceased, and, as she expressed it, she knew the moment the child died. The tumor lost its natural consistence and felt flabby and dead. An incision was made through the linea alba, and the knife came in contact with a hard, gritty substance, three or four lines thick. The escape of several quarts of dark brown fluid followed the incision, and the operatioij had to be discontinued on account of the ensuing syncope. About six weeks afterward a bone presented at the orifice, which the woman extracted, and this was soon followed by a mass of bones, hair, and putrid matter. The discharge was small, and gradually grew less in quantity and offensiveness, a 459, 1871. b 133, April, 1878. « 134, 1846. Fig, 4. — Combined intrauterine and extrauterine gestation (Brit. Med. Jour., May 12, 1894). DELIVERY OF A VIABLE ECTOPIC FETUS. 57 soon ceasing altogether, and the wound closed. By December health was good and the menses had returned. Ahlfeld, Ambrosioni, Galabin, Packard, Thiernesse, Maxson, de Belami- zaran, Dibot, and Chabert are among others recording the phenomenon of coexisting extrauterine and intrauterine pregnancy. Argles* mentions simultaneous extrauterine fetation and superfetation. Sanger'' mentions a triple ectopic gestation, in which there was twin pregnancy in the wall of the uterus and a third ovum at the fimbriated end of the right tube. Careful examination showed this to be a case of intramural twin pregnancy at the point of entrance of the tube and the uterus, while at the abdominal end of the same tube there was another ovum, — the whole being an example of triple unilateral ectopic gestation. The instances of delivery of an extrauterine fetus, with viability of the child, from the abdomen of the mother would attract attention from their rarity alone, but when coupled with associations of additional interest they surely deserve a place in a work of this nature. Osiander ^'^ speaks of an abdominal fetus being taken out alive, and there is a similar case on record in the early part of this century. <= The London Medical and Physical Journal, in one of its early numbers, contained an account of an abdominal fetus penetrating the walls of the bladder and being extracted from the walls of the hypogastrium ; but Sennertus gives a case which far eclipses this, both mother and fetus surviving. He says that in this case the woman, while pregnant, received a blow on the lower part of her body, in consequence of which a small tumor appeared shortly after the accident. It so happened in this case that the peritoneum was extremely dilatable, and the uterus, with the child inside, made its way into the peritoneal sac. In his presence an incision was made and the fetus taken out alive. Jessop'^ gives an ex- ample of extrauterine gestation in a woman of twenty-six, who had pre- viously had normal delivery. In this case an incision was made and a fetus of about eight months' growth was found lying loose in the abdominal cavity in the midst of the intestines. Both the mother and child were saved. This is a very rare result. Campbell, in his celebrated monograph, in a total of 61 operations had only seen recorded the accounts of two children saved, and one of these was too marvelous to believe. Lawson Tait reports a case in which he saved the child, but lost the mother on the fourth day. Parvin describes a case in which death occurred on the third day. Browne" quotes Parry as saying that there is one twin pregnancy in 23 extrauterine concep- tions. He gives 24 cases of twin conception, one of which was uterine, the other extrauterine, and says that of 7 in the third month, with no opera- tion, the mother died in 5. Of 6 cases of from four and a half to seven months' duration, 2 lived, and in 1 case at the fifth month there was an » 476, 1871, ii., 394. "^ 261, 1893. " 559, 1809, 414. d 778, xviii., 261; and 610, December, 1876. « 764, 1882, vi., 444-462. 58 PRENATAL ANOMALIES. intrauterine fetus delivered which lived. Of 11 such cases at nine months, 6 mothers lived and 6 intrauterine fetuses lived. In 6 of these cases no operation was performed. In one case the mother died, but both the uterine and the extrauterine conceptions lived. In another the mother and intra- uterine fetus died, and the extrauterine fetus lived. Wilson " gives an instance of a woman delivered of a healthy female child at eight months which lived. The after-birth came away without assistance, but the woman still pre- sented every appearance of having another child within her, although ex- amination by the vagina revealed none. Wilson called Chatard in consulta- tion, and from the fetal heart-sounds and other symptoms they decided that there was another pregnancy wholly extrauterine. They allowed the case to go twenty-three days, until pains similar to those of labor occurred, and then decided on celiotomy. The operation was almost bloodless, and a living child weighing eight pounds was extracted. Unfortunately, the mother succumbed after ninety hours, and in a month the intrauterine child died from inanition, but the child of extrauterine gestation thrived. Sales ^ gives the case of a negress of twenty-two, who said that she had been " tricked by a negro," and had a large snake in the abdomen, and could dis- tinctly feel its movements. She stoutly denied any intercourse. It was decided to open the abdominal cyst ; the incision was followed by a gush of blood and a placenta came into view, which was extracted with a living child. To the astonishment of the operators the uterus was distended, and it was decided to open it, when another living child was seen and extracted. The cyst and the uterus were cleansed of all clots and the wound closed. The mother died of septicemia, but the children both lived and were doing well six weeks after the operation. A curious case was seen in 1814'= of a woman who at her fifth gestation suffered abdominal uneasiness at the third month, and this became intolerable at the ninth month. The head of the fetus could be felt through the abdomen ; an incision was made through the parietes ; a fully developed female child was delivered, but, unfortunately, the mother died of septic infection. The British Medical Journal quotes : " Pinard (Bull, de I'Acad. de M6d., August 6, 1895) records the following, which he describes as an ideal case. The patient was aged thirty-six, had had no illness, and had been regular from the age of fourteen till July, 1894. During August of that year she had nausea and vomiting ; on the 22d and 23d she lost a fluid, which was just pink. The symptoms continued during September, on the 22d and 23d of which month there was a similar loss. In October she was kept in bed for two days by abdominal pain, which reappeared in November, and was then associated with pain in micturition and defecation. From that time till February 26, 1895, when she came under Pinard's care, she was attended by several doctors, each of whom adopted a different a 125, 1880, xiil., 821-836. b 593, October, 1870. e 460, xv., 51. IDEAL CASE OF ECTOPIC GESTATION. 59 diagnosis and treatment. One of them, thinking she had a fibroid, made her take in all about an ounce of savin powder, which did not, however, pro- duce any ill effect. When admitted she looked ill and pinched. The, left thigh and leg were painful and edematous. The abdomen looked like that of the sixth month of pregnancy. The abdominal wall was tense, smooth, and without linese albicantes. Palpation revealed a cystic immobile tumor, extending 2 inches above the umbilicus and apparently fixed by "deep adhesions. The fetal parts could only be made out with difficulty by deep palpation, but the heart-sounds were easily heard to the right of and below the umbilicus. By the right side of this tumor one could feel a small one, the size of a Tangerine orange, which hardened and softened under examina- tion. When contracted the groove between it and the large tumor became evident. Vaginal examination showed that the cervix, which was slightly deflected forward and to the right and softened, as in uterine gestation, was continuous with the smaller tumor. Cephalic ballottement was obtained in the large tumor. No sound was passed into the uterus for fear of setting up reflex action ; the diagnosis of extrauterine gestation at about six and a half months with a living child was established without requiring to be clinched by proving the uterus empty. The patient was kept absolutely at rest in bed and the edema of the left leg cured by position. On April 30th the fundus of the tumor was 35 cm. above the symphysis and the uterus 11 J cm. ; the cervix was soft as that of a primipara at term. Operation, May 2d : Uterus found empty, cavity 14J cm. long. Median incision in abdominal wall ; cyst walls exposed ; seen to be very slight and filled with enormous vessels, some greater than the little finger. On seizing the wall one of these vessels burst, and the hemorrhage was only rendered greater on attempting to secure it, so great was the friability of the walls. The cyst was therefore rapidly opened and the child extracted by the foot. Hemorrhage was re- strained first by pressure of the hands, then by pressure-forceps and ligatures. The walls of the cyst were sewn to the margins of the abdominal wound, the edge of the placenta being included in the suture. A wound was thus formed 10 cm. in diameter, with the placenta for its base ; it was filled with iodo- form and salicylic gauze. The operation lasted an hour, and the child, a boy weighing 5i pounds, after a brief period of respiratory dilficulties, was perfectly vigorous. There was at first a slight facial asymmetry and a depression on the left upper jaw caused by the point of the left shoulder, against which it had been pressed in the cyst ; these soon disappeared, and on the nineteenth day the boy weighed 12 pounds. The maternal wound was not dressed till May 13th, when it was washed with biniodid, 1 : 4000. The placenta came away piecemeal between May 25th and June 2d. The wound healed up, and the patient got up on the^ forty-third day, having suckled her infant from the first day after its birth." 60 PRENATAL ANOMALIES. 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Of these, 18 died within a week after birth ; 5 within a month ; 1 died at six months of bronchopneumonia ; 1 at seven months of diarrhea ; 2 at eleven months, 1 from croup ; 1 at eighteen months from cholera infantum — making a total of 26 deaths and leaving 14 children to be ac- counted for. Of these, 5 were reported as living and well after operation, with no subsequent report ; 1 was strong and healthy after three weeks, but there has been no report since ; 1 was well at six months, then was lost sight of; 1 was well at the last report ; 2 live and are well at one year ; 2 are living and well at two years ; 1 (Beisone's case) is well at seven years ; and 1 (Tait's case) is well at fourteen and one-half years. The list given on pages 60 and 61 has been quoted by Hirst and Borland.'' It contains data relative to 17 cases in which abdominal section has been successfully performed for advanced ectopic gestation with living children. Long Retention of Extrauterine Pregnancy. — The time of the reten- tion of an extrauterine gestation is sometimes remarkable, and it is no un- common occurrence for several pregnancies to successfully ensue during such retention. The Ephemerides contains examples of extrauterine pregnancy remaining in the abdomen forty-six years ; " Hannseus ^ mentioned an in- stance remaining ten years, the mother being pregnant in the meantime ; Primperosius speaks of a similar instance ; de Blegny,® one of twenty-five years in the abdomen ; Birch, a case of eighteen years in the abdomen, the woman bearing in the meantime ; Bayle,^ one of twenty-six years, and the Ephemerides, another. In a woman of forty-six,s the labor pains inter- vened without expulsion of the fetus. Impregnation ensued twice after- ward, each followed by the birth of a living child. The woman lived to be ninety-four, and was persuaded that the fetus was still in the abdomen, and directed a postmortem examination to be made after her decease, which was done, and a large cyst containing an ossified fetus was discovered in the left side of the cavity. In 1716 "^ a woman of Joigny when thirty years old, having been married four years, became pregnant, and three months later felt movements and found milk in her breasts. At the ninth month she had labor-pains, but the fetus failed to present ; the pains ceased, but recurred in a month, still with a negative result. She fell into a most sickly condition and remained so for eighteen months, Avhen the pains returned again, but soon ceased. Menstruation ceased and the milk in her breasts remained for thirty years. She died at sixty-one of peripneumonia, and on postmortem examination a tumor was found occupying part of the hypogas- tric and umbilical regions. It weighed eight pounds and consisted of a male =■ 538, Nov. 24, 1894. b 843, 372. c 104, cent, x., obs. 48. a Prod. Act., Havn., 107. e 215, Aun. I., obs. 9, Jan.; obs. 8, Feb. t 629, London, xii. g 418, 1721, 422. h 302, iv.,233. LONG RETENTION OF UTERINE PREGNANCY. 63 fetus of full term with six teeth ; it had no odor and its sac contained no liquid. The bones seemed better developed than ordinarily ; the skin was thick, callous, and yellowish. The chorion, amnion, and placenta were ossi- fied and the cord dried up. "Walther " mentions the case of an infant which remained almost petrified in the belly of its mother for twenty-three years. No trace of the placenta, cord, or enveloping membrane could be found. Cordier ^ publishes a paper on ectopic gestation, with particular reference to tubal pregnancy, and mentions that when there is rupture between the broad ligaments hemorrhage is greatly limited by the resistance of the sur- rounding structures, death rarely resulting from the primary rupture in this location. Cordier gives an instance in which he successfully removed a full- grown child, the result of an ectopic gestation which had ruptured intraliga- mentally and had been retained nearly two years. Lospichlerus " gives an account of a mother carrying twins, extrauterine, for six years. Mounsey of Riga, physician to the army of the Czarina, sent to the Royal Society in 1748 the bones of a fetus that had been extracted from one of the fallopian tubes after a lodgment of thirteen years. Starkey Middleton ^ read the report of a case of a child which had been taken out of the abdomen, having lain there nearly sixteen years, during which time the mother had borne four children. It was argued at this time that boys were conceived on the right side and girls on the left, and in commenting on this Middleton remarks that in this case the woman had three boys and one girl after the right fallopian tube had lost its function. Chester" cites the instance of a fetus being retained fifty-two years, the mother not dying until her eightieth year. Margaret Mathew ^ carried a child weighing eight pounds in her abdomen for twenty-six years, and which after death was extracted. Aubrey s speaks of a woman aged seventy years unconsciously carrying an extrauterine fetus for many years, which was only discovered postmortem. She had ceased to menstruate at forty and had borne a child at twenty-seven. Watkins ^ speaks of a fetus being retained forty-three years ; James, others for twenty-five, thirty, forty-six, and fifty years ; Murfee,' fifty-five years; Cunningham, J forty years; Johnson,'^ forty-four years ; Joseph!,' fifteen years (in the urinary bladder) ; Craddock,™ twenty- two years, and da Costa Simoes," twenty-six years. Long Retention of Uterine Pregnancy. — Cases of long retained intra- uterine pregnancies are on record and deserve as much consideration as those that were extrauterine. Albosius speaks of a mother carrying a child in an ossified condition in the uterus for twenty-eight years." Cheselden speaks a Mem. de Berlin, 1774. •> Annals of Gynsecol. and Psediatry, Aug., 1893. c Opera, 1737, iii., 89. ^ 629, 1748, 1018. e 550, vol. v., 104. f 629, 1700, 217. e 162, March, 1842. ^ 778, viii., 106. * 774, 1886. i 810, 1855. k Med. Times and Gaz., London, 1872. 1 535, 1805. m 526, 1846. 1 278, 1886. " Observatio Lithopaedii Senonensis, 1682. 64 PRENATAL ANOMALIES. of a case in which a child was carried many years in the uterus, being con- verted into a clay-like substance, but preserving form and outline. Cald- well " mentions the case of a woman who carried an ossified fetus in her uterus for sixty years. Camerer*" describes the retention of a fetus in the uterus for forty-six years ; Stengel," one for ten years, and Storer and Buzzell, for twenty- two months. Hannseus, in 1686, issued a paper on such a case under the title, " Mater, Infantis Mortui Yivum Sepulchrum," which may be found in French translation.'' Buchner ® speaks of a fetus being retained in the uterus for six years, and Horstius*^^ relates a similar case. Schmidt's Jahrbiicher^ contain the report of a woman of forty-nine, who had borne two children. While threshing com she felt violent pain like that of labor, and after an illness suffered a constant fetid discharge from the vagina for eleven years, fetal bones being discharged with occasional pain. This poor creature worked along for eleven years, at the end of which time she was forced to bed, and died of symptoms of purulent peritonitis. At the necropsy the uterus was found adherent to the anterior wall of the abdomen and containing rem- nants of a putrid fetus with its numerous bones. There is an instance re- corded 8 of the death of a fetus occurring near term, its retention and subsequent discharge being through a spontaneous opening in the abdominal wall one or two months after. Meigs '' cites the case of a woman who dated her pregnancy from March, 1848, and which proceeded normally for nine months, but no labor super- vened at this time and the menses reappeared. In March, 1849, she passed a few fetal bones by the rectum, and in May, 1855, she died. At the necropsy the uterus was found to contain the remains of a fully developed fetus, minus the portions discharged through a fistulous connection between the uterine cavity and the rectum. In this case there had been retention of a fully developed fetus for nine years. Cox' describes the case of a woman who was pregnant seven months, and who was seized with convulsions ; the sup- posed labor-pains passed off, and after death the fetus was found in the womb, having lain there for five years. She had an early return of the menses, and these recurred regularly for four years. Dewees *'^ quotes two cases, in one of which the child was carried twenty months in the uterus ; in the other, the mother was still living two years and five months after fecundation. Another caseJ was in a woman of sixty, who had conceived at twenty-six, and whose fetus was found, partly ossified, in the uterus after death. There are many narratives of the long continuation of fetal move- ments, and during recent years, in the Southern States, there was quite a a 318, 1806, ii., 22-24. b 280, 1774, v., 338. e Eyr, Christiania, 1827, ii., 134. 447, 465. . <= 393, 133-4. 5 66 PRENATAL ANOMALIES. mentioning an instance of a fetu6-o£-five months, which lived twelve hours, weighing 2 pounds, and measuring 12 inches, and which cried vigorously. The pupillary membrane Avas entire, the testes had not descended, and the head was well covered with hair. Usher" speaks of a woman who in 1876 was delivered of 2 male children on the one hundred and thirty-ninth day ; both lived for an hour ; the first weighed 10 ounces 6 drams and meas- ured 9| inches; the other 10 ounces 7 drams, with the same length as the first. Eouth** speaks of a Mrs. F , aged thirty-eight, who had borne 9 children and had had 3 miscarriages, the last conception terminating as guch. Her husband was away, and returned October 9, 1869. She did not again see her husband until the 3d or 4th of January. The date of quickening was not observed, and the child was born June 8, 1870. Dur- ing gestation she was much frightened by a rat. The child was weak, the testes undescended, and it lived but eighteen days, dying of symptoms of atrophy. The parents were poor, of excellent character, and although, according to the evidence, this pregnancy lasted but twenty-two weeks and two days, there was absolutely no reason to suspect infidelity. Ruttel speaks of a child of five months who lived twenty-four hours ; and he saw male twins born at the sixth month weighing 3 pounds each who were alive and healthy a year after. Barker " cites the case of a female child born on the one hundred and fifty-eighth day that weighed 1 pound and was 11 inches long. It had rudimentary nails, very little hair on the head, its eyelids were closed, and the skin much shriveled ; it did not suckle properly, and did not walk until nineteen months old. Three and a half years after, the child was healthy and thriving, but weighed only 29 J pounds. At the time of birth it was wrapped up in a box and placed before the fire. Brouzet speaks of living births of from five to six months' preg- nancy, and Kopp '' speaks of a six months' child Mliich lived four days. The Ephemerides contains accounts of living premature births. Newinton describes a pregnancy of five months terminating with the birth of twins, one of whom lived twenty minutes and the other fifteen. The first was 11 J inches long, and weighed 1 pound 3 J ounces, and the other was 11 inches long, and weighed 1 pound. There is a recent instance of premature birth"* following a pregnancy of between five and a half and six months, the infant weighing 955 grams. One month after birth, through the good offices of the wet-nurse and M. Villemin, Avho attended the child and who invented a " couveuse " for the occasion, it measured 38 cm. long. Moore ^ is accredited with the trustworthy report of the case of a woman who bore a child at the end of tlie fifth month weighing li pounds and measuring 9 inches. It was first nourished by dropping liquid food into its mouth ; and at the age of fifteen months it was healthy and weighed 18 - 180, 1886, 366. b 778, xiii., 132. c 546, 1850, ii., 249, and 392. d 444, iii., 129. e 674, 1895, Jan., p. 22. t 545^ ngo ; and quoted by 548, 1880, ii., 8. SHORT PREGNANCIES. 67 pounds. Eikam" saw a case of abortion at the fifth month in which the fetus was 6 inches in length and weighed about 8 ounces. The head was sufficiently developed and the cranial bones considerably advanced in ossifi- cation. He tied the cord and placed the fetus in warm water. It drew up its feet and arms and turned its head from one side to the other, opening its mouth and trying to breathe. It continued in this wise for an hour, the action of the heart being visible ten minutes after the movements ceased. From its imperfectly developed genitals it was supposed to have been a female. Professor J. Miiller, to whom it was shown, said that it was not more than four months old, and this coincided with the mother's calculation. Villemin ^ before the Soci6t§ Obstetricale et Gyn^cologique reported the case of a two-year-old child, born in the sixth month of pregnancy. That the child had not had six months of intrauterine life he could vouch, the statement being borne out by the last menstrual period of the mother, the date of the first fetal movements, the child's weight, which was 30 J ounces, and its appearance. Budin had had this infant under observation from the beginning and corroborated Villemin's statements. He had examined infants of six or seven months that had cried and lived a few days, and had found the alveolar cavities, filled with epithelial cells, the lung sinking when placed in a vessel of water. Charpentier reported a case of premature birth in his practice, the child being not more than six and a half months and weighing 33^ ounces. So sure was he that it would not live that he placed it in a basin while he attended to the mother. After this had been done, the child being still alive, he wrapped it in cotton and was surprised next day to find it alive. It was then placed in a small, well-heated room and fed with a spoon on human milk ; on the twelfth day it could take the breast, since which time it thrived and grew. There is a case on record" of a child viable at six months and twenty days. The mother had a miscarriage at the beginning of 1877, after which menstruation became regular, appearing last from July 3 to 9, 1877. On January 28, 1878, she gave birth to a male infant, which was wrapped in wadding and kept at an artificial temperature. Being unable to suckle, it was fed first on diluted cow's milk. It was so small at birth that the father passed his ring over the foot almost to the knee. On the thirteenth day it weighed 1250 grams, and at the end of a week it was taking the breast. In December, 1879, it had 16 teeth, weighed 10 kilograms, walked with agility, could pronounce some words, and was especially intelligent. Capuron ^f^ relates an instance of a child born after a pregnancy of six and a half months and in excellent health at two years, and another living at ten years of the same age at birth. Tait ^ speaks of a living female child, born on the one hundred and seventy-ninth day, with no nails on its fingers or toes, no hair, the extremities imperfectly developed, and the skin florid and thin. It a558, B. v., H.2. b 791, Maich, 1895. c 168, Dec, 1879. d 476, April 23, 1842. 68 PRENATAL ANOMALIES. was too feeble to grasp its mother's nipple, and was fed for three weeks by milk from the breast through a quill. At forty days it weighed 3 pounds and measured 13 inches. Before the expiration of three months it died of measles. Dodd * describes a case in which the catamenia were on the 24th of June, 1838, and continued a week ; the woman bore twins on January 11, 1839, one of which survived, the other dying a few minutes after birth. She was never irregular, prompt to the hour, and this fact, coupled with the diminutive size of the children, seemed to verify the dura- tion of the pregnancy. In 1825, Baber of Buxur, India, spoke of a child born at six and a half months, who at the age of fifty days weighed 1 pound and 13 ounces and was 14 inches long. The longest circumference of the head was 10 inches and the shortest 9.1 inches. The child suckled freely and readily. In Spaeth's clinic '' there was a viable infant at six and a half months weighing 900 grams. Spaeth says that he has known a child of six months to surpass in eventual development its brothers born at full term. In some cases there seems to be a peculiarity in women which manifests itself by regular premature births. La Motte, van Swieten, and Fordere mention females who always brought forth their conceptions at the seventh month. The incubator seems destined to be the future means of preserving these premature births. Several successful cases have been noticed, and by means of an incubator Tarnier succeeded in raising infants which at the age of six months were above the average. A full description of the incu- bator may be found." The modified Auvard incubator is easily made ; the accompanying illustrations (Figs. 5, 6, and 7) explain its mechanism. Several improved incubators have been described in recent years, but the Auvard ap- pears to be the most satisfactory. The question of retardation of labor, like that of premature birth, is open to much discussion, and authorities differ as to the limit of protraction with viability. Aulus Gellius ^ says that, after a long conversation with the physicians and wise men, the Emperor Adrian decided in a case before him, that of a woman of chaste manners and irreproachable character, the child born eleven months after her husband's death was legitimate. Under the Roman law the Decemviri established that a woman may bear a viable child at the tenth month of pregnancy. Paulus Zacchias,*^" physician to Pope Innocent X., declared that birth may be retarded to the tenth month, and sometimes to a longer period. A case was decided in the Supreme Court of Friesland, a province in the northern part of the Netherlands, October, 1634, in which a child born three hundred and thirty-three days after the death of the husband was pronounced legitimate. The Parliament of Paris was gallant enough to come to the rescue of a widow and save her a 656, 1841. b 118, May 16, 1882. c 536, 1883, i., 39. d L. iii., chap. 16. LONG PREGNANCIES. 69 reputation by declaring that a child born after a fourteen months' gestation was legitimate., Bartholinus speaks of an unmarried woman of Leipzig who was delivered after a pregnancy of sixteen months. The civil code of France provides that three hundred days shall constitute the longest period Fig. 5. — Modified Auvard incubator ; r, glass plate of the movable lid, 6 ; H^ ventilating tube containing small rotary fan ; K, ventilating slide ; itf", hot-water cans ; 0, slide closing hot-air chamber. of the legitimacy of an infant ; the Scottish law, three hundred days ; and the Prussian law, three hundred and one days. There are numerous cases recorded by the older writers. Amman '^* has one of twelve months' duration ; Enguin,^ one of twelve months' ; '-■ -% ^Si^ . Fig. 7. — Hot-water can for modified Auvard incubator. Fig. 6.— Interior view of a modified Auvard incubator. Buchner, ^ a case of twelve months' ; Benedictus,"^ one of fourteen months' ; de Blegny, <= one of nineteen months' ; Marteau,'^ Osiander, and others of forty-two and forty-four weeks' ; and Stark's Archives,^ one of forty-five a 462, T. Ixi., 163. d 462, T. XXV. bMiscel., 1727, 370. c 215, Ann. i., 23. e 162, L. ii., 3 St. n. 2. 70 PRENATAL ANOMALIES. weeks', living, and also another case of forty-four weeks'. An incredible case is recorded" of an infant which lived after a three years' gestation. Instances of twelve months' duration are also recorded.*"'- "^ *• Jonston "' quotes Paschal in relating an instance of birth after pregnancy of twenty- three months ; Aventium, one after two years ; and Mercurialis, a birth after a four years' gestation — which is, of course, beyond belief. Thormeau writes from Tours, 1580, of a case of gestation prolonged to the twenty-third month, and Santorini, at Venice, in 1721, describes a similar case, the child reaching adult life. Elvert<= records a case of late pregnancy, and Henschel*^^ one of forty-six weeks, but the fetus was dead. Schneider"^ cites an instance of three hundred and eight days' duration. Campbell says ^ that Simpson had cases of three hundred and nineteen, three hundred and thirty-two, and three hundred and thirty-six days'; Meigs had one of four hundred and twenty. James Reid, in a table of 500 mature births, gives 14 as being from three hundred and two to three hundred and fifteen days'. Not so long ago a jury rendered a verdict of guilty of fornication and bastardy when it was alleged that the child was born three hundred and seventeen days after intercourse. Taylor relates a case of pregnancy in which the wife of a laborer went to America three hundred and twenty-two days before the birth. JafFe ' describes an instance of the prolongation of pregnancy for three hundred and sixty-five days, in which the developments and measurements corresponded to the length of protraction. Bryan s speaks of a woman of twenty-five who became pregnant on February 10, 1876, and on June 17th felt motion. On July 28th she was threatened with miscar- riage, and by his advice the woman weaned the child at the breast. She expected to be confined the middle of November, 1876, but the expected event did not occur until April 26, 1877, nine months after the quickening and four hundred and forty days from the time of conception. The boy was active and weighed nine pounds. The author cites Meigs' case, and also one of Atlee's, at three hundred and fifty-six days. Talcott,'' Superintendent of the State Homeopathic Asylum for the Insane, explained the pregnancy of an inmate who had been confined for four years in this institution as one of protracted labor. He said that many such cases have been reported, and that something less than two years before he had charge of a case in which the child was born. He made the report to the New York Senate Commission on Asylums for the Insane as one of three years' protraction. Tidd ' speaks of a woman who was delivered of a male child at term, and again in ten months delivered of a well-developed male child weighing 7J pounds ; he relates the history of another case, in Clifton, W. Va., of a woman expecting confinement on June 1st going over ■■>■ 418, 1753, 206. t> 462, T. xxvii., 48. c 137^ 3. iii., 257. dAnnalen derHeilk., 1811, Oct., 87. e 512, 188, viii., 145, 149. f 261, 1890. g 703, 1877, n. s. xiv., 345. ^ 224, 1883, ii., 665. i 299, xi., 798. LONG PREGNANCIES. 71 to September 15th, the fetus being in the uterus over twelve months, and nine months after quickening ^vas felt. Two extraordinary cases are mentioned,'' one in a woman of thirty-five, who expected to be confined April 24, 1883. In May she had a few labor- pains that passed away, and during the next six months she remained about as large as usual, and was several times thought to be in the early stages of labor. In September the os dilated until the first and second fingers could be passed directly to the head. This condition lasted about a month, but passed away. At times during the last nine months of pregnancy she was almost unable to endure the movements of the child. Finally, on the morn- ing of November 6th, after a pregnancy of four hundred and seventy-six days, she was delivered of a male child weighing 13 pounds. Both the mother and child did well despite the use of chloroform and forceps. The other case was one lasting sixteen months and twenty days. In a rather loose argument, Carey reckons a case of three hundred and fifty days. Menzie ^ gives an instance in a woman aged twenty-eight, the mother of one child, in whom a gestation was prolonged to the seventeenth month. The pregnancy was complicated by carcinoma of the uterus. Bal- lard" describes the case of a girl of sixteen years and six months, whose pregnancy, the result of a single intercourse, lasted three hundred and sixty days. Her labor was short and easy for a primipara, and the child was of the average size. Mackenzie'^ cites the instance of a woman aged thirty- two, a primipara, who had been married ten years and who always had been regular in menstruation. The menses ceased on April 28, 1888, and she felt the child for the first time in September. She had false pains in January, 1889, and labor did not begin until March 8th, lasting sixty-six hours. If all these statements are correct, the probable duration of this pregnancy was eleven months and ten days. Lundie® relates an example of protracted gestation of eleven months, in which an anencephalous fetus was born ; and Martin of Birmingham de- scribes a similar case of ten and a half months' duration. Raux-Tripier ^ has seen protraction to the thirteenth month. Enguin^ reports an observa- tion of an accouchement of twins after a pregnancy that had been prolonged for eleven months. Resnikoff'' mentions a pregnancy of eleven months' duration in an anemic secundipara. The case had been under his observa- tion from the beginning of pregnancy ; the patient would not submit to artificial termination at term, which he advised. After a painful labor of twenty-four hours a macerated and decomposed child was born, together with a closely-adherent placenta. Tarnier^ reports an instance of partus serotinus in which the product of conception was carried in the uterus forty »■ 790, Dec. 27, 1884. b 331, 1853-4. c 224, 1884, i., 56. d 536, 1889, ii., 522. e 759, April, 1895. f 233, 1847. g 460, 1784, 163. ^ 261, No. 24, 1894. i Jour, des Sages-Femmes, May 1, 1894. 72 PRENATAL ANOMALIES. days after term. The fetus was macerated but not putrid, and the placenta had undergone fatty degeneration. At a recent meeting of the Chicago Gynecological Society, Dr. F. A. Stahl reported the case of a German-Bohe- mian woman in which the fifth pregnancy terminated three hundred and two days after the last menstruation. Twenty days before there had occurred pains similar to those of labor, but they gradually ceased. The sacral prom- ontory was exaggerated, and the anteroposterior pelvic diameter of the inlet in consequence diminished. The fetus was large and occupied the first posi- tion. Version was with difficulty effected and the passage of the after- coming head through the superior strait required expression and traction, during which the child died. The mother suffered a deep laceration of the perineum involving an inch of the wall of the rectum. Among others reporting instances of protracted pregnancy are Collins, " eleven months ; Desbrest, ^ eighteen months ; Henderson, " fifteen months ; Jefferies,* three hundred and fifty-eight days, and De la Vergne^ gives the history of a woman who carried an infant in her womb for twenty-nine months ; this case may possibly belong under the head of fetus long retained in the uterus. Unconscious Pregnancy. — There are numerous instances of women who have had experience in pregnancy unconsciously going almost to the moment of delivery, yet experiencing none of the usual accompanying symptoms of this condition. Crowell ' speaks of a woman of good social position who had been married seven years, and who had made extensive preparations for a long journey, when she was seized with a " bilious colic," and, to her dismay and surprise, a child was born before the arrival of the doctor summoned on account of her sudden colic and her inability to retain her water. A peculiar feature of this case was the fact that mental disturbance set in immediately afterward, and the mother became morbid and had to be removed to an asy- lum, but recovered in a few months. Tanner s saw a woman of forty-two who had been suffering with abdominal pains. She had been mai'ried three years and had never been pregnant. Her catamenia were very scant, but this Avas attributed to her change of life. She had conceived, had gone to the full term of gestation, and was in labor ten hours without any suspicion of preg- nancy. She was successfully delivered of a girl, M-hich occasioned much rejoicing in the household. Tasker of Kendall's Mills, Me., reports the case of a young married woman calling him for bilious colic. He found the stomach slightly distended and questioned her about the possibility of pregnancy. Both she and her hus- band informed him that such could not be the case, as her courses had been regular and her waist not enlarged, as she had worn a certain corset all the time. There were no signs of quickening, no change in the breasts, and, a 318, 1826, XXV., 245. b 458, 1769. c 125, 1879, xii., 393. a Trans. M. Soc. Penna., Phila., 1879. e 458, 176I. f 218, 1878. g 778, 1864. PSEUD OCYESIS. 73 in fact, none of the usual signs of pregnancy present. He gave her an opiate, and to her surprise, in about six hours she was the mother of a boy weigh- ing five pounds. Both the mother and child made a good recovery. Duke " cites the instance of a woman who supposed that she was not pregnant up to the night of her miscarriage. She had menstruated and was suckling a child sixteen months old. During the night she was attacked with pains resem- bling those of labor and a fetus slipped into the vagina without any hemor- rhage ; the placenta came away directly afterward. In this peculiar case the woman was menstruating regularly, suckling a child, and at the same time was unconsciously pregnant. Isham ^ speaks of a case of unconscious pregnancy in which extremely small twins were delivered at the eighth month. Fox " cites an instance of a woman who had borne eight children, and yet unconscious of pregnancy. Merriman ^ speaks of a woman forty years of age who had not borne a child for nine years, but who suddenly gave birth to a stout, healthy boy without being cognizant of pregnancy. Dayral* tells of a woman who carried a child all through pregnancy, unconscious of her condition, and who was greatly surprised at its birth. Among the French observers speak- ing of pregnancy remaining unrecognized by the mother until the period of accouchement, Lozes and Rhades record peculiar cases; and Mouron- vals relates an instance in which a woman who had borne three children completely ignored the presence of pregnancy until the pains of labor were felt. Fleishman'' and Miinzenthaler also record examples of unconscious pregnancy. Pseudocyesls. — On the other hand, instances of pregnancy with imaginary symptoms and preparations for birth are sometimes noticed, and many cases are on record. In fact, nearly every text-book on obstetrics gives some space to the subject of pseudocyesls. Suppression of the menses, enlargement of the abdomen, engorgement of the breasts, together with the symptoms produced by the imagination, such as nausea, spasmodic contraction of the abdomen, etc., are for the most part the origin of the cases of pseudo- cyesls. Of course, many of the cases are not examples of true pseudocyesls, with its interesting phenomena, but instances of malingering for mercenary or other purposes, and some are calculated to deceive the most expert obstetricians by their tricks. Weir Mitchell' delineates an interesting case of pseudocyesls as follows : " A woman, young, or else, it may be, at or past the climacteric, eagerly desires a child or is horribly afraid of becoming pregnant. The menses become slight in amount, irregular, and at last cease or not. Meanwhile the abdomen and breasts enlarge, owing to a rapid taking on of fat, and this is far less visible elsewhere. There comes with this excess of fat the most profound conviction of the fact of pregnancy. By »■ 312, 1846. b 124, 1874. c 649, 1888. d 218, 1828. e 146, 1865. f 146, 1865. g 454, 1825, xxiii., 281. 1^834, 1839. i 533, 1895, 393. 74 PRENATAL ANOMALIES. and by the child is felt, the physician takes it for granted, and this goes on until the great diagnostician, Time, corrects the delusion. Then the fat disappears with remarkable speed, and the reign of this singular simulation is at an end." In the same article. Dr. Mitchell cites the two following cases under his personal observation : " I was consulted by a lady in regard to a woman of thirty years of age, a nurse in whom she was interested. This person had been married some three years to a very old man possessed of a considerable estate. He died, leaving his wife her legal share and the rest to distant cousins, unless the wife had a child. For two months before he died the woman, who was very anemic, ceased to menstruate. She became sure that she was pregnant, and thereupon took on flesh at a rate and in a way which seemed to justify her belief. Her breasts and abdomen were the chief seats of this overgrowth. The menses did not return, her pallor in- creased ; the child was felt, and every preparation made for delivery. At the eighth month a physician made an examination and assured her of the absence of pregnancy. A second medical opinion confirmed the first, and the tenth month found her of immense size and still positive as to her con- dition. At the twelfth month her menstrual flow returned, and she became sure it was the early sign of labor. When it passed over she became con- vinced of her error, and at once dropped weight at the rate of half a pound a day despite every eifort to limit the rate of this remarkable loss. At the end of two months she had parted with fifty pounds and was, on the whole, less anemic. At this stage I was consulted by letter, as the woman had be- come exceedingly hysteric. This briefly stated case, which occurred many years ago, is a fair illustration of my thesis. " Another instance I saw when in general practice. A lady who had several children and suflfered much in her pregnancies passed five years without becoming impregnated. Then she missed a period, and had, as usual, vomiting. She made some wild efforts to end her supposed pregnancy, and failing, acquiesced in her fate. The menses returned at the ninth month and were presumed to mean labor. Meanwhile she vomited, up to the eighth month, and ate little. Nevertheless, she took on fat so as to make the abdo- men and breasts immense and to excite unusual attention. No physician examined her until the supposed labor began, when, of course, the truth came out. She was pleased not to have another child, and in her case as in all the others known to me, the fat lessened as soon as the mind was satisfied as to the non-existence of pregnancy. As I now recall the facts, this woman was not more than two months in getting rid of the excess of adipose tissue. Dr. Hirst tells me he has met with cases of women taking on fat with cessation of the menses, and in which there was also a steady belief in the existence of pregnancy. He has not so followed up these cases as to know if in them the fat fell away with speed when once the patient was as- sured that no child existed within her." Plate 2. Conditions simulating pregnancy (pseudocyesis) (Hirst) : 1. Pendulous belly of rachitis. 2. Normal distention in a primipara at term. 3. Normal distention, seventh month. 4. Pen- dulous belly of rachitis (Cesarean section). 5. Twins. 6. Pendulous belly of rachitis ; fat and tympany. 7. Hydranmios. PSEUD OCYESIS. 77 Hirst,^ in an article on the difficulties in the diagnosis of pregnancy, gives several excellent photographs showing the close resemblance between several pathologic conditions and the normal distention of the abdomen in preg- nancy (Plate 2). A woman *> who had several children fell sick with a chest-affection, followed by an edema. For fifteen months she was con- fined to her bed, and had never had connection with her husband during that time. Her menses ceased ; her mammfe became engorged and discharged a serous lactescent fluid ; her belly enlarged, and both she and her phy- sician felt fetal movements in her abdomen. As in her previous pregnancies, she suffered nausea. Naturally, a suspicion as to her virtue came into her husband's mind, but when he considered that she had never left her bed for fifteen months he thought the pregnancy impossible. Still the wife insisted that she was pregnant and was confirmed in the belief by a midwife. The belly continued to increase, and about eleven months after the cessation of the menses she had the pains of labor. Three doctors and an accoucheur were present, and when they claimed that the fetal head presented the hus- band gave up in despair ; but the supposed fetus was born shortly after, and proved to be only a mass of hydatids, with not the sign of a true pregnancy. Girard of Lyons" speaks of a female who had been pregnant several times, but again experienced the signs of pregnancy. Her mammse were engorged with a lactescent fluid, and she felt belly-movements like those of a child ; but during all this time she had regular menstruation. Her abdo- men progressively increased in size, and between the tenth and eleventh months she suffered what she thought to be labor-pains. These false pains ceased upon taking a bath, and with the disappearance of the other signs was dissipated the fallacious idea of pregnancy. There is mentioned ^ an instance of medicolegal interest of a young girl who showed all the signs of pregnancy and confessed to her parents that she had had commerce with a man. The parents immediately prosecuted the seducer by strenuous legal methods, but when her ninth month came, and after the use of six baths, all the signs of pregnancy vanished. Harvey cites sev- eral instances of pseudocyesis, and says we must not rashly determine of the the inordinate birth before the seventh or after the eleventh month. In 1646 a woman, after having laughed heartily at the jests of an ill-bred, covetous clown, was seized with various movements and motions in her belly like those of a child, and these continued for over a month, when the courses appeared again and the movements ceased. The woman was certain that she was pregnant. The most noteworthy historic case of pseudocyesis is that of Queen Mary of England, or " Bloody Mary," as she was called. To insure the succession of a Catholic heir, she was most desirous of having a son by her consort, Philip, and she constantly prayed and wished for pregnancy. Finally her a 792, May, 1895. b 302, iv., 235. c Ibid. ^ ibid. 78 PRENATAL ANOMALIES. menses stopped ; the breasts began to enlarge and became discolored around the nipples. She had morning-sickness of a violent nature and her abdomen enlarged. On consultation with the ladies of her court, her opinion of preg- nancy was strongly confirmed. Her favorite amusement then was to make baby-clothes and count on her fingers the months of pregnancy. AYlien the end of the ninth month approached, the people were awakened one night by the joyous peals of the bells of London announcing the new heir. An am- bassador had been sent to tell the Pope that Mary could feel the new life within her, and the people rushed to St. Paul's Cathedral to listen to the venerable Archbishop of Canterbury describe the baby-prince and give thanks for his deliverance. The spurious labor pains passed away, and after being assured that no real pregnancy existed in her case, Mary went into violent hysterics, and Philip, disgusted with the Avhole affair, deserted her ; then commenced the persecution of the Protestants, which blighted the reign. Putnam ^ cites the case of a healthy brunet, aged forty, the mother of three children. She had abrupt vertical abdominal movements, so strong as to cause her to plunge and sway from side to side. Her breasts were enlarged, the areolae dark, and the uterus contained an elastic tumor, heavy and roll- ing under the hand. Her abdomen progressively enlarged to the regular size of matured gestation ; but the extrauterine pregnancy, which was sup- posed to have existed, was not seen at the autopsy, nothing more than an enlarged liver being found. The movement was due to spasmodic move- ments of the abdominal muscles, the causes being unknown. ^Madden ^ gives the history of a primipara of twenty-eight, married one year, to whom he was called. On entering the room he was greeted by the midwife, who said she expected the child about 8 p. m. The woman was lying in the usual obstetric position, on the left side, groaning, crying loudly, and pulling hard at a strap fastened to the bed-post. She had a partial cessation of menses, and had complained of tumultuous movements of the child and overfloM* of milk from the breasts. Examination showed the cervix low down, the os small and circular, and no signs of pregnancy in the uterus. The abdomen was distended with tympanites and the rectum mucli dilated with accumulated feces. Dr. Madden left her, telling her that she was not pregnant, and when she reappeared at his office in a few days, he reassui'ed her of the nonexist- ence of pregnancy ; she became very indignant, triumphantly squeezed lac- tescent fluid from her breasts, and, insisting that she could feel fetal move- ments, left to seek a more sympathetic accoucheur. Underbill," in the words of Hamilton, describes a woman as "having acquired the most accurate description of the breeding symptoms, and with wonderful facility imagined that she had felt every one of them." He found the woman on a bed com- plaining of great labor-pains, biting a handkerchief, and pulling on a cloth a 218, 1870. b 310, 1872, liii., 255. c 318, 1873-4, xix., ii., 844. SYMPATHETIC MALE NAUSEA OF PREGNANCY. 79 attached to her bed. The finger on the abdomen or vulva elicited symptoms of great sensitiveness. He told her she was not pregnant, and the next day she was sitting up, though the discharge continued, but the simulated throes of labor, which she had so graphically pictured, had ceased. Haultain" gives three examples of pseudocyesis, the first with no apparent cause, the second due to carcinoma of the uterus, while in the third there was a small fibroid in the anterior wall of the uterus. Some cases are of purely nervous origin, associated with a purely muscular distention of the abdomen. Clay reported a case due to ascites. Cases of pseudocyesis in women con- victed of murder are not uncommon, though most of them are imposters hoping for an extra lease of life. Croon ^ speaks of a child seven years old on whom he j^erformed ovari- otomy for a round-celled sarcoma. She had been well up to May, but since then she had several times been raped by a boy, in consequence of which she had constant uterine hemorrhage. Shortly after the first coitus her abdomen began to enlarge, the breasts to develop, and the areolae to darken. In seven months the abdomen presented the signs of pregnancy, but the cervix was soft and patulous ; the sound entered three inches and was followed by some hemor- rhage. The child was well developed, the mons Avas covered with hair, and all the associate symptoms tended to increase the deception. Sympathetic Male Nausea of Pregnancy. ^Associated with preg- nancy there are often present morning-nausea and 'vomiting as prominent and reliable symptoms. Vomiting is often so excessive as to be pro- vocative of most serious issue and even warranting the induction of abortion. This fact is well known and has been thoroughly discussed, but with it is associated an interesting point, the occasional association of the same symptoms sympathetically in the husband. The belief has long been a superstition in parts of Great Britain, descending to America, and even exists at the present day. Sir Francis Bacon has written on this subject, the substance of his argument being that certain loving husbands so sympathize with their pregnant wives that they suffer morning-sickness in their own person. No less an authority than S. Weir Mitchell called attention to the interesting subject of sympathetic vomiting in the husband in his lectures on nervous maladies some years ago. He also quotes the following case associated with pseudocyesis : — " A woman had given birth to two female children. Some years passed, and her desire for a boy was ungratified. Then she missed her flow once, and had thrice after this, as always took place with her when pregnant, a very small but regular loss. At the second month morning-vomiting came on as usual with her. Meanwhile she became verj' fat, and as the growth was largely, in fact excessively, abdominal, she became easily sure of her condi- tion. She was not my patient, but her husband consulted me as to his own " 124, April, 1891. b 318, Feb., 1893. 80 PRENATAL ANOMALIES. morning-sickness, which came on with the first occurrence of this sign in his wife, as had been the case twice before in her former pregnancies. I advised him to leave home, and this proved effectual. I learned later that the woman continued to gain flesh and be sick every morning until the seventh month. Then menstruation returned, an examination was made, and when sure that there was no possibility of her being pregnant she began to lose flesh, and within a few months regained her usual size." Hamill " reports an instance of morning-sickness in a husband two weeks after the appearance of menstruation in the wife for the last time. He had daily attacks, and it was not until the failure of the next menses that the woman had any other sign of pregnancy than , her husband's nausea. His nausea continued for two months, and was the same as that which he had suffered during his wife's former pregnancies, although not until both he and his wife became aware of the existence of pregnancy. The Lancet *• describes a case in which the husband's nausea and vomiting, as well as that of the wife, began and ended simultaneously. Judkins ° cites an instance of a man who was sick in the morning while his wife was carrying a child. This occurred during every pregnancy, and the man related that his own father was simi- larly affected while his mother was in the early months of pregnancy with him, showing an hereditary predisposition. The perverted appetites and peculiar longings of pregnant women furnish curious matter for discussion. From the earliest times there are many such records. Borellus cites an instance, and there are many others, of pregnant women eating excrement with apparent relish. Tulpius, Sennert, Langius, van Swieten, a Castro, and several others report depraved appe- tites. Several writers have seen avidity for human flesh in such females. Fournier ^ knew a woman with an appetite for the blood of her husband. She gently cut him while he lay asleep by her side and sucked blood from the wounds — a modern " Succubus." Par6 ® mentions the perverted appetites of pregnant women, and says that they have been known to eat plaster, ashes, dirt, charcoal, flour, salt, spices, to drink pure vinegar, and to indulge in all forms of debauchery. Plot^^' gives the case of a woman who would gnaw and eat all the linen off her bed. Hufeland's Journal ^^^ records the history of a case of a woman of thirty-two, who had been married ten years, who acquired a strong taste for charcoal, and was ravenous for it. It seemed to cheer her and to cure a supposed dyspepsia. She devoured enormous quantities, preferring hard-wood charcoal. Bruyesinus ^^^ speaks of a woman who had a most perverted appetite for her own milk, and constantly drained her breasts ; Krafft-Ebing cites a similar case. Another case ^^^ is that of a pregnant woman who had a desire for hot and pungent articles of food, and who in a short time devoured a pound of pepper. Scheidemantel cites a a 780, 1888 ; and 596, 1888, Ivii., 635. b 476, 1878, 66. c 272, 1892. ^302, xiv.,624. e 618, 992. MATERNAL IMPBESSIONS. 81 case in which the perverted appetite, originating in pregnancy, became permanent, but this is not the experience of most observers. The pregnant wife of a farmer in Hassfort-on-the-Main ate the excrement of her husband.'^ Many instances could be quoted, some in which extreme cases of poly- dipsia and bulimia developed ; these can be readily attributed to the in- creased call for liquids and food. Other cases of diverse new emotions can be recalled, such as lasciviousness, dirty habits, perverted thoughts, and, on the other hand, extreme piety, chastity, and purity of the mind. Some of the best-natured women are when pregnant extremely cross and irritable, and many perversions of disposition are commonly noticed in pregnancy. There is often a longing for a particular kind of food or dish for which no noticeable desire had been displayed before. Maternal Impressions. — Another curious fact associated with pregnancy is the apparent influence of the emotions of the mother on the child in utero. Every one knows of the popular explanation of many birth-marks, their supposed resemblance to some animal or object seen by. the mother during pregnancy, etc. The truth of maternal impressions, however, seems to be more firmly established by facts of a substantial nature. There is a natural desire to explain any abnormality or anomaly of the child as due to some incident during the period of the mother's pregnancy, and the truth is often distorted and the imagination heavily drawn upon to furnish the satisfactory explanation. It is the customary speech of the dime-museum lecturer to attribute the existence of some " freak " to an episode in the mother's pregnancy. The poor " Elephant-man " firmly believed his peculiarity was due to the fact that his mother while carrying him in utero was knocked down at the circus by an elephant. In some countries the exhibition of monstrosi- ties is forbidden because of the supposed danger of maternal impression. The celebrated " Siamese Twins " for this reason were forbidden to exhibit themselves for quite a period in France. We shall cite only a few of the most interesting cases from medical litera- ture. Hippocrates saved the honor of a princess, accused of adultery with a negro because she bore a black child, by citing it as a case of maternal impression, the husband of the princess having placed in her room a paint- ing of a negro, to the view of which she was subjected during the whole of her pregnancy. Then, again, in the treatise " De Superfoetatione " there occurs the following distinct statement : " If a pregnant woman has a long- ing to eat earth or coals, and eats of them, the infant which is born carries on its head the mark of these things." This statement, however, occurs in a work which is not mentioned by any of the ancient authorities, and is rejected by practically all the modern ones ; according to Ballantyne, there is, there- fore, no absolute proof that Hippocrates was a believer in one of the most popular and long-persisting beliefs concerning fetal deformities. '>■ Ephem. Physico-Medicorum, Leipzig, 1694, 212. 6 82 PRENATAL ANOMALIES. In the explanation of heredity, Hippocrates * states " that the body of the male as well as that of the female furnishes the semen. That which is weak (unhealthy) is derived from weak (unhealthy) parts, that which is strong (healthy) from strong (healthy) parts, and the fetus will correspond to the quality of the semen. If the semen of one part come in greater quantity from the male than from the female, this part will resemble more closely the father ; if, however, it comes more from the female, the part will rather resemble the mother. If it be true that the semen comes from both parents, then it is impossible for the whole body to resemble either the mother or the father, or neither the one nor the other in anything, but necessarily the child will resemble both the one and the other in something. The child will most resemble the one who contributes most to the formation of the parts." Such was the Hippocratic theory of generation and heredity, and it was ingen- iously used to explain the hereditary nature of certain diseases and mal- formations. For instance, in speaking of the sacred disease (epilepsy), Hippocrates says : " Its origin is hereditary, like that of other diseases ; for if a phlegmatic person be born of a phlegmatic, and a bilious of a bilious, and a phthisical of a phthisical, and one having spleen disease of another having disease of the spleen, what is to hinder it from happening that where the father and mother were subject to this disease certain of their offspring should be so affected also ? As the semen comes from all parts of the body, healthy particles will come from healthy parts, and unhealthy from unhealthy parts." According to Par6,^'^ Damascene saw a girl with long hair like a bear, whose mother had constantly before her a picture of the hairy St. John. Pari also appends an illustration showing the supposed resemblance to a bear. Jonston ^^ quotes a case of Heliodoms ; it was an Ethiopian, who by the effect of the imagination produced a white child. Par6 ^'* describes this case more fully : " Heliodorus says that Persina, Queen of Ethiopia, being impregnated by Hydustes, also an Ethiopian, bore a daughter with a white skin, and the anomaly was ascribed to the admiration that a picture of Andro- meda excited in Persina throughout the whole of the pregnancy." Van Helmont ^^^ cites the case of a tailor's M'ife at Mechlin, who during a conflict outside her house, on seeing a soldier lose his hand at her door, gave birth to a daughter with one hand, the other hand being a bleeding stump ; he also speaks of the case of the wife of a merchant at Antwerp, who after seeing a soldier's arm shot off at the siege of Ostend gave birth to a daughter with one arm. Plot '''" speaks of a child bearing the figure of a mouse ; when pregnant, the mother had been much frightened by one of these animals. Gassendus ^^^ describes a fetus with the traces of a wound in the same location as one received by the mother. The Lancet '' speaks of several cases — one of a child with a face resembling a dog whose mother had been bitten ; one a 759, Oct., 1895. b 476, 1863, ii., 27. MATERNAL IMPEESSIONS. 83 of a child with one eye blue and the other black, whose mother during con- finement had seen a person so marked ; of an infant with iins as upper and lower extremities, the mother having seen such a monster ; and another, a child born with its feet covered with scalds and burns, whose mother had been badly frightened by fireworks and a descending rocket. There is " the history of a woman who while pregnant at seven months with her fifth child was bitten on the right calf by a dog. Ten weeks after, she bore a child with three marks corresponding in size and appearance to those caused by the dog's teeth on her leg. Kerr ^ reports the case of a woman in her seventh month whose daughter fell on a cooking stove, shocking the mother, who suspected fatal burns. The woman was delivered two months later of an infant blistered about the mouth and extremities in a manner similar to the burns of her sis- ter. This infant died on the third day, but another was born fourteen months later with the same blisters. Inflammation set in and nearly all the fingers and toes sloughed off. In a subsequent confinement, long after the mental agitation, a healthy unmarked infant was born. Hunt" describes a case which has since become almost classic of a woman fatally burned, when pregnant eight months, by her clothes catching fire at the kitchen grate. The day after the burns labor began and was ter- minated by the birth of a well-formed dead female child, apparently blis- tered and burned in extent and in places corresponding almost exactly to the locations of the mother's injuries. The mother died on the fourth day. Webb ^ reports the history of a negress who during a convulsion while pregnant fell into a fire, burning the whole front of the abdomen, the front and inside of the thighs to the knees, the external genitals, and the left arm. Artificial delivery was deemed necessary, and a dead child, seemingly burned much like its mother, except less intensely, was delivered. There was also one large blister near the inner canthus of the eye and some large blisters about the neck and throat which the mother did not show. There was no history of syphilis nor of any eruptive fever in the mother, who died on the tenth day with tetanus. Graham " describes a woman of thirty-five, the mother of seven children, who while pregnant was feeding some rabbits, when one of the animals jumped at her with its eyes " glaring " upon her, causing a sudden fright. Her child was born hydrocephalic. Its mouth and face were small and rab- bit-shaped. Instead of a nose, it had a fleshy growth | inch long by J inch broad, directed upward at an angle of 45°. The space between this and the mouth was occupied by a body resembling an adult eye. Within this were two small, imperfect eyes which moved freely while life lasted (ten minutes). The child's integument was covered with dark, downy, short hair. The woman recovered and afterward bore two normal children. a 611, No. 19, May 7, 1842. b 124, July, 1857. <= 124, 1881, Ixxxi., 186. d783, X., 419. 6 224,1868, i., 51. 84 PRENATAL ANOMALIES. Parvin mentions an instance of the influence of maternal impression in the causation of a large, vivid, red mark or splotch on the face : " When the mother was in Ireland she was badly frightened by a fire in which some cat- tle were burned. Again, during the early months of her pregnancy she was frightened by seeing another woman suddenly light the fire with kerosene, and at that time became firmly impressed with the idea that her child would be marked." Parvin * also pictures the " turtle-man," an individual with de- formed extremities, who might be classed as an ectro- melus, perhaps as a phocomelus, or seal-like monster. According to the story, when the mother was a few weeks pregnant her husband, a coarse, rough fisherman, fond of rude jokes, put a large live turtle in the cup- board. In the twilight the wife went to the cupboard and the huge turtle fell out, greatly startling her by its hideous appearance as it fell suddenly to the floor and began to move vigorously. Copeland '' mentions a curious case in which a woman was attacked by a rattlesnake when in her sixth month of pregnancy, and gave birth to a child whose arm ex- hibited the shape and action of a snake, and involun- tarily went through snake-like movements. The face and mouth also markedly resembled the head of a snake. The teeth were situated like a serpent's fangs. The mere mention of a snake filled the child (a man of twenty-nine) with great horror and rage, " particularly in the snake season." Beale " gives the history of a case of a child born with its left eye blackened as by a blow, whose mother was struck in a corresponding portion of the face eight hours before confinement. There is on record '^ an account of a young man of twenty-one suflering from congenital deformities attributed to the fact that his mother was frightened by a guinea-pig having been thrust into her face during pregnancy. He also had congenital deformity of the right auricle. At the autopsy, all the skin, tissues, muscles, and bones were found involved. Owen ■= speaks of a woman who was greatly excited ten months previously by a prurient curiosity to see what appearance the genitals of her brother presented after he had submitted to amputation of the penis on ac- count of carcinoma. The whole penis had been removed. The woman stated that from the time she had thus satisfied herself, her mind was unceasingly engaged in reflecting and sympathizing on the forlorn condition of her brother. While in this mental state she gave birth to a son whose penis was entirely absent, but who was otherwise well and likely to live. The other portions of the genitals were perfect and well developed. The appearance of Fig. 8.— The "turtle-man.' ' Internat. Med. Mag., Phila., June, 1892. c 476, 1863, ii., 27. d 536, 1883, i., 381. b 218, 1839, 98. e 476, 1863, 25. PATERNAL IMFBESSIONS. 85 the nephew and the uncle was identical. A most peculiar case ^ is stated by Clerc as occurring in the experience of Kiiss of Strasburg. A woman had a negro paramour in America with whom she had had sexual intercourse several times. She was put in a convent on the Continent, where she stayed two years. On leaving the convent she married a white man, and nine months after she gave birth to a dark-skinned child. The supposition was that during her abode in the convent and the nine months subsequently she had the image of her black paramour constantly before her. Loin '' speaks of a woman who was greatly impressed by the actions of a clown at a circus, and who brought into the world a child that resembled the fantastic features of the clown in a most striking manner. Mackay " describes five cases in which fright produced distinct marks on the fetus. There is a case mentioned '^ in which a pregnant woman was informed that an intimate friend had been thrown from his horse ; the immediate cause of death was fracture of the skull, produced by the corner of a dray against which the rider was thrown. The mother was profoundly impressed by the circumstance, which was minutely described to her by an eye-witness. Her child at birth presented a red and sensitive area upon the scalp corresponding in location with the fatal injury in the rider. The child is now an adult woman, and this area upon the scalp remains red and sensitive to pressure, and is almost devoid of hair. Mastin of Mobile, Alabama, reports a curious instance of maternal impression. During the sixth month of ithe pregnancy of the mother her husband was shot, the ball passing out through the left breast. The woman was naturally much shocked, and remarked to Dr. Mastin : " Doctor, my baby will be ruined, for when I saw the wound I put my hands over my face, and got it covered with blood, and I know my baby will have a bloody face.*' The child came to term without a bloody face. It had, however, a well-defined spot on the left breast just below the site of exit of the ball from its father's chest. The spot was about the size of a silver half-dollar, and had elevated edges of a bright red color, and was quite visible at the distance of one hundred feet. The authors have had personal communication with Dr. Mastin in regard to this case, which he considers the most positive evidence of a case of maternal impression that he has ever met. Paternal Impressions. — Strange as are the foregoing cases, those of pater- nal impression eclipse them. Several are on record, but none are of sufficient authenticity to warrant much discussion on the subject. Those below are given to illustrate the method of report. Stahl, quoted by Steinan, 1843, speaks of the case of a child, the father being a soldier who lost an eye in the war. The child was born with one of its eyes dried up in the orbit, in this respect presenting an appearance like that of the father. Schneider " a 239, Jnly 7, 1873. '' 645, 1879-80, xxxi. e 476, 1891, ii., 1388. <1 844, 213. e 778, xxviii., 167. 86 PRENATAL ANOMALIES. says a man whose wife was expecting confinement dreamt that his oldest son stood beside his bedside with his genitals much mutilated and bleeding. He awoke in a great state of agitation, and a few days later the wife was delivered of a child with exstrophy of the bladder. Hoare " recites the curious story of a man who vowed that if his next child was a daughter he would never speak to it. The child proved to be a son, and during the whole of the father's life nothing could induce the son to speak to his father, nor, in fact, to any other male person, but after the father's death he talked fluently to both men and women. Clark ^ reports the birth of a child whose father had a stiff knee-joint, and the child's knee was stiff and bent in exactly the same position as that of its father. Telegony. — The influence of the paternal seed on the physical and mental constitution of the child is well known. To designate this condition, Telegony is the word that was coined by "Weismann in his " Das Keim- plasma," and he defines it as " Infection of the Germ," and, at another time, as " Those doubtful instances in which the offspring is said to resemble, not the father, but an early mate of the mother," — or, in other words, the alleged influence of a previous sire on the progeny produced by a subsequent one from the same mother. In a systematic discussion of telegony before the Royal Medical Society, Edinburgh, on March 1, 1895," Brunton Blaikie, as a means of making the definition of telegony plainer by practical example, prefaced his remarks by citing the classic example which first drew the attention of the modern scientific world to this phenomenon. The facts .of this case were communicated in a letter from the Earl of Morton to the President of the Royal Society in 1821, and were as follows : In the year 1815 Lord Morton put a male quagga to a young chestnut mare of I Arabian blood, which had never before been bred from. The result was a female hybrid which resembled both parents. He now sold the mare to Sir Gore Ousley, who two years after she bore the hybrid put her to a black Arabian horse. During the two following years she had two foals which Lord Morton thus describes : " They have the character of the Arabian breed as decidedly as can be expected when -^ of the blood are Arabian, and they are fine specimens of the breed ; but both in their color and in the hair of their manes they have a striking resemblance to the quagga. Their color is bay, marked more or less like the quagga in a darker tint. Both are distinguished by the dark line along the ridge of the back, the dark stripes across the forehand, and the dark bars across the back part of the legs." The President of the Royal Society saw the foals and verified Lord Morton's statement, "Herbert Spencer, in the Contemporary Review for May, 1893, gives several cases communicated to him by his friend Mr. Fookes, whom Spencer says is often appointed judge of animals at agricultural shows. After giving » 476, 1831-2, i., 441. b 543, xv., 258. c 759, July, lcj95. TELEGONY. 87 various examples he goes on to say : ' A friend of mine near this had a valuable Dachshund bitch, which most unfortunately had a litter by a stray, sheep-dog. The next year the owner sent her on a visit to a pure Dachs- hund dog, but the produce took quite as much of the first father as the second, and the next year he sent her to another Dachshund, with the same result. Another case : A friend of mine in Devizes had a litter of puppies, unsought for, by a setter from a favorite pointer bitch, and after this she never bred any true pointers, no matter what the paternity was.' " Lord Polwarth, whose very fine breed of Border Leicesters is famed, throughout Britain, and whose knowledge on the subject of breeding is great, says that ' In sheep we always consider that if a ewe breeds to a Shrbp ram, she is never safe to breed pure Leicesters from, as dun or colored legs are apt to come even when the sire is a pure Leicester. This has been proved in various instances, but is not invariable.' " Hon. Henry Scott says : " Dog-breeders know this theory well ; and if a pure-bred bitch happens to breed to a dog of another breed, she is of little use for breeding pure-bred puppies afterward. Animals which produce large litters and go a short time pregnant show this throwing back to previous sires far more distinctly than others — I fancy dogs and pigs most of all, and probably horses least. The influence of previous sires may be carried into the second generation or further, as I have a cat now Avhich appears to be half Persian (long hair). His dam has very long hair and every appearance of being a half Persian, whereas neither have really any Persian blood, as far as I know, but the grand-dam (a very smooth-haired cat) had several litters by a half-Persian tom-cat, and all her produce since have showed the influence retained. The Persian tom-cat died many years ago, and was the only one in the district, so, although I cannot be absolutely positive, still I think this case is really as stated." Breeders of Bedlington terriers wish to breed dogs with as powerful jaws as possible. In order to accomplish this they put the Bedlington terrier bitch first to a bull-terrier dog, and get a mongrel litter which they destroy. They now put the bitch to a Bedlington terrier dog and get a litter of puppies which are practically pure, but have much stronger jaws than they would otherwise have had, and also show much of the gameness of the bull- terrier, thus proving that physiologic as well as anatomic characters may be transmitted in this way. After citing the foregoing examples, Blaikie directs his attention to man, and makes the following interesting remarks : — " We might expect from the foregoing account of telegony amongst ani- mals that whenever a black woman had a child to a white man, and then married a black man, her subsequent children would not be entirely black. Dr. Robert Balfour of Surinam in 1851 wrote to Harvey that he was con- tinually noticing amongst the colored population of Surinam ' that if a negress 88 PRENATAL ANOMALIES. had a child or children by a white, and afterward fruitful intercourse with a negro, the latter oifspring had generally a lighter color than the parents.' But, as far as I know, this is the only instance of this observation on record. Herbert Spencer has shown that when a pure-bred animal breeds with an animal of a mixed breed, the offspring resembles much more closely the pa- rent of pure blood, and this may explain why the circumstance recorded by Balfour has been so seldom noted. For a negro, who is of very pure blood, will naturally have a stronger influence on the subsequent progeny than an Anglo-Saxon, who comes of a mixed stock. If this be the correct explana- tion, we should expect that when a white woman married first a black man, and then a white, the children by the white husband would be dark colored. Unfortunately for the proof of telegony, it is very rare that a white woman does marry a black man, and then have a white as second husband ; never- theless, we have a fair number of recorded instances of dark-colored chil- dren being born in the above way of white parents. " Dr. Harvey mentions a case in which ' a young woman, residing in Edinburgh, and born of white (Scottish) parents, but whose mother, some time previous to her marriage, had a natural (mulatto) child by a negro man- servant in Edinburgh, exhibits distinct traces of the negro. Dr. Simpson — afterward Sir James Simpson — ^whose patient the young woman at one time was, has had no recent opportunities of satisfying himself as to the pre- cise extent to which the negro character prevails in her features ; but he recollects being struck with the resemblance, and noticed particularly that the hair had the qualities characteristic of the negro.' Herbert Spencer got a letter from a ' distinguished correspondent ' in the United States, who said that children by white parents had been ' repeatedly ' observed to show traces of black blood when the women had had previous connection with {i. e., a child by) a negro. Dr. Youmans of New York interviewed several medi- cal professors, who said the above was ' generally accepted as a fact.' Prof. Austin Flint, in ' A Text-book of Human Physiology,' mentioned this fact, and when asked about it said : ' He had never heard the statement ques- tioned.' " But it is not only in relation to color that we find telegony to have been noticed in the human subject. Dr. Middleton Michel gives a most in- teresting case in the American Journal of the Medical Sciences for 1868 : ' A black woman, mother of several negro children, none of whom were de- formed in any particular, had illicit intercourse with a white man, by whom she became pregnant. During gestation she manifested great uneasiness of mind, lest the birth of a mulatto offspring should disclose her conduct. . . . It so happened that her negro husband possessed a sixth digit on each hand, but there was no peculiarity of any kind in the white man, yet when the mulatto child was born it actually presented the deformity of a supernume- rary finger.' Taruifi, the celebrated Italian teratologist, in speaking of the ANTENATAL PATHOLOGY. 89 subject, says : ' Our knowledge of this strange fact is by no means recent, for Fienus, in 1608, said that most of the children born in adultery have a greater resemblance to the legal than to the real father ' — an observation that was confirmed by the philosopher Yanini and by the naturalist Ambrosini. From these 'observations comes the proverb: ' Filium ex adultera excusare matrem a culpa.' Osiander has noted telegony in relation to moral qualities of children by a second marriage. Harvey said that it has long been known that the children by a second husband resemble the first husband in features, mind, and disposition. He then gave a case in which this resemblance was very well marked. Orton, Burdach (Traitg de Physiologic), and Dr. Will- iam Sedgwick have all remarked on this physical resemblance ; and Dr. Metcalfe, in a dissertation delivered before this society in 1855, observed that in the cases of widows remarrying the children of the second marriage frequently resemble the first husband. "An observation probably having some bearing on this subject was made by Count de Stuzeleci (Harvey, loo. dt). He noticed that when an aborig- inal female had had a child by a European, she lost the power of conception by a male of her own race, but could produce children by a white man. He believed this to be the case with many aboriginal races ; but it has been dis- proved, or at all events proved to be by no means a universal law, in every case except that of the aborigines of Australia and New Zealand. Dr. William Sedgwick thought it probable that the unfruitfulness of prostitutes might in some degree be due to the same cause as that of the Australian aborigines who have had children by white men. " It would seem as though the Israelites had had some knowledge of telegony, for in Deuteronomy we find that when a man died leaving no issue, his wife was commanded to marry her husband's brother, in order that he might ' raise up seed to his brother.' " We must omit the thorough inquiry into this subject that is offered by Mr. Blaikie. The explanations put forward have always been on one of three main lines : — (1) The imagination-theory, or, to quote Harvey : "Due to mental causes so operating either on the mind of the female and so acting on her repro- ductive powers, or on the mind of the male parent, and so influencing the qualities of his semen, as to modify the nutrition and development of the offspring." (2) Due to a local influence on the reproductive organs of the mother. (3) Due to a general influence through the fetus on the mother. Antenatal Pathology. — We have next to deal with the diseases, acci- dents, and operations that affect the pregnant uterus and its contents ; these are rich in anomalies and facts of curious interest, and have been recog- nized from the earliest times. In the various works usually grouped together under the general designation of " Hippocratic " are to be found 90 PRENATAL ANOMALIES. the earliest opinions upon the subject of antenatal pathology which the medical literature of Greece has handed down to modern times. That there were medical writers before the time of Hippocrates cannot be doubted, and that the works ascribed to the " Father of Medicine " were immediately fol- lowed by those of other physicians, is likewise not to be questioned ; but whilst nearly all the writings prior to and after Hippocrates have been long lost to the world, most of those that were written by the Coan physician and his followers have been almost miraculously preserved. As Littr6 puts it, " Les 6crits hippocratiques demeurent isol6s au milieu des debris de I'antique litterature medicale." — (Ballantyne.) The first to be considered is the transmission of contagious disease to the fetus in utero. The first disease to attract attention was small- pox. Devilliers, Blot, and Depaul all speak of congenital small-pox, the child born dead and showing evidences of the typical small-pox pustulation, with a history of the mother having been infected during pregnancy. Watson " reports two cases in which a child in utero had small-pox. In the first case the mother was infected in pregnancy ; the other was nursing a patient when seven months pregnant ; she did not take the disease, although she had been infected many months before. Mauriceau ^^^ delivered a woman of a healthy child at full term after she had recovered from a severe attack of this disease during the fifth month of gestation. Mauriceau supposed the child to be immune after the delivery. Vidal reported to the French Academy of Medicine, May, 1871, the case of a woman who gave birth to a living child of about six and one-half months' maturation, which died some hours after birth covered with the pustules of seven or eight days' eruption. The pustules on the fetus were well umbilicated and typical, and could have been nothing but those of small-pox ; besides, this disease was raging in the neighborhood at the time. The mother had never been infected before, and never was subsequently. Both parents were robust and neither of them had ever had syphilis. About the time of conception, the early part of December, 1870, the father had suffered from the semiconfluent type, but the mother, who had been vaccinated when a girl, had never been stricken either during or after her husband's sickness. Quirke'' relates a peculiar instance of a child born at midnight, whose mother was covered with the eruption eight hours after delivery. The child was healthy and showed no signs of the contagion, and was vaccinated at once. Although it remained with its mother all through the sickness, it continued well, with the excep- tion of the ninth day, when a slight fever due to its vaccination appeared. The mother made a good recovery, and the author remarks that had the child been born a short time later, it would most likely have been infected. Ayer " reports an instance of congenital variola in twins. Chantreuil ^ a 629, 1743-50, 1043. b 224, 1886, i., 201. . c 218, 1851, xliv., 397. d 363, 1870, xliii., 173. DISEASE TRANSMITTED TO THE FETUS. 91 speaks of a woman pregnant with twins who aborted at five and a half months. One of the fetuses showed distinct signs of congenital variola, although the mother and other fetus were free from any symptoms of the disease. In 1853 Charcot reported the birth of a premature fetus present- ing numerous variolous pustules together with ulcerations of the derm and mucous membranes and stomach, although the mother had convalesced of the disease some time before. Mitchell^ describes a case of small-pox occur- ring three days after birth, the mother not having had the disease since childhood. Shertzer ^ relates an instance of confluent small-pox in the eighth month of pregnancy. The child was born with the disease, and both mother and babe recovered. Among many others offering evidence of variola in utero are Degner, Derham, John Hunter, Blot, Bulkley, Welch, Wright, Digk, Forbes, Marinus, and Bouteiller. Varicella, Measles, Pneumonia, and even Malaria are reported as having been transmitted to the child in utero. Hubbard " attended a woman on March 17, 1878, in her seventh accouchement. The child showed the rash of varicella twenty-four hours after birth, and passed through the regu- lar course of chicken-pox of ten days' duration. The mother had no signs of the disease, but the children all about her were infected. Ordinarily the period of incubation is from three to four days, with a premonitory fever of from twenty-four to seventy-two hours' duration, when the rash appears ; this case must therefore have been infected in utero. Lomer"* of Ham- burg tells of the case of a woman, twenty-two years, unmarried, pregnant, who had measles in the eighth month, and who gave birth to an infant with measles. The mother was attacked with pneumonia on the fifth day of her puerperium, but recovered ; the child died in four weeks ' of intestinal catarrh. Gautier® found measles transmitted from the mother to the fetus in 6 out of 11 cases, there being 2 maternal deaths in the 11 cases. Netter^ has observed the case of transmission of pneumonia from a mother to a fetus, and has seen two cases in which the blood from the uterine vessels of patients with pneumonia contained the pneumococcus. Wallick s collected a number of cases of pneumonia occurring during pregnancy, show- ing a fetal mortality of 80 per cent. Felkin ^ relates two instances of fetal malaria in which the infection was probably transmitted by the male parent. In one case the father near term suffered severely from malaria ; the mother had never had a chill. The violent fetal movements induced labor, and the spleen was so large as to retard it. After birth the child had seven malarial paroxysms but re- covered, the splenic tumor disappearing. The modes of infection of the fetus by syphilis, and the infection of the mother, have been well discussed, and need no mention here. a 124, 1830, vii., 555. b 547, iv., 756. " 224, 1878, i., 822. d 261, 1889. e 140, 1879, 331. f 300, No. 22, 1889. s 140, 1889, 439. b 318, June, 1889. 92 PRENATAL ANOMALIES. There has been much discussion on the effects on the fetus in utero of medicine administered to the pregnant mother, and the opinions as to the reliability of this medication are so varied that we are in doubt as to a satisfactory conclusion. The effects of drugs administered and eliminated by the mammary glands and transmitted to the child at the breast are well known, and have been witnessed by nearly every physician, and, as in cases of strong metallic purges, etc., need no other than the actual test. However, scientific experiments as to the efficacy of fetal therapeutics have been made from time to time with varying results. Gusserow of Strasbourg tested for iodin, chloroform, and salicylic acid in the blood and secretions of the fetus after maternal administration just before death. In 14 cases in which iodin had been administered, he examined the fetal urine of 11 cases ; in 5, iodin was present, and in the others, absent. He made some similar experiments on the lower animals. Benicke reports having given salicylic acid just before birth in 25 cases, and in each case finding it in the urine of the child shortly after birth. At a discussion held in New York some years ago as to the real effect on the fetus of giving narcotics to the mother, Dr. Gaillard Thomas was almost alone in advocating that the effect was quite visible. Fordyce Barker was strongly on the negative side. Hennihg and Ahlfeld, two German observers, vouch for the opinion of Thomas, and Thornburn states that he has witnessed the effect of nux vomica and strychnin on the fetus shortly after birth. Over fifty years ago, in a memoir on " Placental Phthisis," Sir James Y. Simpson advanced a new idea in the recommendation of potassium chlorate during the latter stages of pregnancy. The efficacy of this suggestion is known, and whether, as Simpson said, it acts by supplying extra oxygen to the blood, or whether the salt itself is conveyed to the fetus, has never been definitely settled. McClintock," who has been a close observer on this subject, reports some interesting cases. In his first case he tried a mixture of iron perchlorid and potassium chlorate three times a day on a woman who had borne three dead children, with a most successful result. His second case failed, but in a third he was successful by the same medication with a woman who had before borne a dead child. In a fourth case of unsuccessful pregnancy for three consecutive births he was successful. His fifth case was extra- ordinary : It was that of a woman in her tenth pregnancy, who, with one exception, had always borne a dead child at the seventh or eighth month. The one exception lived a few hours only. Under this treatment he was successful in carrying the woman safely past her time for miscarriage, and had every indication for a normal birth at the time of report. Thornburn believes that the administration of a tonic like strychnin is of benefit to a fetus which, by its feeble heart-beats and movements, is thought to be un- » 224, 1877, ii., 513. MEDICINE TO THE PREGNANT WOMAN. 93 healthy. Porak* has recently investigated the passage of substances foreign to the organism through the placenta, and oifers an excellent paper on this subject, which is quoted in brief in a contemporary number of Terato- logia.^s9 In this important paper, Porak, after giving some historical notes, describes a long series of experiments performed on the guinea-pig in order to investigate the passage of arsenic, copper, lead, mercury, phosphorus, alizarin, atropin, and eserin through the placenta. The placenta shows a real affinity for some toxic substances ; in it accumulate copper and mer- cury, but not lead, and it is therefore through it that the poison reaches the fetus ; in addition to its pulmonary, intestinal, and renal functions, it fixes glycogen and acts as an accumulator of poisons, and so resembles in its action the liver ; therefore the organs of the fetus possess only a potential activity. The storing up of poisons in the placenta is not so general as the accumula- tion of them in the liver of the mother. It may be asked if the placenta does not form a barrier to the passage of poisons into the circulation of the fetus ; this would seem to be demonstrated by mercury, which was always found in the placenta and never in the fetal organs. In poisoning by lead and copper the accumulation of the poison in the fetal tissues is greater than in the maternal, perhaps from differences in assimilation and disassimilation or from greater diffusion. Whilst it is not an impermeable barrier to the pas- sage of poisons, the placenta offers a varying degree of obstruction : it allows copper and lead to pass easily, arsenic with greater difficulty. The accumu- lation of toxic substances in the fetus does not follow the same law as in the adult. They diffuse more widely in the fetus. In the adult the liver is the chief accumulatory organ. Arsenic, which in the mother elects to accumu- late in the liver, is in the fetus stored up in the skin ; copper accumulates in the fetal liver, central nervous system, and sometimes in the skin ; lead, which is found specially in the maternal liver, but also in the skin, has been observed in the skin, liver, nervous centers, and elsewhere in the fetus. The frequent presence of poisons in the fetal skin demonstrates its physiologic importance. It has probably not a very marked influence on its health. On the contrary, accumulation in the placenta and nerve centers explains the pathogenesis of abortion and the birth of dead fetuses (" mortinatalite "). Copper and lead did not cause abortion, but mercury did so in two out of six cases. Arsenic is a powerful abortive agent in the guinea-pig, probably on account of placental hemorrhages. An important deduction is that whilst the placenta is frequently and seriously affected in syphilis, it is also the special seat for the accumulation of mercury. May this not explain its therapeutic action in this disease ? The marked accumulation of lead in the central nervous system of the fetus explains the frequency and serious char- acter of saturnine encephalopathic lesions. The presence of arsenic in the ^Archives de M6d. exp^rimentale et d'Anatomie path., March, 1894, p. 192. 94 PRENATAL ANOMALIES. fetal skin alone gives an explanation of the therapeutic results of the adminis- tration of this substance in skin diseases. Intrauterine amputations are of interest to the medical man, par- ticularly those cases in which the accident has happened in early pregnancy and the child is born with a very satisfactory and clean stump. Mont^ gomery,* in an excellent paper, advances the theory, which is very plausible, that intrauterine amputations are caused by contraction of bands or mem- branes of organized lymph encircling the limb and producing amputation by the same process of disjunctive atrophy that the surgeons induce by ligature. Weinlechner '' speaks of a case in which a man devoid of all four extremi- ties was exhibited before the Vienna Medical Society. The amputations were congenital, and on the right side there was a very small stump of the upper arm remaining, admitting • the attachment of an artificial apparatus. He was twenty-seven years old, and able to write, to thread a needle, pour water out of a bottle, etc. Cook'' speaks of a female child born of Indian parents, the fourth birth of a mother twenty-six years old. The child weighed 5| pounds ; the circumference of the head was 14 inches and that of the trunk 13 inches. The upper extremities consisted of perfect shoulder joints, but only J of each humerus was present. Both sides showed evidences of amputation, the cicatrix on the right side being 1 inch long and on the left ^ inch long. The right lower limb was merely a fleshy corpuscle | inch wide and J inch long ; to the posterior edge was attached a body resembling the little toe of a newly-born infant. On the left side the limb was represented by a fleshy cor- puscle 1 inch long and ^ inch in circumfer- rig.9.^ntrauterine amputation (Cook). ^ncc, resembling the great toe of an in- fant. There was no history of shock or injury to the mother. The child presented by the breech, and by the ab- sence of limbs caused much difficulty in diagnosis. The three stages of labor were one and one-half hours, forty-five minutes, and five minutes, respec1> ively. The accompanying illustration (Fig. 9) shows the appearance of the limbs at the time of report. Figure 10 represents a negro boy, the victim of intrauterine amputation, who learned to utilize his toes for many purposes. The illustration shows his mode of holding his pen. There is an instance reported '' in which a child at full term was born with an amputated arm, and at the age of seventeen the stump was scarcely if at all smaller than the other. Blake "^ speaks of a case of congenital » 309, 1832. b 118, Jaa. 22, 1878. c 224, 1890, i., 1360. d 222, Oct., 1837. e 218, Deo. 20, 1894. INTRA UTERINE AMPVTA TIONS. 95 amputation of both the upper extremities. Gillilam '^ mentions a case that shows the deleterious influence of even the weight of a fetal limb resting on a cord or band. His case was that of a fetus, the product of a miscarriage of traumatic origin ; the soft tissues were almost cut through and the bone denuded by the limb resting on one of the two umbilical cords, not encir- cling it, but in a sling. The cord was deeply imbedded in the tissues. The coilings of the cord are not limited to compression about the extremi- ties alone, but may even decapitate the head by being firmly wrapped several times about the neck. According to Ballantyne, '^^ there is in the treatise De Octimestri Partu, by Hip- pocrates, a reference to coiling of the umbilical cord round the neck of the fetus. This coiling was, indeed, regarded as one of the dangers of the eighth month, and even the mode of its pro- duction is described. It is said that if the cord be extended along one side of the uterus, and the fetus lie more to the other side, then when the eul- bute is performed the funis must necessarily form a loop round the neck or chest of the infant. If it remain in this position, it is further stated, the mother will suffer j later and the fetus will either perish or be born with difficulty. If the Hippocratic writers knew that this coiling is sometimes quite innocuous, they did not in any place state the fact. The accompanying illustrations (Fig. 11) show the different ways in which the funis may be coiled, the coils sometimes being as many as 8. Bizzen *> mentions an instance in which from strangulation the head of a fetus was in a state of putrefaction, the funis being twice tightly bound around the neck. Cleveland," Cuthbert,"! and Germain " report analogous instances. Matthyssens ^ observed the twisting of the funis about the arm and neck of a fetus the body of which was markedly wasted. There was complete absence of amniotic fluid during labor. Blumenthal « presented to the New York Pathological Society an ovum within which the fetus was under- a 274, 1872, iii., 230. b 124, 1852, xxxiii., 565. <= 778, xiii., 1. ^ 610, 1874-5. e 362^ ix,, 567. f Ann. Soc. de mM. d'Anvers, 1842, 372. e 538, 1871, vi., 278. Fig. 10. — Intrauterine amputation. 96 PRENATAL ANOMALIES. going intrauterine decapitation. Buchanan " describes a case illustrative of the etiology of spontaneous amputation of limbs in utero. Nebinger *• reports a case of abortion, showing commencing amputation of the left thigh from being encircled by the funis. The death of the fetus was probably due to compression of the cord. Owen" mentions an instance in Avhich the left arm and hand of a fetus were found in a state of putrescence from strangulation, the funis being tightly bound around at the upper part. Simpson '^ pub- lished an article on spontaneous amputation of the forearm and rudimentary regeneration of the hand in the fetus. Among other contributors to this Fig. 11— Coiling of the cord. subject are Avery, Boncour, Brown, Ware, Wrangell, Young, JSTettekoven, Martin, Macan, Leopold, Hecker, Giinther, and Friedinger. Wygodzkyo finds that the greatest number of coils of the umbilical cord ever found to encircle a fetus are 7 (Baudelocque), 8 (Cred6), and 9 (Miiller and Gray). His own case was observed this year in Wilna. The patient was a primipara aged twenty. The last period was seen on May 10, 1894. On February 19th the fetal movements suddenly ceased. On the 20th pains set in about two weeks before term. At noon turbid a 774, 1839, x„ 41. *> 124, 1867, liv., 129. c 656, 1851, 573 d Month. Jour. Med. Sc, Edin., 1848. e 261; and quoted 545, Feb. 29, 1896. INTRAUTERINE FRACTURES. 97 liquor amnii escaped. At 2 p. M., on examination, Wygodzky defined a dead fetus in left occipito-anterior presentation, very high in the inlet. The OS was nearly completely dilated, the pains strong. By 4 p. m. the head was hardly engaged in the pelvic cavity. At 7 p. M. it neared the outlet at the height of each pain, but retracted immediately afterward. After 10 p. M. the pains grew weak. At midnight Wygodzky delivered the dead child by expression. Not till then was the cause of delay clear. The funis was very tense and coiled 7 times round the neck and once round the left shoulder; there was also a distinct knot. It measured over 65 inches in length. The fetus was a male, slightly macerated. It weighed over 5 pounds, and was easily delivered entire after division and unwinding of the funis. No marks remained on the neck. The placenta followed ten minutes later and, so far as naked-eye experience indicated, seemed healthy. Intrauterine fractures are occasionally seen, but are generally the re- sults of traumatism or of some extraordinary muscular efforts on the part of the mother. A blow on the abdomen or a fall may cause them. The most interesting cases are those in which the fractures are multiple and the causes unknown. Spontaneous fetal fractures have been discussed thor- oughly, and the reader is referred to any responsible text-book for the theo- ries of causation. Atkinson,* De Luna,^ and Keller report intrauterine fractures of the clavicle. Filippi'' contributes an extensive paper on the medicolegal aspect of a case of intrauterine fracture of the os cranium. Braun of Vienna reports a case of intrauterine fracture of the humerus and femur. Rodrigue** describes a case of fracture and dislocation of the hu- merus of a fetns in utero. Gaultier" reports an instance of fracture of both femora intrauterine. Stanley, Vanderveer, and Young cite instances of in- trauterine fracture of the thigh ; in the case of Stanley the fracture occurred during the last week of gestation, and there was rapid union of the frag- ments during lactation. Danyau, Proudfoot, and Smith ^ mention intrauterine fracture of the tibia ; in Proudfoot's case there was congenital talipes talus. Dolbeaus describes an instance in which multiple fractures were found in a fetus, some of which were evidently postpartum, while others were assuredly antepartum. Hirschfeld ^ describes a fetus showing congenital multiple frac- tures. Gross ^^^ speaks of a wonderful case of Chaupier in which no less than 113 fractures were discovered in a child at birth. It survived twenty-four hours, and at the postmortem examination it was found that some were already solid, some uniting, whilst others were recent. It often happens that the intrauterine fracture is well united at birth. There seems to be a peculiar predisposition of the bones to fracture in the cases in which the frac- tures are multiple and the cause is not apparent. a 545, 1859-60, iii., 532. b 124, 1873, Ixvi., 282. <= Imparziale, Firenze, 1879, xix. d 124, 1854, xxvii., 272. «= 458, 1819, 81. f 779, xviii., 215. g 242, xxxviii., 126. !» 363, xxx., 291. 7 98 PRENATAL ANOMALIES. The results to the fetus of injuries to the pregnant mother are most diversified. In some instances the marvelous escape of any serious conse- quences of one or both is almost incredible, while in others the slightest injury is fatal. Guillemont " cites the instance of a woman who was killed by a stroke of lightning, but whose fetus was saved ; while Fabricius Hil- danus '^ describes a case in which there was perforation of the head, fracture of the skull, and a wound of the groin, due to sudden starting and agony of terror of the mother. Here there was not the slightest history of any exter- nal violence. It is a well-known fact that injuries to the pregnant mother show visible effects on the person of the fetus. The older writers kept a careful record of the anomalous and extraordinary injuries of this character and of their effects. Brendelius tells us of hemorrhage from the mouth and nose of the fetus occasioned by the fall of the mother ; Buchner " mentions a case of fracture of the cranium from fright of the mother ; Eeuther describes a con- tusion of the OS sacrum and abdomen in the mother from a fall, with fracture of the arm and leg of the fetus from the same cause ; Sachse "^ speaks of a fractured tibia in a fetus, caused by a fall of the mother ; Slevogt ^ relates an instance of rupture of the abdomen of a fetus by a fall of the mother ; the Ephemerides contains accounts of injuries to the fetus of this nature, and among others mentions a stake as having been thrust into a fetus in utero ; Verduc ^ offers several examples, one a dislocation of the fetal foot from a maternal fall ; Plocquet ^^ gives an instance of fractured femur ; Walther ^ describes a case of dislocation of the vertebrae from a fall ; and there is also a case ^ of a fractured fetal vertebra from a maternal fall. There is recorded' a fetal scalp injury, together with clotted blood in the hair, after a fall of the mother. Autenrieth describes a wound of the pregnant uterus, which had no fatal issue, and there is also another similar case on reoord.J The modern records are much more interesting and wonderful on this subject than the older ones. Richardson ^^^ speaks of a woman falling down a few weeks before her delivery. Her pelvis was roomy and the birth was easy ; but the infant was found to have extensive wounds on the back, reach- ing from the 3d dorsal vertebra across the scapula, along the back of the humerus, to within a short distance of the elbow. Part of these wounds were cicatrized and part still granulating, which shows that the process of reparation is as active in utero as elsewhere. Injuries about the genitalia would naturally be expected to exercise some active influence on the uterine contents ; but there are many instances reported in which the escape of injury is marvelous. Gibb '' speaks of a woman, about eight months pregnant, who fell across a chair, lacerating her a Lyons, 1590. b 334, cent, v., obs. 3. c Miscel. 1728, 1026. d 452, L. xi. e 282, ann. x., 172. f 799, T. i., 197. g 815, obs. 50. I1524, v., 326. i 462, T. xxi. j 106; 1712, 454. k 476, 1858, i. INJURIES FROM HORNS OF CATTLE. 99 genitals and causing an escape of liquor amnii. There was regeneration of this fluid and delivery beyond term. The labor was tedious and took place two and a half months after the accident. The mother and the female child did well. Purcell * reports death in a pregnant woman from contused wound of the vulva. Morland ^ relates an instance of a woman in the fifth month of her second pregnancy, who fell on the roof of a woodshed by slipping from one of the steps by which she ascended to the roof, in the act of hang- ing out some clothes to dry. She sjliffered a wound on the internal surface of the left nympha IJ inch long and^J inch deep. She had lost about three quarts of blood, and had applied ashes to the vagina to stop the bleeding. She made a recovery by the twelfth day, and the fetal sounds were plainly audible. CuUingworth " speaks of a woman who, during a quarrel with her husband, was pushed away and fell between two chairs, knocking one of them over, and causing a trivial wound one inch long in the vagina, close to the entrance. She screamed, there was a gush of blood, and she soon died. The uterus contained a fetus three or four months old, with the membranes intact, the maternal death being due to the varicosity of the pregnant pudenda, the slight injury being sufficient to produce fatal hemorrhage. Carhart ^ describes the case of a pregnant woman, who, while in the stoop- ing position, milking a cow, was impaled through the vagina by another cow. The child was born seven days later, with its skull crushed by the cow's horn. The horn had entered the vagina, carrying the clothing with it. There are some marvelous cases of recovery and noninterference with pregnancy after injuries from horns of cattle. Corey " speaks of a woman of thirty-five, three months pregnant, weighing 135 pounds, who was horned by a cow through the abdominal parietes near the hypogastric region ; she was lifted into the air, carried, and tossed on the ground by the infuriated animal. There was a wound consisting of a ragged rent from above the os pubis, extending obliquely to the left and upward, through which protruded the great omentum, the descending and transverse colon, most of the small intestines, as well as the pyloric extremity of the stomach. The great omen- tum was mangled and comminuted, and bore two lacerations of two inches each. The intestines and stomach were not injured, but there was consider- able extravasation of blood into the abdominal cavity. The intestines were cleansed and an unsuccessful attempt was made to replace them. The intes- tines remained outside of the body for two hours, and the great omentiun was carefully spread out over the chest to prevent interference with the efforts to return the intestines. The patient remained conscious and calm throughout ; finally deep anesthesia was produced by ether and chloroform, three and a half hours after the accident, and in twenty minutes the intes- tines were all replaced in the abdominal cavity. The edges were pared, sutured, and the wound dressed. The woman was placed in bed, on the a 313, 1870. b 218, 1858-9. <= 521, 1885. d 760, 1884. e 133, 1878. 100 PRENATAL ANOMALIES. right side, and morphin was administered. The sutures were removed on the ninth day, and the wound had healed except at the point of penetration. The woman was discharged twenty days after, and, incredible to relate, was delivered of a well-developed, full-term child just two hundred and two days from the time of the accident. Both the mother and child did well. Luce " speaks of a pregnant woman who was horned in the lower part of the abdomen by a cow, and had a subsequent protrusion of the intestines through the wound. After some minor complications, the wound healed fourteen weeks after the accident, and the woman was confined in natural labor of a healthy, vigorous child. In this case no blood was found on the cow's horn, and the clothing was not torn, so that the wound must have been made by the side of the horn striking the greatly distended abdomen. Richard,* quoted also by Tiffany,*^^ speaks of a woman, twenty-two, who fell in a dark cellar with some empty bottles in her hand, suffering a wound in the abdomen 2 inches above the navel on the left side 8 cm. long. Through this wound a mass of intestines, the size of a man's head, protruded. Both the mother and the child made a good convalescence. Harris " cites the instance of a woman of thirty, a multipara, six months pregnant, who was gored by a cow ; her intestines and omentum protruded through the rip and the uterus was bruised. There was rapid recovery and delivery at term. Wetmore of Illinois saw a woman who in the summer of 1860, when about six months pregnant, was gored by a cow, and the large intestine and the omentum protruded through the wound. Three hours after the injury she was found swathed in rags wet with a compound solution of whiskey and camphor, with a decoction of tobacco. The intes- tines were cold to the touch and dirty, but were washed and replaced. The abdomen was sewed up with a darning needle and black linen thread ; the woman recovered and bore a healthy child at the full maturity of her gesta- tion.'* Crowdace" speaks of a female pauper, six months pregnant, who was attacked by a buffalo, and suffered a wound about 1 J inch long and J inch wide just above the umbilicus. Through this small opening 19 inches of intestine protruded. The woman recovered, and the fetal heart-beats could be readily auscultated. Major accidents in pregnant women are often followed by the happiest results. There seems to be no limit to what the pregnant uterus can success- fully endure. Tiffany,*^' who has collected some statistics on this subject, as well as on operations successfully performed during pregnancy, which will be considered later, quotes ^ the account of a woman of twenty-seven, eight months pregnant, who was almost buried under a clay wall. She received terrible wounds about the head, 32 sutures being used in this location a 545, 1859. I) 236, 1878. c 125, xx. d Harris, 125, xx. e 500, 1863, vii:, 409. f 644, 1881, vi., 203. MAJOR ACCIDENTS IN PREGNANCY. 101 alone. Subsequently she was confined, easily bore a perfectly normal female child, and both did well. Sibois " describes the case of a woman weigh- ing 190 pounds, who fell on her head from the top of a wall from 10 to 12 feet high. For several hours she exhibited symptoms of fracture of the base of the skull, and the case was so diagnosed ; fourteen hours after the accident she was perfectly conscious and suifered terrible pain about the head, neck, and shoulders. Two days later an ovum of about twenty days was expelled, and seven months after she was delivered of a healthy boy weighing lOJ pounds. She had therefore lost after the accident one-half of a double conception. Verrier** has collected the results of traumatism during pregnancy, and summarizes 61 cases. Prowzowsky " cites the instance of a patient in the eighth month of her first pregnancy who was wounded by many pieces of lead pipe fired from a gun but a few feet distant. Neither the patient nor the child suffered materially from the accident, and gestation proceeded ; the child died on the fourth day after birth without apparent cause. Milner'^ records an instance of remarkable tolerance of injury in a pregnant woman. During her six months of pregnancy the patient was accidentally shot through the abdominal cavity and lower part of the thorax. The missile penetrated the central tendon of the diaphragm and lodged in the lung. The injury was limited by localized pneumonia and peritonitis, and the wound was drained through the lung by free expectoration. Recovery ensued, the patient giving birth to a healthy child sixteen weeks later. Belin'' mentions a stab-wound in a pregnant woman from which a considerable portion of the epiploon pro- truded. Sloughing ensued, but the patient made a good recovery, gestation not being interrupted. Fancon ^ describes the case of a woman who had an injury to the knee requiring drainage. She was attacked by erysipelas, which spread over the whole body with the exception of the head and neck ; yet her pregnancy was uninterrupted and recovery ensued. Fancon also speaks of a girl of nineteen, frightened by her lover, who threatened to stab her, who jumped from a second-story window. For three days after the fall she had a slight bloody flow from the vulva. Although she was six months pregnant there was no interruption of the normal course of gestation. Bancrofts speaks of a woman who, being mistaken for a burglar, was shot by her husband with a 44-caliber bullet. The missile entered the second and third ribs an inch from the sternum, passed through the right lung, and escaped at the inferior angle of the scapula, about three inches below the spine ; after leaving her body it went through a pine door. She suffered much hemorrhage and shock, but made a fair recovery at the end of four weeks, though pregnant with her first child at the seventh month. At full "■ 788, 1887, July 1, 345. *> Rev. M6d.-chir. d. Mai. d. Femmes, Paris, 1888, x., 529. c 812^ 1879, iv., 1113. d 533, ixi., 243. e 236, 1878. f Quoted 844, 251. 8 545,1876. 102 PRENATAL ANOMALIES. term she was delivered by foot-presentation of a healthy boy. The mother at the time of report was healthy and free from cough, and was nursing her babe, which was strong and bright. All the cases do not have as happy an issue as most of the foregoing ones, though in some the results are not so bad as might be expected. A German female, thirty-six, while in the sixth month of pregnancy, fell and struck her abdomen on a tub. She was delivered of a normal living child, with the exception that the helix of the left ear was pushed anteriorly, and had, in its middle, a deep incision, which also traversed the antihelix and the tragus, and continued over the cheek toward the nose, where it terminated. The external auditory meatus was obliterated. Gurlt speaks of a woman, seven months pregnant, who fell from the top of a ladder, subsequently losing some blood and water from the vagina. She had also persistent pains in the belly, but there was no deterioration of general health. At her confinement, which was normal, a strong boy was born, wanting the arm below the middle, at which point a white bone protruded. The wound healed and the separated arm came away after birth. Wainwright ^ relates the instance of a woman of forty, who when six months pregnant was run over by railway cars. After a double amputation of the legs she miscarried and made a good recovery. Neugebauer '" reported the history of a case of a woman who, while near her term of pregnancy, committed suicide by jump- ing from a window. She ruptured her uterus, and a dead child with a frac- ture of the parietal bone was found in the abdominal cavity. Staples ■■■ speaks of a Swede of twenty-eight, of Minnesota, who was accidentally shot by a young man riding by her side in a wagon. The ball entered the abdomen two inches above the crest of the right ilium, a little to the rear of the anterior superior spinous process, and took a downward and forward course. A little shock was felt but no serious symptoms followed. In forty hours there was delivery of a dead child with a bullet in its abdomen. Labor was normal and the internal recovery complete. Von Chelius, ^^^ quoting the younger Naegele, gives a remarkable instance of a young peasant of thirty-five, the mother of four children, pregnant with the fifth child, who was struck on the belly violently by a blow from a wagon pole. She was thrown down, and felt a tearing pain which caused her to faint. It was found that the womb had been ruptured and the child killed, for in several days it was delivered in a putrid mass, partly through the natural passage and partly through an abscess opening in the abdominal wall. The woman made a good recovery. A curious accident of pregnancy ^ is that of a woman of thirty-eight, advanced eight months in her ninth pregnancy, who after eating a hearty meal was seized by a violent pain in the region of the stomach and soon afterward with convulsions, supposed to have been puer- peral. She died in a few hours, and at the autopsy it was found that labor a 647, 1877, 59. b 732 ; and 261, 1890, 88. e 538, 1876. d 2I8, Oct. 1, 1868. OPERATIONS DURING PREGNANCY. 103 had not begun, but that the pregnancy had caused a laceration of the spleen, from which had escaped four or five pints of blood. Edge" speaks of a case of chorea in pregnancy in a woman of twenty-seven, not interrupting preg- nancy or retarding safe delivery. This had continued for four pregnancies, but in the fourth abortion took place. Buzzard '' had a case of nervous tremor in a woman, following a fall at her fourth month of pregnancy, who at term gave birth to a male child that was idiotic. Beatty " relates a curious accident to a fetus in utero. The woman was in her first confinement and was delivered of a small but healthy and strong boy. There was a small puncture in the abdominal parietes, through which the whole of the intestines protruded and were constricted. The opening was so small that he had to enlarge it with a bistoury to replace the bowel, which was dark and congested ; he sutured the wound with silver wire, but the child subsequently died. Tiffany ^'^ of Baltimore has collected excellent statistics of operations during pregnancy ; and Mann of Buffalo •* has done the same work, limit- ing himself to operations on the pelvic organs, where interference is sup- posed to have been particularly contraindicated in pregnancy. Mann, after giving his individual cases, makes the following summary and conclusions : — (1) Pregnancy is not a general bar to operations, as has been supposed. (2) Union of the denuded surfaces is the rule, and the cicatricial tissue, '^, formed during the earlier months of pregnancy, is strong enough to resist / the shock of labor at term. (3) Operations on the vulva are of little danger to mother or child. (4) Operations on the vagina are liable to cause severe hemorrhage, but otherwise are not dangerous. (5) Venereal vegetations or warts are best treated by removal. (6) Applications of silver nitrate or astringents may be safely made to the vagina. For such application, phenol or iodin should not be used, pure or in strong solution. (7) Operations on the bladder or urethra are uot dangerous or liable to be followed by abortion. (8) Operations for vesicovaginal fistulse should not be done, as they are dangerous, and are liable to be followed by much hemorrhage and abortion. (9) Plastic operations may be done in the earlier months of pregnancy with fair prospects of a safe and successful issue. (10) Small polypi may be treated by torsion or astringents. If cut, there is likely to be a subsequent abortion. (11) Large polypi removed toward the close of pregnancy will cause hemorrhage. (12) Carcinoma of the cervix should be removed at once. A few of the examples on record of operations during pregnancy of a 244, 1889, i., 516. b 476, 1868, ii., 479. c 224, 1879, i., 701. 4 764,1882. 104 PRENATAL ANOMALIES. special interest, will be given below. Polaillon " speaks of a double ovari- otomy on a woman pregnant at three months, with the subsequent birth of a living child at term. Gordon ^ reports five successful ovariotomies during pregnancy, in Lebedeff's clinic. Of these cases, 1 aborted on the fifth day, 2 on the fifteenth, and the other 2 continued uninterrupted. He collected 204 cases with a mortality of only 3 per cent. ; 22 per cent, aborted, and 69.4 per cent, were delivered at full term. Kreutzman "^ reports two cases in which ovarian tumors were successfully removed from pregnant subjects without the interruption of gestation. One of these women, a secundipara, had gone two weeks over time, and had a large ovarian cyst, the pedicle of which had become twisted, the fluid in the cyst being sanguineous. May ^ describes an ovariotomy performed during pregnancy at Tottenham Hospital. The woman, aged twenty-two, was pale, diminutive in size, and showed an enormous abdomen (Fig. 12), which measured 50 inches in circumference at the umbilicus and 27 inches from the ensiform cartilage to the pubes. At the operation, 36 pints of brown fluid were drawn off. Delivery took place twelve hours after the operation, the mother re- covering, but the child was lost. Gala- bin ^ had a case of ovariotomy performed on a woman in the sixth month of preg- nancy without interruption of pregnancy ; Potter ^ had a case of double ovariotomy with safe delivery at term ; and Storry s had a similar case. Jacobson^ cites a case of vaginal lithotomy in a patient six and a half months pregnant, with normal delivery at full term. Tiffany quotes Keelan's ' description of a woman of thirty-five, in the eighth month of pregnancy, from whom he removed a stone weighing 12 J ounces and measuring 2 by 2 J inches, with subsequent recovery and continuation of pregnancy. Rydj-gier-i mentions a case of obstruction of the intestine during the sixth month of gestation, showing symptoms of strangulation for seven days, in which he performed abdominal section. Recovery of the ^yoman without abortion ensued. The Revue de Chirurgie, 1887, contains an account of a woman who suffered internal strangulation, on whom celiotomy was performed ; she recovered in twenty-five days, and did not miscarry, which shows that severe injury to the intestine with operative interference does not necessarily interrupt pregnancy. Gilmore,"^ without inducing abortion, extirpated the kidney of a negress, aged Mg. 12. — Ovariotomy during pregnancy. (May, British Med. Jour., Deo. 2, 1893.) a 653, 1892. d 224, Dec. 2, 1893. 11476, 1889, i., 628. b 261, 1894. e 224, 1880. i 224, Oct. 15, 1887. Occidental Med. Times, Aug. , 1892. f 125, 1888. g 476, 1882. J 844, 250. k 125, May, 1871. OPERATIONS DURING PREGNANCY. 105 thirty-three, for severe and constant pain. Tiffany " removed the kidney of a woman of twenty-seven, five months pregnant, without interruption of this or subsequent pregnancies. The child was living. He says that Fancon cites instances of operation without abortion. Lovort'' describes an enucleation of the eye in the second month of pregnancy. Pilcher" cites the instance of a woman of fifty-eight, eight months in her fourth pregnancy, whose breast and axilla he removed without interruption of pregnancy. Robson,'^ Polaillon, and Coen report similar instances. Rein speaks of the removal of an enormous echinococcus cyst of the omentum without interruption of pregnancy. Robson" reports a multi- locular cyst of the ovary with extensive adhesions of the uterus, removed at the tenth week of pregnancy and ovariotomy performed without any inter- ruption of the ordinary course of labor. Russell ^ cites the instance of a woman who was successfully t apped at the sixth month of pregnancy. McLean 8 speaks of a successful amputation during pregnancy ; Napper, ^'* one of the arm ; Nicod, one of the arm ; Russell,'' an amputation through the shoulder joint for an injury during pregnancy, with delivery and recovery ; and Vesey ' speaks of amputation for compound fracture of the arm, labor following ten hours afterward with recovery. KeenJ reports the successful performance of a hip-joint amputation for malignant disease of the femur during pregnancy. The patient, who was five months advanced in gestation, recovered without aborting. Robson reports a case of strangulated hernia in the third month of preg- nancy with stercoraceous vomiting. He performed herniotomy in the femoral region, and there was a safe delivery at full term. In the second month of pregnancy he also rotated an ovarian tumor causing acute symptoms, and afterward performed ovariotomy without interfering with pregnancy. Mann quotes Mund6 in speaking of an instance of removal of elephantiasis of the vulva without interrupting pregnancy, and says that there are many cases of the removal of venereal warts without any interference with gestation. Campbell of Georgia operated inadvertently at the second and third month in two cases of vesicovaginal fistula in pregnant women. The first case showed no interruption of pregnancy, but in the second case the woman nearly died and the fistula remained unhealed. Engelmann operated on a large rectovaginal fistula in the sixth month of pregnancy without any in- terruption of pregnancy, which is far from the general result. Cazin and Rey both produced abortion by forcible dilatation of the anus for fissure, but Grayet used both the fingers and a speculum in a case at five months and the woman went to term. By cystotomy Reamy removed a double hair-pin a 533, April 16, 1887. b 238, 1887. " 648, 1879. d 224, 1889. e 224, 1879. ^ 535, 127, n. s. ii., 430-433. S 582, 1852. h476, 1872, ii., 633. * 224, 1878. J 533, March 26, 1892. 106 PRENATAL ANOMALIES. from a woman pregnant six and a half months, without interruption, and according to Mann again, McClintoclc extracted stones from the bladder by the urethra in the fourth month of pregnancy, and Phillips did the same in the seventh month. Hendenberg and Packard " report the removal of a tumor weighing 8f pounds from a pregnant uterus without interrupting ges- tation. The following extract from the University Medical Magazine of Phila- delphia illustrates the after-effects of abdominal hysteropaxy on sub- sequent pregnancies : — "Fraipont (Anncdes de la SociM6 Midico-Chirurgicale de Li^ge, 1894) re- ports four cases where pregnancy and labor were practically normal, though the uterus of each patient had been iixed to the abdominal walls. In two of the cases the hysteropexy had been performed over five years before the pregnancy occurred, and, although the bands of adhesion between the fundus and the parietes must have become very tough after so long a period, no special difficulty was encountered. In two of the cases the forceps was used, but not on account of uterine inertia ; the fetal head was voluminous, and in one of the two cases internal rotation was delayed. The placenta was always expelled easily, and no serious postpartum hemorrhage occurred. Fraipont observed the progress of pregnancy in several of these cases. The uterus does not increase specially in its posterior part, but quite uniformly, so that, as might be expected, the fundus gradually detaches itself from the abdom- inal wall. Even if the adhesions were not broken down they would of ne- cessity be so stretched as to be useless for their original purpose after deliv- ery. Bands of adhesion could not share in the process of involution. As, however, the uterus undergoes perfect involution, it is restored to its original condition before the onset of the disease which rendered hysteropexy neces- sary." The coexistence of an extensive tumor of the uterus with pregnancy does not necessarily mean that the product of conception will be blighted. Brochin ^ speaks of a case in which pregnancy was complicated with fibroma of the uterus, the accouchement being natural at term. Byrne *- mentions a case of pregnancy complicated with a large uterine fibroid. Delivery was effected at full term, and although there was considerable hemorrhage the mother recovered. Ingleby ^ describes a case of fibrous tumor of the uterus termi- nating fatally, but not until three weeks after delivery. Lusk ^ mentions a case of pregnancy with fibrocystic tumor of the uterus occluding the cervix. At the appearance of symptoms of eclampsia version was performed and delivery effected, followed by postpartum hemorrhage. The mother died from peritonitis and collapse, but the stillborn child was resuscitated. Eob- erts^ reports a case of pregnancy associated with a large fibrocellular polypus a 590, 1890, xxv., 306. b 363, xlviii., 1178. c 310, 1877, 170. d 318, li., 75. e 125, 1876, ix., 94. f 476, 1867, i., 333. PROTRUSION OF THE FETAL MEMBRANES. 107 of the uterus. A living child was delivered at the seventh month, 6crase- ment was performed, and the mother recovered. Von Quast ^ speaks of a fibromyoma removed five days after labor. Gervis " reports the removal of a large polypus of the uterus on the fifth day after confinement. Davis " describes the spontaneous expulsion of a large polypus two days after the delivery of a fine, healthy, male child. Deason ^ mentions a case of anomalous tumor of the uterus during pregnancy which was expelled after the birth of the child ; and Daly also ^ speaks of a tumor expelled from the uterus after delivery. Cathell ^ speaks of a case of pregnancy complicated with both uterine fibroids and measles. Other Fig. 13. — Large fibroid blocking the pelvis (Spiegelberg). cases of a similar nature to the foregoing are too numerous to mention. Figure 13, taken from Spiegelberg, shows a large fibroid blocking the pelvis of a pregnant woman. There are several peculiar accidents and anomalies not previously men- tioned which deserve a place here, viz., those of the membranes surround- ing the fetus. Brown s speaks of protrusion of the membranes from the vulva several weeks before confinement. Davies ^ relates an instance in which there was a copious watery discharge during pregnancy not followed " Kansas City Med. Index, 1888. "1593, 1859, xvi., 663. g 616, 1872, XT., 246. b 778, xi., 4. e 778, 1887, xxviii., 170. c 124, 1843, vi., 519. f 775, 1886, 157. h 537, 1834. 108 PRENATAL ANOMALIES. by labor. There is a case mentioned " in which an accident and an inoppor- tune dose of ergot at the fifth month of pregnancy were followed by rupture of the amniotic sac, and subsequently a constant flow of watery fluid con- tinued for the remaining three months of pregnancy. The fetus died at the time, and was born in an advanced state of putrefaction, by version, three months after the accident. The mother died five months after of carcinoma of the uterus. Montgomery ^ reports the instance of a woman who menstru- ated last on May 22, 1850, and quickened on September 26th, and continued well until the 11th of November. At this time, as she was retiring, she became conscious that there was a watery discharge from the vagina, which prove'd to be liquor amnii. Her health was good. The discharge continued, her size increased, and the motions of the child continued active. On the 18th of January a full-sized eight months' child was born. It had an incessant, wailing, low cry, always of evil augury in new-born infants. The child died shortly after. The daily discharge was about 5 ounces, and had lasted sixty- eight days, making 21 pints in all. The same accident of rupture of the membranes long before labor happened to the patient's mother. Bardt " speaks of labor twenty-three days after the flow of the waters ; and Cobleigh * one of seventeen days ; Bradley " relates the history of a case of rupture of the membranes six weeks before delivery. Rains ^ cites an instance in which gestation continued three months after rupture of the membranes, the labor-pains lasting thirty-six hours. Griffiths ^^* speaks of rupture of the amniotic sac at about the sixth month of pregnancy with no untoward interruption of the completion of gestation and with delivery of a living child. There is another observation s of an accouchement terminating successfully twenty-three days after the loss of the amniotic fluid. Camp- bell'^ mentions delivery of a living child twelve days after rupture of the membranes. Chesney ' relates the history of a double collection of waters. WoodJ reports a case in which there was expulsion of a bag of waters be- fore the rupture of the membranes. Bailly, Chestnut, Bjering, Cowger, Duncan, and others also record premature rupture of the membranes with- out interruption of pregnancy. Harris ^ gives an instance of the membranes being expelled from the uterus a few days before delivery at the full term. Chatard, Jr.,' mentions extrusion of the fetal membranes at the seventh month of pregnancy while the patient was taking a long afternoon walk, their subsequent retraction, and normal labor at term. Thurston ■" tells of a case in which Nature had ap- parently effected the separation of the placenta without alarming hemorrhage, the case being one of placenta prsevia, terminating favorably by natural pro- a 366, 1844-45, v., 163. b 308, 1857. o 463, xiii., 33. d 545, 1877, xxxvii. e 224, 1871, ii., 612. f 131, 1875, iii., 253. g 461, 1807, xiii., 33. 1 218, Ixxxvii., 196. i 481, 1868-69, ii., 346. j Month. Jour. Med. Sci., Lond. and Edinb., ix., 853. k778, vii., 47. 1 125, 1886. m224, 1884. ANOMALIES OF THE UMBILICAL CORD. 109 cesses. Playfair* speaks of the detachment of the uterine decidua without the interruption of pregnancy. Guerrant* gives a unique example of normal birth at full term in which the placenta was found in the vagina, but not a vestige of the membranes was noticed. The patient had experienced nothing unusual until within three months of expected confinement, since which time there had been a daily loss of water from the uterus. She recovered and was doing her work. There was no possibility that this was a case of retained secundines. Anomalies of the Umbilical Cord. — Absence of the membranes has its counterpart in the deficiency of the umbilical cord, so frequently noticed in old reports. The Ephemerides, Osiander, Stark's Archives,^^" Thiebault, van der Wiel, Chatton, and Schurig '^^ all speak of it, and it has been noticed since. Danthez " speaks of the development of a fetus in spite of the absence of an umbilical cord. Stute ^ reports an observation of total absence of the umbilical cord, with placental insertion near the cervix of the uterus. There is mentioned ® a bifid funis. The Ephemerides ' and van der Wiel speak of a duplex funis. Nolde^ reports a cord 38 inches long; and Werner '' cites the instance of a funis 51 inches long. There are modern in- stances in which the funis has been bifid or duplex, and there is also a case reported in which there were two cords in a twin pregnancy, each of them measuring five feet in length. The Lancet ' gives the account of a most pe- culiar pregnancy consisting of a placenta alone, the fetus wanting. What this " placenta " was will always be a matter of conjecture. Occasionally death of the fetus is caused by the formation of knots in the cord, shutting off the fetal circulation ; G6ry, Grieve, Mastin, Passot, Piogey, Woets, and others report instances of this nature. Newman J reports a curious case of twins, in which the cord of one child was encircled by a knot on the cord of the other. Among others, Latimer ^ and Motte ^ report instances of the accidental tying of the bowel with the funis, causing an arti- ficial anus. The diverse causes of abortion are too numerous to attempt giving them all, but some are so curious and anomalous that they deserve men- tion. Epidemics of abortion are spoken of by Fickius, Fischer, and the Ephemerides. Exposure to cold is spoken of as a cause,"" and the same is alluded to by the Ephemerides ; " while another case is given as due to exposure while nude." There are several cases among the older writers in which odors are said to have produced abortion, but as analogues are not to be found in modern literature, unless the odor is very poisonous or pungent, we can give them but little credence. The Ephemerides gives the a 610, 1879-80. ^ 609, 1879-80, ii., 480. <= 368, 1842. d 363, xxix., 498. e Solingen,742 f 104, dec. i., ann. i., obs. 39. e 160, vii., 197. h 160, vii., 523. i 476, 1842-43. J 318, 1858, iv., 8-10. ^545, xlvi., 242. 1 242, liv., 494. m 108, dec. i., ann. ii., 121. n 104, dee. ii., ann. i., obs. 116. ° 664, T. iv. 110 PRENATAL ANOMALIES. odor of urine as provocative of abortion ; Sulzberger,* Meyer/^' and Alber^ tus "^ all mention odors ; and Vesti gives as a plausible cause ^ the odor of carbonic vapor. The Ephemerides " mentions singultus as a cause of abor- tion. Mauriceau,^'^ Pelargus, and Valentini ^^3 mention coughing. Hippo- crates mentions ^ the case of a woman who induced abortion by calling exces- sively loud to some one. Fabricius Hildanus ^^* speaks of abortion following a kick in the region of the coccyx. GuUmannus ■" speaks of an abortion which he attributes to the woman's constant neglect to answer the calls of nature, the rectum being at all times in a state of irritation from her negli- gence. Hawley ^ mentions abortion at the fourth or fifth month due to the absoKption of spirits of turpentine. Solingen'*^ speaks of abortion produced by sneezing. Osiander '^^ cites an instance in which a woman suddenly arose, and in doing so jolted herself so severely that she produced abortion. Hip- pocrates speaks of extreme hunger as a cause of abortion. Treuner e speaks of great anger and wrath in a woman disturbing her to the extent of producing abortion. The causes that are observed every day, such as tight lacing, excessive I venery, fright, and emotions, are too well known to be discussed here. There has been reported a recent case of abortion following a viper-bite, and analogues may be found in the writings of Severinus and Oedman, who mention viper-bites as the cause ; but there are so many associate conditions accompanying a snake-bite, such as fright, treatment, etc., any one of which could be a cause in itself, that this is by no means a reUable explanation. In- formation from India on this subject would be quite valuable. The Ephemerides speak of bloodless abortion, and there have been modern instances in which the hemorrhage has been hardly noticeable. Abortion in a twin pregnancy does not necessarily mean the abortion or death of both the products of conception. Chapman ^ speaks of the case of the expulsion of a blighted fetus at the seventh month, the living child remaining to the full term, and being safely delivered, the placenta following. Crisp' says of a case of labor that the head of the child was obstmcted by a round body, the nature of which he was for some time unable to determine. He managed to push the obstructing body up and delivered a living, full-term child ; this was soon followed by a blighted fetus, which was 1 1 inches long, weighed 12 ounces, with a placenta attached weighing 6| ounces. It is quite common for a blighted fetus to be retained and expelled at term with a living child, its twin. Bacon J speaks of twin pregnancy, with the death of one fetus at the fourth month and the other delivered at term. Beall ^ reports the conception of twins, - Diss, deaborta, c. 6. b Diss, de abortu, 21. '^ 476, dec. ii., ann. 2, obs. 62. d 416, opp. iv., 600. » 105, 1730, ii., 374. f 231, 1858-59, xiv., 469. g 160, B. iv., 527. b 550, ix., 194. i 779, xviii., 272. J Clinique, Chicago, vii., 403. k703, xviii., 122. WORMS IN THE UTEEUS. Ill with one fetus expelled and the other retained ; Beauchamp cites a similar instance. Bothwell " describes a twin labor at term, in which one child was living and the other dead at the fifth month and macerated. Belt '' reports an analogous case. Jameson " gives the history of an extraordinary case of twins in which one (dead) child was retained in the womb for- forty-nine weeks, the other having been born alive at the expiration of nine months. Hamilton ^ describes a case of twins in which one fetus died from the effects of an injury between the fourth and fifth months and the second arrived at full period. Moore " cites an instance in which one of the fetuses perished about the third month, but was not expelled until the seventh, and the other was carried to full term. Wilson ^ speaks of a secondary or blighted fetus of the third month with fatty degeneration of the membranes retained and expelled with its living twin at the eighth month of uterogestation. There was a case at Riga in 1839 of a robust girl who conceived in Feb- ruary, and in consequence her menses ceased. In June she aborted, but, to her dismay, soon afterward the symptoms of advanced pregnancy appeared, and in November a full-grown child, doubtless the result of the same impregna- tion as the fetus, was expelled at the fourth month. In 1860 Schuh reported an instance before the Vienna Faculty of Medicine in which a fetus was dis- charged at the third month of pregnancy and the other twin retained until full term. The abortion was attended with much metrorrhagia, and ten weeks afterward the movements of the other child could be plainly felt and pregnancy continued its course uninterrupted. Bates ^ mentions a twin preg- nancy in which an abortion took place at the second month and was followed by a natural birth at full term. Hawkins ^ gives a case of miscarriage, followed by a natural birth at full term ; and Newnham * cites a similar instance in which there was a miscarriage at the seventh month and a birth at full term. Worms in the Uterus. — Haines J speaks of a most curious case — that of a woman who had had a miscarriage three days previous ; she suffered intense pain and a fetid discharge. A number of maggots were seen in the vagina, and the next day a mass about the size of an orange came away from the uterus, riddled with holes, and which contained a number of dead maggots, Idlled by the carbolic acid injection given soon after the miscarriage. The fact seems inexplicable, but after their expulsion the symptoms immediately ameliorated. This case recalls a somewhat similar one given by the older writers, in which a fetus was eaten by a worm.'^ Analogous are those cases spoken of by Bidel ' of lumbricoides found in the uterus ; by Hole,™ in which maggots were found in the vagina and uterus ; and Simpson," in which the a 224, 1889, ii., 717. •> 124, 1855, xxix. o 310, 1842-43, xxii., 15. 11312, 1843. e 519, 1870, iv., 208. f Month. Jour. Med., Lond., 1855. g 771, 1874. ^ 772, 1881. i 776, 1823. J 476, 1889, i., 16. ^ 104, dec. iii., ann. 7 and 8, obs. 32. 1 235, 1856, li., 549. m 543, 1889-90. » 600, 1878-79, 129. 112 PRENATAL ANOMALIES. abortion was caused by worms in the womb — if the associate symptoms were trustworthy. We can find fabulous parallels to all of these in some of the older writings. Par6 " mentions Lycosthenes' account of a woman in Cracovia in 1494 who bore a dead child which had attached to its back a live serpent, which had gnawed it to death. He gives an illustration (Fig. 14) showing the serpent in situ. He also quotes the case of a woman who conceived by a mariner, and who, after nine months, was delivered by a midwife of a shapeless mass, followed by an animal with a long neck, blazing eyes, and clawed feet. Bal- lantyne ^ says that in the writings of Hippocrates there is in the work on " Diseases " {Ilepi vouawv^, which is not usually regarded as genuine, a some- Fig. 14.— Serpent in a fetus (after ParS). what curious statement with regard to worms in the fetus. It is affirmed that flat worms develop in the unborn infant, and the reason given is that the feces are expelled so soon after birth that there would not be sufficient time during extrauterine life for the formation of creatures of such a size. The same remark applies to round worms. The proof of these statements is to be found in the fact that many infants expel both these varieties of parasites with the first stool. It is difficult to know what to make of these opinions ; for, with the exception of certain cases in some of the seventeenth and eighteenth century writers, there are no records in medicine of the occurrence of vermes in the infant at birth. It is possible that other things, such as dried pieces of mucus, may have been erroneously regarded as worms. * ^^^' '''33. b 759_ Oct., 1895. CHAPTER III. OBSTETRIC ANOMALIES. General Considerations. — In discussing obstetric anomalies we shall first consider those strange instances in which stages of parturition are uncon- scious and for some curious reason the pains of labor absent. Some women are anatomically constituted in a manner favorable to child-birth, and pass through the experience in a comparatively easy manner ; but to the great majority the throes of labor are anticipated with extreme dread, particularly by the victims of the present fashion of tight lacing. It seems strange that a physiologic process like parturition should be attended by so much pain and difficulty. Savages in their primitive and natural state seem to have difficulty in many cases, and even animals are not free from it. We read of the ancient wild Irish women breaking the pubic bones of their female children shortly after birth, and by some means preventing union subsequently, in order that these might have less trouble in child-birth — as it were, a modified and early form o f; symphysiotoniyr~'> [n consequence of this custom the females of this race, to quote an old English authority, had a " waddling, lamish gesture in their going." These old writers said that for the same reason the women in some parts of Italy broke the coccyxes of their female children. This report is very likely not veracious, because this bone spontaneously repairs itself so quickly and easily. Rodet and Engelmann,^^^ in their most extensive and interesting papers on the modes of accouchement among the primitive peoples, substantiate the fear, pain, and difficulty with which labor is attended, even in the lowest grades of society. In view of the usual occurrence of pain and difficulty with labor, it seems natural that exceptions to the general rule should in all ages have attracted the attention of medical men, and that literature should be replete with such instances. Pechlin*^^ and Maas^ record instances of painless births. The Ephemerides records a birth as having occurred during asphyxia, and also one during an epileptic attack. Storck also speaks of birth during unconsciousness in an epileptic attack ; and Haen ^^^ and others '' describe cases occurring during the coma attending apoplectic attacks. King" reports the histories of two married women, fond mothers and anticipat- ing the event, who gave birth to children, apparently unconsciously. In » 601, 315. b 708, 1719, ii., 610. <= 546, 1847, xvi., 234. 8 113 114 OBSTETRIC ANOMALIES. the first case, the appearance of the woman verified the assertion ; in the second, a transient suspension of the menstrual influence accounted for it. After some months epilepsy developed in this case. Crawford ^ speaks of a Mrs. D., who gave birth to twins in her first confinement at full term, and who two years after aborted at three months. In December, 1868, a year after the abortion, she was delivered of a healthy, living fetus of about five or six months' growth in the following manner : While at stool, she discovered something of a shining, bluish appearance protruding thi'ough the external labia, but she also , found that when she lay down the tumor disappeared. This tumor proved to be the child, which had been expelled from the uterus four days before, with the waters and membranes intact, but which had not been recognized ; it had passed through the os without pain or symptoms, and had remained alive in the vagina over four days, from whence it was delivered, presenting by the foot. The state of intoxication seems by record of several cases to render birth painless and unconscious, as well as serving as a means of anesthesia in the preanesthetic days. The feasibility of practising hypnotism in child-birth has been dis- cussed, and Fanton^ reports 12 cases of parturition under the hypnotic influ- ence. He says that none of the subjects suffered any pain or were aware of the birth, and offers the suggestion that to facilitate the state of hypnosis it should be commenced before strong .uterine contractions have occurred. Instances of parturition or delivery during sleep, lethargies, trances, and similar conditions are by no means uncommon. Heister " speaks of birth during a convulsive somnolence, and Osiander "^ of a case during sleep. Mont- gomery relates the case of a lady, the mother of several children, M^ho on one occasion was unconsciously delivered in sleep. Case " relates the instance of a French woman residing in the town of Hopedale, who, though near confine- ment, attributed her symptoms to over-fatigue on the previous day. "When summoned, the doctor found that she had severe lumbar pains, and that the os was dilated to the size of a half-dollar. At ten o'clock he suggested that everyone retire, and directed that if anything of import occurred he should be called. About 4 A. M. the husband of the girl, in great fright, summoned the physician, saying : " Monsieur le Medecin, il y a quelque chose entre les jambes de ma femme," and, to Dr. Case's surprise, he found the head of a child wholly expelled during a profound sleep of the mother. In twenty minutes the secundines followed. The patient, who was only twenty years old, said that she had dreamt that something was the matter with her, and awoke with a fright, at which instant, most probably, the head was expelled. She was afterward confined with the usual labor-pains. Palfrey f speaks of a woman, pregnant at term, who fell into a sleep about a 579, 1868-69, n. s., iv., 305-8. b 168, 1890. ^ 402, xii., 103. d 13,j, ii., 74. e 124, ,J,iu., 1868. f 476, 1«64, i., 36. DELIVERY DURING SLEEP, ETC. 115 eleven o'clock, and dreamed that she was in great pain and in labor, and that sometime after a fine child was crawling over the bed. After sleeping for about four hours she awoke and noticed a discharge from the vagina. Her husband started for a light, but before he obtained it a child was born by a head-presentation. In a few minutes the labor-pains returned and the feet of a second child presented, and the child was expelled in three pains, followed in ten minutes by the placenta. Here is an authentic case in which labor pro- gressed to the second stage during sleep. Weill " describes the case of a woman of twenty-three who gave birth to a robust boy on the 16th of June, 1877, and suckled him eleven months. This birth lasted one hour. She became pregnant again and was delivered under the following circumstances : She had been walking on the evening of Sep- tember 5th and returned home about eleven o'clock to sleep. About 3 A. M. she awoke, feeling the necessity of passing urine. She arose and seated herself for the purpose. She at once uttered a cry and called her husband, telling him that a child was born and entreating him to send for a physician. Weill saw the woman in about ten minutes and she was in the same position, so he ordered her to be carried to bed. On examining the urinal he found a female child weighing 10 pounds. He tied the cord and cared for the child. The woman exhibited little hemorrhage and made a complete recovery. She had apparently slept soundly through the uterine contractions until the final strong pain, which aWoke her, and which she imagined was a call for urina- tion. Samelson ^ says that in 1844 he was sent for in Zabelsdorf, some 30 miles from Berlin, to attend Hannah Rhode in a case of labor. She had passed easily through eight parturitions. At about ten o'clock in the morning, after a partially unconscious night, there was a sudden gush of blood and water from the vagina ; she screamed and lapsed into an unconscious condition. At 10.35 the face presented, soon followed by the body, after which came a great flow of blood, welling out in several waves. The child was a male, middle-sized, and was some little time in making himself heard. Only by degrees did the woman's consciousness return. She felt weary and inclined to sleep, but soon after she awoke and was much surprised to know what had happened. She had seven or eight pains in all. Schultze " speaks of a woman who, arriving at the period for delivery, went into an extraordinary state of somnolence, and in this condition on the third day bore a living male child. Berthier .in 1859 observed a case of melancholia with delirium wliich continued through pregnancy. The woman was apparently unconscious of her condition and was delivered without pain. Cripps ^ mentions a case in which there was absence of pain in parturition. Depaul "= mentions a woman who fell in a public street and was delivered of a living child during a a Quoted, 224, 1881, ii., 871. b 224, 1865, ii., Nov. e 476, 1845, i. d476, 1841-42, ii., 367. ^ J. d. sages-femmes, Tar., 1882, 9. 116 OBSTETRIC ANOMALIES. syncope which lasted four hours. Epley * reports painless labor in a patient with paraplegia. Fahnestock *> speaks of the case of a woman who was deliv- ered of a son while in a state of artificial somnambulism, without pain to herself or injury to the child. Among others mentioning painless or unconscious labor are Behrens (during profound sleep), Eger, Tempel, Panis, Agnoia, Blanckmeister, Whitehill, Gillette, Mattel, Murray, Lemoine, and Moglichkeit. Rapid Parturition Without Usual Symptoms. — Births unattended by symptoms that are the usual precursors of labor often lead to speedy deliveries iu awkward places. According to Willoughby,*^ in Darby, February 9, 1667, a poor fool, Mary Baker, while wandering in an open, windy, and cold place, was delivered by the sole assistance of Nature, Eve's midwife, and freed of her afterbirth. The poor idiot had leaned against a wall, and dropped the child on the cold boards, where it lay for more than a quarter of an hour with its funis separated from the placenta. She was only discovered by the cries of the infant. In " Carpenter's Physiology " " is described a remarkable case of instinct in an idiotic girl in Paris, who had been seduced by some miscreant ; the girl had gnawed the funis in two, in the same manner as is practised by the lower animals. From her mental imbecility it can hardly be imagined that she had any idea of the object of this separation, and it must have been instinct that impelled her to do it. Sermon'^^ says the wife of Thomas James was delivered of a lusty child while in a wood by herself. She put the child in an apron with some oak leaves, marched stoutly to her husband's uncle's house a half mile distant, and after two hours' rest went on her journey one mile farther to her own house ; despite all her exer- tions she returned the next day to thank her uncle for the two hours' accom- modation. There is related * the history of a case of a woman Avho was delivered of a child on a mountain during a hurricane, who took off her gown and wrapped the child up in it, together with the afterbirth, and walked two miles to her cottage, the funis being unruptured. Harvey relates a case, which he learned from the President of Munster, Ireland, of a woman with child who followed her husband, a soldier in the army, in daily march. They were forced to a halt by reason of a river, and the woman, feeling the pains of labor approaching, retired to a thicket, and there alone brought forth twins. She carried them to the river, washed them herself, did them up in a cloth, tied them to her back, and that very day marched, barefooted, 12 miles with the soldiers, and was none the worse for her experience. The next day the Deputy of Ireland and the President of Munster, affected by the story, to repeat the words of Harvey, " did both vouchsafe to be godfathers of the infants." Willoughby^^* relates the account of a woman who, having a cramp while in bed with her sister, went to an outhouse, as if to stool, and was there delivered of a child. She quickly returned to bed, her going and her return a 597, xxxvii., 233. b 218, xxxv,, 194. <= igt edition, 219. d 279, 1857. RAPID PARTURITION WITHOUT USUAL SYMPTOMS. 117 not being noticed by her sleeping sister. She buried the child, " and after- ward confessed her wickedness, and was executed in the Staiford Gaol, March 31, 1670." A similar instance is related by the same author of a servant in Darby in 1647. Nobody suspected her, and when delivered she was lying in the same room with her mistress. She arose without awakening anyone, and took the recently delivered child to a remote place, and hid it at the bottom of a feather tub, covering it with feathers ; she returned without any suspi- cion on the part of her mistress. It so happened that it was the habit of the Darby soldiers to peep in at night where they saw a light, to ascertain if everything was all right, and they thus discovered her secret doings, which led to her trial at the next sessions at Darby. Wagner* relates the history of a case of great medicolegal interest. An- unmarried servant, who was pregnant, persisted in denying it, and took every pains to conceal it. She slept in a room with two other maids, and, on ex- amination, she stated that on the night in question she got up toward morn- ing, thinking to relieve her bowels. For tliis purpose she secured a wooden tub in the room, and as she was sitting down the child passed rapidly into the empty vessel. It was only then that she became aware of the nature of her pains. She did not examine the child closely, but was certain it neither moved nor cried. The funis was no doubt torn, and she made an attempt to tie it. Regarding the event as a miscarriage, she took up the tub with its contents and carried it to a sand pit about 30 paces distant, and threw the child in a hole in the sand that she found already made. She covered it up with sand and packed it firmly so that the dogs could not get it. She re- turned to her bedroom, first calling up the man-servant at the stable. She awakened her fellow-servants, and feeling tired sat down on a stool. Seeing the blood on the floor, they asked her if she had made way with the child. She said : " Do you take me for an old sow ? " But, having their suspicions aroused, they traced the blood spots to the sand pit. Fetching a spade, they dug up the child, which was about one foot below the surface. On the access of air, foUoM'ing the removal of the sand and turf, the child began to cry, and was immediately taken up and carried to its mother, who washed it and laid it on her bed and soon gave it the breast. The child was healthy with the exception of a club-foot, and must have been under ground at least fifteen minutes and no air could have reached it. It seems likely that the child was born asphyxiated and was buried in this state, and only began to assume in- dependent vitality when for the second time exposed to the air. This curious case was verified to English correspondents by Dr. Wagner, and is of unques- tionable authority ; it became the subject of a thorough criminal investiga- tion in Germany. During the funeral procession of Marshal MacMahon in Paris an enor- mous crowd was assembled to see the cortege pass, and in this crowd was a a 554, Jan. 17, 1838. 118 OBSTETRIC ANOMALIES. woman almost at the time of delivery ; the jostling which she received in her endeavors to obtain a place of vantage was sufficient to excite contraction, and, in an upright position, she gave birth to a fetus, which fell at her feet. The crowd pushed back and made way for the ambulance officials, and mother and child were carried off, the mother apparently experiencing little embarrass- ment. Quoted by Taylor, ^^' Anderson speaks of a woman accused of child murder, who walked a distance of 28 miles on a single day with her two- days-old child on her back. There is also a case of a female servant '■^ named Jane May, who was fre- quently charged by her mistress with pregnancy but persistently denied it. On October 26th she was sent to market with some poultry. Returning home, she asked the boy who drove her to stop and allow her to get out. She went into a recess in a hedge. In five minutes she was seen to leave the hedge and follow the cart, walking home, a distance of a mile and a half The following day she went to work as usual, and would not have been found out had not a boy, hearing feeble cries from the recess of the hedge, summoned a passer-by, but too late to save the child. At her trial she said she did not see her babe breathe nor cry, and she thought by the sudden birth that it must have been a still-born child. Shortt •" says that one day, while crossing the esplanade at Villaire, between seven and eight o'clock in the morning, he perceived three Hindoo women with large baskets of cakes of " bratties " on their heads, coming from a village about four miles distant. Suddenly one of the women stood still for a minute, stooped, and to his surprise dropped a fully developed male child to the ground. One of her companions ran into the town, about 100 yards distant, for a knife to divide the cord. A few of the female passers-by formed a screen about the mother with their clothes, and the cord was divided. The after-birth came away, and the woman was removed to the town. It was afterward discovered that she was the mother of two children, was twenty-eight years old, had not the slightest sign of approaching labor, and was not aware of parturition until she actually felt the child between her thighs. Smith of Madras, in 1862, says he was hastily summoned to see an English lady who had borne a child without the slightest warning. He found the child, which had been born ten minutes, lying close to the mother's body, with the funis uncut. The native female maid, at the lady's orders, had left the child untouched, lifting the bed-clothes to give it air. The lady said that she arose at 5.30 feeling well, and during the forenoon had walked down a long flight of steps across a walk to a small summer-house within the enclosure of her grounds. Feeling a little tired, she had lain down on her bed, and soon experienced a slight discomfort, and was under the impression that something solid and warm was lying in contact with her person. She directed the ser- vant to look below the bed-clothes, and then a female child was discovered. a 548, 1867, i., 500. b 773, 1863. UNUSUAL PLACES OF BIRTH. 119 Her other labors had extended over six hours, and were preceded by all the signs distinctive of childbirth, which fact attaches additional interest to the case. The ultimate fate of the child is not mentioned. Smith quotes Wilson, who said he was called to see a woman who was delivered without pain while walking about the house. He found the child on the floor with its umbilical cord torn across. Langston * mentions the case of a woman, twenty-three, who, between 4 and 5 A. M., felt griping pains in the abdomen. Knowing her condition, she suspected labor, and determined to go to a friend's house where she could be confined in safety. She had a distance of about 600 yards to go, and when she was about half way she was delivered in an upright position of a child, which fell on the pavement and ruptured its funis in the fall. Shortly after, the placenta was expelled, and she proceeded on her journey, carrying the child in her arms. At 5.50 the physician saw the woman in bed, looking well and free from pain, but complaining of being cold. The child, which was her first, was healthy, well nourished, and normal, with the exception of a slight ecchymosis of the parietal bone on the left side. The funis was lacerated transversely four inches from the umbilicus. Both mother and child progressed favorably. • Doubtless the intense cold had so contracted the blood-vessels as to prevent fatal hemorrhage to mother and child. This case has a legal bear- ing in the supposition that the child had been killed in the fall. There is reported^ the case of a woman in Wales, who, while walking with her husband, was suddenly seized with pains, and would have been delivered by the wayside but for the timely help of Madame Patti, the celebrated diva, who was driving by, and who took the woman in her carriage to her palatial residence close by. It was to be christened in a few days with an appropriate name in remembrance of the occasion. Coleman'^ met an instance in a mar- ried woman, who without the slightest warning was delivered of a child while standing near a window in her bedroom. The child fell to the floor and ruptured the cord about one inch from the umbilicus, but with speedy attention the happiest results were attained. Twitchell ^ has an example in the case of a young woman of seventeen, who was suddenly delivered of a cliild while ironing some clothes. The cord in this case was also ruptured, but the child sustained no injury. Taylor ^^^ quotes the description of a child who died from an injury to the head caused by dropping from the mother at an unexpected time, while she was in the erect position ; he also speaks of a parallel case on record. Unusual Places of Birth. — Besides those mentioned, the other awkward positions in which a child may be born are so numerous and diversified that mention of only a few can be made here. Colton^ tells of a painless labor in an Irish girl of twenty-three, who felt a desire to urinate, and while seated on a 476, 1864, i., 637. »> 548, 1887, ij., 157. <= 476, 1864, ii., 377. d 476, 1864, 476. « 520, 1879, i., 68. 120 OBSTETRIC ANOMALIES. the chamber dropped a child. She never felt a labor-pain, and twelve days after- ward rode 20 miles over a rough road to go to her baby's funeral. Leonhard ^ describes the case of a mother of thirty-seven, who had borne six children alive, who was pregnant for the tenth time, and who had miscalculated her pregnancy. During pregnancy she had an attack of small-pox and suffered all through preg- nancy with constipation. She had taken a laxative, and when returning to bed from stool was surprised to find herself attached to the stool by a band. The child in the vessel began to cry and was separated from the woman, who returned to bed and suddenly died one-half hour later. The mother was entirely unconscious of the delivery. Westphal ^ mentions a delivery in a water-closet. Brown " speaks of a woman of twenty-six who had a call of nature while in bed, and while sitting up she gave birth to a fine, full-grown child, which, falling on the floor, ruptured the funis. She took her child, lay down with it for some time, and feeling easier, hailed a cab, drove to a hospital with the child in her arms, and wanted to walk upstairs. She was put to bed and delivered of the placenta, there being but little hemorrhage from the cord ; both she and her child made speedy recoveries. Thebault ^ reports an instance of delivery in the erect position, with rupture of the funis at the placenta. There was recently a rumor, probably a newspaper fabrication, that a woman while at stool in a railway car gave birth to a child which was found alive on the track afterward. There is a curious instance on record in which a child was born in a hip- bath and narrowly escaped drowning.'' The mother was a European woman aged forty, who had borne two children, the last nine years before. She was supposed to have dropsy of the abdomen, and among other treatments was the use of a speculum and caustic applications for inflammation of the womb. The escape of watery fluid for two days was considered evidence of the rup- ture of an ovarian cyst. At the end of two days, severe pains set in, and a warm hip-bath and an opiate were ordered. "While in the bath she bore a fully-matured, living, male child, to the great surprise of herself and her friends. The child might have been drowned had not assistance been close at hand. Birth by the Rectum. — In some cases in which there is some obstacle to the delivery of a child by the natural passages, the efforts of nature to expel the product of conception lead to an anomalous exit. There are some details of births by the rectum mentioned in the last century by Reta and others. Payne ^ cites the instance of a woman of thirty-three, in labor thirty- six hours, in whom there was a congenital absence of the vaginal orifice. The finger, gliding along the perineum, arrived at a distended anus, just inside of which was felt a fetal head. He anesthetized the patient and delivered the n 554, No. 24, 1837. b 807, xxi., 329. c 224, April 3, 1863. a 809, 1875, ii., 230. e 548, 1862, ii., 396. f 491, 1886, 542. BIRTH THROUGH PERINEAL PERFORATION. 121 child with forceps, and without perineal rupture. There was little hemor- rhage, and the placenta was removed with slight difficulty. Five mouths later Payne found an unaltered condition of the perineum and vicinity ; there was absence of the vaginal orifice, and, on introducing the finger along the anterior wall of the rectum, a fistula was found, communicating with the vagina; above this point the arrangement and the situation of the parts were normal. The woman had given birth to three still-born children, and always menstru- ated easily. Coitus always seemed satisfactory, and no suspicion existed in the patient's mind, and had never been suggested to her, of her abnormality. Harrison* saw a fetus delivered by the anus after rupture of the uterus; the membranes came away by the same route. In this case the neck of the uterus was cartilaginous and firmly adherent to the adjacent parts. In seven days after the accouchement the woman had completely regained her health. Vallisneri™^ reports the instance of a woman who possessed two uteruses, one communicating with the vagina, the other with the rectum. She had permitted rectal copulation and had become impregnated in this manner. Louis, the celebrated French surgeon, created a furore by a pamphlet entitled *'De partium externarum generationi inservientium in mulieribus naturali vitiosa et morbosa dispositione, etc.," for which he was punished by the Sor- bonne, but absolved by the Pope. He described a young lady who had no vaginal opening, but who regularly menstruated by the rectum. She allowed her lover to have connection with her in the only possible way, by the rectum, which, however, sufficed for impregnation, and at term she bore by the rec- tum a well-formed child. Hunter'' speaks of a case of pregnancy in a woman with a double vagina, who was delivered at the seventh month by the rectum. Mekeln'^ and Andrews'^ give instances of parturition through the anus. Morisani^ describes a case of extrauterine pregnancy with tubal rupture and discharge into the culdesac, in which there was delivery by the rectum. After an attack of severe abdominal pain, followed by hemorrhage, the woman ex- perienced an urgent desire to empty the rectum. The fetal movements ceased, and a recurrence of these symptoms led the patient to go to stool, at which she passed blood and a seromucoid fluid. She attempted manually to remove the oifending substances from the rectum, and in consequence grasped the leg of a fetus. She was removed to a hospital, where a fetus nine inches long was removed from the rectum. The rectal opening gradually cicatrized, the sac became obliterated, and the woman left the hospital well. Birth Through Perineal Perforation. — Occasionally there is perineal perforation during labor, with birth of the child through the opening. Brown ^ mentions a case of rupture of the perineum with birth of a child between the vaginal opening and the anus. Cassidys reports a case of child-birth through the perineum. A successful operation was performed fifteen days after the a Reportorio Med.-Chirurg. di Torino, 1825. l> Trans. N. Y. Obs. Soc, 3879, i., 348. <= 372, 1833, 184. d 526, 1839. e 838, 1889. f 476, 1860, i., 496. S 545, ix., 192. 122 OBSTETRIC ANOMALIES. accident. Dupuytren" speaks of the passage of an infant through a central opening of the perineum. Capuron, Gravis, and Lebrun all report accouche- ment through a perineal perforation, without alteration in the sphincter ani or the fourchet. In his " Diseases of Women " Simpson speaks of a fistula left by the passage of an infant through the perineum. Wilson, Toloshinoff, Stolz, Argles, Demarquay, Harley, Hernu, Martyn, Lamb, Mor&re, Pollock, and others record the birth of children through perineal perforations. Birth Through the Abdominal Wall. — HoUerius^^^ gives a very pecu- liar instance in which the abdominal walls gave way from the pressure exerted by the fetus, and the uterus ruptured, allowing the child to be extracted by the hand from the umbilicus ; the mother made a speedy recovery. In such cases delivery is usually by means of operative interference (which will be spoken of later), but rarely, as here, spontaneously. Farquharson ^ and 111 ° both mention rupture of the abdominal parietes during labor. There have been cases reported in which the recto-vaginal septum has been ruptured, as well as the perineum and the sphincter ani, giving all the appear- ance of a birth by the anus. There is an account* of a female who had a tumor projecting between the vagina and rectum, which was incised through the intestine, and proved to be a dead child. Saviard'^^ reported what he considered a rather unique case, in which the uterus was ruptured by external violence, the fetus being thrown forward into the abdomen and afterward extracted from an umbilical abscess. Birth of the Fetus Enclosed in the Membranes. — Harvey*"* says that an infant can rest in its membranes several hours after birth without loss of life. Schurig^^^ eventrated a pregnant bitch and her puppies lived in their membranes half an hour. Wrisberg cites three observations of infants born closed in their membranes ; one lived seven minutes ; the other two nine minutes ; all breathed when the membranes were cut and air admitted. Willoughby*^ recorded the history of a case which attracted much comment at the time. It was the birth of twins enclosed in their secundines. The sac was opened and, together with the afterbirth, was laid over some hot coals ; there was, however, a happy issue, the children recovering and living. Since Wil- loughby's time several cases of similar interest have been noticed, one in a woman ^ of forty, who had been married sixteen years, and who had had several pregnancies in her early married life and a recent abortion. Her last preg- nancy lasted about twenty-eight or twenty-nine weeks, and terminated, after a short labor, by the expulsion of the ovum entire. The membranes had not been ruptured, and still enclosed the fetus and the liquor amnii. On break- ing them, the fetus was seen floating on the waters, alive, and, though very diminutive, was perfectly formed. It continued to live, and a day afterward took the breast and began to cry feebly. At six weeks it weighed 2 pounds 2 ounces, and at ten months, 12 pounds, but was still very weak and ill-nour- a 368, 1832, iii., 684. b 524, 1789. <= 600, 1878-9, xli., 43. 4 470,1722. e 492, 1828. "DRY BIRTHS." 123 ished. Evans * has an instance of a fetus expelled enveloped in its membranes entire and unruptured. The membranes were opaque and preternaturally thickened, and were opened with a pair of scissors ; strenuous eiforts were made to save the child, but to no purpose. The mother, after a short con- valescence, made a good recovery. Forman ^ reports an instance of unruptured membranes at birth, the delivery following a single pain, in a woman of twenty-two, pregnant for a second time. Woodson '= speaks of a case of twins, one of which was born enveloped in its secundines. Van Bibber ^ was called in great haste to see a patient in labor. He reached the house in about fifteen minutes, and was told by the midwife, a woman of experience, that she had summoned him because of the expulsion from the womb of something the like of which she had never seen before. She thought it must have been some variety of false conception, and had wrapped it up in some flannel. It proved to be a fetus enclosed in its sac, with the placenta, all having been expelled together and intact. He told the nurse to rupture the membranes, and the child, which had been in the unrup- tured sac for over twenty minutes, began to cry. The infant lived for over a month, but eventually died of bronchitis. Cowger® reports labor at the end of the seventh month without rupture of the fetal sac. Macknus ^ and Rootes s speak of expulsion of the entire ovum at the full period of gestation. Roe mentions a case of parturition with unruptured membrane. Slusser ^ describes the delivery of a full-grown fetus without rupture of the membrane. " Dry Births." — The reverse of the foregoing are those cases in which, by reason of the deficiency of the waters, the birth is dry. Numerous causes can be stated for such occurrences, and the reader is referred elsewhere for them, the subject being an old one. The Ephemerides speaks of it, and Rudolph ^'^ discusses its occurrence exhaustively and tells of the difficulties of such a labor. Burrall ' mentions a case of labor without apparent liquor amnii, delivery being effected by the forceps. Strong J records an unusual obstetric case in which there was prolongation of the pregnancy, with a large child, and entire absence of liquor amnii. The case was also complicated with interstitial and subserous fibroids and a contracted pelvis, combined with a posterior position of the occiput and nonrotation of the head. Lente*^ mentions a case of labor without liquor amnii ; and Townsend ' records de- livery without any sanguineous discharge. Cosentino "" mentions a case of the absence of liquor amnii associated with a fetal monstrosity. Delivery After Death of the Mother. — Curious indeed are those a 252, 1852-3, i., 146. b 538, 1896, Feb. 1, 160. <= 124, 1860, 569. d 510, 1879, iv., 303. e 538, xxv., 84. f 476, 1846, i., 186. g 476, 1845, ii., 474. h West. Lancet, Cinein., xii., 501. i 124, cxl., 446. J 218, ex., 30. k 124, clxi., 125. ' 124, 1854, 342. m Arch, di Ostet. e Ginec, p. 41, Feb. -March, 1894. 124 OBSTETRIC ANOMALIES. anomalous cases in which the dehvery is effected spontaneously after the death of the mother, or when, by manipulation, the child is saved after the maternal decease. Wegelin " gives the account of a birth in which version was per- formed after death and the child successfully delivered. Bartholinus, Wolff, Schenck, Horstius, Hagendorn, Fabricius Hildanus, Valerius, Eolfinck, Cor- narius, Boener, and other older writers cite cases of this kind. Pinard'' gives a most wonderful case. The patient was a woman of thirty-eight who' had experienced five previous normal labors. On October 27th she fancied she had labor pains and went to the LariboisiSre Maternity, where, after a careful examination, three fetal poles were elicited, and she was told, to her surprise, of the probability of triplets. At 6 p. m., November 13th, the pains of labor commenced. Three hours later she was having great dyspnea with each pain. This soon assumed a fatal aspect and the midwife attempted to resuscitate the patient by artificial respiration, but failed in her efforts, and then she turned her attention to the fetuses, and, one by one, she extracted them in the short space of five minutes ; the last one was born twelve minutes after the mother's death. They all lived (the first two being females), and they weighed from 4J to 6J pounds. Considerable attention has been directed to the advisability of accelerated and forced labor in the dying, in order that the child may be saved. Belluzzi has presented several papers on this subject. Csurgay of Budapest mentions saving the child by forced labor in the death agonies of the mother. Devil- liers" considers this question from both the obstetric and medicolegal points of view. Hyneaux mentions forcible accouchement practised on both the dead and the dying. Rogowicz advocates artificial delivery by the natural channel in place of Cesarian section in cases of pending or recent death, and Th6venot ^ discussed this question at length at the International Medico-Legal Congress in 1878. Duer® presented the question of postmortem delivery in tliis country. Kelly ^ reports the history of a woman of forty who died in her eighth pregnancy, and who was delivered of a female child by version and artificial means. Artificial respiration was successfully practised on the child, although fifteen minutes had elapsed from the death of the mother to its extraction. Driver « relates the history of a woman of thirty-five, who died in the eighth month of gestation, and who was delivered postmortem by the vagina, man- ual means only being used. The operator was about to perform Cesarean section when he heard the noise of the membranes rupturing. Thornton ^ reports the extraction of a living child by version after the death of the mother. Aveling ' has compiled extensive statistics on all varieties of post- mortem deliveries, collecting 44 cases of spontaneous expulsion of the fetus aft«r death of the mother. ' 160, B. i., 4 St., n. 7. b 140, Jan., 1889. c 789, 1862, 581. d 140, 1878. e 125, xii., 1 and 374. f 125, viii., 558. g 579, 1860, 494. h 272, 1858. i 778, 1873, xiv., 240. DELIVERY AFTER DEATH OF THE MOTHER. 125 Aveling states that in 1820 the Council of Cologne sanctioned the placing of a gag in the mouth of a dead pregnant woman, thereby hoping to prevent suffocation of the infant, and there are numerous such laws on record, although most of them pertain ±o the performance of Cesarean section immediately after death. Reiss records the death of a woman who was hastily buried while her husband was away, and on his return he ordered exhumation of her body, and on opening the coffin a child's cry was heard. The infant had evidently been born postmortem. It lived long afterward under the name of " Fils de la terre." Willoughby^^ mentions the curious instance in which rum- bling was heard from the coffin of a woman during her hasty burial. One of her neighbors returned to the grave, applied her ear to the ground, and was sure she heard a sighing noise. A soldier with her affirmed her tale, and together they went to a clergyman and a justice, begging that the grave be opened. When the coffin was opened it was found that a child had been born, which had descended to her knees. In Derbyshire, to this day, may be seen on the parish register : "April ye 20, 1650, was buried Emme, the wife of Thomas Toplace, who was found delivered of a child after she had lain two hours in the grave." Johannes Matthaeus relates the case of a buried woman, and that some time afterward a noise was heard in the tomb. The coffin was immediately opened, and a living female child rolled to the feet of the corpse. Hagen- dorn mentions the birth of a living child some hours after the death of the mother. Dethardingius mentions a healthy child born one-half hour after the mother's death. In the Gentleman's Magazine " there is a record of an in- stance, in 1759, in which a midwife, after the death of a woman whom she had failed to deliver, imagined that she saw a movement under the shroud, and found a child between its mother's legs. It died soon after. Valerius Maximus says that while the body of the mother of Gorgia Epirotas was being carried to the grave, a loud noise was heard to come from the coffin, and on examination a live child was found between the thighs, — whence arose the proverb : " Gorgiam prius ad funus elatum, quam natum fuisse." Other cases of postmortem delivery are less successful, the delivery being delayed too late for the child to be viable. The first of Aveling's cases was that of a pregnant woman who was hanged by a Spanish Inquisitor in 1551. While still hanging, four hours later, two children were said to have dropped from her womb. The second case was of a woman of Madrid, who after death was shut in a sepulcher. Some months after, when the tomb was opened, a dead infant was found by the side of the corpse. Kolfinkius tells of a woman who died during parturition, and her body being placed in a cellar, five days later a dead boy and girl were found on the bier. Bartholinus is accredited with the following : Three midwives failing to deliver a woman, a xxix., 390. 126 OBSTETRIC ANOMALIES. she died, and forty-eight hours after death her abdomen swelled to such an extent as to burst her grave-clothes, and a male child, dead, was seen issuing from the vagina. Bonet^^^ tells of a woman, who died in Brussels in 1633, who, undelivered, expired in convulsions on Thursday. On Friday abdomi- nal movements in the corpse were seen, and on Sunday a dead child was found hanging between the thighs. According to Aveling, Herman of Berne reports the instance of a young lady whose body was far advanced in putrefaction, from which was expelled an unbroken ovum containing twins. Even the placenta showed signs of decomposition. Naumann relates the birth of a child on the second day after the death of the mother. Eichter of WeisSenfels, in 1861, reported the case of a woman who died in convulsions, and sixty hours after death an eight months' fetus came away. Stapedius writes to a friend of a fetus being found dead between the thighs of a woman who expired suddenly of an acute disease. Schenk mentions that of a woman, dying at 5 P. M., a child having two front teeth was born at 3 A. m. Veslingius tells of a woman dying of epilepsy on June 6, 1630, from whose body, two days later, issued a child. Wolfius relates the case of a woman dying in labor in 1677. Abdominal movements being seen six hours after death. Cesarean section was suggested, but its performance was delayed, and eighteen hours after a child was spontaneously born. Hoyer of Mulhausen tells of a child with its mouth open and tongue protruding, which was born while the mother was on the way to the grave. Bedford of Sydney, accord- ing to Aveling, relates the story of a case in which malpractice was suspected on a woman of thirty-seven, who died while pregnant with her seventh child. The body was exhumed, and a transverse rupture of the womb six inches long above the cervix was found, and the body of a dead male child lay between the thighs. In 1862, Lanigan tells of a woman who was laid out for funeral obsequies, and on removal of the covers for burial a child was found in bed with her. Swayne is credited with the description of the death of a Moman whom a midwife failed to deliver. Desiring an inquest, the coroner had the body exhumed, when, on opening the cofhn, a well-developed male infant was found parallel to and lying on the lower limbs, the cord and placenta being entirely unattached from the mother. Some time after her decease Harvey found between the thighs of a dead woman a dead infant which had been expelled postmortem. Mayer" relates the history of a case of a woman of forty-five who felt the movement of her child for the fourth time in the middle of November. In the following March she had hemoptysis, and serious symptoms of inflammation in the right lung following, led to her apparent death on the 31st of the month. For two days previous to her death she had failed to perceive the fetal movements. She was kept on her back in a room, covered up and undisturbed, for thirty- six hours, the members of the family occasionally visiting her to sprinkle holy a 801, 1H.J4. ANTEPARTUM CRYING OF THE CHILD. 127 water on her face. There was no remembrance of cadaveric distortion of the features or any odor. When the undertakers were drawing the shroud on they noticed a half-round, bright-red, smooth-looking body between the geni- tals which they mistook for a prolapsed uterus. Early on April 2d, a few hours before interment, the men thought to examine the swelling they had seen the day before. A second look showed it to be a dead female child, now lying between the thighs and connected with the mother by the umbilical cord. The interment was stopped, and Mayer was called to examine the body, but with negative results, though the signs of death were not plainly visible for a woman dead fifty-eight hours. By its development the body of the fetus con- firmed the mother's account of a pregnancy of twenty-one weeks. Mayer satisfies himself at least that the mother was in a trance at the time of delivery and died soon afterward. Moritz ^ gives the instance of a woman dying in pregnancy, undelivered, who happened to be disinterred several days after burial. The body was in an advanced state of decomposition, and a fetus was found in the coffin. It was supposed that the pressure of gas in the mother's body had forced the fetus from the uterus. Ostmann '' speaks of a woman married five months, who was suddenly seized with rigors, headache, and vomiting. For a week she continued to do her daily work, and in addition was ill-treated by her husband. She died suddenly without having any abdominal pain or any symptoms indicative of abortion. The body was examined twenty-four hours after death and was seen to be dark, discolored, and the abdomen distended. There Avas no sanguineous discharge from the genitals, but at the time of rais- ing the body to place it in the coffin, a fetus, with the umbilical cord, escaped from the vagina. There seemed to have been a rapid putrefaction in this case, generating enough pressure of gas to expel the fetus as well as the uterus from the body. This at least is the view taken by Hofiman and others in the solution of these strange cases. Antepartum Crying of the Child. — There are on record fabulous cases of children crying in the uterus during pregnancy, and all sorts of unbe- lievable stories have been constructed from these reported occurrences. Quite possible, however, and worthy of belief are the cases in which the child has been heard to cry during the progress of parturition — that is, during delivery. Jonston " speaks of infants crying in the womb, and attempts a scientific explanation of the fact. He also quotes the following lines in reference to this subject : — " Mirandum foetus materna olausus in alvo Dioitur insuetos ore dedisse souos. Causa subest ; doluit se aDgusta sede teueri, Et oupiit magnae cernere moliis opus. Aut quia quserendi studio vis fessa parentum Aucupii aptas innuit esse manus. ' ' a Quoted by 124, cvi., 117. >> 807, Band. 28, 228. <= 447, 464. 128 OBSTETRIC ANOMALIES. The Ephemerides * gives examples of the child hiccoughing in the uterus. Cases of crying before delivery, some in the vagina, some just before the com- plete expulsion of the head from the os uteri, are very numerous in the older writers ; and itis quite possible that on auscultation of the. pregnant abdomen fetal sounds may have been exaggerated into cries. Bartholinus,'' Borellus, " Boyle, Buchner, PauUini, Mezger, Eiolanus, Lentillus, Marcellus Donatus, ■* and WolfF ^ all speak of children crying before delivery ; and Mazinus ^ relates the instance of a puppy whose feeble cries could be heard before expulsion from the bitch. Osiander fully discusses the subject of infants crying during parturition. McLean s describes a case in which he positively states that a child cried lustily in utero during application of the forceps. He compared the sound as though from a voice in the cellar. This child w^as in the uterus, not in the vagina, and continued the crying during the whole of the five minutes occupied by delivery. Cesarean Section. — ^Although the legendary history of Cesarean section is quite copious, it is very seldom that we find authentic records in the writings of the older medical observers. The works of Hippocrates, Aretseus, Galen, Celsus, and Aetius contain nothing relative to records of successful Cesarean sections. However, Pliny says that Scipio Africanus was the first and Manlius the second of the Romans who owed their lives to the operation of Cesarean section ; in his seventh book he says that Julius Caesar was bom in this way, the fact giving origin to his name. Others deny this and say that his name came from the thick head of hair which he possessed. It is a fre- quent subject in old Roman sculpture, and there are many delineations of the birth of Bacchus by Cesarean section from the corpse of Semele. Greek mythology tells us of the birth of Bacchus in the following manner : After Zeus burnt the house of Semele, daughter of Cadmus, he sent Hermes in great haste with directions to take from the burnt body of the mother the fruit of seven months. This child, as we know, was Bacchus, ^sculapius, accord- ing to the legend of the Romans, had been excised from the belly of his dead mother, Corinis, who was already on the funeral pile, by his benefactor, Apollo ; and from this legend all products of Cesarean sections were regarded as sacred to Apollo, and were thought to have been endowed with sagacity and bravery. Old records tell us that one of the kings of Navarre was delivered in this way, and we also have records of the birth of the celebrated Doge, Andreas Doria, by this method. Jane Seymour was supposed to have been delivered of Edward VI. by Cesarean section, the father, after the consultation of the physicians was announced to him, replying : " Save the child by all means, for I shall be able to get mothers enough." Robert II. of Scotland was sup- a 104, dec. ii., ann. v., obs. 194, and obs. 15. b 190, cent, i., hist. 18. c Cent, iii., obs. 72. d 306, L. vi., cap. ii., 620. 8 Lect. memor., T. ii., 647, 666, 983. i 514, T. iii., 8. g 125, xxii., 166. CESAREAN SECTION. 129 posed to have been delivered in this way after the death of his mother, Mar- gery Bruce, who was Idlled by being thrown from a horse. Shakespere's immortal citation of Macduff, " who was from his mother's womb untimely ripped," must have been such a case, possibly crudely done, perchance by cattle- horn. Pope Gregory XIV. was said to have been taken from his mother's belly after her death. The Philosophical Transactions, "^^ in the last century, contain accounts of Cesarean section performed by an ignorant butcher and also by a midwife ; and there are many records of the celebrated case per- formed by Jacob Niifer, a cattle gelder, at the beginning of the sixteenth century. By the advent of antisepsis and the improvements of Porro and others. Cesarean section has come to be a quite frequent event, and a record of the successful cases would hardly be considered a matter of extraordinary interest, and would be out of the province of this work, but a citation of anomalous cases will be given. Baldwin^ reports a case of Cesarean section on a typical rachitic dwarf of twenty-four, who weighed 100 pounds and was only 47 J inches tall. It was the ninth American case, according to the calculation of Harris, only the third successful one, and the first, successful one in Ohio. The woman had a uniformly contracted pelvis whose anteroposterior diameter was about IJ inches. The hygienic surroundings for the operation were not of the best, as the woman lived in a cellar. Tait's method of per- forming the operation was determined upon and successfully performed. Convalescence was prompt, and in three weeks the case was dismissed. The child was a female of 7 J pounds which inherited the deformities of its mother. It thrived for nine and a half months, when it died of angina Ludovici. Figure 15 represents the mother and child. Harris ^^* gives an account of an operation upon a rachitic dwarf who was impregnated by a large man, a baby weighing 14 pounds and measuring 20 inches being delivered by the knife. St. Braun*" gives the account of a Porro-Cesarean operation in the case of a rachitic dwarf 3 feet 10 inches tall, in which both the mother and child recovered. Mund6 "^ speaks of twins being delivered by Cesarean section. Franklin'' gives the instance of a woman delivered at full term of a living child by this means, in whom was also found a dead fetus. It lay behind the stump of the amputated cervix, in the culdesac of Douglas. The patient died of hemorrhage. Croston" reports a case of Cesarean section on a primipara of twenty-four at full term, with the delivery of a double female monster weighing 12 J pounds. This monster consisted of two females of about the same size, united from the sternal notch to the navel, having one cord and one placenta. It was stillborn. The diagnosis was made before operation by vaginal examination. In a communication to Croston, Harris remarked that this was the first suc- » 533, Aug. 9, 1890, 138. b 657, 1888 ; quoted by 124, 1890. 218, 1876, ci., 747. '1224, 1894. e 218, Dec. 21, 1893. 9 130 OBSTETRIC ANOMALIES. eessful Cesarean section for double monstrous conception in America, and added that in 1881 Collins and Leidy performed the same operation without success. Instances of repeated Cesarean section were quite numerous, and the pride of the operators noteworthy, before the uterus was removed at the first opera- tion, as is now generally done. Bacque " reports two sections in the same woman, and Bertrandi speaks of a case in which the operation was success- fully executed many times in the same woman. Rosenberg "" reports three «ases repeated successfully by Leopold of Dresden. Skutsch reports a case in Fig. 15.— Cesarean operation on a dwarf (Baldwin). which it was twice performed on a woman with a rachitic pelvis, and who the second time was pregnant with twins ; the children and mother recovered. Zweifel •= cites an instance in which two Cesarean sections were performed on a patient, both of the children delivered being in vigorous health. Stolz ^ relates a similar case. Beck " gives an account of a Cesarean operation tAvice on the same woman ; in the first the child perished, but in the second it survived. Merinar ^ cites an instance of a woman thrice opened. Parravini « gives a a 463, xi., 572. b 125, 1891. e 261, 1889, No. 13. d 368, 1885, iii., 182 e 593, 1849-50, vi., 355. f 264, 1856, xi, 172. g 360, 1860, 273. CESAREAN SECTION BY THE PATIENT HERSELF. 131 similar instance. Charlton * gives an account of the performance carried out successfully four times in the same woman ; Chisholm *> mentions a case in which it was twice performed. MichaeUs of Kiel " gives an instance in which he performed the same operation on a woman four times, with successful issues to both mother and children, despite the presence of peritonitis the last time. He had operated in 1826, 1830, 1832, and 1836. Coe* and Gueniot^ both mention cases in which Cesarean section had been twice performed with success- fill terminations as regards both mothers and children. Eosenberg ^ tabulates a number of similar cases from medical literature. Cases of Cesarean section by the patient herself are most curious, but may be readily believed if there is any truth in the reports of the opera- tion being done in savage tribes. Felkin ^ gives an account of a successful case performed in his presence, with preservation of the lives of both mother and child, by a native African in Kahura, Uganda Country (Fig. 16). The Fig. 16. — Cesarean operation in Uganda. Fig. 17.— Suture of abdominal walls after Cesarean section in Africa. Fig. 18. — Knife used in performing Cesarean section in Africa. young girl was operated on in the crudest manner, the hemorrhage being checked by a hot iron. The sutures were made by means of seven thin, hot iron spikes, resembling acupressure-needles, closing the peritoneum and skin (Fig. 17). The wound healed in eleven days, and the mother made a complete re- covery. Thomas Cowley ^ describes the case of a negro woman who, being unable to bear the pains of labor any longer, took a sharp knife and made a deep incision in her belly — deep enough to wound the buttocks of her child, and extracted the child, placenta and all. A negro horse-doctor was called, who sewed the wound up in a manner similar to the way dead bodies are closed at the present time. a 318, 1837, xlvii., 417. '» 318, 1808, iv., 178. c 628, Heft vii., viii., 1836. a New York Polyclinic, Aug. 15, 1894. e 739, July 5, 1894. f 125, xxiv.. No. 10, 1891. s 318, April, 1884. ^ Lond. Med. Jour., 1785, vi., 366. 132 OBSTETRIC ANOMALIES. Barker " gives the instance of a woman who, on being abused by her hus- band after a previous tedious labor, resolved to free herself of the child, and slyly made an incision five inches long on the left side of the abdomen with a weaver's knife. When Barker arrived the patient was literally drenched with blood and to all appearance dead. He extracted a dead child from the abdomen and bandaged the mother, who lived only forty hours. In his discourses on Tropical Diseases Moseley speaks of a young negress in Jamaica who opened her uterus and extracted therefrom a child which lived six days ; the woman recovered. Barker relates another case ^ in Eensselaer County, N. Y., in which the incision was made with the razor, the woman likewise recovering. There is an interesting account " of a poor woman at Prischtina, near the Servian frontier, who, suffering greatly from the pains of labor, resolved to open her abdomen and uterus. She summoned a neighbor to sew up the incision after she had extracted the child, and at the time of report, several months later, both the mother and child were doing well. Madigar^ ^ cites the case of a woman of thirty-four, in her seventh confine- ment, who, while temporarily insane, laid open her abdomen with a razor, in- cised the uterus, and brought out a male child. The abdominal wound was five inches long, and extended from one inch above the umbilicus straight down- ward. There was little or no bleeding and the uterus was firmly contracted. She did not see a physician for three hours. The child was found dead and, with the placenta, was lying by her side. The neighbors were so frightened by the awftil sight that they ran away, or possibly the child might have been saved by ligature of the funis. Not until the arrival of the clergyman was anything done, and death ultimately ensued. A most wonderful case of endurance of pain and heroism was one occurring in Italy,^ which attracted much European comment at the time. A young woman, illegitimately pregnant, at full terra, on March 28th, at dawn, opened her own abdomen on the left side with a common knife such as is generally used in kitchens. The wound measured five inches, and was directed obliquely outward and downward. She opened the uterus in the same direction, and endeavored to extract the fetus. To expedite the extraction, she drew out an arm and amputated it, and finding the extraction still difficult, she cut oif the head and completely emptied the womb, including the placenta. She bound a tight bandage around her body and hid the fetus in a straw mattress. She then dressed herself and attended to her domestic duties. She afterward mounted a cart and went into the city of Viterbo, where she showed her sis- ter a cloth bathed in blood as menstrual proof that she was not pregnant. On returning home, having walked five hours, she was seized with an attack of vomiting and fainted. The parents called Drs. Serpieri and Baliva, who relate the case. Thirteen hours had elapsed from the infliction of the wound, a 597, 1830-1, i., 381. b 599^ ii._ 49. c wien. med. Wochenschrift, 1880, No. 13. <3 476, 1884, i., 146. e 359^ May 2, 1886. DELIVERY OF FETUS BY CATTLE-HORN INJURIES. 133 through which the bulk of the intestines had been protruding for the past six hours. The abdomen was irrigated, the toilet made, and after the eighteenth day the process of healing was well progressed, and the woman made a recovery after her plucky efforts to hide her shame. Cases like the foregoing excite no more interest than those on record in which an abdominal section has been accidental, as, for instance, by cattle- horns, and the fetus born through the wound. Zuboldie " speaks of a case in which a fetus was born from the wound made by a bull's horn in the mother's abdomen. Deneux^^* describes a case in which the wound made by the horn was not sufficiently large to permit the child's escape, but it was sub- sequently brought through the opening. Pigne ^ speaks of a woman of thirty- eight, who in the eighth month of her sixth pregnancy was gored by a bull, the horn effecting a transverse wound 27 inches long, running from one an- terior spine to the other. The woman was found cold and insensible and Fig. 19.— Aceoucliement by a bull (after an engraving dated 1647). with an imperceptible pulse. The small intestines were lying between the thighs and covered with coagulated blood. In the process of cleansing, a male child was expelled spontaneously through a rent in the uterus. The woman was treated with the usual precautions and was conscious at midday. In a month she was up. She lived twenty years without any inconvenience except that due to a slight hernia on the left side. The child died at the end of a fortnight. In a very exhaustive article Harris of Philadelphia <= has collected nearly all the remaining cases on record, and brief extracts from some of them will be given below. In Zaandam, Holland, 1647, a farmer's wife was tossed by a furious bull. Her abdomen was ripped open, and the child and membranes escaped. The child suffered no injuries except a bruised upper lip and lived nine months. The mother died within forty hours of her injuries. Figure a 297, ii., n. 43. b 162, July, 1836. 125, 1887, XX., 673. 134 OBSTETRIC ANOMALIES. 19, taken from an engraving dated 1647, represents an accouchement by a mad bull, possibly the same case. In Dillenberg, Germany, in 1779, a multipara was gored by an ox at her sixth month of pregnancy ; the horn entered the right epigastric region, three inches from the linea alba, and perforated the uterus. The right arm of the fetus protruded ; the wound was enlarged and the fetus and placenta delivered. Thatcher " speaks of a woman who was gored by a cow in King's Park, and both mother and child were safely deliv- ered and survived. In the Parish of Zecoytia, Spain, in 1785, Marie Gratien was gored by an ox in the superior portion of her epigastrium, making a wound eight inches long which wounded the uterus in the same direction. Dr. Antonio di Zubeldia and Don Martin Monaco were called to take charge of the case. While they were preparing to effect delivery by the vagina, the woman, in an attack of singultus, ruptured the line of laceration and expelled the fetus, dead. On the twenty-first day the patient was doing well. The wound closed at the end of the sixteenth week. The woman subsequently enjoyed excellent health and, although she had a small ventral hernia, bore and nursed two children. Marsh ^ cites the instance of a woman of forty-two, the mother of eight chil- dren, who when eight months pregnant was horned by a cow. Her clothes were not torn, but she felt that the child had slipped out, and she caught it in her dress. She was seen by some neighbors twelve yards from the place of accident, and was assisted to her house. The bowels protruded and the child was separated from the funis. A physician saw the woman three-quar- ters of an hour afterward and found her pulseless and thoroughly exhausted. There was considerable but not excessive loss of blood, and several feet of intestine protruded through the wound. The womb was partially inverted through the wound, and the placenta was still attached to the inverted por- tion. The wound in the uterus was Y-shaped. The mother died in one and a half hours from the reception of her injuries, but the child was uninjured. Scott ° mentions the instance of a woman thirty-four years old who was gored by an infuriated ox while in the ninth month of her eighth pregnancy. The horn entered at the anterior superior spinous process of the ilium, involv- ing the parietes and the uterus. The child was extruded thrgugh the wound about half an hour after the occurrence of the accident. The cord was cut and the child survived and thrived, though the mother soon died. Stalpart "^ tells the almost incredible story of a soldier's wife who went to obtain water from a stream and was cut in two by a cannonball while stooping over. A passing soldier observed something to move in the water, which, on investi- gation, he found to be a living child in its membranes. It was christened by order of one Cordua and lived for some time after. Postmortem Cesarean Section. — The possibility of delivering a child a 319, July, 1850, 88. b 538, 1867. 1=518,1885,111,341. d Dissert, de Foet. Nutrit, 45. POSTMORTEM CESAREAN SECTION. 135 by Cesarean section after the death of the mother has been known for a long time to the students of medicine. In the olden times there were laws making compulsory the opening of the dead bodies of pregnant women shortly after death. Numa Pompilius established the first law, which was called "lex regia," and in later times there were many such ordinances. A full description of these laws is on record.^"^ Life was believed possible after a gestation of six months or over, and, as stated, some famous men were sup- posed to have been born in this manner. Fran9ois de Civile, who on great occasions signed himself " trois fois enterr4 et trois fois par le gr^ce de Dieu, ressucit6," saw the light of the world by a happy Cesarean operation on his exhumed mother. Fabricius Hildanus and Bourton report similar instances. Bourton cites among others the case of an infant who was found living twelve hours after the death of his mother. Dufour " and Mauriceau ^^^ are two older French medical writers who discuss this subject. Flajani ^^ speaks of a case in which a child was delivered at the death of its mother, and some of the older ItaUan writers discuss the advisability of the operation in the moribund state before death actually ensues. Heister ^^^ writes of the delivery of the child after the death of the mother by opening the abdomen and uterus. Harris'' relates several interesting examples. In Peru in 1794 a Sambi woman was killed by lightning, and the next day the abdomen was opened by official command and a living child was extracted. The Princess von Swartzen- berg, who was burned to death at a ball in Paris in 1810, was said to have had a living child removed from her body the next day. Like all similar instances, this was proved to be false, as her body was burned beyond the possibility of recognition, and, besides, she was only four months pregnant. Harris ** men- tions another case of a young woman who threw herself from the Pont Neuf into the Seine. Her body was recovered, and a surgeon who was present seized a knife from a butcher standing by and extracted a living child in the presence of the curious spectators. Campbell ^*^ discusses this subject most thoroughly, though he advances no new opinions upon it. Duer tabulates the successful results of a number of cases of Cesarean section after death as follows : — Children extracted between 1 and 5 minutes after death of the mother, 21 " lOandlS " " " " " 13 " 15 and 30 " " " " " 2 Ihour " " " " 2 2 hours " " " " 2 Garezky of St. Petersburg " collected reports of 379 cases of Cesarean section after death with the following results : 308 were extracted dead ; 37 showed signs of life ; 34 were born alive. Of the 34, only 5 lived for any length of time. He concludes that if extracted within five or six minutes after death, they may be born ahve ; if from six to ten minutes, they may i* 462, T. xix., 263. l> 125, 1880, 141. , e Quoted by 545, Aug. 23, 1879. 136 OBSTETRIC ANOMALIES. still be born alive, though asphyxiated ; if from ten to twenty-six minutes, they will be highly asphyxiated. In a great number of these cases the infant was asphyxiated or dead in one minute. Of course, if the death is sudden, as by apoplexy, accident, or suicide, the child's chances are better. These statistics seem conscientious and reliable, and we are safe in taking them as indicative of the usual result, which discountenances the old reports of death as taking place some time before extraction. Peuch * is credited with statistics showing that in 453 operations 101 chil- dren gave signs of life, but only 45 survived. During the Commune of Paris, Tarnier, one night at the Maternit6,,was called to an inmate who, while lying in bed near the end of pregnancy, had been killed by a ball which fractured the base of the skull and entered the brain. He removed the child by Cesarean section and it hved for several days. In another case a pregnant woman fell from a window for a distance of more than 30 feet, instant death resulting ; thirty minutes at least after the death of the mother an infant was removed, which, after some difficulty, was resuscitated and lived for thirteen years. Tarnier states that delivery may take place three-quarters of an hour or even an hour after the death of the mother, and he also quotes an extraordinary case by Hubert of a successful Cesarean operation two hours after the mother's death ; the woman, who was eight months pregnant, was instantly killed while crossing a railroad track. ^ Hoffman " records the case of a successful Cesarean section done ten min- utes after death. The patient was a woman of thirty-six, in her eighth month of pregnancy, who was suddenly seized with eclampsia, which terminated fatally in ten hours. Ten minutes after her last respiration the Cesarean sec- tion was performed and a living male child delivered. This infant was nour- ished with the aid of a spoon, but it died in twenty-five hours in consequence of its premature birth and enfeebled vitality. Green ^ speaks of a woman, nine months pregnant, who was run over by a heavily laden stage-coach in the streets of Southwark. She died in about twenty minutes, and in about twenty minutes more a living child was ex- tracted from her by Cesarean section. There was a similar case in the H6pital St. Louis, in Paris, in 1829 ; but in this case the child was born alive five minutes after death. Squire « tells of a case in which the mother died of dilatation of the aorta, and in from twenty to thirty minutes the child was saved. In comment on this case Aveling is quoted as saying that he believed it possible to save a child one hour after the death of the mother. No less an authority than Playfair speaks of a case in which a child Avas born half an hour after the death of the mother. Beckman ' relates the history of a woman who died suddenly in convulsions. The incision was made about five minutes after death, and a male child about four pounds in weight was a 844, 644. b 844, 645. c 261, 1895, No. 50, 1319. d 550, xii., 46-51. (^ 476, 1877, ii., 89. f 199, 1869. RUPTURE OF THE UTERUS DURING PREGNANCY. 137 extracted. The child exhibited feeble heart-contractions and was despaired of. Happily, after numerous and persistent means of resuscitation, applied for about two and a half hours, regular respirations were established and the child eventually recovered. "Walter " reports a successful instance of removal of the child after the death of the mother from apoplexy. Cleveland ^ gives an account of a woman of forty-seven which is of special interest. The mother had become impregnated five months after the cessa- tion of menstruation, and a uterine sound had been used in ignorance of the impregnation at this late period. The mother died, and one hour later a living child was extracted by Cesarean section. There are two other recent cases recorded of extraction after an hour had expired from the death. One is cited by Veronden " in which the extraction was two hours after death, a living child resulting, and the other by Blatner ^ in which one hour had elapsed after death, when the child was taken out alive. Cases of rupture of the uterus during pregnancy from the pressure of the contents and delivery of the fetus by some unnatural passage are found in profusion through medical literature, and seem to have been of special interest to the older observers. Benivenius " saw a case in which the uterus ruptured and the intestines protruded from the vulva. An instance similar to the one recorded by Benivenius is also found in the last century in Germany.^^ Bouillon*' and Desbois, two French physicians of the last century, both record examples of the uterus rupturing in the last stages of pregnancy and the mother recovering. SchreiberS gives an instance of rupture of the uterus occasioned by the presence of a 13-pound fetus, and there is recorded ^ the account of a rupture caused by a 20-pound fetus that made its way into the abdomen. We find old accounts of cases of rupture of the uterus with birth by the umbilicus and the recovery of the woman.^ Vespr6-i describes a case in which the uterus was ruptured by the feet of the fetus. Farquharson ^ has an account of a singular case in midwifery in which the abdomen ruptured from the pressure of the fetus ; and quite recently Geo- ghegan ^ illustrates the possibilities of uterine pressure in pregnancy by a post- mortem examination after a fatal parturition, in which the stomach was found pushed through the diaphragm and lying under the left clavicle. Heywood Smith™ narrates the particulars of a case of premature labor at seven months in which rupture of the uterus occurred and, notwithstanding the fact that the case was complicated by placenta prsevia, the patient recovered. Eupture of the uterus and recovery does not necessarily prevent subsequent successful pregnancy and delivery by the natural channels. Whinery ^ relates » 573, 1855, v., 179. b 125, 1878, xi., 626-632. c 780, 1876, iv., 7. a 125, 1875, viii., 160. e L. iv., obs. B., 13. f Histoire de la Soc. Eoyale de M6d., Paris, 1776, 310. s 160, iii., 235. bSamml. Medic. Wahrnehmungen, 1 B., 363. i 108, dec. i., vlli., 90. J 462, T. xlii., 84. 1^ 524, 1789. 1 465, 1881, 52. ni476, 1875, ii., 911. ^124, Oct., 1866. 138 OBSTETRIC ANOMALIES. an instance of a ruptured uterus in a healthy Irish woman of thirty-seven from whom a dead child was extracted by abdominal section and who was safely delivered of a healthy female child about one year afterward. Analo- gous to this case is that of Lawrence,* who details the instance of a woman who had been delivered five times of dead children ; she had a very narrow pelvis and labor was always induced at the eighth month to assure delivery. In her sixth pregnancy she had miscalculated her time, and, in consequence, her uterus ruptured in an unexpected parturition, but she recovered and had several subsequent pregnancies. Occasionally there is a spontaneous rupture of the vagina during the process of parturition, the uterus remaining intact. Wiltshire reports such a case in a woman who had a most prominent sacrum ; the laceration was trans- verse and quite extensive, but the woman made a good recovery. Schauta pictures an exostosis on the promontory of the sacrum (Fig. 20). Blenkin- sop * cites an instance in which the labor was neither protracted nor abnormally severe, yet the rupture of the vagina took place with the escape of the child into the abdomen of the mother, and was from thence extracted by Cesarean sec- tion. A peculiarity of this case was the easy expulsion from the uterus, no instrumental or other manual interfer- ence being attempted and the uterus remaining perfectly intact. In some cases there is extensive sloughing of the genitals after parturition with recovery far beyond Fig. 20.-Knob-like exostosis on the promontory expectation. Gooch mentions a CaSC (Schauta). in which the whole vagina sloughed, yet to his surprise the patient recov- ered. Aetius and Benivenius speak of recovery in such cases after loss of the whole uterus. Cazenave of Bordeaux'' relates a most marvelous case in which a primipara suffered in labor from an impacted head. She was twenty-five, of very diminutive stature, and was in labor a long time. After labor, sloughing of the parts commenced and progressed to such an extent that in one month there were no traces of the labia, nymphse, vagina, perineum, or anus. There was simply a large opening extending from the meatus urinarius to the coccyx. The rectovaginal septum, the lower portion of the rectum, and the neck of the bladder were obliterated. The woman sur- vived, although she always experienced great difficulty in urination and in entirely emptying the rectum. A similar instance is reported ^ in a woman of thirty who was thirty-six hours in labor. The fundus of the uterus a 224, 1885, 601. b 656, No. xi., Dec. 2, 1841. « 330, No. 84, Feb. 7, 1839. d 124, Aug., 1838. ACCIDENTAL EXTRACTION OF PELVIC ORGANS. 139 descended into the vagina and the whole uterine apparatus was removed. The lower part of the rectum depended between the labia ; in the presence of the physician the nurse drew this out and it separated at the sphincter ani. On examining the parts a single opening was seen, as in the preceding case, from the pubes to the coccyx. Some time afterward the end of the intestine desceiided several inches and hung loosely on the concave surface of the rec- tum. A sponge was introduced to support the rectum and prevent access of air. The destruction of the parts was so complete and the opening so large as to bring into view the whole inner surface of the pelvis, in spite of which, after prolonged suppuration, the %vound cicatrized from behind forward and health returned, except as regards the inconvenience of feces and urine. Milk-secretion appeared late and lasted two months without influencing the other functions. There are cases in which, through the ignorance of the midwife or the physician, prolapsed pelvic organs are mistaken for afterbirth and ex- tracted. There have been instances in which the whole uterus and its ap- pendages, not being recognized, have been dragged out. Walters" cites the instance of a woman of twenty-two, who was in her third confinemeiit. The midwife in attendance, finding the afterbirth did not come away, pulled at the funis, which broke at its attachment. She then introduced her hand and tore away what proved to be the whole of the uterus, with the right ovary and fallopian tube, a portion of the round ligament, and the left tube and ovarian ligament attached to it. A large quantity of omentum protruded from the vulva and upper part of the vagina, and an enormous rent was left. Walters saw the woman twenty-one hours afterward, and ligated and severed the pro- truding omentum. On the twenty-eighth day, after a marvelous recovery, she was able to drive to the Royal Berkshire Hospital, a distance of five miles. At the time of report, two years and six months after the mutilation, she was in perfect health. Walters looked into the statistics of such cases and found 36 accidental removals of the uterus in the puerperium with 14 recoveries. All but three of these were without a doubt attended by previous inversion of the uterus. A medical man was tried for manslaughter in 1878'' because he made a similar mistake. He had delivered a woman by means of the forceps, and, after delivery, brought away what he thought a tumor. This " tumor " con- sisted of the uterus, with the placenta attached to the fundus, the ftmis, a por- tion of the lateral ligament, containing one ovary and about three inches of vagina. The uterus was not inverted. A horrible case, with similar results, happened in France, and was reported by Tardieu." A brutal peasant, whose wife was pregnant, dragged out a fetus of seven months, together with the uterus and the whole intestinal canal, from within 50 cm. of the pylorus to within 8 cm. of the ileocecal valve. The woman was seen three-quarters of a 476, 1884, ii., 779. ^ 548, 1878, ii., 728. o 141, xxxix., 157, 172. 140 OBSTETRIC ANOMALIES. an hour after the intestines had been found in the yard (where the brute had thrown them), still alive and reproaching her murderer. Hoffinan "* cites an instance in which a midwife, in her anxiety to extract the afterbirth, made traction on the cord, brought out the uterus, ovaries, and tubes, and tore the vulva and perineum as far as the anus. Woodson '' tells the story of a negress who was four months pregnant, and who, on being seized with severe uterine pains in a bath, succeeded in seizing the fetus and dragging it out, but inverting the uterus in the operation. There is a case recorded " of a girl of eighteen, near her labor, who, being driven from her house by her father, took refiige in a neighboring house, and soon felt the pains of child-birth. The accoucheur was summoned, pro- nounced them false pains, and went away. On his return he found the girl dying, with her uterus completely inverted and hanging between her legs. This unfor- tunate maiden had been delivered while standing upright, with her elbows on the back of a chair. The child suddenly escaped, bringing with it the uterus, but as the funis ruptured the child fell to the floor. Wagner pictures partial prolapse of the womb in labor (Fig. 21). It would too miich extend this chap- ter to include the many accidents inci- dent to labor, and only a few of especial interest will be given. Cases like rupture of an aneurysm during labor, extensive hemorrhage, the entrance of air into the uterine veins and sinuses, and common lacerations will be omitted, together with complicated births like those of double monsters, etc., but there are several other cases that deserve mention. Eldridge'* gives an instance of separation of the symphysis pubis during labor, — a natural symphysiotomy. A separation of | inch could be discerned at the symphysis, and in addition the sacroiliac synchondrosis was also quite movable. The woman had not been able to walk in the latter part of her pregnancy. The child weighed lOJ pounds and had a large head in a remarkably advanced stage of ossification, with the fontanelles nearly closed. Delivery was eifected, though during the passage of the head the pubes separated to such an extent that Eldridge placed two fingers between them. The mother recovered, and had perfect union and normal locomotion. Fig. 21.— Partial prolapse of tlie womb in labor (Wagner). "■ 807, 1865. American System of Obstetrics, Hiist. b 124, 1860. ^269, 1884, xlix., 495. SYMPHYSIOTOMY. 141 Sanders " reports a case of the separation of the pubic bones in labor. Studley ^ mentions a case of fracture of the pelvis during instrumental deliv- ery. Humphreys *= cites a most curious instance. The patient, it appears, had a large exostosis on the body of the pubes which, during parturition, was forced through the walls of the uterus and bladder, resulting in death. Kilian reports four cases of death from perforation of the uterus in this manner. Schauta pictures such an exostosis (Fig. 22). Chandler * relates an instance in which there was laceration of the liver during parturition ; and Hubbard "^ records a case of rupture of the spleen after labor. Symphysiotomy is an operation consisting of division of the pubic symphy- sis in order to facilitate delivery in narrow pelves. This operation has under- gone a most remarkable revival during the past two years. It originated in a suggestion by Pineau in his work on surgery in 1598,*' and in 1665 was first performed by La Courv6e upon a dead body in order to save the child, and afterward by Plenk, in 1766,s for the same purpose. In 1777 Sigault first proposed the operation on the living, and Ferrara was the one to carry out, practically, the proposition, — although Sigault is generally considered to be the first symphysiotomist, and the pro- cedure is very generally known as the "Sigaultean operation." From Fer- rara's time to 1858, when the oper- ation had practically died out, it had Fig. 22.— Exostosis on the symphysis (Schauta). been performed 85 times, with a re- corded mortality of 33 per cent. In 1866 the Italians, under the leadership of Morisani of Naples, revived the operation, and in twenty years had per- formed it 70 times with a mortality of 24 per cent. Owing to rigid anti- septic technic, the last 38 of these operations (1886 to 1891) showed a mortality of only 5^ per cent., while the infant-mortality was only lOf per cent. The modern history of this operation is quite interesting, and is very completely reviewed by Hirst and Dorland.^ In November, 1893, Hirst reported 212 operations since 1887, with a maternal mortality of 12.73 per cent, and a fetal mortality of 28 per cent. In his later statistics Morisani gives 55 cases with 2 maternal deaths and 1 infantile death, while Zweifel' reports 14 cases from the Leipzig clinic with no maternal death and 2 fetal deaths, 1 from asphyxia and 1 from pneumonia, two days after birth. All the modern statistics are correspond- ingly encouraging. a Trans. Amer. Instit. Homeopathy. b 125, 1879, xii., 269. <: 531, 1857-8, iii., 322-326. d 218, xxxiii. , 398. <= 597, xxx., 75. f 533, Jan. 12, 1895. S 843, 401. Ii843, 401. i 261, No. 22, 1893. 142 OBSTETRIC ANOMALIES. Irwin reports a case in which the firm attachment of the fetal head to the uterine parietes rendered delivery without artificial aid impossible, and it was necessary to perfiarm craniotomy. The right temporal region of the child adhered to the internal surface of the neck of the uterus, being connected by membranes. The woman was forty-four years old, and the child was her fourth. Delay in the Birth of the Second Twin, — In twin pregnancies there is sometimes a delay of many days in the birth of a second child, even to such an extent as to give suspicion of superfetation. Pignot speaks of one twin two months before the other. De Bosch speaks of a delay of seven- teen days ; and there were 2 cases on record in France in the last century, * one of M'hich was delayed ten days, and the other showed an interval of seven weeks between the delivery of the twins. There is an old case on record ^ in which there was an interval of six weeks between deliveries ; Jansen ^^ gives an account of three births in ten months ; Pinart " mentions a case with an interval of ten days ; Thilenius, one of thirteen days ; and Ephemerides, one of one week. Wildberg'* describes a case in which one twin was born two months after the other, and there was no secretion of milk until after the second birth. A full description of Wildberg's case is given in another journal ^ in brief, as follows : A woman, eighteen months married, was in labor in the eighth month of pregnancy. She gave birth to a child, which, though not fully matured, lived. There was no milk-secretion in her breasts, and she could distinctly feel the movements of another child ; her abdomen increased in size. After two months she had another labor, and a fully developed and strong child was born, much heavier than the first. On the third day after, the breasts became enlarged, and she experienced considerable fever. It was noticeable in this case that a placenta was discharged a quarter of an hour after the first birth. Irvine ' relates an instance of thirty-two days' delay ; and Pfau^ one of seven days'. Carson ^ cites the instance of a noblewoman of forty, the mother of four children, who was talten ill about two weeks before confinement was expected, and was easily delivered of a male child, which seemed well formed, with perfect nails, but weakly. After the birth the mother never became healthy or natural in appearance. She was supposed to be dying of dropsy, but after forty-four days the mystery was cleared by the birth of a fine, well-grown, and healthy daughter. Both mother and child did well. Addison ' describes the case of a woman who was delivered of a healthy male child, and everything was well until the evening of the fourth day, when intense labor-pains set in, and well-formed twins about the size of a pigeon's egg were born. In this strange case, possibly an example of superfetation, » 418, 1751, 107 ; and 418, 1752, 112. b igo, iv. B., 771. « 462, T. xl., 448. d 611, April 5, 1845. e 136, 1844, 3 Heft. f 546, Dec. 28, 1844. g 611, April 20, 1844. h 224, 1880, i., 242. i 476, 1886, i., 477. DELAY IN THE BIRTH OF THE SECOND TWIN. 143 the patient made a good recovery and the first child lived. A similar case is reported by Lumby " in which a woman was delivered on January 18th, by a midwife, of a full-grown and healthy female child. On the third day she came down-stairs and resumed her ordinary duties, which she con- tinued until February 4th (seventeen days after). At this time she was de- livered of twins, a boy and a girl, healthy and well-developed. The placenta was of the consistency of jelly and had to be scooped away with the hand. The mother and children did well. This woman was the mother of ten children besides the product of this conception, and at the latter occurrence had entire absence of pains and a very easy parturition. Pincott ^ had a case with an interval of seven weeks between the births ; Vale *= 1 of two months ; Bush * 1 of seventeen days ; and Burke ^ 1 with an interval of two months. Douglas ^ cites an instance of twins being born four days apart. Bessems of Antwerp, in 1866, mentions a Avoman with a bicor- nate uterus who bore two twins at fifty -four days' interval. a 224, 1878, i., 227. b 224, 1886. <= 476, 1842. d 535, 1825, 121. e 582, 1855, 241. f 538, xxvii., 196. CHAPTEE IV. PEOLIFICITT. General Historic Observations. — Prolificity is a much discussed sub- ject, for besides its medical and general interest it is of importance in social as well as in political economy. Superfluous population was a question that came to consciousness early ; Aristotle spoke of legislation to prevent the in- crease of population and the physical and mental deterioration of the race, — he believed in a population fixed as regards numbers, — and later Lycurgus transformed these precepts into a terrible law. Strabonius reports that the inhabitants of Cathea brought their infants at the age of two months before a magistrate for inspection. The strong and promising were preserved and the weak destroyed. The founders of the Roman Empire followed a similar usage. With great indignation Seneca, Ovid, and Juvenal reproved this barbarity of the Romans. With the domination of Christianity this custom gradually diminished, and Constantine stopped it altogether, ordering succor to the people too poor to rear their own children. The old Celts were so jealous of their vigor that they placed their babes on a shield in the river, and regarded those that the waves respected as legitimate and worthy to become members of their clans. In many of the Oriental countries, where the population is often very excessive and poverty great, the girl babies of- the lower classes were destroyed. At one time the crocodiles, held sacred in the Nile, were given the surplus infants. By destroying the females the breed- ing necessarily diminished, and the number of the weaker and dependent classes became less. In other countries persons having children beyond their ability to support were privileged to sell them to citizens, who contracted to raise them on condition that they became their slaves. General Law, and the Influence of War. — In the increase of the world's population, although circumstances may for the time alter it, a general average of prolificity has, in the long run, been maintained. In tlie history of every nation artificial circumstances, such as fashion, war, poverty, etc., at some period have temporarily lowered the average of prolificity ; but a further search finds another period, under opposite circumstances, which will more than compensate for it. The effect of a long-continued war or wars on generation and prolificity has never been given proper consideration. In such times marriages become much less frequent ; the husbands are separated 144 INFLUENCE OF RURAL AND URBAN LIFE. 145 from their wives for long periods ; many women are left widows ; the females become in excess of the males ; the excitement of the times overtops the desire for sexual intercourse, or, if there is the same desire, the unprolific prostitute furnishes the satisfaction ; and such facts as these, coupled with many similar ones, soon produce an astonishing effect upon the comparative birth-rate and death-rate of the country. The resources of a country, so far as concerns population, become less as the period of peace-disturbance is prolonged. Mayo-Smith" quotes von Mayr in the following example of the influence of the war of 1870-71 on the birth-rate in Bavaria, — the figures for births are thrown back nine months, so as to show the time of conception : Before the war under normal conception the number of births was about 16,000 per month. During the war it sank to about 2000 per month. Immediately on the cessation of hostilities it arose to its former number, while the actual return of the troops brought an increase of 2000 per month. The maximum was reached in March, 1872, when it was 18,450. The war of 1866 seems to have passed over Germany without any great influence, the birth-rate in 1865 being 39.2; in 1866, 39.4; in 1867, 38.3; in 1868, 38.4. On the other hand, while the birth-rate in 1870 was 40.1, in 1871 it was only 35.9 ; in 1872 it recovered to 41.1, and remained above 41 down to 1878. Von Mayr believes the war had a depressing influence upon the rate apart from the mere absence of the men, as shown in the fact that immediately upon the cessation of hostilities it recovered in Bavaria, although it was several months before the return of the troops. Mayo-Smith, in remarking on the influence of war on the marriage-rate, says that in 1866 the Prussian rate fell from 18.2 to 15.6, while the Austrian rate fell from 15.5 to 13.0, In the war of 1870—71 the Prussian rate fell from 17.9 in 1869 to 14.9 in 1870 and 15.9 in 1871 ; but in the two years after peace was made it rose to 20.6 and 20.2, the highest rates ever recorded. In France the rate fell from 16.5 to 12.1 and 14.4, and then rose to 19.5 and 17.7, the highest rates ever recorded in France. Influence of Rural and Urban Life. — Rural districts are always very prolific, and when we hear the wails of writers on " Social Economy," bemoan- ing the small birth-rates of their large cities, we need have no fear for urban extinction, as emigration from the country by many ambitious sons and daughters, to avail themselves of the superior advantages that the city offers, will not only keep up but to a certain point increase the population, until the reaction of overcrowding, following the self-regulating law of compensation, starts a return emigration. The effect of climate and race on prolificity, though much spoken of, is not so great a factor as supposed. The inhabitants of Great Britain are surpassed by none in the point of prolificity ; yet their location is quite northern. The Swedes have always been noted for their fecundity. Olaf a Statistics and Sociology, New York, 1895. 10 146 PROLIFICITY. Eudbeck" says that from 8 to 12 was the usual family number, and some ran as high as 25 or 30. According to Lord Kames, in Iceland before the plague (about 1710) families of from 15 to 20 were quite common. The old settlers in cold North America were always blessed with large families, and Quebec is still noted for its prolificity. There is little difference in this respect among nations, woman being limited about the same everywhere, and the general average of the range of the productive function remaining nearly identical in all nations. Of course, exception must be made as to the extremes of north or south. Ancient and Modern Prolificity. — Nor is there much difference between ancient and modern times. We read in the writings of Aristotle, Pliny, and Albucasis of the wonderftil fertility of the women of Egypt, Arabia, and other warm countries, from 3 to 6 children often being born at once and living to maturity ; but from the wonder and surprise shown in the narration of these facts, they were doubtless exceptions, of which parallels may be found in the present day. The ancient Greek and Roman families were no larger than those of to-day, and were smaller in the zenith of Roman affluence, and continued small until the period of decadence. Legal Encouragement of Prolificity. — In Quebec Province, Canada, according to a Montreal authority,'' 100 acres of land are allotted to the father who has a dozen children by legitimate marriage. The same journal states that, stimulated by the premium offered, families of 20 or more are not rare, the results of patriotic efforts. In 1895, 1742 "chefs de famille" made their claim according to the conditions of the law, and one, Paul Bellanger, of the River du Loup, claimed 300 acres as his premium, based on the fact that he was the father of 36 children. Another claimant. Monsieur Thioret de Sainte Genevieve, had been presented by his wife, a woman not yet thirty years old, with 17 children. She had triplets twice in the space of five years and twins thrice in the mean time. It is a matter of conjecture what the effect would be of such a premium in countries with a lowering birth-rate, and a French medical journal, quoting the foregoing, regretfully wishes for some countrymen at home like their brothers in Quebec. Old Explanations of Prolificity. — The old explanation of the causation of the remarkable exceptions to the rules of prolificity was similar to that advanced by Empedocles, who says that the greater the quantity of semen, the greater the number of children at birth. Par6,"8 later, uses a similar reason to explain the causation of monstrosities, grouping them into two classes, those due to deficiency of semen, such as the acephalous type, and those due to ex- cess, such as the double monsters. Hippocrates, in his work on the " Nature of the Infant," tells us that twins are the result of a single coitus, and we are also informed that each infant has a chorion ; so that both kinds of plurd gestation (monochorionic and dichorionic) were known to the ancients. In this a Atlantica, Upsal, 1684. b 738, June, 1895. OLD RECORDS OF GREAT PROLIFICITY. 147 treatise it is further stated that the twins may be male or female, or both males or both females ; the male is formed when the semen is thick and strong. The greatest number of children at a single birth that it is possible for a woman to have has never been definitely determined. Aristotle gives it as his opinion that one woman can bring forth no more than 5 children at a single birth, and discredits reports of multiplicity above this number ; while Pliny, who is not held to be so trustworthy, positively states that there were authentic records of as many as 12 at a birth. Throughout the ages in which superstitious distortion of facts and unquestioning credulity was unchecked, all sorts of incredible accounts of prolificity are found. Martin Cromerus, a Polish historian, quoted by Par6, who has done some good work in statistical research on this subject, says * that Margaret, of a noble and ancient family near Cracovia, the wife of Count Yirboslaus, brought forth 36 living children on January 20, 1296. The celebrated case of Countess Margaret, daughter of Florent IV., Earl of Holland, and spouse of Count Hermann of Henneberg, was supposed to have occurred just before this, on Good Friday, 1278. She was at this time forty-two years of age, and at one birth brought forth 365 infants, 182 males, 182 females, and 1 hermaphrodite. They were all baptized in two large brazen dishes by the Bishop of Treras, the males being called John, the females Elizabeth. During the last century the basins were still on exhibi- tion in the village church of Losdun, and most of the visitors to Hague went out to see them, as they were reckoned one of the curiosities of Holland. The affliction was ascribed to the curse of a poor woman who, holding twins in her arms, approached the Count«ss for aid. She was not only denied alms, but was insulted by being told that her twins were by different fathers, whereupon the poor woman prayed God to send the Countess as many children as there were days in the year. There is room for much speculation as to what this case really was. There is a possibility that it was simply a case of hydatidi- form or multiple molar pregnancy, elaborated by an exhaustive imagination and superstitious awe. As late as 1799 there was a woman of a town of Andalusia who was reported to have been delivered of 16 male infants, 7 of which were alive two months later. Mayo-Smith remarks that the proportion of multiple births is not more than 1 per cent, of the total number of parturitions. The latest statistics, by Westergaard, give the following averages to number of cases of 100 births in which there were 2 or more at a birth : — Sweden, .... 1.45 Germany, 1.24 Bavaria, .... 1.38 Denmark, . . . .1.34 Holland, 1.30 Prassia, . . - .1.26 Scotland, .... 1.22 Norway, 1.32 Saxony, .... 1.20 Italy, 1.21 Austria, 1.17 Switzerland, . .1.16 France, 0.99 Belgium, 0.97 Spain, 0.85 a 618, 1014. 148 PROLIFICITY. In Prussia, from 1826 to 1880, there were 85 cases of quadruplets and 3 cases of 5 at a birth. > The most extensive statistics in regard to multiple births are those of Veit, who reviews 13,000,000 births in Prussia. According to his deductions, twins occur once in 88 births ; triplets, once in 7910 ; and quadruplets, once in 371,126. Recent statistics suppKed by the Boards of Health of New York and Philadelphia place the frequency of twin births in these cities at 1 in every 120 births, while in Bohemia twins occur once in about 60 births, a proportion just twice as great.* Of 150,000 twin pregnancies studied by Veit, in one-third both children were boys ; in slightly less than one-third both were girls ; in the remaining third both sexes were represented. Authentic records of 5 and 6 at a birth are extremely rare and infinitesimal in proportion. The reputed births in excess of 6 must be looked on with suspicion, and, in fact, in the great majority of reports are apochryphal. The examples of multiple births of a single pregnancy will be taken up under their respective numbers, several examples of each being given, together with the authorities. Many twin and triplet brothers have figured prominently in history, and, in fact, they seem especially favored. The instance of the Horatii and the Curatii, and their famous battle, on which hung the fate of Rome and Alba, is familiar to every one, their strength and wisdom being legendary with the Romans. Twins and triplets, being quite common, will not be considered here, although there are 2 cases of interest of the latter that deserve citation. Sperling *'^ reports 2 instances of triplets ; in the first there was 1 placenta and chorion, 2 amnions, and the sex was the same ; in the second case, in which the sexes were different, there were 3 placentas, 3 chorions, and 3 amnions. What significance this may have is only a matter of conjecture. Petty *> describes a case of triplets in which one child was born alive, the other 2 having lost their vitality three months before. Mirabeau " has recently found that triple births are most common (1 to 6500) in multiparous women between thirty and thirty-four years of age. Heredity seems to be a factor, and duplex uteruses predispose to multiple births. Ross "^ repoi-ts an instance of double uterus with triple pregnancy. Quadruplets are supposed to occur once in about every 400,000 births. There are 72 instances recorded in the Index Catalogue of the Surgeon General's Library, U. S. A., up to the time of compilation, not including the subsequent cases in the Index Medicus. At the Hotel-Dieu, in Paris, in 108,000 births, covering a period of sixty years, mostly in the last century, there was only one case of quadruplets. The following extract of an account of the birth of quadruplets is given by Dr. De Leon of IngersoU, Texas : — " I was called to see Mrs. E. T. Page, January 10, 1890, about 4 o'clock a 844, 14!2. b 490, 1845. c Ueber Drillingsgeburten, Miinchen, 1894. d Mlidecin, Paris, 1879, v., No. 43, 2. QUADRUPLETS. 149 A. M. ; found her in labor and at full time, although she assured me that her ' time ' was six weeks ahead. At 8 o'clock A. m. I delivered her of a girl baby ; I found there were triplets, and so informed her. At 11a. m. I delivered her of the second girl, after having rectified presentation, which was singular, face, hands, and feet all presented ; I placed in proper position and practised ' version.' This child was ' still-born,' and after considerable effort by artificial respiration it breathed and came around ' all right.' The third girl was born at 11.40 a.m. This was the smallest one of the four. In attempting to take away the placenta, to my astonishment I found the feet of another child. At 1 p. m. this one was born ; the head of this child got firmly impacted at the lower strait, and it was with a great deal of difficulty and much patient effort that it was finally disengaged ; it was blocked by a mass of placenta and cords. The first child had its own placenta ; the second and third had their placenta ; the fourth had also a placenta. They weighed at birth in the aggregate 19 J pounds without cloth- ing ; the first weighed 6 pounds ; the second 5 pounds ; the third 4J pounds ; the fourth 4 pounds. Mrs. Page is a blonde, about thirty-six years old, and has given birth to 14 children, twins three times before this, one pair by her first husband. She has been married to Page three years, and has had 8 children in that time. I have waited on her each time. Page is an Englishman, small, with dark hair, age about twenty-six, and weighs about 115 pounds. They are in St. Joseph, Mo., now, having contracted with Mr. Uffner of New York to travel and exhibit themselves in Denver, St. Joseph, Omaha, and Nebraska City, then on to Boston, Mass., where they will spend the summer." There is a report from Canada" of the birth of 4 living children at one time. The mother, a woman of thirty-eight, of small stature, weighing 100 pounds, had 4 living children of the ages of twelve, ten, eight, and seven years, respectively. She had aborted at the second month, and at full term was delivered of 2 males, weighing, respectively, 4 pounds 9 J ounces and 4 pounds 3 ounces ; and of 2 females, weighing 4 pounds 3 ounces and 3 pounds 13| ounces, respectively. There was but one placenta, and no more exhaustion or hemorrhage than at a single birth. The father weighed 169 pounds, was forty-one years old, and was 5 feet 5 inches tall, healthy and robust. The Journal of St. Petersburg, a newspaper of the highest standard, stated that at the end of July, 1871, a Jewish womaii residing in Courland gave birth to 4 gii'ls, and again, in May, 1872, bore 2 boys and a girl ; the mother and the 7 children, born within a period of ten months, were doing well at the time of the report. In the village of Iwokina, on May 26, 1854, ^ the wife of a peasant bore 4 children at a birth, all surviv- ing. Bousquet " speaks of a primiparous mother, aged twenty-four, giving birth to 4 living infants, 3 by the breech and 1 by the vertex, apparently all a 250, Oct., 1883. >> 476, 1857, ii., 259. o 140, 1894, ii., 55. 150 PROLIFICITY. in one bag of membranes. They were nourished by the help of 3 wet-nurses. Bedford ^ speaks of 4 children at a birth, averaging 5 pounds each, and all nursing the mother. Quintuplets are quite rare, and the Index Catalogue of the Surgeon General's Library, U. S. A., gives only 19 cases, reports of a few of which will be given here, together with others not given in the Catalogue, and from less scientific though reliable sources. In the year 1731 ^^^ there was one case of quintuplets in Upper Saxony and another near Prague, Bohemia. In both of these cases the children were all christened and had all lived to maturity. Garthshore " speaks of a healthy woman, Margaret Waddington, giving birth to 5 girls, 2 of which lived ; the 2 that lived weighed at birth 8 pounds 12 ounces and 9 pounds, respectively. He discusses the idea that woman was meant to bear more than one child at a birth, using as his argument the existence of the double nipple and mamma, to which might be added the not infrequent occurrence of polymazia. In March, 1736, <= in a dairy cellar in the Strand, London, a poor woman gave birth to 3 boys and 2 girls. In the same journal was reported the birth at Wells, Somersetshire, in 1739, of 4 boys and a girl, all of whom were christened and were healthy. Parg ^ in 1549 gives several instances of 5 children at a birth, and Pliny reports that in the peninsula of Greece there was a woman who gave birth to quintuplets on four different occasions. Petritus, a Greek physician,^ speaks of the birth of quintuplets at the seventh month. Two males and one female were born dead, being attached to the same placenta ; the others were united to a common placenta and lived three days. Chambon ^ mentions an instance of 5 at a birth. Not far from Berne, Switzerland, the wife of John Gelinger, a preacher in the Lordship of Berne, brought forth twins, and within a year after she brought forth quintuplets, 3 sons and 2 daughters. s There is a similar instance reported in 1827 '^ of a woman of twenty-seven who, having been delivered of twins two years before, was brought to bed with 5 children, 3 boys and 2 girls. Their length was from 15 J to 16 J inches. Although regularly formed, they did not seem to have reached maturity. The mother was much exhausted, but recovered. The children appeared old-looking, had tremulous voices, and slept continually ; during sleep their temperatures seemed very low. Kennedy ^ showed before the Dublin Pathological Society 5 fetuses with the involucra, the product of an abortion at the third month. At Naples in 1839 Giuseppa Califani gave birth to 5 children; and about the same time Paddock reported the birth in Franklin County, Pa., of quintuplets. The Lancet J relates an account of the birth of quintuplets, 2 boys and 3 girls, by the wife of a peasant on March 1, 1854. Moffitt'' records the 1 538, 1867. b 629, 1787, 344. o 374, Oct. 5, 1736. d 618, L. XXV., chap, ill., 54. e 302, iv., 183. f 302, xix., 389. 8 618,1014. h 371, T. ii., 1827. i 476, 1837, 743. J 476, 1857, ii., 259. k 545, 1881. QUINTUPLETS. 151 birth at Monticello, 111., of quintuplets. The woman was thirty-five years of age ; examination showed a breech presentation ; the second child was born by a foot-presentation, as was the third, but the last was by a head- presentation. The combined weight was something over 19 pounds, and of the 5, 3 were still-born, and the other 2 died soon after birth. The Elgin Courant (Scotland), 1858, speaks of a woman named Elspet Gordon, at Rothes, giving birth to 3 males and 2 females. Although they were six months' births, the boys all lived until the following morning. The girls were still-born. One of the boys had two front teeth when born. Dr. Dawson of Rothes is the obstetrician mentioned in this case. The following recent instance is given with full details to illustrate the difficulties attending the births of quintuplets. Stoker * has reported the case of a healthy woman, thirty-five years old, 5 feet 1 inch high, and of slight build, whom he delivered of 5 fetuses in the seventh month of pregnancy, none of the children surviving. The patient's mother had on two occasions given birth to twins. The woman herself had been married for six years and had borne 4 children at full term, having no difficulty in labor. When she came under observation she computed that she had been pregnant for six months, and had had her attention attracted to the unusually large size of her abdomen. She complained of fixed pain in the left side of the abdomen, on which side she thought she was larger. Pains set in with regularity and the labor lasted eight and three-quarter hours. After the rupture of the membranes the first child presented by the shoulder. Version was readily performed ; the child was dead (recently). Examination after the birth of the first child disclosed the existence of more than one remaining fetus. The membranes protruded and became tense with each contraction. The presentation was a transverse one. In this case also there was little difficulty in effecting internal version. The child lived a couple of hours. The third fetus was also enclosed in a separate sac, which had to be ruptured. The child presented by the breech and was delivered naturally, and lived for an hour. In the fourth case the membranes had likewise to be ruptured, and alarming hemorrhage ensued. Version was at once practised, but the chin became locked with that of the remaining fetus. There was some difficulty and considerable delay in freeing the children, though the extent of locking was not at any time formidable. The child was dead (recently). The fifth fetus presented by the head and was delivered naturally. It lived for half an hour. The placenta was delivered about five minutes after the birth of the last child, and consisted of two portions united by a narrow isthmus. One, the smaller, had two cords attached centrally and close together; the other, and larger, had two cords attached in a similar way and one where it was joined to the isthmus. The organ appeared to be perfectly healthy. The cord of the fourth child was so short that it had to be ligated in the vagina. The •■^ 476, 1895, ii., 1164. 152 PROLIFIGITY. children were all females and of about the same size, making a total weight of 8 pounds. The mother rallied quickly and got on well. Trustworthy records of sextuplets are, of course, extremely scarce. There are few catalogued at Washington, and but two authentic cases are on record in the United States. On December 30, 1831,^^* a woman in Dropin was delivered of 6 daughters, all living, and only a little smaller than usual in size. The mother was not quite twenty years old, but was of strong constitution. The 6 lived long enough to be baptized, but died the evening of their births. There was a case " of sextuplets in Italy in 1844. In Maine, June 27, 1847, a woman was delivered of 6 children, 2 sur- viving and, together with the mother, doing well.'' In 1885 there was reported the birth of sextuplets in Lorca, Spain, of which only one survived. *= At Dallas, Texas, in 1888,"^ Mrs. George Hirsh of Navarro County gave birth to 6 children, the mother and the children all doing well. There were 4 boys and 2 girls, and they were all perfect, well formed, but rather small. Valsalli ^ gives an instance which is quoted by the Medical News ^ without giving the authority. Valsalli's account, which differs slightly from the account in the Medical News, is briefly as follows : While straining at stool on the one hundred and fifteenth day of pregnancy the membranes ruptured and a foot prolapsed, no pain having been felt before the accident. A fetus was delivered by the midwife. Valsalli was summoned and found the woman with an enormously distended abdomen, within which were felt numerous fetal parts ; but no fetal heart-sounds or movements were noticed. The cervix was only slightly dilated, and, as no pains were felt, it was agreed to wait. On the next day the membranes were ruptured and 4 more fetuses were deliv- ered. Traction on the umbilical cord started hemorrhage, to check which the physician placed his hand in the uterine cavity. In this most arduous posi- tion he remained four hours until assistance from Lugano came. Then, in the presence of the three visiting physicians, a sixth amniotic sac was deliv- ered with its fetus. The woman had a normal convalescence, and in the fol- lowing year gave birth to healthy, living twins. The News says the chil- dren all moved vigorously at birth ; there were 4 males and 2 females, and for the 6 there was only one placenta. The mother, according to the same authority, was thirty-six years of age, and was in her second pregnancy. Multiple Births over Six. — When we pass sextuplets the records of multiple births are of the greatest rarity and in modern records there are almost none. There are several cases mentioned by the older writers whose statements are generall}- worthy of credence, which, however incredible, are of sufficient interest at least to find a place in this chapter. Albucasis affirms that he knew of the birth of seven children at one time ; and d'Alechampius reports that Bonaventura, the slave of one Savelli, a gentleman of Siena, gave » 152, 1844; 348. b 218, 1847. c 373, 1885. d 450, Nov. 17, 1888. e 350, 1888. f 533, March 23, 1895. MULTIPLE BIRTHS OVER SIX. 153 birth to 7 children, 4 of whom were baptized. At the Parish of San Ildefonso, Valladolid, Julianna, wife of Benito Quesada, gave birth to 3 children in one day, and during the following night to 4 more.^ Sigebert, in his Chronicles, says that the mother of the King of Lombardy had borne 7 children at a birth. Borellus "^ says that in 1650 the lady of the then present Lord Darre gave birth to eight perfect children at one parturition and that it was the unusual event of the country. Mrs. Timothy Bradlee of Trumbull County, Ohio, in 1872 is reported to have given birth to 8 children at one time.<= They were healthy and living, but quite small. The mother was married six years previously and then weighed 273 pounds. She had given birth to 2 pairs of twins, and, with these 3 boys and 5 girls, she had borne 12 children in six years. She herself was a triplet and her father and her mother were of twin births and one of her grandmothers was the mother of 5 pairs of twins. This case was most celebrated and was much quoted, several British journals extracting it. Watering of Maregnac'^ speaks of the simultaneous birth of 8 children at one time. When several months preg- nant the woman was seized with colicky pains and thought them a call of nature. She went into a vineyard to answer it, and there, to her great astonishment, gave birth to 8 fetuses. Watering found them enclosed in a sac, and thought they probably had died from mutual pressure during growth. The mother made a good recovery. In 1755 Seignette of Dijon " reports the simultaneous birth of nine children. Franciscus Picus Mirandulse, quoted by Par6, says that one Dorothea, an Italian, bore 20 children at 2 confinements, the first time bearing 9 and the second time eleven. He gives a picture of this marvel of prolificity, in which her belly is represented as hanging down to her knees, and supported by a girdle from the neck (Fig. 23). In the Annals, History, and Guide to Leeds and York, according to Walford,*^^ there is mention of Ann Birch, who in 1781 was delivered Fig. 23.— Pregnancy with 11 fetuses (after Par6). => 373, Nov. 22, 1885 ; quoted by 476, 1885, ii., 1125 ; and several other authorities, b Observ., cent, ii., Paris, 1656. c 218, Sept. 26, 1872. d349, June, 1880. e 280, 1755, i., 300. 154 PROLIFICITY. of 10 children. One daughter, the sole survivor of the 10, married a market gardener named Piatt, who was well known in Leeds. Jonston**' quotes Baytraff as saying that he knew of a case in which 9 children were born simultaneously ; and also says that the Countess of Altdorf gave birth to twelve at one birth. Albucasis mentions a case of fifteen well-formed children at a birth. According to LeBrun,'' Gilles de Trazegines, who accompanied Saint Louis to Palestine, and who was made Constable of France, was one of thirteen infants at a simultaneous accouchement. The Marquise, his mother, was impregnated by her husband before his departure, and during his absence had 13 living children. She was suspected by the native people and thought to be an adulteress, and some of the children were supposed to be the result of superfetation. They condemned them all to be drowned, but the Marquis appeared upon the scene about this time and, moved by compassion, acknowledged all 13. They grew up and thrived, and took the name of Trazegines, meaning, in the old language, 13 drowned, although many commentaries say that "ghies" was supposed to mean in the twelfth century " nes," or, in full, the interpretation would be " 13 born." Cases in which there is a repetition of multiple births are quite numer- ous, and sometimes so often repeated as to produce a family the size of which is almost incredible. Aristotle is credited with saying'' that he knew the history of a woman who liad quintuplets four times. Pliny's case of quin- tuplets four times repeated has been mentioned ; and Par6,^'^ who may be believed when he quotes from his own experience, says that the wife of the last Lord de Maldemeure, who lived in the Parish of Seaux, was a marvel of prolificity. Within a year after her marriage she gave birth to twins ; in the next year to triplets ; in the third year to quadruplets ; in the fourth year to quintuplets, and in the fifth year bore sextuplets ; in this last labor she died. The then present Lord de Maldemeure, he says, was one of the final sextuplets. This case attracted great notice at the time, as the family was quite noble and very well known. Seaux, their home, was near Chambellay. Picus Mirandulse gathered from the ancient Egyptian inscriptions that the women of Egypt brought forth sometimes 8 children at a birth, and that one woman bore 30 children in 4 confinements. He also cites, from the history of a certain Bishop of Necomus, that a woman named Antonia, in the Territory of Mutina, Italy, now called Modena, had brought forth 40 sons before she was forty years of age, and that she had had 3 and 4 at a birth. At the auction of the San Donato collection of pictures a portrait of Dianora Frescobaldi, by one of the Bronzinos in the sixteenth century, sold for about $3000. At the bottom of this portrait was an inscription stating that she was the mother of 52 children. This remarkable woman never had less than 3 at a birth, and tradition gives her as many as 6. Merriman " quotes a case of a woman, a shopkeeper named Blunet, who " 302, iv., 183. b 302, xix., 389. 374, Sept., 1783, iii , 753. REPETITION OF MULTIPLE BIRTHS. 155 had 21 children in 7 successive births. They were all born alive, and 12 still survived and were healthy. As though to settle the question as to whom should be given the credit in this case, the father or the mother, the father experimented upon a female servant, who, notwithstanding her youth and delicateness, gave birth to 3 male children that lived three weeks. According to despatches from Lafayette, Indiana, investigation following the murder, on December 22, 1895, of Hester Curtis, an aged woman of that city, developed the rather remarkable fact that she had been the mother of 25 children, including 7 pairs of twins. According to a French authority the wife of a medical man at Fuente- major, in Spain, forty-three years of age, * was delivered of triplets 13 times. Puech read a paper before the French Academy in which he re- ports 1262 twin births in Nimes from 1790 to 1875, and states that of the whole number in 48 cases the twins were duplicated, and in 2 cases thrice repeated, and in one case 4 times repeated. Warren'' gives an instance of a lady, Mrs. M , thirty-two years of age, married at fourteen, who, after the death of her first child, bore twins, one living a month and the other six weeks. Later she again bore twins, both of whom died. She then miscarried with triplets, and afterward gave birth to 12 living children, as follows : July 24, 1858, 1 child; June 30, 1859, 2 children; March 24, 1860, 2 children; March 1, 1861, 3 children; February 13, 1862, 4 children; making a total of 21 children in eighteen years, with remarkable prolificity in the later pregnancies. She was never confined to her bed more than three days, and the children were all healthy. A woman in Schlossberg, Germany, gave birth to twins ; after a year, to triplets, and again, in another year, to 3 fairly strong boys.'' In the State Papers, Domestic Series, Charles I., according to Walford,^^^ appears an extract from a letter from George Garrard to Viscount Conway, which is as follows : " Sir John Melton, who entertained you at York, hath buried his wife, Curran's daughter. Within twelve months she brought him 4 sons and a daughter, 2 sons last summer, and at this birth 2 more and a daughter, all alive." Swan*^ mentions a woman who gave birth to 6 children in seventeen months in 2 triple pregnancies. The first terminated prematurely, 2 children dying at once, the other in five weeks. The sec- ond was uneventful, the 3 children living at the time of the report. Eockwell "^ gives the report of a case of a woman of twenty-eight, herself a twin, who gave birth to twins in January, 1879. They died after a few weeks, and in March, 1880, she again bore twins, one living three and the other nine weeks. On March 12, 1881, she gave birth to triplets. The first child, a male, weighed 7 pounds ; the second, a female, Q\ pounds ; the » 365, Oct. 1, 1863. »> 218, 1862, 331. « 224, 1878, ii., 767. d 512, March, 1893. e 612, Columbus, 1881. 156 PROLIFICITY. third, a male, 5J pounds. The third child lived twenty days, the other two died of cholera infantum at the sixth month, attributable to the bottle-feed- ing. Banerjee" gives the history of a case of a woman of thirty being de- livered of her fourth pair of twins. Her mother was dead, but she had 3 sisters living, of one of which she was a twin, and the other 2 were twins. One of her sisters had 2 twin terms, 1 child surviving ; like her own children, all were females. A second sister had a twin term, both males, 1 surviving. The other sister aborted female twins after a fall in the eighth month of pregnancy. The name of the patient was Mussamat Somni, and she was the wife of a respectable Indian carpenter. There are recorded the most wonderful accounts of prolificity, in which, by repeated multiple births, a woman is said to have borne children almost beyond belief. A Naples correspondent to a Paris Journal ^ gives the following : " About 2 or 3 stations beyond Pompeii, in the City of Nocera, lives Maddalena Granata, aged forty-seven, who was married at twenty-eight, and has given birth to 52 living and dead children, 49 being males. Dr. de Sanctis, of Nocera, states that she has had triplets 15 times." Peasant Kirilow " was presented to the Empress of Russia in 1853, at the age of seventy years. He had been twice married, and his first wife had presented him with 57 children, the fruits of 21 pregnancies. She had quad- ruplets four times, triplets seven times, and twins thrice. By his second wife he had 15 children, twins six times, and triplets once. This man, accordingly, was the father of 72 children, and, to magnify the wonder, all the children were alive at the time of presentation. Herman, in some Russian statistics, ^ relates the instance of Fedor Vassilet, a peasant of the Moscow Jurisdiction, who in 1872, at the age of seventy-five years, was the father of 87 children. He had been twice married ; his first wife bore him 69 children in 27 accouche- ments, having twins sixteen times, triplets seven times, and quadruplets four times, but never a single birth. His second wife bore him 18 children in 8 accouchements. In 1872, 83 of the 87 children were living. The author says this case is beyond all question, as the Imperial Academy of St. Petersburg, as well as the French Academy, have substantial proof of it. The family are still living in Russia, and are the object pf governmental favors. The following fact is interesting from the point of exaggeration, if for nothing else : " The New York Medical Journal is accredited with publishing the following extract from the history of a journey to Saragossa, Barcelona, and Valencia, in the year 1585, by Philip II. of Spain. The book was written by Henrique Cock, who accompanied Philip as his private secretary. On page 248 the following statements are to be found : At the age of eleven years, Margarita Goncalez, whose father was a Biscayian, and whose mother was French, was married to her first husband, who was forty years » 540, June 1, 1894. b Quoted by 536, 1886, i., 57. •; 476, 1857, ii., 259. d 476, 1878, i., 289. EXTREME PROLIFICITY BY SINGLE BIRTHS. 157 old. By him she had 78 boys and 7 girls. He died thirteen years after the marriage, and, after having remained a widow two years, the woman married again. By her second husband, Thomas Gchoa, she had 66 boys and 7 girls. These children were all born in Valencia, between the fifteenth and thirty- fifth year of the mother's age, and at the time when the account was written she was thirty-five years old and pregnant again. Of the children, 47 by the first husband and 52 by the second were baptized ; the other births were still or premature. There were 33 confinements in all." Extreme Prolificity by Single Births. — The number of children a woman may bring forth is therefore not to be accurately stated ; there seems to be almost no limit to it, and even when we exclude those cases in which remarkable multiplicity at each birth augments the number, there are still some almost incredible cases on record. The statistics of the St. Pancras Royal Dispensary, 1853, estimated the number of children one woman may bear as from 25 to 69. Eisenmenger relates the history of a case of a woman in the last century bearing 51 children, and there is another case* in which a woman bore 44 children, all boys. Atkinson ^ speaks of a lady married at sixteen, dying when she was sixty-four, who had borne 39 children, all at single births, by one husband, whom she survived. The children, 32 daughters and 7 sons, all attained their majority. There was a case of a woman in America" who in twenty-six years gave birth to 22 children, all at single births. Thoresby in his "History of Leeds," 1715, mentions three remarkable cases — one the wife of Dr. Phineas Hudson, Chancellor of York, as having died in her thirty-ninth year of her twenty- fourth child ; another of Mrs. Joseph Cooper, as dying of her twenty-sixth child, and, lastly, of Mrs. William Greenhill, of a village in Hertford, England, who gave birth to 39 children during her life. Brand, a writer of great repute, in his " History of Newcastle," quoted by Walford,*^** mentions as a well attested fact the wife of a Scotch weaver who bore 62 children by one husband, all of whom lived to be baptized. A curious epitaph is to be seen at Conway, Carnarvonshire : — "Here lieth the body of Nicholas Hookas, of Conway, gentleman, who was one-and-fortieth child of his father, William Hookes, Esq. , by Alice, his wife, and the father of 27 children. He died 20th of March, 1637." On jSTovember 21, 1768, Mrs. Shury, the wife of a cooper, in Vine Street, Westminster, was delivered of 2 boys, making 26 by the same hus- band. She had previously been confined with twins during the year. It would be the task of a mathematician to figure the possibilities of paternity in a man of extra long life who had married several prolific women during his prolonged period of virility. A man by the name of Pearsons of Lexton, Nottingham, at the time of the report had been married 4 times. By his first 3 wives he had 39 children and by his last 14, making a » 559, 1806, 1 B., 127. » 224, 1883, ii., 557. " 218, Sept. 26, 1872. 158 PROLIFIGITY. total of 53. He was 6 feet tall and lived to his ninety-sixth year. We have already mentioned the two Eussian cases in which the paternity was 72 and 87 children respectively, and in "Notes and Queries," June 21, 1856, there is an account of David Wilson of Madison, Ind., who had died a few years previously at the age of one hundred and seven. He had been 5 times mar- ried and was the father of 47 children, 35 of whom were living at the time of his death. On a tomb in Ely, Cambridgeshire, there is an inscription saying that Richard Worster, buried there, died on May 11, 1856, the tomb being in memory of his 22 sons and 5 daughters. Artaxerxes was supposed to have had 106 children ; Conrad, Duke of Moscow, 80 ; and in the polygamous countries the number seems incredible. Herotinus was said ^ to have had 600 ; and Jonston also quotes instances of 225 and even of 650 in the Eastern countries. Recently there have been published accounts of the alleged experiments of Luigi Erba, an Italian gentleman of Perugia, whose results have been an- nounced. About forty years of age and being quite wealthy, this bizarre philanthropist visited various quarters of the world, securing women of differ- ent races ; having secured a number sufficient for his purposes, he retired with them to Polynesia, where he is accredited with maintaining a unique establishment with his household of females. In 1896, just seven years after the experiment commenced, the reports say he is the father of 370 children. The following is a report from Raleigh, N. C, on July 28, 1893, to the New York Evening Post : — " The fecundity of the negro race has been the subject of much comment and discussion. A case has come to light in this State that is one of the most remarkable on record. Moses Williams, a negro farmer, lives in the eastern section of this State. He is sixty-five years old (as nearly as he can make out), but does not appear to be over fifty. He has been married twice, and by the two wives has had born to him 45 children. By the first wife he had 23 children, 20 of whom were girls and 3 were boys. By the second wife he had 22 children — 20 girls and 2 boys. He also has about 50 grand- children. The case is well authenticated." We also quote the following, accredited to the " Annals of Hygiene : " — " Were it not part of the records of the Berks County courts, we could hardly credit the history of John Heffner, who was accidentally killed some years ago at the age of sixty-nine. He was married-first in 1 840. In eight years his wife bore him 17 children. The first and second years of their marriage she gave birth to twins. For four successive years afterward she gave birth to triplets. In the seventh year she gave birth to one child and died soon afterward. Heffner engaged a young woman to look after his large brood of babies, and three months later she became the second Mrs. Heffner. She " 447, 466. POSSIBLE DESCENDANTS. 159 presented her husband with 2 children in the first two years of her wedded life. Five years later she had added 10 more to the family, having twins 5 times. Then for three years she added but 1 a year. At the time of the death of the second wife 12 of the 32 children had died. The 20 that were left did not appear to be any obstacle to a young widow with one child con- senting to become the third wife of the jolly little man, for he was known as one of the happiest and most genial of men, although it kept him toiling like a slave to keep a score of mouths in bread. The third Mrs. Heffner became the mother of 9 children in ten years, and the contentment and happiness of the couple were proverbial. One day, in the fall of 1885, the father of the 41 children was crossing a railroad track and was run down by a locomotive and instantly killed. His widow and 24 of the 42 children are still living." Many Marriages. — In this connection it seems appropriate to mention a few examples of multimarriages on record, to give an idea of the possibilities of the extent of paternity. St. Jerome mentions a widow who married her twenty- second husband, who in his time had taken to himself 20 loving spouses. A gentleman living in Bordeaux'*^ in 1772 had been married 16 times. DeLongueville, a Frenchman, lived to be one hundred and ten years old, and had been joined in matrimony to 10 wives, his last wife bearing him a son in his one hundred and first year. Possible Descendants. — When we indulge ourselves as to the possible number of living descendants one person may have, we soon get extraordinary figures. The Madrid Estafette " states that a gentleman, Senor Lucas Ne- queiras Saez, who emigrated to America seventy years previously, recently returned to Spain in his own steamer, and brought with him his whole family, consisting of 197 persons. He had been thrice married, and by his first wife had 11 children at 7 births ; by his second wife, 19 at 13 births, and by his third wife, 7 at 6 births. The youngest of the 37 was thirteen years old and the eldest seventy. This latter one had a son aged forty-seven and 16 children besides. He had 34 granddaughters, 45 grandsons, 45 great granddaughters, 39 great grandsons, all living. Senor Saez himself was ninety-three years old and in excellent health. At Litchfield, Conn., there is said to be the following inscription : **^ — "Here lies the body of Mrs. Mary, wife of Dr. John Bull, Esq. She died November 4, 1778, aetat. ninety, having had 13 children, 101 grandchil- dren, 274 great grandchildren, and 22 great-great grandchildren, a total of 410; surviving, 336." In Esher Church there is an inscription, scarcely legible, which records the death of the mother of Mrs. Mary Morton on April 18, 1634, and saying that she was the wonder of her sex and age, for she lived to see nearly 400 issued from her loins. » 224, 1883, ii., 207. 160 PROLIFICITY. The following is a communication to " Notes and Queries," March 21, 1891 : " Mrs. Mary Honeywood was daughter and one of the coheiresses of Eobert Waters, Esq., of Lenham, in Kent. She was born in 1527 ; married in February, 1543, at sixteen years of age, to her only husband, Eobert Honeywood, Esq., of Charing, in Kent. She died in the ninety-third year of her age, in May, 1620. She had 16 children of her own body, 7 sons and 9 daughters, of whom one had no issue, 3 died young — the young- est was slain at Newport battle, June 20, 1600. Her grandchildren, in the second generation, were 114 ; in the third, 228, and in the fourth, 9 ; so that she could almost say the same as the distich doth of one of the Dalburg family of Basil : ' Rise up, daughter, and go to thy daughter, for thy daugh- ter's daughter hath a daughter.' " In Markshal Church, in Essex, on Mrs. Honeywood' s tomb is the follow- ing inscription : ' Here lieth the body of Mary Waters, the daughter and co- heir of Robert Waters, of Lenham, in Kent, wife of Robert Honeywood, of Charing, in Kent, her only husband, who had at her decease, lawfully de- scended from her, 367 children, 16 of her own body, 114 grandchildren, 228 in the third generation, and 9 in the fourth. She lived a most pious life and died at Markshal, in the ninety-third year of her age and the forty-fourth of her widowhood. May 11, 1620.' (From 'Curiosities for the Ingenious,' 1825.) S. S. R." Animal prolificity, though not finding a place in this work, presents some wonderful anomalies.* a In illustration we may note the following : In the Illustrated London News, May 11, 1895, is a portrait of "Lady Millard," a fine St. Bernard bitch, the property of Mr. Thorp of Northwold, with her litter of 21 puppies, born on February 9, 1895, their sire being a magnificent dog — "Young York." There is quoted an incredible account i of a cow, the property of J. N. Sawyer of Ohio, which gave birth to 56 calves, one of which was fuUy matured and lived, the others being about the size of kittens ; these died, together with the mother. There was a cow in France, in 1871, delivered of 5 calves. 1609, 1879, i., 525. CHAPTER V. MAJOR TEEATA. Monstrosities have attracted notice from the earliest time, and many of the ancient philosophers made references to them. In mythology we read of Centaurs, impossible beings who had the body and extremities of a beast ; the Cyclops, possessed of one enormous eye ; or their parallels in Egyptian myths, the men with pectoral eyes, — the creatures " whose heads do beneath their shoulders grow ;" and the Fauns, those sylvan deities whose lower extremities bore resemblance to those of a goat. Monsters possessed of two or more heads or double bodies are found in the legends and fairy tales of every nation. Hippocrates, his precursors, Empedocles and Demo- critus, and Pliny, Aristotle, and Galen, have all described monsters, although in extravagant and ridiculous language. Ballantyne remarks that the occasional occurrence of double monsters was a fact known to the Hippocratic school, and is indicated by a passage in De morbis mvliehribus, in which it is said that labor is gravely interfered with when the infant is dead or apoplectic or double. There is also a reference to monochorionic twins (which are by modern teratologists regarded as mon- strosities) in the treatise De Superfcetatione, in which it is stated that " a woman, pregnant with twins, gives birth to them both at the same time, just as she has conceived them ; the two infants are in a single chorion." Ancient Explanations of Monstrosities. — From the time of Galen to the sixteenth century many incredible reports of monsters are seen in medical literature, but without a semblance of scientific truth. There has been little improvement in the mode of explanation of monstrous births until the present century, while in the Middle Ages the superstitions were more ludicrous and observers more ignorant than before the time of Galen. In his able article on the teratologic records of Chaldea, Ballantyne* makes the following trite statements : " Credulity and superstition have never been the peculiar pos- session of the lower types of civilization only, and the special beliefs that have gathered round the occurrence of teratologic phenomena have been common to the cultured Greek and Roman of the past, the ignorant peasant of modern times, and the savage tribes of all ages. Classical writings, the literature of the Middle Ages, and the popular beliefs of the present day all contain views a 759, 1894, 130. 11 161 162 MAJOR TERATA. concerning teratologic subjects which so closely I'esemble -those of the Chal- dean magi as to be indistinguishable from them. Indeed, such works as those of Obsequens, Lycosthenes, Licetus, and Ambroise Par6 only repeat, but with less accuracy of description and with greater freedom of imagina- tion, the beliefs of ancient Babylon. Even at the present time the most impossible cases of so-called ' maternal impressions ' are widely scattered through medical literature ; and it is not very long since I received a letter from a distinguished member of the profession asking me whether, in my opinion, I thought it possible for a woman to give birth to a dog. Of course, I do not at all mean to infer that teratology has not made immense advances within recent times, nor do I suggest that on such subjects the knowledge of the magi can be compared with that of the average medical student of the present ; but what I wish to emphasize is that, in the literature of ancient Babylonia, there are indications of an acquaintance with structural defects and malformations of the human body which will compare favorably with even the writings of the sixteenth century of the Christian era." Many reasons were given for the exist- ence of monsters, and in the Middle Ages these were as faulty as the descriptions themselves. They were interpreted as divi- nations, and were cited as forebodings and examples of wrath, or even as glorifica- tions of the Almighty. The semi-human creatures were invented or imagined, and cited as the results of bestiality and allied forms of sexual perversion prevalent in those times. "We find minute descriptions and portraits of these impossible results of wicked practices in many of the older medical books. According to Par6 " there was born in 1493, as the result of illicit intercourse between a woman and a dog, a creature resembling in its upper extremities its mother, while its lower extremities were the exact counterpart of its canine father (Fig. 24). This particular case was believed by Bateman and others to be a precursor to the murders and wickedness that followed in the time of Pope Alexander I. Volateranus, Cardani, and many others cite instances of this kind. Lycosthenes says that in the year 1110, in the bourg of Li6ge, there was found a creature with the head, visage, hands, and feet of a man, and the rest of the body like that of a pig. Par6 quotes this case and gives an illustration. Rhodiginus** mentions a shepherd of Cybare by the name of Cratain, who had connection with a female goat and " 618, 1031. b 679, L. xxv., chap. 32. Fig. 24.— Dog-boy (after Par«). ANCIENT EXPLANATIONS OF MONSTROSITIES. 163 impregnated her, so that she brought forth a beast with a head .resembling that of the father, but with the lower extremities of a goat. He says that the likeness to the father was so marked that the head-goat of the herd recog- nized it, and accordingly slew the goatherd who had sinned so unnaturally. In the year 1547, at Cracovia,!^^ a very strange monster was born, which lived three days. It had a head shaped like that of a man ; a nose long and hooked like an elephant's trunk ; the hands and feet looking like the web-foot of a goose ; and a tail with a hook on it. It was supposed to be a male, and was looked upon as a result of sodomy. Rueff* says that the pro- creation of human beings and beasts is brought about — (1) By the natural appetite ; (2) By the provocation of nature by delight ; (3) By the attractive virtue of the matrix, which in beasts and women is alike. Plutarch, in his " Lesser Parallels," says that Aristonymus Ephesius, son of Demonstratus, being tired of women, had carnal knowledge with an ass, which in the process of time brought forth a very beautiful child, who became the maid Onoscelin He also speaks of the origin of the maiden Hippona, or as he calls her. Hippo, as being from the connection of a man with a mare. Aristotle mentions this in his paradoxes, and we know that the patron of horses was Hippona. In Helvetia ^'^ was reported the exist- ence of a colt (whose mother had been covered by a bull) that was half horse and half bull. One of the kings of France was supposed to have been presented with a colt with the hinder part of a hart, and which could out- run any horse in the kingdom. Its mother had been covered by a hart. Writing in 1557, Lycosthenes reports the mythical birth of a serpent by a woman. It is quite possible that some known and classified type of monstrosity was indicated here in vague terms. In 1726 Mary Toft, of Godalming, in Surrey, England, achieved considerable notoriety throughout Surrey, and even over all England, by her extensively circulated statements that she bore rabbits. Even at so late a day as this the credulity of the people was so great that many persons believed in her. The woman was closely watched, and being detected in her maneuvers confessed her fraud. To show the extent of discussion this case called forth, there are no less than nine pamphlets and books in the Surgeon-General's library at Wash- ington devoted exfelusively to this case of pretended rabbit-breeding. Hamilton in 1848, and Hard'' in 1884, both report the births in this country of fetal monstrosities with heads which showed marked resemblance to those of dogs. Doubtless many of the older cases of the supposed results of bestiality, if seen to-day, could be readily classified among some of our known forms of monsters. Modern investigation has shown us the sterile results of the connections between man and beast or between beasts of a " The Expert Midwife," London, 1637. *> 269, xlviii., 246. 164 MAJOR TERATA. diiferent species, and we can only wonder at the simple credulity and the imaginative minds of our ancestors. At one period certain phenomena of nature, such as an eclipse or comet, were thought to exercise their influence on monstrous births. Eueff mentions that in Sicily there happened a great eclipse of the sun, and that women immediately began to bring forth deformed and double-headed children. Before ending these preliminary remarks, there might be mentioned the marine monsters, such as mermaids, sea-serpents, and the like, which from time to time have been reported ; even at the present day there are people who devoutly believe that they have seen horrible and impossible demons in the sea. Par6* describes and pictures a monster, at Rome, on Novem- ber 3, 1520, with the upper portion of a child apparently about five or six years old, and the lower part and ears of a fish- like animal. He also pictures a sea- devil in the same chapter, together with other grueeome examples of the power of imagination. Early Teratology. — Besides such cases as the foregoing, we find the medi- eval writers report likely instances of terata, as, for instance, Bhodiginus, ^'^ who speaks of a monster in Italy with two heads and two bodies ; Lycosthenes saw a double monster, both components of which slept at the same time ; he also says this creature took its food and drink simultaneously in its two mouths. Even Saint Augustine says that he knew of a child born in the Orient who, from the belly up, was in all parts double. The first evidences of a step toward classification and definite reasoning in regard to the causation of monstrosities were evinced by Ambroise Par6 in the sixteenth century, and though his ideas are crude and some of his phenomena impossible, yet many of his facts and arguments are worthy of consideration. Pari attributed the cause of anomalies of excess to an excessive quantity of semen, and anomalies of default to deficiency of the same fluid. He has collected many instances of double terata from reliable sources, but has interspersed his collection with accounts of some hideous and impossible creatures, such as are illustrated in the accompanying figure (Fig. 25), which shows a creature that was born shortly after a battle of a 618, 1053. Fig. 25.— Bird-boy (after Par«). SCIENTIFIC TERATOLOGY. 165 Louis XII., in 1512 ; it had the wings, crest, and lower extremity of a bird and a human head and trunk ; besides, it was an hermaphrodite, and had an extra eye in the knee. Another illustration represents a monstrous head found in an egg, said to have been sent for examination to King Charles at Metz in 1569. It represented the face and visage of a man, with small living serpents taking the place of beard and hair. So credulous were people at this time that even a man so well informed as Par6 believed in the pos- sibility of these last two, or at least represented them as facts. At this time were also reported double hermaphroditic terata, seemingly without latter- day analogues. Rhodiginus * speaks of a two-headed monster born in Ferrari, Italy, in 1540, well formed, and with two sets of genitals, one male and the Fig. 26.— Bicephalio and hermaphroditic monster (after Par6). Fig. 27. -Double hermaphroditic monster (after Pare). other female (Fig. 26). Par6 '° gives a picture (Fig. 27) of twins, born near Heidelberg in 1486, which had double bodies joined back to back ; one of the twins had the aspect of a female and the other of a male, though both had two sets of genitals. Scientific Teratology. — About the first half of the eighteenth century what might be called the positive period of teratology begins. Following the advent of this era come M6ry, Duverney, Winslow, Lgmery, and Littre. In their works true and concise descriptions are given and violent attacks are made against the ancient beliefs and prejudices. From the beginning of the second half of the last century to the present time may be termed the scien- tific epoch of teratology. We can almost with a certainty start this era with a 679, L. xxiv., chap. 30. '' 618, 1016. 166 MAJOR TERATA. the names of Haller, Morgagni, Geoffroy-Saint-Hilaire, and Meckel, who adduced the explanations asked for by Harvey and Wolff. From the appearance of the treatise by Geoifroy-Saint-Hilaire, teratology has made enormous strides, and is to-day well on the road to becoming a science. Hand in hand with embryology it has been the subject of much investiga^ tion in this century, and to enumerate the workers of the present day who have helped to bring about scientific progress would be a task of many pages. Even in the artificial production of monsters much has been done, and a glance at the work of Dareste " well repays the trouble. Essays on terato- genesis, with reference to batrachians, have been offered by Lombardini ; and by LerebouUet and Knoch with reference to fishes. Foil and Warynski *• have reported their success in obtaining visceral inversion, and even this branch of the subject promises to become scientific. Terata are seen in the lower animals and always excite interest. Par6 " gives the history of a sheep with three heads, born in 1577; the central head was larger than the other two, as shown in the accompanying illustration (Fig. 28). Many of the Museums of Natural History contain evidences of animal terata. At Hallse is a two-headed mouse ; the Conant Museum in Maine contains the skele- ton of an adult sheep with two heads ; there was an account of a two-headed pigeon published in France in 1734 ;'^ Leidy found a two-headed snake in a field near Philadelphia; Geoffroy- Saint-Hilaire and Conant both found similar creatures, and there is one in the Museum at Harvard ; Wyman saw a living double-headed snake in the Jardin des Plantes in Paris in 1853, and many parallel instances are on record. Classification. — We shall attempt no scientific discussion of the causa- tion or embryologic derivation of the monster, contenting ourselves with simple history and description, adding any associate facts of interest that may be suggested. For further information, the reader is referred to the authors cited or to any of the standard treatises on teratology. Many classifications of terata have been offered, and each possesses some advantage. The modern reader is referred to the modification of the group- ing of Geoffroy-Saint-Hilaire given by Hirst and Piersol*i', or those of Blanc 212 and Guinard =*«". For convenience, we have adopted the following classification, which will include only those monsters that have lived after - Recherches sur la production artificielle des monstruositSs, etc., Paris, 1894, 8". b Eecueil zoologique Suisse, 1883. <= 618, 1034. a Mfimoires de I'Acad. des Sciences. Fig. 28.— Three-headed sheep {after Parf). TRIPLE MONSTERS. 167 Class 1.- Class 2. Class 3. Class 4. Class 5. Class 6. Class 7. Class 8. Class 9. Class 10. Class 11. Class 12. birth, and who have attracted general notice or attained some fame in their time, as attested by accounts in contemporary literature. — Union of several fetuses. — Union of two distinct fetuses by a connecting band. — Union of two distinct fetuses by an osseous junction of the cranial bones. — Union of two distinct fetuses in which one or more parts are eliminated by the junction. — Fusion of two fetuses by a bony union of the ischii. — Fusion of two fetuses below the umbilicus into a common lower extremity. — Bicephalic monsters. — Parasitic monsters. — Monsters with a single body and double lower extremities. — ^Diphallic terata. , — ^Petus in fetu, and dermoid cysts. — Hermaphrodites. Class I. — ^Triple Monsters. — Haller and Meckel were of the opinion that no cases of triple monsters worthy of credence are on record, and since their time this has been the popular opinion. Surely none have ever lived. Licetus*^^ describes a human monster with two feet and seven heads and as many arms. Bartho- linus * speaks of a three-headed monster who after birth gave vent to horrible cries and expired. Borellus ^^ speaks of a three- headed dog, a veritable Cerberus. Blasius ^^* published an essay on triple monsters in 1677. Bordenave ^ is quoted as mention- ing a human monster formed of three fetuses, but his description proves clearly that it was only the union of two. Probably the best example of this anomaly that we have was described by Galvagni at Cattania in 1834. This monster had two necks, on one of which was a single head normal in dimensions. On the other neck were two heads, as seen in the accompanying illustration (Fig. 29). Geoffroy-Saint-Hilaire mentions several cases, and Martin de Pedro publishes a description of a case in Madrid in 1879. There are also on record some cases of triple monster by inclusion which will be spoken of later. Instances in the lower animals have been seen, the three-headed sheep of Par6, already spoken of, being one. Class II. — Double Monsters. — A curious mode of junction, probably the most interesting, as it admits of longer life in these monstrosities, is that of a simple cartilaginous band extending between two absolutely distinct and Fig. 29. —Three-headed monster (Galvagni). a 190, cent, vi., obs. 49, 278. b 302, xxxiv., 158. 168 MAJOR TERATA. different individuals. The band is generally in the sternal region. In 1752''^* there was described a remarkable monstrosity which consisted of conjoined twins, a perfect and an imperfect child, connected at their ensiform cartilages by a band 4 inches in circumference. The Hindoo sisters, de- scribed by Dr. Andrew Berry,^ lived to be seven years old ; they stood face to face, with their chests GJ inches and their pubes 8 J inches apart. Mitchell " describes the full-grown female twins, born at Newport, Ky., called the New- port twins. The woman who gave birth to them became impregnated, it is said, immediately after seeing the famous Siamese twins, and the products of this pregnancy took the conformation of those celebrated exhibitionists. Perhaps the best known of all double monsters were the Siamese twins. They were exhibited all over the globe and had the additional benefit and advertisement of a much- mooted discussion as to the advis- ability of their severance, in which opinions of the leading medical men of all nations were advanced. The literature on these famous brothers is simply stupendous. The amount of material in the Surgeon-General's library at "Washington would sur- prise an investigator. A curious volume in this library is a book con- taining clippings, advertisements, and divers portraits of the twins. It will be impossible to speak at all fully on this subject, but a short history and running review of their lives Avill be given : Eng and Chang were born in Siam about May, 1811. Their father was of Chinese extraction and had gone to Siam and there married a woman whose father was also a Chinaman. Hence, for the most part, they were of Chinese blood, which probably accounted for their dark color and Chinese features. Their mother was about thirty-five years old at the time of their birth and had borne 4 female children prior to Chang and Eng. She afterward had twins several times, having eventually 14 children in all. She gave no history of special significance of the pregnancy, although she averred that the head of one and the feet of the other were borij at the same time. The twins Were both feeble at birth, and Eng continued delicate, while Chang thrived. It was only with difficulty that their lives were saved, a 776, 1821. b818, 1832. Fig. 30. — Siamese twins at eighteen years of age. SIAMESE TWINS. 169 as Chowpahyi, the reigning king, had a superstition that such freaks of nature always presaged evil to the country. They were really discovered by Robert Hunter, a British merchant at Bangkok, who in 1824 saw them boating and stripped to the waist. He prevailed on the parents and King Chow- pahyi to allow them to go away for exhibition. They were first taken out of the country by a certain Captain Coifin. The first scientific descrip- tion of them was given by Professor J. C. Warren, who examined them in Boston, at the Harvard University, in 1829. At that time Eng was 5 feet 2 inches and Chang 5 feet IJ inches in height. They presented all Fig. 31. — Siamese twins in old age. the characteristics of Chinamen and wore long black queues coiled thrice around their heads, as shown by the accompanying illustration (Fig. 30). After an eight-weeks' tour over the Eastern States they went to London, arriv- ing at that port November 20, 1829. Their tour in France was forbidden on the same grounds as the objection to ,the exhibition of Ritta-Christina, namely, the possibility of causing the production of monsters by maternal impressions in pregnant women. After their European tour they returned to the United States and settled down as farmers in North Carolina, adopt- ing the name of Bunker. When forty-four years of age they married two sis- 170 MAJOR TERATA. ters, English women, twenty-six and twenty-eight years of age, respectively. Domestic infelicity soon compelled them to keep the wives at different houses, and they alternated weeks in visiting each wife. Chang had six children and Eng five, all healthy and strong. In 1869 they made another trip to Europe, ostensibly to consult the most celebrated surgeons of Great Britain and France on the advisability of being separated. It was stated that a feeling of antagonistic hatred after a quarrel prompted them to seek " surgical sepa- ration," but the real cause was most likely to replenish their depleted exchequer by renewed exhibition and advertisement. A most pathetic characteristic of these illustrious brothers was the affec- tion and forbearance they showed for each other until shortly before their death. They bore each other's trials and petty maladies with the greatest sympathy, and in this manner rendered their lives far more agreeable than a casual observer would suppose possible. They both became Christians and members or attendants of the Baptist Church. Figure 31 is a representation of the Siamese twins in old age. On each side of them is a son. The original photograph is in the Mutter Museum, College of Phy- sicians, Philadelphia. The feasibility of the operation of separating them was discussed by many of the leading men of America, and Thompson, Fergus- son, Syme, Sir J. Y. Simpson, N^laton, and many others in Eu- rope, with various reports and opinions after examination. These opinions can be seen in full in nearly any large medical library. At this time they had diseased and atheromatous arteries, and Chang, who was quite intem- perate, had marked spinal curvature, and shortly afterward became hemi- plegic. They were both partially blind in their two anterior eyes, possibly from looking outward and obliquely. The point of junction was about the sterno-xiphoid angle, a cartilaginous band extending from sternum to sternum. In 1869 Simpson measured this band and made the distance on the superior aspect from sternum to sternum 4J inches, though it is most likely that during the early period of exhibition it was not over 3 inches. The illustration shows very well the position of the joining band (Fig. 32). Fig. 32. — Diagram from a cast showing the position of the ligament and of the primary anterior incisions. Dur- ing life the twins never assumed the face-to-face position in which they are here represented, and which is without douht that of their fetal life. "ORISSA SISTERS." 171 The twins died on January 17, 1874, and a committee of surgeons from the College of Physicians of Philadelphia, consisting of Doctors Andrews, Allen, and Pancoast, went to North Carolina to perform an autopsy on the body, and, if possible, to secure it. They made a long and most interesting report on the results of their trip to the College. The arteries, as was anticipated, were found to have undergone calcareous degeneration. There was an hepatic connection through the band, and also some interlacing diaphragmatic fibers therein. There was slight vascular intercommunica- tion of the livers and independence of the two peritoneal cavities and the intestines (Fig. 33). The band itself was chiefly a coalescence of the xyphoid cartilages, surrounded by areolar tissue and skin (Fig. 34). The "Orissa sisters," or Radica-Doddica, shown in Europe in 1893, were similar to the Siamese twins in conformation. They were born in /;,_^.^.'». Fig. 33. — Diagrammatic representation of the livers, portraying the relations of the vessels, etc. The arrows show the direction in which an injection passed from Chang to Eng. ^£MG I ^ CJMNO Fig. 34. — Diagrammatic representation of the band. A^ upper or hepatic pouch of Chang; E^ E (dotted line), union of the ensiform cartilages ; 7), connecting liver band, or the "tract of portal con- tinuity;" 5, the peritoneal pouch of Eng; (7, the lower peritoneal pouch of Chang ; F, F, lower bor- der of the band. Orissa, India, September, 1889, and were the result of the sixth pregnancy, the other five being normal. They were healthy girls, four years of age, and apparently perfect in every respect, except that, from the ensiform cartilage to the umbilicus, they were united by a band 4 inches long and 2 inches wide (Fig. 35). The children when facing each other could draw their chests three or four inches apart, and the band was so flexible that they could sit on either side of the body. Up to the date mentioned it was not known whether the connecting band contained viscera. A portrait of these twins was shown at the World's Fair in Chicago. In the village of Arasoor, district of Bhavany, there was reported a mon- strosity in the form of two female children, one 34 inches and the other 33| inches high, connected by the sternum. They were said to have had small-pox and to have recovered. They seemed to have had individual ner- vous systems, as when one was pinched the other did not feel it, and while one slept the other was awake. There must have been some vascular connection, as medicine given to one affected both. 172 MAJOR TERATA. Fig. 36 shows a mode of cartilaginous junction by which each component of a double monster may be virtually independent. Operations on Conjoined Twins. — Swingler " speaks of two girls joined at the xiphoid cartilage and the umbilicus, the band of union being 1 J inches thick, and running below the middle of it was the umbilical cord, common to both. They first ligated the cord, which fell off in nine days, and then sepa- rated the twins with the bistoury. They each made early recovery and lived. In the Ephemerides of 1690 Konig gives a description of two SwiSs sisters born in 1689 and united belly to belly, who were separated by means Fig. 35.— Radica-Doddica, the " Orissa Sisters." Fig. 36.— Skeleton showing a mode of junction of independent double monsters. of a ligature and the operation afterward completed by an instrument. The constricting band was formed by a coalition of the xiphoid cartilages and the umbilical vessels, surrounded by areolar tissue and covered with skin. Le Beau " says that under the Eoman reign, A. D. 945, two male children were brought from Armenia to Constantinople for exhibition. They were well formed in every respect and united by their abdomens. After they had been for some time an object of great curiosity, they were removed by governmen- tal order, being considered a presage of evil. They returned, however, at a Quoted 302, vol. xxxiv. b Histoire du Bas-Empire, 1776. CRANIOPAGI. 173 the commencement of the reign of Constantine VII., when one of them took sick and died. The surgeons undertook to preserve the other by separating him from the corpse of his brother, but he died on the third day after the operation. In 1866 Boehm" gives an account of Guzenhausen's case of twins who were united sternum to sternum. An operation for separation was per- formed without accident, but one of the children, already very feeble, died three days after ; the other survived. The last attempt at an oper- ation like this was in 1881, when Biaudet and Buginon attempted to separate conjoined sisters (Marie-Adfele) born in Switzerland on June 26th. Unhappily, they were very feeble and life was despaired of when the opera- tion was performed, on October 29th. Ad&le died six hours afterward, and Marie died of peritonitis on the next day. Class III. — Those monsters joined by a fusion of some of the cranial bones are some- times called craniopagi. A very ancient obser- vation of this kind is cited by Geoffroy-Saint- Hilaire. These two girls were born in 1495, and lived to be ten years old. They were normal in every respect, except that they were joined at the forehead, causing them to stand face to face and belly to belly (Fig. 37). When one walked for- ward, the other was compelled to walk backward ; their noses almost touched, and their eyes were directed laterally. At the death of one an attempt to separate the other from the cadaver was made, but it was unsuccessful, the second soon dying ; , , „ ,> ' _ .< o ' j,jg_ 37._Craniopagus (after Par6). the operation necessitated opening the cranium and parting the meninges. Bateman ^'^ said that in 1501 there was living an instance of double female twins, joined at the forehead. This case was said to have been caused in the following manner : Two women, one of whom was pregnant with the twins at the time, were engaged in an earnest conversation, when a third, coming up behind them, knocked their heads together with a sharp blow. Bateman describes the death of one of the twins and its excision from the other, who died subsequently, evidently of septic infection. There is a possibility that this is merely a duplication of the account of the preceding case with a slight anachronism as to the time of death. At a foundling hospital in St. Petersburg ^ there were born two living girls, in good health, joined by the heads. They were so united that the nose of one, if prolonged, would strike the ear of the other ; they had perfectly independent existences, but their vascular systems had evident connection. » 161, 1866, 152. ^ 573, July, 1855. 174 MAJOR TERATA. Through extra mobility of their necks they could really lie in a straight line, one sleeping on the side and the other on the back. There is a report " of two girls joined at their vertices, who survived their birth. With the excep- tion of this junction they were well formed and independent in existence. There was no communication of the cranial cavities, but simply fusion of the cranial bones covered by superficial fascia and skin (Fig. 38). Daubenton has seen a case of union at the occiput,'' but further details are not quoted. Class IV. — The next class to be considered is that in which the indi- viduals are separate and well formed, except that the point of fusion is a common part, eliminating their individual components in this location. The pygopagous twins belong in this section. According to Bateman,^^^ twins were born in 1493 at Rome joined back to back, and survived their birth. The same authority speaks of a female child who was born with " 2 bellies, 4 arms, 4 legs, 2 heads, and 2 sets of privates, and was exhibited throughout Italy for gain's sake." The " Biddenden Maids " were born in Bidden- den, Kent, in 1100." Their names were Mary and Eliza Chulkhurst, and their parents were fairly well-to-do people. They were supposed to have been united at the hips and the shoulders, and lived until 1134. At the death of one it was proposed to separate them, but the remaining sister refused, saying, "As we came together, we will also go together," and, after about six hours of this Mezentian existence, they died. They bequeathed to the church-wardens of the parish and their successors land to the extent of 20 acres, at the present time bringing a rental of about $165.00 annually, with the instructions that the money was to be spent in the distribution of cakes (bearing the impression of their images, to be given away on each Easter Sunday to all strangers in Biddenden) and also 270 quartern loaves, with cheese in proportion, to all the poor in said parish. Ballantyne has accompanied his description of these sisters by illustrations, one of which shows the cake (Fig. 39). Heaton ^ gives a very good description of these maids ; and a writer in "Notes and Queries" of March 27, 1875, gives the following information relative to the bequest : — " On Easter Monday, at Biddenden, near Staplehurst, Kent, there is a distribution, according to ancient custom, of ' Biddenden Maids' cakes,' with bread and cheese, the cost of which is defrayed from the proceeds of some a 212, 259. b 302, xxxiv. c 759, Oct., 1895. d 224, 1869, i., 363. Fig. 38. — Twins joined at forehead. THE "BIDDENDEN MAIDS." 175 20 acres of land, now yielding £35 per annum, and known as the ' Bread and Cheese Lands.' About the year 1100 there lived Eliza and Mary Chulk- hurst, who were joined together after the manner of the Siamese twins, and who lived for thirty-four years, one dying, and then being followed by her sister within six hours. They left by their will the lands above alluded to, and their memory is perpetuated by imprinting on the cakes their effigies ' in their habit as they lived.' The cakes, which are simple flour and water, are four inches long by two inches wide, and are much sought after as curiosi- ties. These, which are given away, are distributed at the discretion of the church-wardens, and are nearly 300 in number. The bread and cheese amounts to 540 quartern loaves and 470 pounds of cheese. The distribu- tion is made on land belonging to the charity, known as the Old Poorhouse. Formerly it used to take place in the Church, immediately after the service in the afternoon, but in consequence of the unseemly disturbance which used to ensue the practice was discontinued. The Church used to be filled with a congregation whose conduct was occa- sionally so reprehensible that some- times the church-wardens had to use their wands for other purposes than sym- bols of office. The impressions of the ' maids ' on the cakes are of a primitive character, and are made by boxwood dies cut in 1814. They bear the date 1100, when Eliza and Mary Chulkhurst are supposed to have been born, and also their age at death, thirty-four years." Ballantyne ''^^ has summed up about all there is to be said on this national monstrosity, and his discussion of the case from its historic as well as tera- tologic standpoint is so excellent that his conclusions will be quoted : — " It may be urged that the date fixed for the birth of the Biddenden Maids is so remote as to throw grave doubt upon the reality of the occur- rence. The year 1100 was, it will be remembered, that in which William Eufus was found dead in the New Forest, ' with the arrow either of a hunter or an assassin in his breast.' According to the Anglo-Saxon Chronicle, sev- eral ' prodigies ' preceded the death of tfiis profligate and extravagant mon- arch. Thus it is recorded that ' at Pentecost blood was observed gushing from the earth at a certain town of Berkshire, even as many asserted who Fig. 39.— Biddenden Maids' cake (Ballantyne). 176 MAJOR TERATA. declared that they had seen it. And after this, on the morning after Lam- mas Day, King William was shot.' Now, it is just possible that the birth of the Biddenden Maids may have occurred later, but have been antedated by the popular tradition to the year above mentioned. For such a birth would, in the opinion of the times, be regarded undoubtedly as a most evi- dent prodigy or omen of evil. Still, even admitting that the date 1100 must be allowed to stand, its remoteness from the present time is not a convincing argument against a belief in the real occurrence of the phenomenon ; for of the dicephalic Scottish brothers, who lived in 1490, we have credible historic evidence. Further, Lycosthenes, in his " Chronicon Prodigiorum atque Ostentorum " (p. 397), published in 1557, states, upon what authority I know not, that in the year 1112 joined twins resembling the Biddenden phenom- enon in all points save in sex were born in England. The passage is as fol- lows : ' In Anglia natus est puer geminus a clune ad superiores partes ita divisus, ut duo haberet capita, duo corpora Integra ad renes cum suis brachiis, qui baptizatus triduo supervixit.' It is just possible that in some way or other this case has been confounded with the story of Biddenden ; at any rate, the occurrence of such a statement in Lycosthenes' work is of more than pass- ing interest. Had there been no bequest of land in connection with the case of the Kentish Maids, the whole affair would probably soon have been for- gotten. " There is, however, one real difficulty in accepting the story handed down to us as authentic, — the nature of the teratologic phenomenon itself. All the records agree in stating that the Maids were joined together at the shoulders and hips, and the impression on the cakes and the pictures on the ' broadsides ' show this peculiar mode of union, and represent the bodies as quite separate in the space between the above-named points. The Maids are shown with four feet and two arms, the right and left respectively, whilst the other arms (left and right) are fused together at the shoulder accord- ing to one illustration, and a little above the elbow according to another. Now, although it is not safe to say that such an anomaly is impossible, I do not know of any case of this peculiar mode of union ; but it may be that, as Prof. A. E. Simpson has suggested, the Maids had four separate arms, and were in the habit of going about with their contiguous arms round each other's necks, and that this gave rise to the notion that these limbs were united. If this be so, then the teratologic difficulty is removed, for the case becomes perfectly comparable with the well-known but rare type of double terata known as the pygopagous twins, which is placed by Taruffi with that of the ischiopagous twins in the group dicephalus lecanopagus. Similar instances, which are well known to students of teratology, are the Hungarian sisters (Helen and Judith), the North Carolina twins (Millie and Christine), and the Bohemian twins (Eosalie and Josepha Blazek). The interspace between the thoraces may, however, have simply been the addition HELEN AND JUDITH, THE HUNGARIAN SISTERS. 177 of the first artist who portrayed the Maids (from imagination ?) ; then it may be surmised that they were ectopagous twins. " Pygopagous twins are fetuses united together in the region of the nates and having each its own pelvis. In the recorded cases the union has been usually between the sacra and coccyges, and has been either osseous or (more rarely) ligamentous. Sometimes the point of junction was the middle line posteriorly, at other times it was rather a posterolateral union ; and it is probable that in the Biddenden Maids it was of the latter kind ; and it is likely, from the proposal made to separate the sisters after the death of one, that it was ligamentous in nature. " If it be granted that the Biddenden Maids were pygopagous twins, a study of the histories of other recorded cases of this monstrosity serves to demonstrate many common characters. Thus, of the 8 cases which Taruffi has collected, in 7 the twins were female ; and if to these we add the sisters Rosalie and Josepha Blazek and the Maids, we have 10 cases, of which 9 were girls. Again, several of the pygopagous twins, of whom there are scientific records, survived birth and lived for a number of years, and thus resembled the Biddenden terata. Helen and Judith, for instance, were twenty-three years old at death ; and the North Carolina twins, although born in 1851, are still alive. There is, therefore, nothing inherently improb- able in the statement that the Biddenden Maids lived for thirty-four years. With regard also to the truth of the record that the one Maid survived her sister for six hours, there is confirmatory evidence from scientifically observed instances, for Joly and Peyrat (Bull, de I'Acad. Mdd., iii., pp. 51 and 383, 1874) state that in the case seen by them the one infant lived ten hours after the death of the other. It is impossible to make any statement with regard to the internal structure of the Maids or to the characters of their genital organs, for there is absolutely no information forth- coming upon these points. It may simply be said, in conclusion, that the phenomenon of Biddenden is interesting not only on account of the curious bequest which arose out of it, but also because it was an instance of a very rare teratologic type, occurring at a very early period in our national history." Possibly the most famous example of twins of this type were Helen and Judith, the Hungarian sisters, born in 1701 at Szony, in Hungary. They were the objects of great curiosity, and were shown successively in Holland, Germany, Italy, France, England, and Poland. At the age of nine they were placed in a convent, where they died almost simultaneously in their twenty-second year. During their travels all over Europe they were exam- ined by many prominent physiologists, psychologists, and naturalists ; Pope and several minor poets have celebrated their existence in verse ; Buffon speaks of them in his " Natural History," and all the works on teratology for a century or more have mentioned them. A description of them can be best 12 178 MAJOR TERATA. given by a quaint translation by Fisher of the Latin lines composed by a Hungarian physician and inscribed on a bronze statuette of them :" — Two sisters wonderful to behold, who have thus grown as one, That naught their bodies can divide, no power beneath the sun. The town of Szoenii gave them birth, hard by far-famed Komom, Which noble fort may all the arts of Turkish sultans scorn. Lucina, woman's gentle friend, did Helen first receive ; And Judith, when three hours had passed, her mother's womb did leave. One urine passage serves for both ; — one anus, so they tell ; The other parts their numbers keep, and serve their owners well. Their parents poor did send them forth, the world to travel through, That this great wonder of the age should not be hid from view. The inner parts concealed do lie hid from our eyes, alas ! But all the body here you view erect in solid brass. They were joined back to back in the lumbar region, and had all their parts separate except the anus between the right thigh of Helen and the left of Judith and a single vulva. Helen was the larger, better looking, the more active, and the more intelligent. Judith at the age of six became hemiplegic, and afterward was rather delicate and de- pressed. They menstruated at sixteen and continued with regularity, although one began before the other. They had a mutual affection, and did all in their power to alleviate the circumstances of their sad position. Judith died of cerebral and pulmonary affections, and Helen, who previously enjoyed good health, soon after her sister's first indisposition sud- denly sank into a state of collapse, although preserving her mental faculties, and expired almost immediately after her sister. They had measles and small-pox simultaneously, but were affected in different degree by the maladies. The emotions, inclinations, and appetites were not simultaneous. Eccardus, in a very inter- esting paper, discusses the physical, moral, and religious questions in refer- ence to these wonderful sisters, such as the advisability of separation, the admissibility of matrimony, and, finally, whether on the last day they would rise as joined in life, or separated. There is an account*' of two united females, similar in conjunction to the "Hungarian sisters," who were born in Italy in 1700. They were killed at the age of four months by an attempt of a surgeon to separate them. Fig. 40.— The Hungarian sisters. a 773, 1866. b 105, v., 445. MILLIE- CHRISTINE—R 08A-J0SEPHA BLAZEK. 179 In 1856 there was reported to have been born in Texas, twins after the manner of Helen and Judith, united back to back, who lived and attained some age. They were said to have been of different natures and dispositions, and inclined to quarrel very often. Pancoast » gives an extensive report of Millie-Christine, who had been extensively exhibited in Europe and the United States. They were born of slave parents in Columbus County, N. C, July 11, 1851 ; the mother, who had borne 8 children before, was a stout negress of thirty-two, with a large pelvis. The presentation was first by the stomach and afterward by the breech. These twins were united at the sacra by a cartilaginous or possibly osseous union. They were exhibited in Paris in 1873, and provoked as much discussion there as in the United States. Physically, Millie was the weaker, but had the stronger will aiid the dominating spirit. They menstrp.- ated regularly from the age of thir- teen. One from long habit yielded instinctively to the other's move- ments, thus preserving the necessary harmony. They ate separately, had distinct thoughts, and carried on dis- tinct conversations at the same time. They experienced hunger and thirst generally simultaneously, and defe- cated and urinated nearly at tlie same times. One, in tranquil sleep, would be wakened by a call of nature of the other. Common sensibility was ex- perienced near the location of union. They were intelligent and agreeable and of pleasant appearance, although slightly under size ; they sang duets with pleasant voices and accompanied themselves with a guitar ; they walked, ran, and danced with apparent ease and grace. Christine could bend over and lift Millie up by the bond of union. A recent example of the pygopagus type was Rosa- Josepha Blazek, ^ born in Skerychov, in Bohemia, January 20, 1878. These twins had a broad bony union in the lower part of the lumbar region, the pelvis being obviously completely fused. They had a common urethral and anal aperture, but a double vaginal orifice, with a very apparent septum. The sensation was dis- tinct in each, except where the pelves joined. They were exhibited in Paris a 631, 1871, i. ^ 778, xxii-, 265. Fig. 41. — Millie-Christine (Fancoast). 180 MAJOR TERATA. in 1891, being then on an exhibition tour around the world. Rosa was the stronger, and when she walked or ran forward she drew her sister with her, who must naturally have reversed her steps. They had independent thoughts and separate minds ; one could sleep while the other was awake. Many of their appetites were different, one preferring beer, the other wine ; one relished salad, the other detested it, etc. Thirst and hunger were not simultaneous. Baudoin " describes their anatomic construction, their mode of life, and their mannerisms and tastes in a quite recent article. Fig. 42 is a reproduction of an early photograph of the twins, and Fig. 43 represents a recent photo- graph,of these " Bohemian twins," as they are now called. Fig. 42. — Blazek sisters. The latest record we have of this type of monstrosity is that given by Tynberg to the County Medical Society of New York, May 27, 1895. The mother was present with the remarkable twins in her arms, crying at the top of their, voices. These two children were born at midnight on April 15th. Tynberg remarked that he believed them to be distinct and separate children, and not dependent on a common arterial system ; he also expressed his inten- tion of separating them, but did not believe the operation could be performed with safety before another year. Jacobi "^ describes in full Tynberg's instance of pygopagus. He says the confinement was easy ; the head of one was born first, soon followed by the feet and the rest of the twins. The placenta was a 728, July 8, 1891. b 165, Oct., 1895. ISCHIOPAGI. 181 single and the cord consisted of two branches. The twins were united below the third sacral vertebrae in such a manner that they could lie along- side of each other. They were females, and had two vaginae, two urethrse, four labia minora, and two labia majora, one anus, but a double rectum divided by a septum. They micturated independently but defecated simul- taneously. They virtually lived separate lives, as one might be asleep while the other cried, etc. Class V. — While instances of ischiopagi are quite numerous, few have attained any age, and, necessarily, little notoriety. Pare" speaks of twins Fig. 43. — Bohemian twins. united at the pelves, who were born in Paris July 20, 1570. They were baptized, and named Louis and Louise. Their parents were well known in the rue des Gravelliers. According to Bateman,^^' and also Rueff, in the year 1552 there were born, not far from Oxford, female twins, who, from the description given, were doubtless of the ischiopagus type. They seldom wept, and one was of a cheerful disposition, while the other was heavy and drowsy, sleeping continually. They only lived a short time, one expiring a day before the other. Licetus *^^ speaks of Mrs. John Waterman, a resident of Fishertown, near Salisbury, England, who gave birth to a double female monster on October 26, 1664, which evidently from the description was » 618, 1010. 182 MAJOR TERATA. joined by the ischii. It did not nurse, but took food by both the mouths; all its actions were done in concert ; it was possessed of one set of genito- urinary organs ; it only lived a short while. Many people in the region flocked to see the wonderful child, whom Licetus called " Monstrum Angli- cum." It is said that at the same accouchement the birth of this monster was followed by the birth of a well-formed female child, who survived. Geoffroy-SainHIilaire quotes a description of twins who were born in France on October 7, 1838, symmetrically formed and united at their ischii. One was christened Marie-Louise, and the other Hortense-Honorine. Their avaricious parents took the children to Paris for exhibition, the exposures of which soon sacrificed their lives. In the year 1841 there was born in the island of Ceylon, of native parents, a monstrous child that was soon Fig. 44.— Tynberg's ease. brought to Columbo, where it lived only two months." It had two heads and seemed to have duplication in all its parts except the anus and male generative organs. Montgomery ^ speaks of a double child born in County Roscommon, Ireland, on the 24th of July, 1827. It had two heads, two chests with arms complete, two abdominal and pelvic cavities united end to end, and four legs, placed two on either side. It had only one anus, which was situated between the thighs. One of the twins was dark haired and was baptized Mary, while the other was a blonde and was named Catherine. These twins felt and acted independently of each other ; they each in succes- sion sucked from the breast or took milk from the spoon, and used their limbs vigorously. One vomited without affecting the other, but the feces were discharged through a common opening. a 318, vol. Ixi., 58. b 3i3_ vol. xv. MINNA AND MINNIE FINLEY—" JONES TWINS.' 183 Goodell * speaks of Minna and Minnie Finley, who were born in Ohio and examined by him. They were fused together in a common longitudinal axis, having one pelvis, two heads, four legs, and four arms. One was weak and puny and the other robust and active ; it is probable that they had but one rectum and one bladder. Goodell accompanies his description by the mention of several analogous cases. Ellis ^ speaks of female twins, born in Millville, Tenn., and exhibited in New York in 1868, who were joined at the pelves in a longitudinal axis. Between the limbs on either side were to be seen well-developed female genitals, and the sisters had been known to urinate from both sides, beginning and ending at the same time. Huff" details a description of the "Jones twins," born on June 24, 1889, in Tipton County, Indiana, whose spinal columns were in apposition at the lower end. The labor, of less than two hours' duration, was completed Fig. 45. — The Jones twins. before the arrival of the physician. Lying on their mother's back, they could both nurse at the same time. Both sets of genitals and ani were on the same side of the line of union, but occupied normal positions with reference to the legs on either side. Their weight at birth was 12 pounds and their length 22 inches. Their mother was a medium-sized brunette of 19, and had one previous child then living at the age of two ; their father was a finely formed man 5 feet 10 inches in height. The twins differed in complexion and color of the eyes and hair. They were publicly exhibited for some time, and died February 19 and 20, 1891, at St. John's Hotel, Buffalo, N. Y. Figure 45 shows their appearance several months after birth. '^ Class VI. — In our sixth class, the first record we have is from the Com- mentaries of Sigbert, which contains a description of a monstrosity born in the reign of the Emperor Theodosius, who had two heads, two chests with four » 547, 1870. ' *> 218, 1871, 218 et seq. e 125, vol. xxii., 923. 184 MA JOE TERATA. arms attached, but a single lower extremity. The emotions, affections, and appetites were different. One head might be crying while the other laughed, or one feeding while the other was sleeping. At times they quarreled and occasionally came to blows. This monster is said to have lived two years, one part dying four days before the other, which evinced symptoms of decay like its inseparable neighbor. Eoger of Wendover ^*^ says that in Lesser Brittany and Normandy, in 1062, there was seen a female monster, consisting of two women joined about the umbilicus and fused into a single lower extremity. They took their food by two mouths but expelled it at a single orifice. At one time, one of the women laughed, feasted, and talked, while the other wept, fasted, and kept a religious silence. The account relates how one of them died, and the survi- vor bore her dead sister about for three years before she was overcome by the oppression and stench of the cadaver. Batemen '*' describes the birth of a boy in 1529, who had two heads, four ears, four arms, but only two thighs and two legs. Buchanan" speaks at length of the famous "Scottish Brothers," who were the cynosure of the eyes of the Court of James III. of Scotland. This monster consisted of two men, ordinary in appearance in the superior extremities, whose trunks fused into a single lower extremity. The King took diligent care of their education, and they became proficient in music, languages, and other court accomplishments. Between them they would carry on animated conversations, sometimes merging into curious debates, followed by blows. Above the point of union they had no synchronous sen- sations, while below, sensation was common to both. This monster lived twenty-eight years, surviving the royal patron, who died June, 1488. One of the brothers died some days before the other, and the survivor, after carrying about his dead brother, succumbed to " infection from putrescence." There was reported to have been born'^^ in Switzerland a double-headed male monster, who in 1538, at the age of thirty, was possessed of a beard on each face, the two bodies fused at the umbilicus into a single lower extremity. These two twins resembled one another in contour and countenance. They were so joined that at rest they looked upon one another. They had a single wife, with whom they were said to have lived in harmony. In the Gentleman's Magazine about one hundred and fifty years since there was given the portrait and description of a double woman, who was exhibited all over the large cities of Europe. Little can be ascertained anatomically of her construction, with the exception that it was stated that she had two heads, two necks, four arms, two legs, one pelvis, and one set of pelvic organs. The most celebrated monster of this type was Ritta-Christina (Figs. 46 and 47), who was born in Sassari, in Sardinia, March 23, 1829. These twins were the result of the ninth confinement of their mother, a woman of thirty-two. Their superior extremities were double, but they joined in a common trunk aRerum Scoticarum Historia, Aberdeen, 1762, L. xiii. RITTA- CHRISTINA. 185 at a point a little below the mammse. Below this point they had a common trunk and single lower extremities. The right one, christened Ritta, was feeble and of a sad and melancholy countenance ; the left, Christina, was vigorous and of a gay and happy aspect. They suckled at different times, and sensations in the upper extremities were distinct. They expelled urine and feces simultaneously, and had the indications in common. Their parents, who were very poor, brought them to Paris for the purpose of public exhibi- tion, which at first was accomplished clandestinely, but finally interdicted by the public authorities, who feared that it would open a door for psychologic discussion and speculation. This failure of the parents to secure public patronage increased their poverty and hastened the death of the children by unavoidable exposure in a cold room. The nervous system of the twins had little in common except in the line of union, the anus, and the sexual organs. Fig. 46.— Skeleton of Eitta-Christina. Fig. 47. — Eitta-Christina. and Christina was in good health all through Ritta's sickness ; when Ritta died, her sister, who was suckling at the mother's breast, suddenly relaxed hold and expired with a sigh. At the postmortem, which was secured with some difficulty on account of the authorities ordering the bodies to be burned, the pericardium was found single, covering both hearts. The diges- tive organs were double and separate as far as the lower third of the ilium, and the cecum was on the left side and single, in common ^with the lower bowel. The livers were fused and the uterus was double. The vertebral columns, which were entirely separate above, were joined below by a rudi- mentary OS innominatum. There was a junction between the manubrium of each. Sir Astley Cooper saw a monster in Paris in 1792 which, by his description, must have been very similar to Ritta-Christina. 186 MAJOR TEE ATA. The Tocci brothers were born in 1877 in the province of Turin, Italy. They each had a well-formed head, perfect arms, and a perfect thorax to the sixth rib ; they had a common abdomen, a single anus, two legs, two sacra, two vertebral columns, one penis, but three buttocks, the central one containing a rudimentary anus. The right boy was christened Giovanni-Batista, and the left Giacomo. Each individual had power over the corresponding leg on his side, but not over the other one. Walking was there- fore impossible. All their sensa- tions and emotions were distinctly individual and independent. At the time of the report, in 1882, they were in good health and showed every indication of attaining adult age. Figure 48 represents these twins as they were exhibited sev- eral years ago in Germany. McCallum'' saw two female children in Montreal in 1878 named Marie - Rosa Drouin. They formed a right angle with their single trunk, which com- menced at the lower part of the thorax of each . They had a single genital fissure and the external organs of generation of a female. A little over three inches from the anus was a rudimentary limb with a movable articulation ; it meas- ured five inches in length and tapered to a fine point, being fiir- nished with a distinct nail, and it contracted strongly to irritation. Marie, the left child, was of fair complexion and more strongly developed than Rosa. The sen- sations of hunger and thirst were not experienced at the same time, and one might be asleep while the other was crying. The pulsations and the respira- tory movements were not synchronous. They were the products of the second gestation of a mother aged twenty-six, whose abdomen was of such preternatural size during pregnancy that she was ashamed to appear in public. a 778, vol. XX., 120. r^^^H ^Hn#^ r% t H/ ' '^^1 \ I kJ ''^ J^^lfl ■L^;:- ■ ^^Hmw^'x^' ; '{; K^l^^^^ 1 ^^^^K^:^ n^--^' ■T--r?^-^-r^ ,™„ \ Fig. 48.— The Tooci brothers. BIGEPHALIC MONSTERS. 187 The order of birth was as follows : one head and body, the lower extremity, and the second body and head. Class VII. — There are many instances of bicephalic monsters on record. Par6 * mentions and gives an illustration of a female apparently sin- gle in conformation, with the exception of having two heads and two necks. The Ephemerides, Haller, Schenck, and Archenholz cite examples, and there is an old account '' of a double-headed child, each of whose heads were baptized, one called Martha and the other Mary. One was of a gay and the other a sad visage, and both heads received nourishment ; they only lived a couple of days. There is another similar record of a Milanese girl who had two heads, but was in all other respects single, with the exception that after death she was found to have had two stomachs. Besse mentions a Bavarian woman of twenty-six with two heads, one of which was comely and the other extremely ugly ; Batemen ^^^ quotes what is apparently the same case — a woman in Bavaria in 1541 with two heads, one of which was deformed, who begged from door to door, and who by reason of the influence of pregnant women was given her expenses to leave the country. A more common occurrence of this type is that in which there is fusion of the two heads. Moreau " speaks of a monster in Spain which was shown from town to town. Its heads were fused j it had two mouths and two noses ; in each face an eye well conformed and placed above the nose ; there was a third eye in the middle of the forehead common to both heads ; the third eye was of primitive development and had two pupils. Each face was well formed and had its own chin. Buffon mentions a cat, the exact analogue of Moreau's case. Sutton^ speaks of a photograph sent to Sir James Paget in 1856 by William Budd of Bristol. This portrays a living child with a supernumerary head, which had mouth, nose, eyes, and a brain of its own (Fig. 49). The eyelids were abortive, and as there was no orbital cavity the eyes stood out in the form of naked globes on the forehead. When born, the corneas of both heads were transparent, but then became opaque from exposure. The brain of the supernumerary head was quite visible from without, and was covered by a membrane beginning to slough. On the right side of the head was a rudimentary external ear. The nurse said that when the child sucked some milk regurgitated through the supernumerary mouth. The great phy- siologic interest in this case lies in the fact that every movement and every act of the natural face was simultaneously repeated by the supernumerary face in a perfectly consensual manner, i. e., when the natural mouth sucked, the second mouth sucked ; when the natural face cried, yawned, or sneezed, the second face did likewise ; and the eyes of the two heads moved in unison. The fate of the child is not known. Home " speaks of a child born in Bengal with a most peculiar fusion of "618,1006. b 469, 1665. c Quoted, 302, xxxiv., 171. d275! 1895, 133. e 629, 1791, 299. 188 MAJOR TERATA. the head. The ordinary head was nearly perfect and of usual volume, but fused with its vertex and reversed was a supernumerary head (Fig. 50). Each head had its own separate vessels and brain, and each an individual sensibility, but if one had milk first the other had an abundance of saliva in its mouth. It narrowly escaped being burned to death at birth, as the mid- wife, greatly frightened by the monstrous appearance, threw it into the fire to destroy it, from whence it was rescued, although badly burned, the vicious conformation of the accessory head being possibly due to the accident. At the age of four it was bitten by a venomous serpent and, as a result, died. Its skull is in the possession of the Royal College of Surgeons in London. Fig. 49. — Infant -with a supernumerary head (after Sutton). Fig. 50.— Two-headed boy (Home's case). The following well-known story of Edward Mordake, though taken from lay sources, is of sufficient notoriety and interest to be mentioned here : " One of the weirdest as well as most melancholy stories of human de- formity is that of Edward Mordake, said to have been heir to one of the noblest peerages in England. He never claimed the title, however, and com- mitted suicide in his twenty-third year. He lived in complete seclusion, refusing the visits even of the members of his own family. He was a young man of fine attainments, a profound scholar, and a musician of rare ability. His figure was remarkable for its grace, and his face — that is to say, his natural face — was that of an Antinous. But upon the back of his head was another face, that of a beautiful girl, ' lovely as a dream, hideous as a devil.' The female face was a mere mask, 'occupying only a small portion of the posterior part of the skull, yet exhibiting every sign of intelligence, of a PARASITIC TERATA. 189 malignant sort, however.' It would be seen to smile and sneer while Mor- dake was weeping. The eyes would follow the movements of the spectator, and the lips would ' gibber without ceasing.' No voice was audible, but Mordake avers that he was kept from his rest at night by the hateful whis- pers of his ' devil twin,' as he called it, ' which never sleeps, but talks to me forever of such things as they only speak of in hell. No imagination can conceive the dreadful temptations it sets before me. For some unforgiven wickedness of my forefathers I am knit to this fiend — for a fiend it surely is. I beg and beseech you to crush it out of human semblance, even if I die for it.' Such were the words of the hapless Mordake to Manvers and Treadwell, his physicians. In spite of careful watching he managed to procure poison, whereof he died, leaving a letter requesting that the ' demon face ' might be destroyed before his burial, ' lest it continues its dreadful whisperings in my grave.' At his own request he was interred in a waste place, without stone or legend to mark his grave." A most curious case was that of a Fellah woman" who was delivered at Alexandria of a bicephalic monster of apparently eight months' pregnancy. This creature, which was born dead, had one head white and the other black, the change of color commencing at the neck of the black head. The bizarre head was of negro conformation and fully developed, and the colored skin was found to be due to the existence of pigment similar to that found in the black race. The husband of the woman had a light bifown skin, like an ordinary Fellah man, and it was ascertained that there were some negro laborers in port during the woman's pregnancy ; but no definite information as to her relations with them could be established, and whether this was a case of maternal impression or superfetation can only be a matter of conjecture. Fantastic monsters, such as acephalon, paracephalon, cyclops, pseuden- cephalon, and the janiceps (Fig. 51), prosopthoracopagus (Fig. 52), dispro- sopus (Fig. 53), etc., although full of interest, will not be discussed here, as none are ever viable for any length of time, and the declared intention of this chapter is to include only those beings who have lived. Class VIII. — The next class includes the parasitic terata, monsters that consist of one perfect body, complete in every respect, but from the neighborhood of whose umbilicus depends some important portion of a second body. Par6, Benivenius, and Columbus describe adults with acephalous monsters attached to them. Schenck mentions 13 cases, 3 of which were observed by him. Aldrovandus'^^ shows 3 illustrations under the name of ''monstrum bicorpum monocephalon." Buxtorf*^ speaks of a case in which the nates and lower extremities of one body proceeded out of the abdomen of the other, which was otherwise perfect. Eeichel and Ander- son " mention a living parasitic monster, the inferior trunk of one body pro- ceeding from the pectoral region of the other. a 789, Aug. 5, 1848. •> 107, vol. vii., n. xii., 101. <= 629, vol. Ixxix. 190 MAJOR TERATA. Pare^ says that there was a man in Paris in 1530, quite forty years of age, who carried about a parasite without a head, which hung pendant from his belly. This individual was exhibited and drew great crowds. Par4 Fig. 51.— Janioeps. Fig. 52.— Prosopthoracopagus. Fig. 53. — Disprosopus. appends an illustration, which is, perhaps, one of the most familiar in all tera- tology. He also ^ gives a portrait (Fig. 54) of a man who had a parasitic head Fig. 54. — ^Parasitic monster (after Par^). Fig. 55. — Tlioracopagus. Lazarus-Joannes Baptista Colloredo. proceeding from his epigastrium, and who was born in Germany the same year that peace was made with the Swiss by King Francis. This creature lived a 618, 1007. b618, 1012. LAZARUS-JOANNES BAPTISTA GOLLOREDO. 191 to manhood and both heads were utilized in alimentation. Bartholinus " details a history of an individual named Lazarus- Joannes Baptista CoUoredo (Fig. 55), born in Genoa in 1617, who exhibited himself all over Europe. From his epigastrium hung an imperfectly developed twin that had one thigh, hands, body, arms, and a well-formed head covered with hair, which in the normal position hung lowest. There were signs of independent existence in the parasite, movements of respiration, etc., but its eyes were closed, and, although saliva constantly dribbled from its open mouth, nothing was ever ingested. The genitals were imperfect and the arms ended in badly formed hands. Bartholinus examined this monster at twenty-two, and has given the best report, although while in Scotland in 1642 he was again examined, and ac- credited with being married and the father of several children who were fully and admirably developed. Moreau quotes a case of an infant similar in con- formation to the foregoing monster, who was born in Switzerland in 1764, and whose supernumerary parts were amputated by means of a ligature. Winslow reported before the Academic Eoyale des Sciences the history of a girl of twelve who died at the H6tel-Dieu in 1733. She was of ordinary height and of fair conformation, with the exception that hanging from the left flank was the inferior half of another. girl of diminutive proportions. The supernumerary body was immovable, and hung so heavily that it was said to be supported by the hands or by a sling. Urine and feces were evacu- ated at intervals from the parasite, and received into a diaper constantly worn for this purpose. Sensibility in the two was common, an impres- sion applied to the parasite being felt by the girl. Winslow gives an inter- esting report of the dissection of this monster, and mentions that he had seen an Italian child of eight who had a small head proceeding from under the cartilage of the third left rib. Sensibility was common, pinching the ear of the parasitic head causing the child with the perfect head to cry. Each of the two heads received baptism, one being named John and the other Matthew. A curious question arose in the instance of the girl, as to whether the extreme unction should be administered to the acephalous fetus as well as to the child. In 1742, during the Ambassadorship of the Marquis de I'Hopital at Naples, he saw in that city an aged man, well conformed, Avith the exception that, like the little girl of Winslow, he had the inferior extremities of a male child growing from his epigastric region. Haller and Meckel have also observed cases hke this. Bordat described before the Royal Institute of France, August, 1826, a Chinaman, twenty-one years of age, who had an acephalous fetus attached to the surface of his breast (possibly " A-ke"). Dickinson '' describes a wonderful child five years old, who, by an extra- ordinary freak of nature, was an amalgamation of two children. From the body of an otherwise perfectly formed child was a supernumerary head pro- a 190, hist. Iviii. *" '^03, 1880. 192 MAJOR TERATA. truding from a broad base attached to the lower lumbar and sacral region. This cephalic mass was covered with hair about four or five inches long, and showed the rudiments of an eye, nose, mouth, and chin. This child was on exhibition when Dickinson saw it. Montar6 and Reyes were commissioned by the Academy of Medicine of Havana to examine and report on a mon- strous girl of seven months, living in Cuba. The girl was healthy and well developed, and from the middle line of her body between the xiphoid carti- lage and the umbilicus, attached by a soft pedicle, was an accessory individual, irregular, of ovoid shape, the smaller end, representing the head, being upward. The parasite measured a little over 1 foot in length, 9 inches about the head, and 7 1 inches around the neck. The cranial bones were distinctly felt, and the top of the head was covered by a circlet of hair. There were two rudi- mentary eyebrows ; the left eye was represented by a minute perforation encircled with hair ; the right eye was traced by one end of a mucous groove which ran down to another transverse groove representing the mouth ; the right third of this latter groove showed a primitive tongue and a triangular tooth, which appeared at the fifth month. There was a soft, imperforate nose, and the elements of the vertebral column could be distinguished beneath the skin ; there were no legs ; apparently no vascular sounds ; there was separate sensation, as the parasite could be pinched without attracting the per- fect infant's ' notice. The mouth of the parasite con- stantly dribbled saliva, but showed no indication of receiving aliment.^ Louise L., known as "La dame a quatre jambes," was born in 1869, and had attached to her pelvis another rudimentary pelvis and two atrophied legs of a parasite, weighing 8 kilos. The attachment was eiFected by means of a pedicle 33 cm. in diameter, having a bony basis, and being fixed without a joint. The attachment almost obliterated the vulva and the perineum was displaced far backward. At the insertion of the parasite were two rudimentary mammse, one larger than the other (Fig. 56). No genitalia were seen on the parasite and it exhibited no active move- ments, the joints of both limbs being ankylosed. The woman could localize sensations in the parasite except those of the feet. She had been married five years, and bore, in the space of three years, two well-formed daugh+ers. Quite recently there was exhibited in the museums of the United States an individual bearing the name " Laloo," who was born in Oudh, India, and was the second of four children. At the time of examination he was about nineteen years of age. The upper portion of a parasite was firmly attached a 234, 1886, i., 81. Fig. 56.— Louise L. DUPLICATION OF THE LOWER EXTREMITIES. 193 to the lower right side of the sternum of the individual by a bony pedicle, and lower by a fleshy pedicle, and apparently contained intestines. The anus of the parasite was imperforate ; a well-developed penis was found, but no testi- cles ; there was a luxuriant growth of hair on the pubes. The penis of the parasite was said to show signs of erection at times, and urine passed through it without the knowledge of the boy. Perspiration and elevation of tem- perature seemed to occur simultaneously in both. To pander to the morbid curiosity of the curious, the " Dime Mu- seum " managers at one time shrewdly clothed the parasite in female attire, calling the two brother and sister ; but there is no doubt that all the traces of sex were of the male type. An anal- ogous case was that of "A-Ke," a Chinaman, who was exhibited in London early in the century, and of whom and his parasite anatomic models are seen in our museums. Figure 58 repre- sents an epignathus, a peculiar type of parasitic monster, in which the parasite is united to the inferior maxillary bone of the autosite. Class IX. — Of "Lusus naturae" none is more curious than that of dup- lication of the lower extremities. Par6 '' says that on January 9, 1529, there was living in Germany a male infant having four legs and four arms. In Paris, at the Acad6mie des Sciences, on September 6, 1830, there was pre- sented by Madame Hen, a midwife, a living male child with four legs, the anus being nearly below the middle of the third buttock; and the scrotum between the two left thighs, the testicles not yet descended. There was a well- formed and single pelvis, and the supernumerary legs were immovable. Aldrqvandus mentions several similar instances, and gives the figure of one born in Rome ; he also describes several quadruped birds. Bardsley " speaks of a male child with one head, four arms, four legs, and double generative organs. He gives a portrait of the child when it was a little over a year old. Heschl published in Vienna in 1878 a description of a girl of seventeen, a 611, 1012. b 781, 1838, vol. vi. Eig. 57.— Laloo. '1 194 MAJOR TERATA. who instead of having a duplication of the superior body, as in " Millie- Christine, the two-headed nightingale," had double parts below the second lumbar vertebra. Her head and upper body resembled a comely, delicate girl of twelve. Wells "^ describes Mrs. B., aged twenty, still alive and healthy (Fig. 59). The duplication in this case begins just above the waist, the spinal column dividing at the third lumbar vertebra, below this point everything being double. Micturition and defecation occur at different times, but menstrua- tion occurs simultaneously. She was married at nineteen, and became preg- nant a, year later on the left side, but abortion was induced at the fourth month on account of persistent nausea and the expectation of impossible delivery. Whaley,*^ in speaking of this case, said Mrs. B. utilized her out- side legs for walking ; he also remarks that when he informed her that she was pregnant on the left side she replied, " I think you are mistaken ; if it had been on my right side I would come nearer believing it ;" — and after further questioning he found, from the patient's observation, that her right genitals were almost invariably used for coitus. Bechlinger of Para, Brazil," describes a woman of twenty-five, a native of Martinique, whose father was French and mother a quadroon, who had a modified duplication of the lower body. There was a third leg attached to a con- tinuation of the processus coccygeus of the sacrum, and in addition to well- developed mammae regularly situated, there were two rudimentary ones close to- gether above the pubes. There were two vaginse and two well-developed vulvae, both having equally developed sensations. The sexual appetite was markedly developed, and coitus was practised in both vaginse. A somewhat similar case, possibly the same, is that of Blanche Dumas, born in 1860. She had a very broad pelvis, two imperfectly developed legs, and a super- numerary limb attached to the symphysis, without a joint, but with slight passive movement. There was a duplication of bowel, bladder, and genitalia. At the junction of the rudimentary limb with the body, in front, were two rudimentary mammary glands, each containing a nipple (Fig. 60). Other instances of supernumerary limbs will be found in Chapter VI. Class X. — The instances of diphallic terata, by their intense interest to the natural bent of the curious mind, have always elicited much discus- sion. To many of these cases have been attributed exaggerated function, " 125, 1888, 1266. b 224, 1889, i., 96. c Annals of Gynecology, 1888. Fig. 58. — Epignathus. DIPHALLIC TERATA. 195 Fig. 59.— Dipygus (Wells). notwithstanding the fact that modern observation almost invariably shows that the virile power diminishes in exact proportion to the extent of duplica- tion. Taylor '" quotes a description of a monster, exhibited in London, with two distinct penises, but with only one distinct testicle on either side. He could exercise the function of either organ. Schenck, Schurig, Bartholinus, Loder, and Ollsner report instances of diphallic terata ; the latter case * was in a soldier of Charles VI., twenty-two years old, who applied to the surgeon for a bubonic affec- tion, and who declared that he passed urine from the orifice of the left glans and also said that he was incapable of true coitus. Val- entini mentions an instance in a boy of four, in which the two penises were superimposed. Buc- chettoni'' speaks of a man with two penises placed side by side. There was an anonymous case described " of a man of ninety-three with a penis which was for more than half its length divided into two distinct members, the right being somewhat larger than the left. From the middle of the penis up to the symphysis only the lower wall of the urethra was split. Jenisch*^ describes a diphallic infant, the offspring ,of a woman of twenty-five who had been married five years. Her first child was a well-formed female, and the second, the infant in question, cried much during the night, and several times vomited dark-green matter. In lieu of one penis there were two, situated near each other, the right one of natural size and the left larger, but not furnished with a prepuce. Each penis had its own urethra, from which dribbled urine and some meconium. There was a ° Medicorum Siles. Satyrae. Lipsise, 1736. ^ Anatomia, etc., p. 120, CEniponte, 1740. c 559, 1808, Band ii., 335. i Med. Corresp.-Blatt des wurttemb. arztl. Ver., Stuttg., 1837. Fig. 60.— Blanche Dumas. 196 MAJOR TERATA. Fig. 61. — Double penis (Jenisch's case). duplication of each scrotum, but only one testicle in each, and several other minor malformations (Fig. 61). Gor6, reported by Velpeau, ^ has seen an infant of eight and one-half months with two penises and three lower extremities. The penises were 4 cm. apart and the scrotum divided, containing one testicle in each side. Each penis was provided with a ure- thra, urine being discharged from both simultaneously. In a similar case, spoken of by Geoffroy-Saint-Hilaire, the two organs Mere also separate, but urine and semen escaped some- times from one, sometimes from both. The most celebrated of all the diphallic terata was Jean Baptista dos Santos, who when but six months old was spoken of by Acton. His father and mother were healthy and had two well-formed children. He was easily born after an uneventful pregnancy. He was good- looking, well proportion- ed, and had two distinct penises, each as large as that of a child of six months. Urination pro- ceeded simultaneously from both penises ; he had also two scrotums. Behind and between the legs there was another limb, or rather two, united throughout their length. It was con- nected to the pubis by a short stem J inch long and as large as the little finger, consisting of separ- ate bones and cartilages. There was a patella in the supernumerary limb on the anal aspect, and a joint freely movable. This compound limb had no a 283, 1844. Fig. 62.— Jean Baptista dos Santos. JEAN BAPTISTA DOS SANTOS. 197 power of motion, but was endowed with sensibility. A journal in London,-'' after quoting Acton's description, said that the child had been exhibited in Paris, and that the surgeons advised operation. Fisher,'' to whom we are indebted for an exhaustive work in Teratology, received a report from Havana in July, 1865, which detailed a description of Santos at twenty- two years of age, and said that he was possessed of extraordinary animal passion, the sight of a female alone being sufficient to excite him. He was said to use both penises, after finishing with one continuing with the other ; but this account of him does not agree with later descriptions, in which no excessive sexual ability had been noticed. Hart <= describes the adult Santos in full, and accompanies his article with an illustration. At this time he was said to have developed double genitals, and possibly a double bladder communicating by an imperfect septum. At adulthood the anus was three inches anterior to the os coccygeus. In the sitting or lying posture the supernumerary limb rested on the front of the inner surface of the lower third of his left thigh. He was in the habit of wearing this limb in a sling, or bound firmly to the right thigh, to prevent its unseemly dangling when erect. The perineum proper was absent, the entire space between the anus and the posterior edge of the scrotum being occupied by the pedicle. Santos' mental and physical functions were developed above normal, and he impressed everybody with his accomplishments. GeofFroy-Saint-Hilaire records an in- stance in which the conformation was similar to that of Santos. There was a third lower extremity consisting of two limbs fused into one with a single foot containing ten distinct digits. He calls the case one of arrested twin development. Van Buren and Keyes * describe a case in a man of forty-two, of good, healthy appearance. The two distinct penises of normal size were appa- rently well formed and were placed side by side, each attached at its root to the symphysis. Their covering of skin was common as far as the base of the glans ; at this point they seemed distinct and perfect, but the meatus of the left was imperforate. The right meatus was normal, and through it most of the urine passed, though some always dribbled through an opening in the perineum at a point where the root of the scrotum should have been. On lifting the double-barreled penis this opening could be seen and was of suffi- cient size to admit the finger. On the right side of the aperture was an elongated and rounded prominence similar in outline to a labium majus. This prominence contained a testicle normal in shape and sensibility, but slightly undersized, and surrounded, as was evident from its mobility, by a tunica vaginalis. The left testicle lay on the tendon of the adductor longus in the left groin ; it was not fully developed, but the patient had sexual de- sires, erections, and emissions. Both penises became erect simultaneously, a 549, April, 1847, 322. b 773, 1866. e 476, 1866, i., 71. d " Surgical Diseases of the Genito- Urinary Organs," New York, 1874. 198 MAJOR TERATA. the right more vigorously. The left leg was shorter than the right and con- genitally smaller ; the mammae were of normal dimensions. Sangalli " speaks of a man of thirty-five who had a supernumerary penis, furnished with a prepuce and capable of erection. At the apex of the glans opened a canal about 12 cm. long, through which escaped monthly a serous fluid. Smith'' mentions a man who had two penises and two bladders, on one of which lithotomy was performed. According to Ballantyne, Taruffi, the scholarly observer of terata, mentions a child of forty-two months and height of 80 cm. who had two penises, each furnished with a urethra and well- forme4 scrotal sacs which were inserted in a fold of the groin. There were two testicles felt in the right scrotum and one in the left. Fecal evacuations escaped through two anal orifices. There is also another case mentioned similar to the foregoing in a man of forty ; but here there was an osseous projection in the middle line behind the bladder. This patient said that erection was simultaneous in both penises, and that he had not married because of his chagrin over his deformity. Cole " speaks of a child with two well-developed male organs, one to the left and the other to the right of the median line, and about i or J inch apart at birth. The urethra bifurcated in the perineal region and sent a branch to each penis, and urine passed from each meatus. The scrotum was divided into three compartments by two raphes, and each compartment contained a testicle. The anus at birth was imperforate, but the child was successfully operated on, and at its sixtieth day weighed 17 pounds. Lange* says that an infant was brought to Karg for relief of anal atresia when fourteen days old. It was found to possess duplicate penises, which communicated each to its distinct half of the bladder as defined by a median fold. The scrotum was divided into three portions by two raphes, and each lateral compartment contained a fully formed testicle. This child died because of its anal malformation, which we notice is a frequent associate of malformations or duplicity of the penis. There is an example in an infant described " in which there were two penises, each about | inch long, and a divided scrotal sac 2^ inches long. Englisch*^ speaks of a German of forty who possessed a double penis of the bifid type. Ballantyne and his associates define diphallic terata as individuals pro- vided with two more or less well-formed and more or less separate penises, who may show also other malformations of the adjoining parts and organs (e. g., septate bladder), but who are not possessed of more than two lower limbs. This definition excludes, therefore, the cases in which in addition to a double penis there is a supernumerary lower extremity — such a casej for example, as that of Jean Baptista dos Santos, so frequently described by teratologists. It also excludes the more evident double terata, and, of course, the cases of a "Laseienza a e la piat. dell. anat. patolog." Pavia, 1875, i., 117. b 775, 1878, 91. c 579, 1894, 159. d 720, 1895, 215. e 759^ April, 1895. f Quoted 759, Oct., 1895. FETUS IN FETU. 199 duplication of the female genital organs (double clitoris, vulva, vagina, and uterus). Although Schurig, Meckel, Hinaly, Taruffi, and others give bib- liographic lists of diphallic terata, even in them erroneous references are common, and there is evidence to show that many cases have been duplicated under different names. Ballantyne and Skirving " have consulted all the older original references available and eliminated duplications of reports, and, adhering to their original definition, have collected and described indi- vidually 20 cases ; they offer the following conclusions : — 1. Diphallus, or duplication of the penis in an otherwise apparently single individual, is a very rare anomaly, records of only 20 cases having been found in a fairly exhaustive search through teratologic literature. As a distinct and well-authenticated type it has only quite recently been recognized by teratologists. 2. It does not of itself interfere with intrauterine or extrauterine life ; but the associated anomalies (e. g., atresia ani) may be sources of danger. If not noticed at birth, it is not usually discovered till adult life, and even then the discovery is commonly accidental. 3. With regard to the functions of the pelvic viscera, urine may be passed by both penises, by one only, or by neither. In the last instance it finds exit by an aperture in the perineum. There is reason to believe that semen may be passed in the same way; but in most of the recorded cases there has been sterility, if not inability to perform the sexual act. 4. All the degrees of duplication have been met with, from a fissure of the glans penis to the presence of two distinct penises inserted at some dis- tance from each other in the inguinal regions. 5. The two penises are usually somewhat defective as regards prepuce, urethra, etc. ; they may lie side by side, or more rarely may be situated anteroposteriorly ; they may be equal in size, or less commonly one is dis- tinctly larger than the other ; and one or both may be perforate or imperforate. 6. The scrotum may be normal or split ; the testicles, commonly two in number, may be normal or atrophic, descended or undescended ; the prostate may be normal or imperfectly developed, as may also the vasa deferentia and vesiculse seminales. 7. The commonly associated defects are : More or less completely septate bladder, atresia ani, or more rarely double anus, double urethra, increased breadth of the bony pelvis with defect of the symphysis pubis, and possibly duplication of the lower end of the spine, and hernia of some of the abdom- inal contents into a perineal pouch. Much more rarely, duplication of the heart, lungs, stomach, and kidneys has been noted, and the lower limbs may be shorter than normal. Class XI. — Cases of fetus in fetu, those strange instances in which one might almost say that a man may be pregnant with his brother or sister, or in a 759, 1895. 200 MAJOR TERATA. which an infant may carry its twin without the fact being apparent, will next be discussed. The older cases were cited as being only a repetition of the process by which Eve was born of Adam. Figure 63 represents an old engraving showing the birth of Eve. Bartholinus, the Ephemerides, Otto, Paullini, Schurig, and Plot speak of instances of fetus in fetu. E,uysch " describes a tumor contained in the abdomen of a man which was composed of hair, molar teeth, and other evidences of a fetus. Huxham reported to the Royal Society in 1748 the history of a child which was born with a tumor near the anus larger than the whole body of the child ; this tumor contained rudiments of an embryo. Young'' speaks of a fetus which lay encysted between the laminse of the transverse mesocolon, and Highmore published a report of a fetus in a cyst communicating with the duodenum. Dupuytren gives an example in a boy of thirteen, in whom was found a fetus. Gaetano-Nocito, cited by Philipeaux,^"^ has the history of a man of twenty-seven who was taken with a great pain in the right hypochondrium, and from which issued subsequently fetal bones and a mass of macerated embryo. His mother had had several double pregnancies, and from the length of the respective tibise one of the fetuses seemed to be of two months' and the other of three months' intrauterine life. The man died five years after the abscess had burst spontaneously. Brodie " speaks of a case in which fetal remains were taken from the abdomen of a girl of two and one-half years. Gaither ^ describes a child of two years and nine months, supposed to be aifected with ascites, who died three hours after the physician's arrival. In its abdomen was found a fetus weighing almost two pounds and connected to the child by a cord resembling an umbilical cord. This clyld was healthy for about nine months, and had a precocious longing for ardent spirits, and drank freely an hour before its death. Blundell " says that he knew " a boy who was literally and without evasion with child, for the fetus was contained in a sac communicating with the ab- domen and was connected to the side of the cyst by a short umbilical cord ; nor did the fetus make its appearance until the boy was eight or ten years a 698, Tome ii. b 550, i., 234. e 550, 1819. d 598, 1809, i., 170 et seq. e 476, 1828-1829, 260. Fig. 63. — Birth of Eve (after an old engraving FETUS IN FETU. 201 old, when after much enlargement of pregnancy and subsequent flooding the boy died." The fetus, removed after death, on the whole not very imper- fectly formed, was of the size of about six or seven months' gestation. Bury " cites an account of a child that had a second imperfectly developed fetus in its face and scalp. There was a boy by the name of Bissieu'' who from the earliest age had a pain in one of his left ribs ; this rib was larger than the rest and seemed to have a tumor under it. He died of phthisis at fourteen, and after death there was found in a pocket lying against the transverse colon and communicating with it all the evidences of a fetus. At the H6pital de la Charity in Paris, Velpeau startled an audience of 500 students and many physicians by saying that he expected to find a rudi- mentary fetus in a scrotal tumor placed in his hands for operation. His diagnosis proved correct, and brought him resounding praise, and all won- dered as to his reasons for expecting a fetal tumor. It appears that he had read with care a report by Fatti " of an operation on the scrotum of a child which had increased in size as the child grew, and was found to contain the ribs, the vertebral column, the lower extremities as far as the knees, and the two orbits of a fetus ; and also an account '^ of a similar operation performed by Wendt of Breslau on a Silesian boy of seven. The left testicle in this case was so swollen that it hung almost to the knee, and the fetal remains removed weighed seven ounces. Sulikowski ^ relates an instance of congenital fetation in the umbilicus of a girl of fourteen, who recovered after the removal of the anomaly. Are- tseos described to the members of the medical fraternity in Athens ^ the case of a woman of twenty-two, who bore two children after a seven months' preg- nancy. One was very rudimentary and only 2J inches long, and the other had an enormous head resembling a case of hydrocephalus. On opening the head of the second fetus, another, three inches long, was found in the medulla oblongata, and in the cranial cavity with it were two additional fetuses, neither of which was perfectly formed. Broca s speaks of a fetal cyst being passed in the urine of a man of sixty- one ; the cyst contained remnants of hair, bone, and cartilage. Atlee ^ sub- mits quite a remarkable case of congenital ventral gestation, the subject being a girl of six, who recovered after the discharge of the fetal mass from the abdomen. Mclntyre ' speaks of a child of eleven, playing about and feeling well, but whose abdomen progressively increased in size IJ inches each day. After ten days there was a large fluctuating mass on the right side ; the abdomen was opened and the mass enucleated ; it was found to contain a fetal mass weighing nearly five pounds, and in addition ten pounds of fluid were removed. The child made an early recovery. Rogers ' mentions a fetus that » 490, 1834. b 302, iv., 179. <= 240, 1826. d 240, 1829. e 233, 1851-2, 17, 143. f 536, April 16, 1862. g 362, No. 26, 1868. b 768, 1879. i 616, Feb., 1894. J 131, 1875. 202 MAJOR TERATA. was found in a man's bladder. Bouchacourt " reports the successful extir- pation of the remains of a fetus from the rectum of a child of six. Miner *> describes a successful excision of a congenital gestation. Modern literature is full of examples, and nearly every one of the fore- going instances could be paralleled from other sources. Eodriguez " is quoted as reporting that in July, 1891, several newspapers in the city of Mexico published, under the head of " A Man-mother," a wonderful story, accom- panied by wood-cuts, of a young man from whose body a great surgeon had extracted a " perfectly developed fetus." One of these wood-cuts represented a tumor at the back of a man opened and containing a crying baby. In commenting upon this, after reviewing several similar cases of endocymian monsters that came under his observation in Mexico, Rodriguez tells what the case which had been so grossly exaggerated by the lay journals really was : An Indian boy, aged twenty-two, presented a tumor in the sacrococ- cygeal region measuring 53 cm. in circumference at the base, having a vertical diameter of 17 cm. and a transverse diameter of 13 cm. It had no pedicle and was fixed, showing unequal consistency. At birth this tumor was about the size of a pigeon's egg. A diagnosis of dermoid cyst was made and two operations were performed on the boy, death following the second. The skeleton showed interesting conditions ; the rectum and pelvic organs were natural, and the contents of the cyst verified the diagnosis. Quite similar to the cases of fetus in fetu are the instances of dermoid cysts. For many years they have been a mystery to physiologists, and their origin now is little more than hypothetic. At one time the fact of finding such a formation in the ovary of an unmarried woman was presumptive evidence that she was unchaste ; but this idea was dissipated as soon as examples were reported in children, and to-day we have a well-defined difference between congenital and extrauterine pregnancy. Dermoid cysts of the ovary may consist only of a wall of connective tissue lined with epidermis and contain- ing distinctly epidermic scales which, however, may be rolled up in firm masses of a more or less soapy consistency ; this variety is called by Orth epidermoid cyst ; or, according to Warren, a form of cyst made up of skin containing small and ill-defined papillae, but rich in hair follicles and seba- ceous glands. Even the erector pili muscle and the sudoriparous gland are often found. The hair is partly free and rolled up into thick balls or is still attached to the walls. A large mass of sebaceous material is also found in these cysts. Thomson reports a case of dermoid cyst of the bladder con- taining hair, which cyst he removed. It was a pedunculated growth, and it was undoubtedly vesical and not expelled from some ovarian source through the urinary passage, as sometimes occurs. The simpler forms of the ordinary dermoid cysts contain bone and teeth. The complicated teratoma of this class may contain, in addition to the pre- a 368, 1850. b 230, 1874. c 791, April, 1893. Plate 3. \ ■«^„ > Dermoid cvst laid open, showing maxillary bone containing teeth ; the head of one of the long bones ; skin with hair growing from its surface ; serous membrane (probe passed under- neath) ; mucous membrane of stomach directly next to serous membrane (Baldy). DERMOID CYSTS. 203 viously mentioned structures, cartilage and glands, mucous and serous mem- brane, muscle, nerves, and cerebral substance, portions of eyes, fingers with nails, mammae, etc. Figure 64 represents a cyst containing long red hair that was removed from a blonde woman aged forty-four years who had given birth to six children. Cullingworth reports the history of a woman in whom both ovaries were apparently involved by dermoids, who had given birth to 12 children and had three miscarriages — the last, three months before the removal of the growths. The accompanying illustration (PL 3), taken Fig. 64.— Dermoid cyst containing long red hair, removed from a liglit-haired woman aged forty-four years (Montgomery). from Baldy," pictures a dermoid cyst of the complicated variety laid open and exposing the contents in situ. Mears of Philadelphia reports a case of ovarian cyst removed from a girl of six and a half by Bradford of Kentucky in 1875. From this age on to adult life many similar cases are recorded. Nearly every medical museum has preserved specimens of dermoid cysts, and almost all physicians are well acquainted with their occurrence. The curious formations and contents and the bizarre shapes are of great variety. Graves ^ mentions a dermoid cyst containing the left side of a human a " An American Text-Book of Gynecology," Philadelphia, 1894. ^ 533, 1895, 212. 204 MAJOR TERATA. face, an eye, a molar tooth, and various bones. Dermoid cysts are found also in regions of the body quite remote from the ovary. The so-called " orbital wens " are true inclusion of the skin of a congenital origin, as are the nasal dermoids and some of the cysts of the neck. Weil reported the case of a man of twenty-two years who was born with what was supposed to be a spina bifida in the lower sacral region. Accord- ing to Senn, the swelling never caused any pain or inconvenience until it in- flamed, when it opened spontaneously and suppurated, discharging a large quantity of offensive pus, hair, and sebaceous material, thus proving it to have been a dermoid. The cyst was freely incised, and there were found numer- ous openings of sweat glands, from which drops of perspiration escaped when the patient was sweating. Dermoid cysts of the thorax are rare. Bramann reported a case in which a dermoid cyst of small size was situated over the ster- num at the junction of the manubrium with the gladi- olus, and a similar cyst in the anterior median line of the neck near the left cornu of the hyoid bone. Chitten removed a dermoid from the sternum of a female of thirty-nine, the cyst con- taining 11 ounces of athe- romatous material. In the Museum of St. Bartholo- mew's Hospital in London there is a congenital tumor which was removed from the anterior mediastinum of a woman of twenty- one, and contained portions of skin, fat, sebaceous material, and two pieces of bone similar to the superior maxilla, and in which several teeth were found. Dermoids are found in the palate and pharynx, and open dermoids of the conjunctiva are classified by Sutton with the moles. According to Senn, Barker collected sixteen dermoid tumors of the tongue. Bryk successfully removed a tumor of this nature the size of a fist. Wellington Gray removed an enormous lingual dermoid from the mouth of a negro. It con- tained 40 ounces of atheromatous material (Fig. 65). Dermoids of the rectum are reported. Duyse " reports the history of a case of labor during which a rectal dermoid was expelled. The dermoid contained a cerebral vesicle, a a La Flandre M^d., March 14, 1895. Fig. 65. — Large lingual dermoid protruding from the mouth (after Gray). MULTIPLE DERMOID CYSTS. 205 rudimentary eye, a canine and a molar tooth, and a piece of bone. There is little doubt that many cases of fetus in fetu reported were really dermoids of the scrotum. Ward * reports the successful removal of a dermoid cyst weighing 30 pounds from a woman of thirty-two, the mother of two children aged ten and twelve, respectively. The report is briefly as follows : " The patient has always been in good health until within the last year, during which time she has lost flesh and strength quite rapidly, and when brought to my hospital by her physician. Dr. James of Williamsburg, Kansas, was quite weak, although able to walk about the house. A tumor had been growing for a number of years, but its growth was so gradual that the patient had not considered her condition critical until quite recently. The tumor was diagnosed to be cystoma of the left ovary. Upon opening the sac with the trocar we were confronted by complications entirely unlooked for, and its use had to be abandoned entirely because the thick contents of the cyst would not flow freely, and the presence of sebaceous matter blocked the in- strument. As much of the fluid as possible was removed, and the abdominal incision was enlarged to allow of the removal of the large tumor. An ovarian hematoma the size of a large orange was removed from the right side. We washed the intestines quite as one would wash linen, since some of the contents of the cyst had escaped into the abdominal cavity. The ab- domen was closed without drainage, and the patient placed in bed without experiencing the least shock. Her recovery was rapid and uneventful. She returned to her home in four weeks after the operation. " The unusual feature in this case was the nature of the contents of the sac. There was a large quantity of long straight hair growing from the cyst wall and an equal amount of loose hair in short pieces floating through the tumor- contents, a portion of which formed nuclei for what were called ' moth-balls,' of which there were about 1 J gallons. These balls, or marbles, varied from the size of moth-balls, as manufactured and sold by druggists, to that of small walnuts. They seemed to be composed of sebaceous matter, and were evi- dently formed around the short hairs by the motion of the fluid produced by walking or riding. There was some tissue resembling true skin attached to the inner wall of the sac." There are several cases of multiple dermoid cysts on record, and they may occur all over the body. Jamieson ^ reports a case in which there were 250, and in Maclaren's case there were 132. According to Crocker, Hebra and Eayer also each had a case. In a case of Sangster, reported by Politzer, although most of the dermoids, as usual, were like fibroma-nodules and therefore the color of normal skin, those over the mastoid processes and clavicle were lemon-yellow, and were generally thought to be xanthoma until they were excised, and Politzer found they were typical dermoid cysts with the usual contents of degenerated epithelium and hair. a Internat. Med. Magaz., Phila., July, 1895. '' 318, Sept., 1873, 223. 206 MAJOR TERATA. Hermaphroditism. — Some writers claim that Adam was the first herma- phrodite and support this by Scriptural evidence.'' We find in some of the ancient poets traces of an Egyptian legend in which the goddess of the moon was considered to be both male and female. From mythology we learn that Hermaphroditus was the son of Hermes, or Mercury, and Venus Aphrodite, and had the powers both of a father and mother. In speaking of the fore- going Ausonius writes, " Cujus erat facies in qua paterque materque cognosci possint, nomen traxit ab illis." Ovid and Virgil both refer to legendary hermaphrodites, and the knowledge of their existence was preva- lent in the olden times. The ancients considered the birth of hermaphro- dites bad omens, and the Athenians threw them into the sea, the Romans, into the Tiber. Livy speaks of an hermaphrodite being put to death in Umbria, and another in Etruria. Cicero, Aristotle, Strabonius, and Pliny all speak concerning this subject. Martial ^ and TertuUian noticed this anomaly among the Romans. Aetius and Paulus iEgineta speak of females in Egypt with prolonged clitorides which made them appear like hermaphrodites. Throughout the Middle Ages we frequently find accounts, naturally exagger- ated, of double-sexed creatures. Harvey, Bartholinus, Paullini, Schenck, WolfF, Wrisberg, Zacchias, Marcellus Donatus, Haller, Hufeland, de Graff, and many others discuss hermaphroditism. Many classifications have been given, as, e. g., real and apparent ; masculine, feminine, or neuter ; horizontal and vertical ; unilateral and bilateral, etc. The anomaly in most cases consists of a malformation of the external genitalia. A prolonged clitoris, prolapsed ovaries, grossness of figure, and hirsute appearance have been accountable for many supposed instances of hermaphrodites. On the other hand, a cleft scrotum, an ill-developed penis, perhaps hypospadias or epispa- dias, rotundity of the mammse, and feminine contour have also provoked accounts of similar instances. Some cases have been proved by dissection to have been true hermaphrodites, portions or even entire genitalia of both sexes having been found. Numerous accounts, many mythical, but always interesting, are given of these curious persons. They have been accredited with having performed the functions of both father and mother, notwithstanding the statements of some of the best authorities that they are always sterile. Observation has shown that the sexual appetite diminishes in proportion to the imperfections in the genitalia, and certainly many of these persons are sexually indifferent. We give descriptions of a few of the most famous or interesting instances of hermaphroditism. Par6 "^ speaks of a woman who, besides a vulva, from which she menstruated, had a penis, but without prepuce or signs of erectility. Haller alludes to several cases in which prolonged clitorides have been the cause of the anomaly. In commenting on this form of hermaphroditism Albu- casius"^ describes a necessary operation for the removal of the clitoris. » Genesis, chap, i., verse 27. *> 509, lib. 1, ep. 91. c 618, L. xxv., chap. vi. INTERESTING INSTANCES OF HERMAPHRODITISM. 207 Columbus " relates the history of an Ethiopian woman who was evidently a spurious female hermaphrodite. The poor wretch entreated him to cut off her penis, an enlarged clitoris, which she said was an intolerable hindrance to her in coitus. De Graff and Riolan describe similar cases. There is an old record of a similar creature, supposing herself to be a male, who took a wife, but previously having had connection with a man, the outcome of which was pregnancy, was shortly after marriage delivered of a daughter. There is an account '^ of a person in Germany who, for the first thirty years of life, was regarded as feminine, and being of loose morals became a mother. At a certain period she began to feel a change in her sexual inclinations ; she married and became the father of a family. This is doubtless a distortion of the facts of the case of Catherine or Charies Hgffman, born in 1824, and who was considered a female until the age of forty. At puberty she had the instincts of a woman, and cohabitated with a male lover for twenty years. Her breasts were well formed and she menstruated at nineteen. At the age of forty-six her sexual desires changed, and she attempted coitus as a man, with such evident satisfaction that she married a woman soon after- ward. Fitch speaks of a house-servant " with masculine features and move- ments, aged twenty-eight, and 5 feet and 9 inches tall, who was arrested by the police for violating the laws governing prostitution. On examination, well-developed male and female organs of generation were found. The labia majora were normal and flattened on the anterior surface. The labia minora and hymen were absent. The vagina was spacious and the woman had a profuse leukorrhea. She stated that several years previously she gave birth to a normal child. In place of a clitoris she had a penis which, in erection, measured 5J inches long and 3f inches in circumference. The glans penis and the urethra were perfectly formed. The scrotum contained two testicles, each about an inch long ; the mons veneris was sparsely covered with straight, black hair. She claimed functional ability with both sets of genitalia, and said she experienced equal sexual gratification with either. Semen issued from the penis, and every three weeks she had scanty menstrua- tion, which lasted but two days. Beclard'^ showed Marie-Madeline Lefort, nineteen years of age, 1| meters in height. Her mammae were well developed, her nipples erectile and surrounded by a brown areola, from which issued several hairs. Her feet were small, her pelvis large, and her thighs like those of a woman. Projecting from the vulva was a body looking like a penis 7 cm. long and slightly erectile at times ; it was imperforate and had a mobile prepuce. She had a vulva with two well-shaped labia as shown by the accompanying illustration (Fig. 66). She menstruated slightly and had an opening at the root of the clitoris. The parotid region showed signs of a beard and she had a De re anatomica, L. xxv. b 224, 1889, i., 1038. c 597, Nov. 22, 1890. d Facalt6 de M6d. de Paris, 1815. 208 MAJOR TERATA. hair on her upper lip. On August 20, 1864, a person came into the Hdtel- Dieu, asking treatment for chronic pleurisy. He said his age was sixty-five, and he pursued the calling of a mountebank, but remarked that in early life he had been taken for a woman. He had menstruated at eight and had been examined by doctors at sixteen. The menstruation continued until 1848, and at its cessation he experienced the feelings of a male. At this time he presented the venerable appearance of a long-bearded old man (Fig. 67). At the autopsy, about two months later, all the essentials of a female were delineated. A Fallopian tube, ovaries, uterus, and round ligaments were found, and a drawing in cross-section of the parts was Fig. 66.— Marie-Madeline Lefort at sixteen years of age. Fig. 67.— Marie-Madeline Lefort at sixty- five years of age. made (Fig. 68). There is no doubt but that this individual was Marie- Madeline Lefort in age. , Worbe ^ speaks of a person who was supposed to be feminine for twebty- two years. At the age of sixteen she loved a farmer's son, but the union was delayed for some reason, and three years later her grace faded and she became masculine in her looks and tastes. It was only after lengthy discus- sion, in which the court took part, that it was definitely settled that this person was a male. Adelaide Pr6ville, ''''* who was married as a female, and as such lived the last ten years of her life in France, was found on dissection at the Hotel- a 461, Jan. et Fev., 1816. INTERESTING INSTANCES OF HERMAPHRODITISM. 209 Dieu to be a man. A man was spoken of in both France and Germany " who passed for many years as a female. He had a cleft scrotum and hypo- spadias, which caused the deception. Sleeping with another servant for three years, he constantly had sexual congress with her during this period, and finally impregnated her. It was supposed in this case that the posterior wall of the vagina supplied the deficiency of the lower boundary of the urethra, forming a complete channel for the semen to proceed through. Long ago in Scotland ^"^ a servant was condemned to death by burial alive for impregnat- ing his master's daughter while in the guise and habit of a woman. He had always been considered a woman. We have heard of a recent trustworthy account of a pregnancy and delivery in a girl who had been impregnated by a bed-fellow who on examina- tion proved to be a male pseu- dohermaphrodite. Fournier '' speaks of an in- dividual in Lisbon in 1807 who was in the highest de- gree of perfection, both male and female. The figure was graceful, the voice feminine, the mammae well developed, and menstruation was regular. The female genitalia were nor- mal except the labia majora, which were rather diminutive. The thighs and the pelvis were not so wide as those of a woman. There was some beard on the chin, but it was worn close. The male genitalia were of the size and appearance of a male adult and were covered with the usual hair. This person had been twice pregnant and aborted at the third and fifth month. During coitus the penis became erect, etc. Schrell " describes a case in which, independent of the true penis and tes- ticles, which were well formed, there existed a small vulva furnished with labia and nymphse, communicating with a rudimentary uterus provided with round ligaments and imperfectly developed ovaries. Schrell remarks that in this case we must notice that the female genitalia were imperfectly developed, ^ili^sadds that perfect hermaphroditism is a physical impossibility without gr&nt alterations of the natural connections of the bones and other a 789, k^lje^\^6. b 302, iv., 164. J ■ • c Med.-Chir. prakt. Archiv von Bader, etc., i., 1804. 1/1 iSstr Fig. 68. — Mesial section showing the generative organs of Marie-Madeline Lefort. The sound is introduced into the vagina, and from thence into the orifice of the urethra ; IT, the uterus ; 0, the ovary and Fallopian tuhe. 210 MAJOR TERATA. parts of the pelvis. Cooper * describes a woman with an enormous develop- ment of the clitoris, an imperforate uterus, and absence of vagina ; at first sight of the parts they appeared to be those of a man. In 1859 Hugier succeeded in restoring a vagina to a young girl of twenty who had an hypertrophied clitoris and no signs of a vagina. The accom- panying illustrations show the conformation of the parts before operation with all the appearance of ill-developed male genitalia, and the appearance afterward with restitution of the vaginal opening (Fig. 69). Virchow in 1872, Boddaert in 1875, and Marchand in 1883 report cases of duplication of the genitalia, and call their cases true hermaphrodites from an anatomic standpoint. There is a specimen in St. Bartholomew's Hospital in London from a man of forty-four, who died of cerebral hemorrhage. He Fig. 69. — Occlusion of the vulva and hypertrophy of the clitoris, hefore and after operation ; B, sound introduced into a narrow vulvar orifice ; C, labium majus containing an ovary ; D, urinary meatus. was well formed and had a beard and a full-sized penis. He was married, and it was stated that his wife had two children.'' The bladder and the in- ternal organs of generation were those of a man in whom neither testis had descended into the scrotum, and in whom the uterus masculinus and vagina were developed to an unusual degree. The uterus, nearly as large as in the adult female, lay between the bladder and rectum, and was enclosed between two layers of peritoneum, to which, on either side of the uterus, were attached the testes. There was also shown "^^ in London the pelvic organs from a case of complex or vertical hermaphroditism occurring in a child of nine months who died from the effects of an operation for the radfcsi-^re of a right in- guinal hernia. The external organs were those of a male w^hjmdescended » 392, 1840, 243. b7^xliv., 102. Plate 4. ^■ ,,>' N Pseudo-external bilateral hermaphroditism (Krug). SPURIOUS HERMAPHRODITISM. 211 testes. The bladder was normal and its neck was surrounded by a prostate gland. Projecting backward were a vagina, uterus, and broad ligaments, round ligaments, and Fallopian tubes, with the testes in the position of the ovaries. There were no seminal vesicles. The child died eleven days after the operation. The family history states that the mother had had 14 chil- dren and eight miscarriages. Seven of the children were dead and showed no abnormalities. The fifth and sixth children were boys and had the same sexual arrangement. Barnes, Chalmers, Sippel, and Litten describe cases of spurious herma- phroditism due to elongation of the clitoris. In Litten's case ^ the clitoris was 3J inches long, and there was hydrocele of the processus vaginalis on both sides, making tumors in the labium on one side and the inguinal canal on the other, which had been diagnosed as testicles and again as ovaries. There was associate cystic ovarian disease. Plate 4 is taken from a case of false external bilateral hermaphroditism. Phillips ^ mentions four cases of spurious hermaphroditism in one family, and recently Pozzi " tells of a family of nine individuals in whom this anomaly was observed. The first was alive and had four children ; the second was christened a female but was probably a male ; the third, fourth, and fifth were normal but died young ; the sixth daughter was choreic and feeble-minded, aged twenty-nine, and had one illegitimate child ; the seventh, a boy, was healthy and married ; the eighth was christened a female, but when seventeen was declared by the Faculty to be a male ; the ninth was christened a female, but at eighteen the genitals were found to be those of a male, though the mammse were well developed. O'Neill ^ speaks of a case in which the clitoris was five inches long and one inch thick, having a groove in its inferior surface reaching down to an oblique opening in the perineum. The scrotum contained two hard bodies thought to be testicles, and the general appearance was that of hypospadias. Postmortem a complete set of female genitalia was found, although the ovaries were very small. The. right round ligament was exceedingly thick and reached down to the bottom of the false scrotum, where it was firmly attached. The hard bodies proved to be on one side an irreducible omental hernia, probably con- genital, and on the other a hardened mass having no glandular structure. The patient was an adult. As we have seen, there seems to be a law of evolution in hermaphroditism which prevents perfection. If one set of genitalia are extraordinarily developed, the other set are correspondingly atrophied. In the case of extreme development of the clitoris and approxi- mation to the male type we must expect to find imperfectly developed uterus or ovaries. This would answer for one of the causes of sterility in these cases. There is a type of hermaphroditism in which the sex cannot be definitely » 161, Ixxv. b 778, xxviii., 158. <= 368, 1885, ii., 109. d 124, 1851, 588. 212 MAJOR TERATA. declared, and soinetimes dissection does not definitely indicate the predomi- nating sex. Such cases are classed under the head of neuter hermaphro- dites, possibly an analogy of the " genus epiccenum " of Quintilian. Marie Dorothde, of the age of twenty-three, was examined and declared a girl by Hufeland and Mursina, while Stark, Raschig, and Martens maintained that she was a boy. This formidable array of talent on both sides provoked much discussion in contemporary publications, and the case attracted much notice. Marc saw her in 1803,* at which time she carried contradicting certificates as to her sex. He found an imperforate penis, and on the in- ferior face near the root an opening for the passage of urine. No traces of nymphse, vagina, testicles, nor beard were seen. The stature was small, the form debilitated, and the voice effeminate. Marc came to the conclusion that it was impossible for any man to determine either one sex or the other. Everard Home dissected a dog with apparent external organs of the female, but discovered that neither sex was sufficiently pronounced to admit of classi- fication. Home also saw at the Royal Marine Hospital at Plymouth, in 1779, a marine who some days after admission was reported to be a girl. On examination Home found him to possess a weak voice, soft skin, volum- inous breasts, little beard, and the thighs and legs of a woman. There was fat on the pubis, the penis was short and small and incapable of erection, the testicles of fetal size ; he had no venereal desires whatever, and as regards sex was virtually neuter. The legal aspect of hermaphroditism has always been much discussed. Many interesting questions arise, and extraordinary complications naturally occur. In Rome a hermaphrodite could be a witness to a testament, the ex- clusive privilege of a man, and the sex was settled by the predominance. If the male aspect and traits together with the generative organs of man were most pronounced, then the individual could call himself a man. " Hermaphro- ditus an ad testamentum adhiberi possit qualitas sexus incalescentis ostendit." There is a peculiar case on record ^ in which the question of legal male inheritance was not settled until the individual had lived as a female for fifty- one years. This person was married when twenty-one, but finding coitus impossible, separated after ten years, and though dressing as a female had coitus with other women. She finally lived with her brother, with whom she eventually came to blows. She prosecuted him for assault, and the brother in return charged her with seducing his wife. Examination ensued, and at this ripe age she was declared to be a male. The literature on hermaphroditism is so extensive that it is impossible to select a proper representation of the interesting cases in this limited space, and the reader is referred to the modern French works on this subject, in which the material is exhaustive and the discussion thoroughly scientific. o 302, xxi., 104. b 359^ j„iy 29, 1895. CHAPTER VI. MII^OE TEEATA. Ancient Ideas Relative to Minor Terata. — The ancients viewed with great interest the minor structural anomalies of man, and held them to be divine signs or warnings in much the same manner as they considered more pronounced monstrosities. In a most interesting and instructive article, Ballantyne '* quotes Ragozin in saying that the Chaldeo-Babylonians, in addi- tion to their other numerous subdivisions of divination, drew presages and omens for good or evil from the appearance of the liver, bowels, and viscera of animals offered for sacrifice and opened for inspection, and from the natural defects or monstrosities of babies or the young of animals. Ballan- tyne names this latter subdivision of divination fetomancy or teratoscopy, and thus renders a special chapter as to omens derived from monstrous births, given by Lenormant : — " The prognostics which the Chaldeans claimed to draw from monstrous births in man and the animals are worthy of forming a class by themselves, insomuch the more as it is the part of their divinatory science with which, up to the present time, we are best acquainted. The development that their astrology had given to ' g6n6thliaque,' or the art of horoscopes of births, had led them early to attribute great importance to all the teratologic facts which were there produced. They claimed that an experience of 470,000 years of observations, all concordant, fully justified their system, and that in nothing was the influence of the stars marked in a more indubitable manner than in the fatal law which determined the destiny of each individual according to the state of the sky at the moment when he came into the world. Cicero, by the very terms which he uses to refute the Chaldeans, shows that the result of these ideas was to consider all infirmities and mon- strosities that new-born infants exhibited as the inevitable and irremediable consequence of the action of these astral positions. This being granted, the observation of similar monstrosities gave, as it were, a reflection of the state of the sky, on which depended all terrestrial things ; consequently, one might read in them the future with as much certainty as in the stars themselves. For this reason the greatest possible importance was attached to the terato- logic auguries which occupy so much space in the fragments of the great a 759, i., 127. 213 214 MINOR TERATA. treatise on terrestrial presages which have up to the present time been pub- lished." The rendering into English of the account of 62 teratologic cases in the human subject with the prophetic meanings attached to them by Chaldean diviners, after the translation of Opport, is given as follows by Ballantyne, some of the words being untranslatable : — "When a woman gives birth to an infant — (1) that has the ears of a lion, there will be a powerful king in the country ; (2) that wants the right ear, the days of the master (king) will be prolonged (reach old age) ; (3) tljat wants both ears, there will be mourning in the country, and the country will be lessened (diminished) ; (4) whose right ear is small, the house of the man (in whose house the birth took place) will be destroyed ; (5) whose ears are both small, the house of the man will be built of bricks ; (6) whose right ear is mudissu tehaat (monstrous), there will be an androgyne in the house of the new-born ; (7) whose ears are both mudissu (deformed), the country will perish and the enemy rejoice ; (8) whose right ear is round, there will be an androgyne in the house of the new-born ; (9) whose right ear has a wound below, and tur re ut of the man, the house will be destroyed ; (10) that has two ears on the right side and none on the left, the gods will bring about a stable reign, the country will flourish, and it will be a land of repose ; (11) whose ears are both closed, sa a au; (12) that has a bird's beak, the country will be peaceful ; (13) that has no mouth, the mistress of the house will die ; (14) that has no right nostril, the people of the world will be injured ; (15) whose nostrils are absent, the country wUl be in affiction, and the house of the man will be ruined ; (16) whose jaws are absent, the days of the master (king) will be prolonged, but the house (where the infant is born) will be ruined. When a woman gives birth to an infant — (17) that has no lower jaw, mut ta at mat, the name will not be efiaced ; (20) that has no nose, affliction wUl seize upon the country, and the master of the house will die ; (21) that has neither nose nor virile member (penis), the army of the king will be strong, peace will be in the land, the men of the king will be sheltered from evil influences, and Lilit (a female demon) shall not have power over them ; (22) whose upper lip overrides the lower, the people of the world will rejoice {or good augury for the troops) ; (23) that has no lips, affliction will seize upon the land, and the house of the man will be destroyed ; (24) whose tongue is Jcuri. aat, the man will be spared (?) ; (25) that has no right hand, the country will be convulsed by an earthquake ; (26) that has no fingers, the town will have no births, the bar shall be lost ; (27) that has no fingers on the right side, the master (king) will not pardon his adversary (or shall be humiliated by his enemies) ; (28) that has six fingers on the right side, the man will take the lukunu of the house ; (29) that has six very small toes on both feet, he shall not go to the lukimu ; (30) that has six toes on each foot, the people of the worid will be injured (calamity to the troops) ; ANCIENT IDEAS RELATIVE TO MINOR TERATA. 215 (31) that has the heart open and that has no skin, the country will suffer from calamities ; (32) that has no penis, the master of the house will be enriched by the harvest of his field ; (33) that wants the penis and the umbilicus, there will be ill-will in the house, the woman (wife) will have an overbearing eye (be haughty) ; but the male descent of the palace will be more extended. When a woman gives birth to an infant — (34) that has no well-marked sex, calamity and affliction will seize upon the land ; the master of the house shall have no happiness ; (35) whose anus is closed, the country will suffer from want of nourishment ; (36) whose right testicle (?) is absent, the country of the master (king) will perish ; (37) whose right foot is absent, his house will be ruined and there will be abundance in that of the neighbor ; (38) that has no feet, the canals of thfe country will be cut (intercepted) and the house ruined ; (39) that has the right foot in the form of a fish's tail, the booty of the country of the humble will not be imas sa hir ; (40) whose hands and feet are like four fishes' tails (fins), the master (king) shall perish (?) and his country shall be consumed ; (41) whose feet are moved by his great hunger, the house of the su su shall be destroyed ; (42) whose foot hangs to the tendons of the body, there will be great prosperity in the land ; (43) that has three feet, two in their normal position (attached to the body) and the third between them, there will be great prosperity in the land ; (44) whose legs are male and female, there will be rebellion ; (45) that wants the right heel, the country of the master (king) will be destroyed. When a woman gives birth to an infant — (46) that has many white hairs on the head, the days of the king will be prolonged ; (47) that has much ipga on the head, the master of the house will die, the house will be destroyed ; (48) that has much pinde on the head, joy shall go to meet the house (that has a head on the head, the good augury shall enter at its aspect into the house) ; (49) that has the head full of hali, there will be ill-will toward him and the master (king) of the town shall die ; (50) that has the head full of siksi, the king will repudiate his masters ; (51) that has some pieces of flesh (skin) hanging on the head, there shall be ill-will ; (52) that has some branches (?) (excrescences) of flesh (skin) hanging on the head, there shall be ill-will, the house will perish ; (53) that has some formed fingers (horns ?) on the head, the days of the king will be less and the years lengthened (in the duration of his old age) ; (54) that has some kali on the head, there will be a king of the land ; (55) that has a of a bird on the head, the master of the house shall not prosper ; (.56) that has some teeth already through (cut), the days of the king will arrive at old age, the country will show itself powerful over (against) strange (feeble) lands, but the house where the infant is born will be ruined ; (57) that has the beard come out, there will be abundant rains ; (58) that has some birta on the head, the country will be strengthened (reinforced) ; (59) that has on the head the mouth of an old man and that foams (slabbers), there will be great prosperity in the land, the god Bin will give a magnificent harvest (inundate the land with fertility), and abundance shall be in the land ; (60) that has on one side of the head a thickened ear, the first-born of the men shall live a long time (?) ; 216 MINOR TERATA. (61) that has on the head two long and thick ears, there will be tranquility and the pacifi- cation of litigation (contests) ; (62) that has the figure in horn (like a horn?) ..." As ancient and as obscure as are these records, Ballantyne has carefully gone over each, and gives the following lucid explanatory comments : — " What 'ears like a Hon' (No. 1) may have been it is difficult to determine ; but doubt- less the direction and shape of the auricles were so altered as to give them an animal appearance, and possibly the deformity was that called ' orechio ad ansa ' by Lombroso. The absence of one or both ears (Nos. 2 and 3) has been noted in recent times by Virchow (Archiv fur path. Anat., xxx., p. 221), Grradenigo (Taruffi's ' Storia della Teratologia,' vi., p. 552),' and others. Generally some cartilaginous remnant is found, but on this point the Chaldean record is silent. Variations in the size of the ears (Nos. 4 and 5) are well known at the present time, and have been discussed at length by Binder (Archiv fur Psychiatric und Nervenkrankheiten, xx., 1887) and others. The exact malformation indicated in Nos. 6 and 7 is, of course, not to be determined, although further researches in Assyriology may clear up this point. The 'round ear' (No. 8) is one of Binder's types, and that with a ' wound below ' (No. 9) probably refers to a case of fistula auris congenita (Toyn- bee, 'Diseases of the Ear,' 1860). The instance of an infant born with two ears on the right side (No. 1 0) was doubtless one of cervical auricle or preauricular appendage, whilst closure of the external auditory meatus (No. 11) is a well-known deformity. "The next thirteen cases (Nos. 12-24) were instances of anomalies of the mouth and nose. The 'bird's beak' (No. 12) may have been a markedly aquiline nose; No. 13 was a case of astoma ; and Nos. 14 and 15 were instances of stenosis or atresia of the anterior nares. Fetuses with absence of the maxillae (Nos. 16 and 17) are in modern terminology called agnathous. Deformities like that existing in Nos. 20 and 21 have been observed in paracephalic and cyclopic fetuses. The coincident absence of nose and penis (No. 21) is interesting, especially when taken in conjunction with the popular belief that the size of the former organ varies with that of the latter. Enlargement of the upper lip (No. 22), called epimacrochelia by Taruffi, and absence of the lips (No. 23), known now under the name of brachychelia, have been not unfrequently noticed in recent times. The next six cases (Nos. 25-30) were instances of malformations of the upper limb : Nos. 25, 26, and 27 were prob- ably instances of the so-called spontaneous or intrauterine amputation ; and Nos. 28, 29, and 30 were examples of the comparatively common deformity known as Polydactyly. No. 31 was probably a case of ectopia cordis. "Then follow five instances of genital abnormalities (Nos. 32-36), consisting of absence of the penis (epispadias ?), absence of penis and umbilicus (epispadias and exomphalos ?), hermaphroditism, imperforate anus, and nondescent of one testicle. The nine following cases (Nos. 37-45) were anomalies of the lower limbs : Nos. 37, 38, and 42 may have been spontaneous amputations ; Nos. 39 and 40 were doubtless instances of webbed toes (syn- dactyly), and the deformity indicated in No. 45 was presumably talipes equinus. The infant born with three feet (No. 43) was possibly a case of parasitic monstrosity, several of which have been reported in recent teratologic literature ; but what is meant by the state- ment concerning ' male and female legs ' it is not easy to determine. "Certain of the ten following prodigies (Nos. 46-55) cannot in the present state of our knowledge be identified. The presence of congenital patches of white or gray hair on the scalp, as recorded in No. 46, is not an unknown occurrence at the present time ; but what the Chaldeans meant by ipga, pinde, liali, siksi, and Icali on the head of the new-born infant it is impossible to tell. The guess may be hazarded that cephalhematoma, hydro- cephalus, meningocele, nevi, or an excessive amount of vernix caseosa were the conditions indicated, but a wider acquaintance with the meaning of the cuneiform characters is neces- sary before any certain identification is possible. The ' pieces of skin hanging from the ABNORMAL ELASTICITY OF THE SKIN. 217 head ' (No. 51) may have been fragments of the membranes ; but there is nothing in the accompanying prediction to help us to trace the origin of the popular belief in the good luck following the baby born with a caul. If No. 53 was a case of congenital horns on the head, it must be regarded as a unique example, unless, indeed, a form of fetal ichthyosis be indicated. "The remaining observations (No. 56-62) refer to cases of congenital teeth (No. 56), to deformity of the ears (Nos. 60 and 61), and a horn (No. 62)." From these early times almost to the present day similar significance has been attached to minor structural anomalies. In the following pages the individual anomalies will be discussed separately and the most interesting examples of each will be cited. It is manifestly evident that the object of this chapter is to mention the most striking instances of abnormism and to give accompanying descriptions of associate points of interest, rather than to offer a scientific exposition of teratology, for which the reader is referred elsewhere. Congenital defect of the epidermis and true skin is a rarity in pathology. Pastorello " speaks of a child which lived for two and a half hours whose hands and feet were entirely destitute of epidermis ; the true skin of those parts looked like that of a dead and already putrefying child. Hanks *" cites the history of a case of antepartum desquamation of the skin in a living fetus. Hochstetter " describes a full-term, living male fetus with cutaneous defect on both sides of the abdomen a little above the umbilicus. The placenta and membranes were normal, a fact indicating that the defect was not due to amniotic adhesions ; the child had a club-foot on the left side. The mother had a fall three weeks before labor. Abnormal Elasticity of the Skin. — In some instances the skin is affixed so loosely to the underlying tissues and is possessed of so great elas- ticity that it can be stretched almost to the same extent as India rubber. There have been individuals who could take the skin of the forehead and pull it down over the nose, or raise the skin of the neck over the mouth. They also occasionally have an associate muscular development in the sub- cutaneous tissues similar to the panniculus adiposus of quadrupeds, giving them preternatural motile power over the skin. The man recently exhibited under the title of the " Elastic-Skin Man " was an example of this anomaly. The first of this class of exhibitionists was seen in Buda-Pesth some years since and possessed great elasticity in the skin of his whole body ; even his nose could be stretched. Figure 70 represents a photograph of an exhibi- tionist named Felix Wehrle, who besides having the power to stretch his skin could readily bend his fingers backward and forward. The photograph was taken in January, 1888. In these congenital cases there is loose attachment of the skin without hypertrophy, to which the term dermatolysis is restricted by Crocker. Job van Meekren,^^" the celebrated Dutch physician of the seventeenth century, a 153, July, 1845. b 125, 1880, 595. c 263, 1894, 542. 218 MINOR TERATA. states that in 1657 a Spaniard, Georgius Albes, is reported to have been able to draw the skin of the left pectoral region to the left ear, or the skin under the face over the chin to the vertex. The skin over the knee could be extended half a yard, and when it retracted to its normal position it was not in folds. Seiffert examined a case of this nature in a young man of nineteen, and, contrary to Kopp's supposition, found that in some skin from over the left second rib the elastic fibers were quite normal, but there was transforma- tion of the connective tissue of the dermis into an unformed tissue like a myxoma, with total disappearance of the connective-tissue bundles. Laxity of the skin after distention is often seen in multipara, both in the breasts and in the abdominal walls, and also from obesity, but in all such cases the skin falls in folds, and does not have a normal appear- ance like that of the true " elastic-skin man." Occasionally abnormal development of the scalp is noticed. McDowall * records an instance in an epileptic idiot of twenty-two. On each side of the median line of the head there were five deep furrows (Fig. 71), more curved and shorter as the distance from the median line increased. In the illustration the hair in the furrows is left longer than that on the rest of the head. The patient was distinctly microcephalic and the right side of the body was markedly wasted. The folds were due to hyper- trophy of the muscles and scalp, and the same sort of furrowing is noticed when a dog " pricks his ears." This case may possibly be considered as an example of reversion to inferior types. Cowan ^ records two cases of the foregoing nature in idiots. The first case (Fig. 72) was a paralytic idiot of thirty-nine, whose cranial development was small in proportion to the size of the face and body ; the cranium was oxycephalic ; the scalp was lax and redundant and the hair thin ; there were 13 furrows, five on each side running anteroposteriorly, and three in the occipital region running transversely. The occipitofrontalis muscle had no action on them. The second case was that of an idiot of forty-four of a more degraded type than the previous one. The cranium was round and bullet-shaped and the hair a 465, Jan., 1893. b 465, Oct., 1893. Fig. 70. — An "elastic-skin man." IMPERVIOUS SKIN. 219 generally thick. The scalp was not so lax as in the other case, but the furrows were more crooked. By tickling the scalp over the back of the neck the two median furrows involuntarily deepened. Impervious Skin. — There have been individuals who claimed that their skin was impervious to ordinary puncture, and from time to time these indi- viduals have appeared in some of the larger medical clinics of the world for inspection. According to a recent number of the London Graphic, there is in Berlin a Singhalese who baffles all investigations by physicians by the impenetrability of his skin. The bronzed Easterner, a Hercules in shape, claims to have found an elixir which will render the human skin impervious to any metal point or sharpened edge of a knife or dagger, and calls himself the " Man with Iron Skin." He is now exhibiting himself, and his greatest feat is to pass with his entire body through a hoop the inside of which is hardly Fig. 71. — Abnormal development of scalp (McDowall). Fig. 72.— Abnormal development of scalp (Cowan). big enough to admit his body and is closely set with sharp knife-points, dag- gers, nails, and similar things. Through this hoop he squeezes his body with absolute impunity. The physicians do not agree as to his immunity, and some of them think that Rhannin, which is his name, is a fakir who has by long practice succeeded in hardening himself against the impressions of metal upon his skin. The professors of the Berlin clinic, however, consid- ered it worth while to lecture about the man's skin, pronouncing it an inex- plicable matter. This individual performed at the London Alhambra in the latter part of 1895. Besides climbing with bare feet a ladder whose rungs were sharp-edged swords, and lying on a bed of nail points with four men seated upon him, he curled himself up in a barrel, through whose inner edges nails projected, and was rolled about the stage at a rapid rate. Emerging from thence uninjured, he gracefully bows himself off the stage. 220 MINOR TERATA. Some individuals claim immunity from burns and show many interesting feats in handling fire. As they are nothing but skilful " fire jugglers " they deserve no mention here. The immunity of the participants in the savage fire ceremonies will be discussed in Chapter IX. Albinism is characterized by the absolute or relative absence of pigment of the skin, due to an arrest, insufficiency, or retardation of this pigment. Following Tr6lat and Guinard, we may divide albinism into two classes, — general and partial. As to the etiology of albinism, there is no known cause of the com- plete form. Heredity plays no part in a num- ber of cases investigated by the authors. D'Aub6, by his observations on white rabbits, believes that the influence of con- sanguinity is a marked factor in the production of albinism ; there are, however, many instances of heredity in this ano- maly on record, and this idea is possibly in har- mon}' with the majority of observers. Geoffroy- Saint-Hilaire has noted that albinism can also be the consequence of a pathologic condition having its origin in ad- verse surroundings, the circumstances of the parents, such as the want of exercise, nourishment, light, etc. Lesser knew a family in which six out of seven were albinos, and in some tropical countries, such as Loango, Lower Guinea, it is said to be endemic. It is exceptional for the parents to be affected ; but in a case of Schlegel, quoted by Crocker, the grandfather was an albino, and Marey" describes the case of the Cape May albinos, in which the mother and father were " fair emblems of the African race," and of their children three were black and three were white, born in the following order : two consecutive black boys, - 124, 1839. Fig. 73.— An albino family. ALBINISM. 221 two consecutive white girls, one black girl, one white boy. Sym of Edin- burgh " relates the history of a family of seven children, who were alternately white and black. All but the seventh were living and in good health and mentally without defect. The parents and other relatives were dark. Figure 73 portrays an albino family by the name of Cavalier who exhibited in Minneapolis in 1887. Examples of the total absence of pigment occur in all races, but particu- larly is it interesting when seen in negroes who are found absolutely white but preserving all the characteristics of their race, as, for instance, the kinky, woolly hair, flattened nose, thick lips, etc. Ren6 Caill6, in his " Voyage a Tombouctou," says that he saw a white infant, the oifspring of a negro and negress. Its hair was white, its eyes blue, and its lashes flaxen. Its pupils were of a reddish color, and its physiognomy that of a Mandingo. He says such cases are not at all uncommon ; they are really negro albinos. Thomas Jefferson, in his " History of Virginia," has an excellent description of these negroes, with their tremulous and weak eyes ; he remarks that they freckle easily. Buffon speaks of Ethiops with white twins, and says that albinos are quite common in Africa, being generally of delicate constitution, twinkling eyes, and of a low degree of intelligence ; they are despised and ill-treated by the other negroes. Prichard, quoted by Sedgwick, speaks of a case of atavic transmission of albinism through the male line of the negro race. The grandfather and the grandchild were albinos, the father being black. There is a case *> of a brother and sister who were albinos, the parents being of ordinary color but the grandfather an albino. Coinde, quoted by Sedgwick, speaks of a man who, by two different wives, had three albino children. A description of the ordinary type of albino would be as follows : The skin and hair are deprived of pigment ; the eyebrows and eyelashes are of a brilliant white or are yellowish ; the iris and the choroid are nearly or entirely deprived of coloring material, and in looking at the eye we see a roseate zone and the ordinary pink pupil ; from absence of pigment they neces- sarily keep their eyes three-quarters closed, being photophobic to a high degree. They are amblyopic, and this is due partially to a high degree of ametropia (caused by crushing of the eyeball in the endeavor to shut out light) and from retinal exhaustion and nystagmus. Many authors have claimed that they have little intelligence, but this opinion is not true. Ordi- narily the reproductive functions are normal, and if we exclude the results of the union of two albinos we may say that these individuals are fecund. Partial albinism is seen. The parts most often affected are the genitals, the hair, the face, the top of the trunk, the nipple, the back of the hands and fingers. Folker " reports the history of a case of an albino girl having pink eyes and red hair, the rest of the family having pink eyes and white » 476, July 11, 1891. b 580, Aug., 1888. - 476, 1876, i., 795. 222 MINOR TERATA. hair. Partial albinism, necessarily congenital, presenting a piebald appear- ance, must not be confounded with leukoderma, which is rarely seen in the young and which will be described later. Albinism is found in the lower animals, and is exemplified ordinarily- by rats, mice, crows, robins, etc. In the Zoologic Garden at Baltimore two years ago was a pair of pure albino opossums. The white elephant is cele- brated in the religious history of Oriental nations, and is an object of venera- tion and worship in Siam. White monkeys and white roosters are also worshiped. In the Natural History Museum in London there are stuifed examples of albinism and melanism in the lower animals. Melanism is an anomaly, the exact contrary of the preceding. It is characterized by the presence in the tissues and skin of an excessive amount of pigment. True total melanism is unknown in man, in whom is only observed partial melanism, characterized simply by a pronounced coloration of part of the integument. Some curious instances have been related " of an infant with a two-colored face, and of others with one side of the face white and the other black ; whether they were cases of partial albinism or partial melanism cannot be ascertained from the descriptions. Such epidermic anomalies as ichthyosis, scleroderma, and moUuscum sim- plex, sometimes appearing shortly after birth, but generally seen later in life, will be spoken of in the chapter on Anomalous Skin Diseases. Human horns are anomalous outgrowths from the skin and are far more frequent than -ordinarily supposed. Nearly all the older writers cite exam- ples. Aldrovandus, Amatus Lusitanus, Boerhaave, Dupr6, Schenck, Eiver- ius, Vallisneri, and many others mention horns on the head. In the ancient times horns were symbolic of wisdom and power. Michael Angelo in his famous sculpture of Moses has given the patriarch a pair of horns. Rho- dius "*" observed a Benedictine monk who had a pair of horns and who was addicted to rumination. Fabricius ^'^ saw a man with horns on his head, whose son ruminated ; the son considered that by virtue of his ruminating characteristics his father had transmitted to him the peculiar anomaly of the family. Fabricius Hildanus ^^* saw a patient with horns all over the body and another with horns on the forehead. Gastaher ^ speaks of a horn from the left temple ; Zacutus Lusitanus *^^ saw a horn from the heel ; "Wroe, ^^^ one of considerable length from the scapula ; Cosnard, one from the bregma ; the Ephemerides, from the foot ; Borellus, from the face and foot, and Ash,<^ horns all over the body. Home, Cooper, and Treves have collected examples of horns, and there is one 1 1 inches long and 2 J in circumference in a London museum. Lozes collected reports of 71 cases of horns, — 37 in females, 31 in males, and three in infants. Of this number, 15 were on the head, eight on the face, 18 on the lower extremities, eight on the trunk, and three on the glans a 683, 1696, 254. b 418, 1776. c 629, 176. HUMAN HORNS. 223 penis. Wilson " collected reports of 90 cases, — 44 females, 39 males, the sex not being mentioned in the remainder. Of these 48 were on the head, four on the face, four on the nose, 11 on the thigh, three on the leg and foot, six on the back, five on the glans penis, and nine on the trunk. Lebert's **^ col- lection numbered 109 cases of cutaneous horns. The greater frequency among females is admitted by all authors. Old age is a predisposing cause. Several patients over seventy have been seen and one of ninety-seven.'' Instances of cutaneous horns, when seen and reported by the laity, give rise to most amusing exaggerations and descriptions. The following account " is given in New South Wales, obviously embellished with apocryphal details by some facetious journalist : The child, five weeks old, was born with hair two inches long all over the body ; his features were fiendish and his eyes shone like beads beneath his shaggy brows. He had a tail 18 inches long, horns from the skull, a full set of teeth, and claw-like hands ; he snapped like a dog and crawled on all fours, and refused the natural suste- nance of a normal child. The mother almost became an imbecile after the birth of the monster. The country people about Bomballa considered this devil-child a punishment for a rebuff that the mother gave to a Jewish peddler selling Crucifixion-pictures. Vexed by his persistence, she said she would sooner have a devil in her house than his picture. Lamprey*^ has made a minute examination of the much-spoken-of " Horned Men of Africa." He found that this anomaly was caused by a congenital malformation and remarkable development of the infraorbital ridge of the maxillary bone (Fig. 74). He described several cases, and through an interpreter found that they were congenital, followed no history of traumatism, caused little inconvenience, and were unassociated with dis- turbance of the sense of smell. He also learned that the deformity was quite rare in the Cape Coast region, and received no information tending to prove the conjecture that the tribes in West Africa used artificial means to produce the anomaly, although such custom is prevalent among many aborigines. Probably the most remarkable case of a horn was that of Paul Rodrigues, a Mexican porter,® who, from the upper and lateral part of his head, had a horn 14 inches in circumference and divided into three shafts, which he concealed by constantly wearing a peculiarly shaped red cap. There is in Paris a wax model of a horn, eight or nine inches in length, removed from an old woman by the celebrated Souberbielle. Figure 75 is from a wax model supposed to have been taken from life, showing an enormous grayish-black horn proceeding from the forehead. Warren mentions a case under the care of Dubois, in a woman from whose forehead grew a horn six inches in diam- eter and six inches in height. It was hard at the summit and had a fetid ■■>■ 550, vol. xxvii., p. 60. ^ 418, 1776, i., 311. c Quoted in 759, April, 1894. d 224, 1887, ii., 1273. - New York Medical Eepository, 1820. 224 MINOR TERATA. odor. In 1696 there was an old woman in France who constantly shed long horns from her forehead, one of which was presented to the King. Bartholinus mentions a horn 12 inches long. Voigte cites the case of an old woman who had a horn branching into three portions, coming from her fore- head. Sands " speaks of a woman who had a horn 6f inches long, growing from her head. There is an account '' of the extirpation of a horn nearly ten inches in length from the forehead of a woman of eighty-two. Bejau " describes a woman of forty from whom he excised an excrescence resembling a ram's horn, growing from the left parietal region. It curved forward and nearly reached the corresponding tuberosity. It was eight cm. long, two cm. broad at the base, and 1 J cm. at the apex, and was quite mobile. It began to grow at the age of eleven and had constantly increased. Vidal presented Fig. 74. — "African horned man " (Lamprey). Fig. 75.— Wax model of a large frontal horn. before the Academic de M^decine in 1886 a twisted horn from the head of a woman. This excrescence was ten inches long, and at the time of presenta- tion reproduction of it was taking place in the woman. Figure 76 shows a case of ichthyosis cornea pictured in the Lancet, 1850.'^ There was a woman of seventy-five, living near York,« who had a horny growth from the face which she broke off and which began to reproduce, the illustration (Fig. 77) representing the growth during twelve months. Lall <■ mentions a horn from the cheek ; Gregory reports one that measured 7i inches long that was removed from the temple of a woman in Edinburgh ; Chariere of Barnstaple saw a horn that measured seven inches growing from the nape of a woman's neck ; Kameya Iwa^ speaks of a dermal horn of the «■ 597, 1851. b 124, 1857. e 779, xvi., 267. <= 749, 1886, 487. f 435,1883. ■1476, 1850, ii., 342. g Tokei Iji Shinshi, 1881. HUMAN SOBNS. 225 auricle ; Saxton of New York has excised several horns from the tympanic membrane of the ear ; Noyes " speaks of one from the eyelid ; Bigelow ^ Fig. 76. — Ichthyosis cornea. Fig. 77.— Facial horn. mentions one from the chin ; Minot " speaks of a horn from the lower lip, and Doran ■* of one from the neck. Gould" cites the instance of a horn growing from an epitheliomatous penis. The patient was fifty- two years of age and the victim of congenital phimosis. He was circumcised four years previously, and shortly after the wound healed there ap- peared a small wart, followed by a horn about the size of a marble. Jewett speaks of a penile horn 3 J inches long and 3f inches in diameter; Pick mentions one 2J inches long (Fig. 78). There is an account ^ of a Russian peasant boy who had a horn on his penis from earliest childhood. Johnson k mentions a case of a horn from the scrotum, which was of sebaceous origin and was subsequently sup- planted by an epithelioma. Ash reported the case of a girl named Annie Jackson, living in Waterford, Ireland, who had horny excres- a 538, 1869. ^ 331, 1867, vol. xix. c 218, 1864. d 779, 1881. e 476, 1887, i., 421. f 324, Aug. 13, 1887. g 476, 1844. 15 Fig. 78.— Horn of the penis (after Pick). 226 MINOR TERATA. cences from her joints, arms, axillse, nipples, ears, and forehead. Locke speaks of a boy at the Hdpital de la Charity in Paris, who had horny excrescences four inches long and 1 ^ inches in circumference growing from his fingers and toes. Wagstaffe ^ presents a horn which grew from the middle of the leg six inches below the knee in a woman of eighty. It was a flattened spiral of more than two turns, and during forty years' growth had reached the length of 14.3 inches. Its height was 3.8 inches, its skin-attachment 1.5 inches in diameter, and it ended in a blunt extremity of 0.5 inch in diameter. Stephens '' mentions a dermal horn on the buttocks at the seat of a carcino- matous cicatrix. Harris " and Domonceau ^ speak of horns from the leg. Cruveilhier " saw a Mexican Indian who had a horn four inches long and eight inches in circumference growing from the left lumbar region. It had been sawed off twice by the patient's son and was finally extirpated by Faget. The length of the pieces was ., , ^ 12 inches. Bellamy '' saw a horn on the clitoris about the size of a tiger's claw in a woman of seventy. It had its origin from beneath the preputium clitoridis. Horns are generally soli- tary, but cases of multiple formation are known. Lewin and Heller record a syphilitic case with eight cutaneous horns on the palms and soles. A female patient of Manzu- rofFhad as many as 185 horns. Pancoast « reports the case of a man whose nose, cheeks, forehead, and lips were covered with horny growths, which had apparently undergone epitheliomatous degeneration. The patient was a sea-captain of seventy-eight, and had been exposed to the winds all his life. He had suffered three attacks of erysipelas from prolonged exposure. When he consulted Pancoast the horns had nearly all fallen off and were brought to the physician for inspection ; and the photograph (Fig. 79) was taken after the patient had tied the horns in situ on his face. Anomalies of the Hair. — Congenital alopecia is quite rare, and it is seldom that we see instances of individuals who have been totally destitute of hair from birth. Danz '' knew of two adult sons of a Jewish family who Fig. 79.- -Cutaneous horns. Showing heginning epitheliomatous degeneration of the base (after Pancoast). a 779, 1870. d462, xiv., 145. g 631, 1878. b 435, 1872. 6 Anat. patholog. du corps humain. 527, 1842. f 779, 1870. ^ 160, 1792. ANOMALIES OF THE HAIR. 227 never had hair or teeth. Sedgwick " quotes the case of a man of fifty-eight who ever since birth was totally devoid of hair and in whom sensible perspira- tion and tears were absent. A cousin on his mother's side, born a year before him, had precisely the same peculiarity. Buffon says that the Turks and some other people practised depilatory customs by the aid of ointments and pomades, principally about the genitals. Atkinson ^ exhibited in Philadel- phia a man of forty who never had any distinct growth of hair since birth, was edentulous, and destitute of the sense of smell and almost of that of taste. He had no apparent perspiration, and when working actively he was obliged to wet his clothes in order to moderate the heat of his body. He could sleep in wet clothes in a damp cellar without catching cold. There was some hair in the axillae and on the pubes, but only the slightest down on the scalp, and even that was absent on the skin. His maternal grandmother and uncle were similarly affected ; he was the youngest of 21 children, had never been sick, and though not able to chew food in the ordinary manner, he had never suffered from dyspepsia in any form. He was married and had eight children. Of these, two girls lacked a number of teeth, but had the ordinary quantity of hair. HilP speaks of an aboriginal man in Queensland who was entirely devoid of hair on the head, face, and every part of the body. He had a sister, since dead, who was similarly hairiest. Hill men- tions the accounts given of another black tribe, about 500 miles west of Brisbane, that contained hairless members. This is very strange, as the Australian aboriginals are a very hairy race of people. Hutchinson ^ mentions a boy of three and a half in whom there was con- genital absence of hair and an atrophic condition of the skin and appendages. His mother was bald from the age of six, after alopecia areata. Schede re- ports two cases of congenitally bald children of a peasant woman (a boy of thirteen and a girl of six months). They had both been born quite bald, and had remained so. In addition there were neither eyebrows nor eyelashes and nowhere a trace of lanugo. The children were otherwise healthy and well formed. The parents and brothers were healthy and possessed a full growth of hair. Thurman ** reports a case of a man of fifty-eight, who was almost devoid of hair all his life and possessed only four teeth. His skin was very delicate and there was absence of sensible perspiration and tears. The skin was peculiar in thinness, softness, and absence of pigmentation. The hair on the crown of the head and back was very fine, short, and soft, and not more in quantity than that of an infant of three months. There was a similar pecu- liarity in his cousin-germ an. Williams mentions the case of a young lady of fifteen with scarcely any hair on the eyebrows or head and no eyelashes. She was edentulous and had never sensibly perspired. She improved under tonic treatment. a 222, 1863, i., 453. >> 218, March 29, 1883. c 224, 1881, i., 177. d 650, 1885-6, ii., 116. « 550, xxxi., 71. 228 MINOR TERATA. Rayer quotes the case of Beauvais, who was a patient in the Hopital de la Charity in 1827. The skin of this man's cranium was apparently completely naked, although in examining it narrowly it was found to be beset with a quantity of very white and silky hair, similar to the down that covers the scalp of infants ; here and there on the temples there were a few black specks, occa- sioned by the stumps of several hairs which the patient had shaved oif. The eyebrows were merely indicated by a few fine and very short hairs ; the free edges of the eyelids were without cilia, but the bulb of each of these was indi- cated by a small, whitish point. The beard was so thin and weak that Beauvais clipped it off only every three weeks. A few straggling hairs were observed on the breast and pubic region, as in young people on the approach of puberty. There was scarcely any under the axillae. It was rather more abundant on the inner parts of the legs. The voice was like that of a full-grown and well- constituted man. Beauvais was of an amorous disposition and had had syph- ilis twice. His mother and both sisters had good heads of hair, but his father presented the same defects as Beauvais. Instances are on record of women devoid of hair about the genital region. Riolan says that he examined the body of a female libertine who was totally hairless from the umbilical region down. Congenital alopecia is seen in animals. There is a species of dog, a native of China but now bred in Mexico and in the United States, which is distinguished for its congenital alopecia. The same fact has been observed occasionally in horses, cattle, and dogs. Heusner " has seen a pigeon desti- tute of feathers, and which engendered a female which in her turn transmitted the same characteristic to two of her young. Sexualism and Hair Growth. — The growth or development of the hair may be accelerated by the state of the organs of generation. This is peculiarly noticeable in the pubic hairs and the beard, and is fully exemplified in the sec- tion on precocious development (Chapter VII.) ; however, Moreau de la Sarthe showed a child to the Medical Faculty of Paris in whom precocious develop- ment of the testicles had influenced that of the hair to such a degree that, at the age of six, the chest of this boy was as thickly set with hair as is usually seen in adults. It is well known that eunuchs often lose a great part of their beards, and after removal of the ovaries women are seen to develop an extra quantity of hair. Gerberon '' tells of an infant with a beard, and PauUini " and the Ephemerides mention similar instances. Bearded women are not at all infrequent. Hippocrates mentions a female who grew a beard shortly after menstruation had ceased. It is a well-recognized fact that after the menopause women become more hirsute, the same being the case after removal of any of the functional generative apparatus. Vicat saw a virgin who had a beard, and Joch*^ - 390, 153. b 215, ann.,ii. c 620, cent, iii., obs. 64. d Dissert., etc., Jenae. BEARDED WOMEN. 229 speaks of "foeminis barbati." Leblond" says that certain women of Ethiopia and South America have beards and little or no menstruation. He also says that sterility and exces- sive chastity are causes of female beards, and cites the case of Schott of a young widow who secluded herself in a cloister and soon had a beard. Barbara Urster, who lived in the 16th century, had a beard to her girdle. The most celebrated " bearded woman " was E,osine- Marguerite Miiller, who died in a hospital in Dresden in 1732, with a thick beard and heavy mustache. Julia Pastrana had her face covered with thick hair and had a full beard and mus- tache. She exhibited defective dentition in both jaws, and the teeth present were arranged in an irregular fashion. She had pronounced prognathism, which gave her a simian appearance (Fig. 80). Ecker examined in 1876 a woman who died at Fribourg, whose face contained a full beard and a luxuriant mustache. Fig. 80.— Julia Pastrana. Fig. 81. Fig. 82. Bearded insane women (Harris). Harris '' reports several cases of bearded women, inmates of the Coton Hill Lunatic Asylum. One of the patients was eighty-three years of age and had a 302, iii., 9. b 224, June 2, 1894. 230 MINOR TERATA. been insane forty-four years following a puerperal period. She would not permit the hair on her face to be cut, and the curly white hairs had attained a length of from eight to ten inches on the chin, while on the upper lip the hairs were scarcely an inch. This patient was quite womanly in all her senti- ments (Fig. 81). The second case was a woman of thirty-six, insane from emotional melancholia. She had tufts of thick, curly hair on the chin two inches long, light yellowish in color, and a few straggling hairs on the upper lip. The third case (Fig. 82) was that of a woman of sixty-four, who exhibited a strong passion for the male sex. Her menstruation had been regular until the menopause. She plaited her beard, and it was seven or eight inches long on the chin and one inch on the lip. This woman had extremely hairy legs. Another case was that of a woman of sixty- two, who, though bald, developed a beard before the climacteric. Her structural proportions were feminine in character, and it is said that her mother, who was sane, had a beard also. A curious case was that of a Avoman of twenty- three (Mrs. Viola M.), who from the age of three had a considerable quantity of hair on the side of the cheek which eventually became a full beard. She was quite feminine and was free from excessive hair elsewhere, her nose and forehead being singularly bare. Her voice was very sweet ; she was married at seventeen and a half, having two normal children, and nursed each for one month. " The bearded woman " of every circus side-show is an evidence of the curious interest in which these women are held. The accompanying illustration (Fig. 83) is a representation of a " bearded woman " born in Bracken County, Ky. Her beard measured 15 inches in length. There is a class of anomalies in which there is an exaggerated develop- ment of hair. We would naturally expect to find the primitive peoples, who are not provided with artificial protection against the wind, supplied with an extra quantity of hair or having a hairy coat hke animals ; but this is some- times found among civiHzed people. This abnormal presence of hair on the human body has been known for many years ; the description of Esau in the Fig. 83.— "Bearded woman.' EXAGGERATED DEVELOPMENT OF HAIR. 231 Bible is an early instance. Aldrovandus says that in the sixteenth century there came to the Canary Islands a family consisting of a father, son, and two daughters, who were covered all over their bodies by long hair, and their portrait, certainly reproduced from life, resembles the modern instances of " dog men." In 1883 there was shown in England and France, afterward in America, a girl of seven named " Krao," a native of Indo-China. The whole body of this child was covered with black hair. Her face was of the prognathic type, and this, with her extraordinary prehensile powers of feet and lips, gave her the title of "Darwin's missing link." In 1875 there was exhibited in Paris, under the name of " I'homme-chien " Adrien Jeftichew, a Russian Fig. 84. — Two examples of extreme hirsuties in a family. peasant of fifty-five, whose face, head, back, and limbs were covered with a brown hairy coat looking like wool and several centimeters long. The other parts of the body were also covered with hair, but less abundantly. This individual had a son of three, Theodore, who was hairy like himself. A family living in Burmah (Shive-Maon, whose history is told by Craw- ford and Yule), consisting of a father, a daughter, and a granddaughter, were nearly covered with hair. Figure 84 represents a somewhat similar family who were exhibited in this country. Teresa Gambardella, a young girl of twelve, mentioned by Lombroso, was covered all over the body, with the exception of the hands and feet, by thick, bushy hair. This hypertrichosis was exemplified in this country only a few months since by a person who went the rounds of the dime museums under 232 MINOR TERATA. the euphonious name of " Jo-Jo, the dog-face boy." His face was truly that of a skye-tcrrier (Fig. 85). Sometimes the hairy anomalies are but instances of naevus pilosus. The Indian ourang-outang woman examined at the office of the Lancet was an example of this kind. Hebra, Hildebrandt, Jablokoff, and Klein describe similar cases. Many of the older "wild men" were individuals bearing extensive hairy moles. Rayer remarks that he has seen a young man of sixteen who exhibited himself to the public under the name of a new species of wild man whose breast and back were covered with light brown hair of considerable length. Fig. 85.— "Jo-Jo." Womau with a mane" (naevus pilosus). The surface upon which it grew was of a brownish hue, different from the color of the surrounding integument. Almost the whole of the right arm was covered in the same manner. On the lower extremity several tufts of hair were observed implanted upon brown spots from seven to eight lines in diameter symmetrically disposed upon both legs. The hair was brown, of the same color as that of the head. Bichat* informs us that he saw at Paris an un- fortunate man who from his birth was afflicted with a hairy covering of his face like that of a wild boar, and he adds that the stories which were current among the vulgar of individuals with a boar's head, wolf's head, etc., un- a Anat. G6n6rale, Paris, 1812, T. iv., 827. N^VUS PILOSUS. 233 doubtedly referred to cases in which the face was covered to a greater or less degree with hair. Villerme saw a child of six at Poitiers in 1808 whose body, except the feet and hands, was covered with a great number of promi- nent brown spots of different dimensions, beset with hair shorter and not so strong as that of a boar, but bearing a certain resemblance to the bristles of that animal. These spots occupied about one-fifth of the surface of this child's skin. Campaignac in the early part of this century exhibited a case in which there was a large tuft of long black hair growing from the shoulder. Dufour " has detailed a case of a young man of twenty whose sacral region contained a tuft of hair as long and black, thick and pliant, as that of the head, and, particularly remarkable in this case, the skin from which it grew was as fine and white as the integument of the rest of the body. There was a woman exhibited recently, under the advertisement of " the lady with a mane," who had growing from the center of her back between the shoulders a veritable mane of long, black hair, which doubtless proceeded from a form of nsevus (Fig. 86). Duyse ^ reports a case of extensive hypertrichosis of the back in a girl aged nine years ; her teeth were normal ; there was pigmentation of the back and numerous pigmentary nevi on the face. Below each scapula there were tumors of the nature of fibroma moUuscum. In addition to hairy nevi on the other parts of the body there was localized ichthyosis. Ziemssen figures an interesting case of nsevus pilosus resembling "bathing tights" (Fig. 87). There were also present several benign tumors (fibroma moUuscum) and numerous smaller nevi over the body. Schulz first observed the patient in 1878. This individual's name was Blake, and he stated that he was born with a large nsevus spread- ing over the upper parts of the thighs and lower parts of the trunk, like bathing-tights, and resembling the pelt of an animal. The same was true of the small hairy parts and the larger and smaller tumors. Subsequently the altered portions of the skin had gradually become somewhat larger. The skin of the large hairy nsevus, as well as that of the smaller ones, was stated by Schulz to have been in the main thickened, in part uneven, verrucose, from very light to intensely dark brown in color ; the consistency of the larger mammiform and smaller tumors soft, doughy, and elastic. The case was really one of large congenital nsevus pilosus and fibroma moUuscum combined. A Peruvian boy was shown at the Westminster Aquarium with a dark, hairy mole situated in the lower part of the trunk and on the thighs in the position of bathing tights. Nevins Hyde records two similar cases with "■ 162, T. xxvi., 274. •> La Plandre Mfed., Oct. 4, 1894. Fig. 87. — Large nse- vus pilosus resembling " bathing-tights." 234 MINOR TERATA. dermatolytic growths." A sister of the Peruvian boy referred to had a still larger growth, extending from the nucha all over the back. Both she and her brother had hundreds of smaller hairy growths of all sizes scattered irregularly over the face, trunk, and limbs. According to Crocker, a still more extraordinary case, with extensive dermatolytic growths all over the back and nevi of all sizes elsewhere, is described and engraved in " Lavater's Physiognomy," 1848. Baker "^ describes an operation in which a large mole occupying half the forehead was removed by the knife. In some instances the hair and beard is of an enormous length. Erasmus Wilson of Lon- don saw a female of thirty- eight, whose hair measured 1.65 meters long. Leonard of Philadelphia speaks of a man in the interior of this country whose beard trailed on the ground when he stood upright, and measured 2.24 meters long. Not long ago there appeared the famous so-called " Seven Suther- land Sisters," whose hair touched the ground, and with whom nearly every one is familiar through a hair tonic which they extensive- ly advertised. In Nature, January 9, 1892, is an ac- count of a Percheron horse whose mane measured 13 feet and whose tail meas- ured almost ten feet, prob- ably the greatest example of excessive mane development on record. Figure 88 represents Miss Owens, an exhibitionist, whose hair measured eight feet three inches. In Leslie's Weekly, January 2, 1896, there is a portrait of an old negress named Nancy Garrison whose woolly hair was equally as long. The Epheraerides " contains the account of a woman who had hair from the mons veneris which hung to the knees ; it was affected with plica polo- nica, as was also the other hair of the body. Eayer saw a Piedmontese of twenty-eight, with an athletic build, who had " 445, hi., 93. b 550, ixi. c 104, dec. 2, an. vi., 1688. Fig. 88. — Example of excessive growth of hair. ANOMALIES OF THE COLOR OF THE HAIR. 235 but little beard or hair on the trunk, but whose scalp was covered with a most extraordinary crop. It was extremely fine and silky, was artificially frizzled, dark brown in color, and formed a mass nearly five feet in circum- ference. Certain pathologic conditions may give rise to accidental growths of hair. Boyer was accustomed to quote in his lectures the case of a man who, having an inflamed tumor in the thigh, perceived this part becoming covered in a short time with numerous long hairs. Bayer speaks of several instances of this kind. In one the part affected by a blister in a child of two became covered with hair. Another instance was that of a student of medicine, who after bathing in the sea for a length of time, and exposing himself to the hot sun, became affected with coppery patches, from which there sprang a growth of hair. Bricheteau, quoted by the same authority, speaks of a woman of twenty-four, having white skin and hair of deep black, who after a long ill- ness occasioned by an affection analogous to marasmus became covered, especially on the back, breast, and abdomen, with a multitude of small eleva- tions similar to those which appear on exposure to cold. These Httle elevations became brownish at the end of a few days, and short, fair, silky hair was observed on the summit of each, which grew so rapidly that the whole surface of the body with the exception of the hands and face became velvety. The hair thus evolved was afterward thrown out spontaneously and was not afterward reproduced. Anomalies of the Color of the Hair. — New-born infants sometimes have tufts of hair on their heads which are perfectly white in color. Schenck speaks of a young man whose beard from its first appearance grew white. Young men from eighteen to twenty occasionally become gray ; and accord- ing to Rayer, paroxysms of rage, unexpected and unwelcome news, diseases of the scalp such as favus, wounds of the head, habitual headache, over- indulgence of the sexual appetite, mercurial courses too frequently repeated, too great anxiety, etc., have been known to blanch the hair prematurely. The well-accepted fact of the sudden changing of the color of the hair from violent emotions or other causes has always excited great interest, and many ingenious explanations have been devised to account for it. There is a record in the time of Charles V. of a young man who was committed to prison in 1546 for seducing his girl companion, and while there was in great fear and grief, expecting a death-sentence from the Emperor the next day. When brought before his judge, his face was wan and pale and his hair and beard gray, the change havjng taken place in the night. His beard was filthy with drivel, and the Emperor, moved by his pitiful condition, pardoned him. There was a clergyman " of Nottingham whose daughter at the age of thirteen experienced a change from jet-blackness of the hair to white in a single night, but this was confined to a spot on the back of the head IJ a 564, iii., 515. 236 MINOR TEE ATA. inches in length. Her hair soon became striped, and in seven years was totally white. The same article speaks of a girl in Bedfordshire, Maria Seeley, aged eight, whose face was swarthy, and whose hair was long and dark on one side and light and short on the other. One side of her body was also brown, while the other side was light and fair. She was seen by the faculty in London, but no cause could be established. Voigtel mentions the occurrence of canities almost suddenly. Bichat had a personal acquaintance whose hair became almost entirely gray in conse- quence of some distressing news that reached him. Cassan '' records a similar case. According to Eayer, a woman by the name of P6rat, sum- moned before the Chamber of Peers to give evidence in the trial of the assassin Louvel, was so much affected that her hair became entirely white in a single night. Byron makes mention of this peculiar anomaly in the open- ing stanzas of the " Prisoner of Chillon : " — ' ' My hair is gray, but not with years, Nor grew it white In a single night. As men's have grown from sudden fears." The commentators say that Byron had reference to Ludovico Sforza and others. The fact of the change is asserted of Marie Antoinette, the wife of Louis XVI., though in not quite so short a period, grief and not fear being the cause. Ziemssen cites Landois' case of a compositor of thirty-four who was admitted to a hospital July 9th with symptoms of delirium tremens ; until improvement began to set in (July 13th) he was continually tormented by terrifying pictures of the imagination. In the night preceding the day last mentioned the hair of the head and beard of the patient, formerly blond, became gray. Accurate examination by Landois showed the pigment con- tents of the hair to be unchanged, and led him to believe that the white color was solely due to the excessive development of air-bubbles in the hair shaft. Popular belief brings the premature and especially the sudden whitening into connection with depressing mental emotions. We might quote the German expression — " Sich graue Haare etwas wachsen lassen " (" To worry one's self gray "). Brown-S6quard observed on several occasions in his own dark beard hairs which had turned white in a night and which he epilated. He closes his brief communication on the subject with the belief that it is quite possible for black hair to turn white in one night or even in a less time, although Hebra and Kaposi discredit sudden canities (Duhring). Raymond and Vulpian '' observed a lady of neurotic type whose hair during a severe paroxysm of neuralgia following a mental strain changed color in iive hours over the entire scalp except on the back and sides ; most of the hair changed from black to red, but some to quite white, and in two days » 162, Jan., 1827. b 476, Oct. 14, 1882. SUDDEN CHANGING OF THE COLOR OF THE HAIR. 237 all the red hair became white and a quantity fell off. The patient recovered her general health, but with almost total loss of hair, only a few red, white, and black hairs remaining on the occipital and temporal regions. Crocker cites the case of a Spanish cock which was nearly killed by some pigs. The morning after the adventure the feathers of the head had become completely white, and about half of those on the back of the neck were also changed. Dewees" reports a case of puerperal convulsions in a patient under his care which was attended with sudden canities. From 10 A. m. to 4 p. m. 50 ounces of blood were taken. Between the time of Dr. Dewees' visits, not more than an hour, the hair anterior to the coronal suture turned white. The next day it was less light, and in four or five days was nearly its natural color. He also mentions two cases of sudden blanching from fright. Fowler^ mentions the case of a healthy girl of sixteen who found one morning while combing her hair, which was black, that a strip the whole length of the back hair was white, starting from a surface about two inches square around the occipital protuberance. Two weeks later she had patches of ephelis over the whole body. Prentiss, in Science, October 3, 1890, has collected numerous instances of sudden canities, several of which will be given : — "In the Canada Journal of Medical Science, 1882, p. 113, is reported a case of sudden canities due to business- worry. The microscope showed a great many air-vesicles both in the medullary substance and between the medullary and cortical substance. "In the Boston Medical and Surgical Journal, 1851, is reported a case of a man thirty years old, whose hair ' was scared ' white in a day by a grizzly bear. He was sick in a mining camp, was left alone, and fell asleep. On waking he found a grizzly bear standing over him. " A second case is that of a man of twenty-three years who was gambling in California. He placed his entire savings of $1100 on the turn of a card. He was under tremendous nervous excitement while the cards were being dealt. The next day his hair was perfectly white. " In the same article is the statement that the jet-black hair of the Pacific Islanders does not turn gray gradually, but when it does turn it is sudden, usually the result of fright or sudden emotions." D'Alben, quoted by Fournier,'^ describes a young man of twenty-four, an officer in the regiment of Touraine in 1781, who spent the night in carnal dissipation with a mulatto, after which he had violent spasms, rendering flex- ion of the body impossible. His beard and hair on the right side of the body was found as white as snow, the left side being unchanged. He appeared be- fore the Faculty de Montpelier, and though cured of his nervous symptoms his hair was still white, and no suggestion of relief was offered liim. Louis of Bavaria, who died in 1294, on learning of the innocence of his - Phila. Med. Museum, iii., 219. b 476, 1853, i., 556. c 302, iv., 176. 238 MINOR TERATA. wife, whom he had put to death on a suspicion of her infidelity, had a change of color in his hair, which became white almost immediately. Vauvilliers, the celebrated Hellenist, became white-haired almost immediately after a terri- ble dream, and Brizard, the comedian, experienced the same change after a narrow escape from drowning in the Rhone. The beard and the hair of the Duke of Brunswick whitened in twenty-four hours after hearing that his father had been mortally wounded at the battle of Auerstadt. De Schweinitz " speaks of a well-formed and healthy brunette of eighteen in whom the middle portion of the cilia of the right upper eyelid and a number of the hairs of the lower lid turned white in a week. Both eyes were myopic, but no other cause could be assigned. Another similar case is cited by Hirsh- berg, *" and the authors have seen similar cases. Thornton of Margate records the case of a lady in whom the hair of the left eyebrow and eyelashes began to turn white after a fortnight of sudden grief, and within a week all the hair of these regions was quite white and remained so. No other part was affected nor was there any other symptom. After a traumatic ophthalmitis of the left and sympathetic inflammation of the right eye in a boy of nine, Schenck observed that a group of cilia of the right upper lid and nearly all the lashes of the upper lid of the left eye, which had been enucleated, turned silvery-wliite in a short time. Ludwig has known the eyelashes to become white after small-pox. Communications are also on record of local decolor- ization of the eyebrows and lashes in neuralgias of isolated branches of the trigeminus, especially of the supraorbital nerve. Temporary and Partial Canities. — Of special interest are those cases in which whiteness of the hair is only temporary. Thus, Compagne mentions a case in which the black hair of a woman of thirty-six began to fade on the twenty-third day of a malignant fever, and on the sixth day following was perfectly white, but on the seventh day the hairs became darker again, and on the fourteenth day after the change they had become as black as thev were originally. Wilson records a case in which the hair lost its color in winter and regained it in summer. Sir John Forbes, according to Crocker, had gray hair for a long time, then suddenly it all turned white, and after remaining so for a year it returned to its original gray. Grayness of the hair is sometimes only partial. According to Crocker an adult whose hair was generally brown had a tuft of white hair over the tem- ple, and several like cases are on record. Lorry tells us that grayness of one side only is sometimes occasioned by severe headache. Hagedorn has known the beard to be black in one place and white in another. Brandis mentions the hair becoming white on one side of the face wliile it continued of its former color on the other. Rayer quotes cases of canities of the whole of one side of the body. Richelot observed white mottUng of hair in a girl sick with chlorosis. a 792, May, 1889. b 262, 1888. ANOMALOUS COLOR CHANGES OF THE HAIR. 239 The whitening extended from the roots to a distance of two inches. The prob- able cause was a temporary alteration of the pigment^forming function. When the chlorosis was cured the natural color returned. PauUini and Riedlin, as well as the Ephemerides, speak of different colored hair in the same head, and it is not at all rare to see individuals with an anomalously colored patch of hair on the head. The members of the ancient house of Rohan were said to possess a tuft of white hair on the front of their heads. Michelson of Konigsberg describes a curious case in a barrister of twenty- three affected with partial canities. In the family of both parents there was stated to be congenital premature canities, and some white hairs had been observed even in childhood. In the fifteenth year, after a grave attack of scarlet fever, the hair to a great extent fell out. The succeeding growth of hair was stated to have been throughout lighter in tissue and color and fissured at the points. Soon after bunches of white hair appeared on the occiput, and in the succeeding years small patches of decolored hairs were observed also on the anterior and lateral portions of the scalp. In the spring of 1880 the patient exhibited signs of infiltration of the apex of the right lung, and afterward a violent headache came on. At the time of the report the patient presented the ap- pearance shown in Figure 89. The com- plexion was delicate throughout, the eye- lashes and eyelids dark brown, the mous- tache and whiskers blond, and in the latter were a few groups of white hair. The white patches were chiefly on the left . . Fig. 89.— Mottled hair (Michelson). side of the head. The liairs growing on them were unpigmented, but otherwise normal. The patient stated that his head never sweated. He was stout and exhibited no signs of internal disease, except at the apex of the right lung. Anomalous Color Changes of the Hair. — The hair is liable to undergo certain changes of color connected with some modification of that part of the bulb secreting its coloring-matter. Alibert, quoted by Rayer, gives us a report of the case of a young lady who, after a severe fever which followed a very difficult labor, lost a fine head of hair during a discharge of viscid fluid, which inundated the head in every part. He tells us, further, that the hair grew again of a deep black color after the recovery of the patient. The same writer tells of the case of James B — , born with brown hair, who, having lost it all during the course of a sickness, had it replaced with a crop of the brightest red. White and gray hair has also, under peculiar circumstances, 240 MINOR TERATA. been replaced by hair of the same color as the individual had in youth. We are even assured by Bruley that in 1798 the white hair of a woman sixty years of age changed to black a few days before her death. The bulbs in this case were found of great size, and appeared gorged with a substance from which the hair derived its color. The white hairs that remained, on the con- trary, grew from shriveled bulbs much smaller than those producing the black. This patient died of phthisis." A very singular case, published early in the century, was that of a woman whose hair, naturally fair, assumed a tawny red color as often as she was affected with a certain fever, and returned to its natural hue as soon as the symptoms abated.'' Villerm6 ^"^ alludes to the case of a young lady, sixteen years of age, who had never suffered except from trifling headaches, and who, in the winter of 1817, perceived that the hair began to fall out from several parts of her head, so that before six months were over she became entirely bald. In the beginning of January, 1819, her head became covered with a kind of black wool over those places that were first denuded, and light brown hair began to develop from the rest of the scalp. Some of this fell out again when it had grown from three to four inches ; the rest changed color at different distances from its end and grew of a chestnut color from the roots. The hair, half black, half chestnut, had a very singular appearance. Alibert and Beigel relate cases of women with blond hair which all came off after a severe fever (typhus in one case), and when it grew again it was quite black. Alibert also saw a young man who lost his brown hair after an illness, and after restoration it became red. According to Crocker, in an idiotic girl of epileptic type (in an asylum at Edinburgh), with alternating phases of stupidity and excitement, the hair in the stupid phase was blond and in the excited condition red. The change of color took place in the course of two or three days, beginning first at the free ends, and remaining of the same tint for seven or eight days. The pale hairs had more air-spaces than the darker ones. There was much structural change in the brain and spinal cord. Smyly of Dublin reported a case of suppurative disease of the temporal bone, in which the hair changed from a mouse-color to a reddish- brown ; and Squire records a congenital case in a deaf mute, in whom the hair on the left side was in light patches of true auburn and dark patches of dark brown like a tortoise-shell cap ; on the other side the hair was a dark brown. Crocker mentions the changes which have occurred in rare instances after death from dark brown to red. Chemic colorations of various tints occur. Blue hair is seen in workers in cobalt mines and indigo works ; green hair in copper smelters ; deep red- brown hair in handlers of crude anilin ; and the hair is dyed a purplish- brown whenever chrysarobin applications used on a scalp come in contact with an alkali, as when washed with soap. Among such cases in older » 458, T. iv., 290. b 454 t. v., 59. ANOMALIES OF THE NAILS. 241 literature Blanchard and Marcellus Donatus speak of green hair ; Eosse saw two instances of the same, for one of which he could find no cause ; the other patient worked in a brass foundry. Many curious causes are given for alopecia. Gilibert and Merlet " mention sexual excess ; Marcellus Donatus ^ gives fear ; the Ephemerides speaks of baldness from fright ; and Leo Afrioanus, in his description of Barbary, describes endemic baldness. Neyronis " makes the following ob- servation : A man of seventy-three, convalescent from a fever, one morning, about six months after recovery perceived that he had lost all his hair, even his eyelashes, eyebrows, nostril-hairs, etc. Although his health continued good, the hair was never renewed. The principal anomalies of the nails observed are absence, hyper- trophy, and displacement of these organs. Some persons are born with finger-nails and toe-nails either very rudimentary or entirely absent; in others they are of great length and thickness. The Chinese nobility allow their finger-nails to grow to a great length and spend much ^S^^^^^^is ^^ time in the care of these nails. '^■'i"-^i»ii^^%*-^^ ji>£'4!^k ^ Some savage tribes have long and thick nails resembling the claws of beasts, and use them in the same way as the lower ani- mals. There is a description of a person with finger-nails that resembled the horns of a goat. ^ t. „„ t> ^ ^ . ^ Fig. 90. — Deformed toe-nails. Neuhof, in his books on Tartary and China, says that many Chinamen have two nails on the little toe, and other instances of double nails have been reported. The nails may be reversed or arise from anomalous positions. Bartho- linus " speaks of nails from the inner side of the digits ; in another case, in which the fingers were wanting, he found the nails implanted on the stumps. Tulpius says he knew of a case in which nails came from the articulations of three digits ; and many other curious arrangements of nails are to be found. Bouhuot sent a description and drawing of some monstrous nails to the AcadSmie des Sciences de Paris (Fig. 90). The largest of these was the left great toe-nail, which, from its extremity to its root, measured 4| inches ; the laminae of which it consisted were placed one over the other, like the tiles on a roof, only reversed. This nail and several of the others were of unequal thickness and were variously curved, probably on account of the pressure of the shoe or the neighboring digits. Bayer mentions two nails sent to him by Bricheteau, physician of the Hdpital Necker, belonging to an old a Diss, calvites, Paris, 1662. ^ 306, L. i., cap. i., p. 15. •; 463, v., 73. ^ 282, Nov., 1734, 173. e 190, cent, ii., hist. 44. 16 242 MINOR TERATA. woman who had lived in the Salp6triere. They were very thick and spirally twisted, like the horns of a ram. Saviard informs us that he saw a patient at the Hdtel Dieu who had a horn like that of a ram, instead of a nail, on each great toe, the extremities of which were turned to the metatarsus and overlapped the whole of the other toes of each foot. The skeleton of Simore, preserved in Paris, is remarkable for the ankylosis of all the articulations and the considerable size of all the nails. The fingers and toes, spread out and ankylosed, ended in nails of great length and nearly of equal thickness. A woman by the name of Melin, living in the last century in Paris, was surnamed " the woman with nails ; " according to the description given by Saillant in 1776 she presented another and not less curious instance of the excessive growth of the nails. Musaeus " gives an account of the nails of a girl of twenty, which grew to such a size that some of those of the fingers were five inches in length. They were composed of several layers, whitish interiorly, reddish-gray on the ex- terior, and full of black points. These nails fell off at the end of four months and were succeeded by others. There were also horny laminae on the knees and shoulders and elbows which bore a resemblance to nails, or rather talons. They were sensitive only at the point of insertion into the skin. Various other parts of the body, particularly the backs of the hands, pre- sented these horny productions. One of them was four inches in length. This horny growth appeared after small-pox. Ash, in the Philosophical Trans- actions, records a somewhat similar case in a girl of twelve. Anomalies of the Teeth. — Pliny, Colombus, van Swieten, Haller, Mar- cellus Donatus, Baudelocque, Soemmering, and Gardien all cite instances in which children have come into the world with several teeth already erupted. Haller*"" has collected 19 cases of children born with teeth. Polydorus Virgilus describes an infant who was born with six teeth. Some celebrated men are supposed to have been born with teeth ; Louis XIV. was accredited with having two teeth at birth. Bigot, a physician and philosopher of the six- teenth century ; Boyd, the poet ; Valerian, Eichard III., as well as some of the ancient Greeks and Romans, were reputed to have had this anomaly. The significance of the natal eruption of teeth is not always that of vigor, as many of the subjects succumb early in life. There were two cases typical of fetal dentition shown before the AcadSmie de Mddecine de Paris. One of the subjects had two middle incisors in the lower jaw and the other had one tooth well through. Levison *> saw a female born with two central incisors in the lower jaw. Thomas " mentions a case of antenatal development of nine teeth. Puech, Mattel, Dumas, Belluzi, and others report the eruption of teeth in the new- born. In Dumas' case the teeth had to be extracted on account of ulceration of the tongue. a Diss, de unguibus monstrosis, Hafniae, 1716. b 476, 1846, ii., 699. c 125, vii., 501. EDENTULOUSNESS. 243 Instances of triple dentition late in life are quite numerous, many occur- ring after a hundred years. Mentzelius speaks of a man of one hundred and ten who had nine new teeth. Lord Bacon cites the case of a Countess Desmond, who when over a century old had two new teeth ; Hufeland saw an instance of dentition at one hundred and sixteen ; Nitzsch speaks of one at one hundred, and the Ephemerides contain an account of a triple dentition at one hundred and twenty. There is an account * of a country laborer who lost all his teeth by the time he arrived at his sixtieth year of age, but about a half year after- ward a new set made their appearance. Bisset '' mentions an account of an old woman who acquired twelve molar teeth at the age of ninety-eight. Carre " notes a case of dental eruption in an individual of eighty-five. Mazzoti speaks of a third dentition, and Ysabeau ^ writes of dentition of a molar at the age of ninety-two. There is a record of a physician of the name of Slave who retained all his second teeth until the age of eighty, when they fell out ; after five years another set appeared, which he retained until his death at one hundred. In the same report® there is mentioned an old Scotchman who died at one hundred and ten, whose teeth were renewed at an advanced age after he had lost his second teeth. One of the older journals ^^^ speaks of dentition at seventy, eighty-four, ninety, and one hundred and fourteen. The Philosophical Transactions of London contain accounts of dentition at seventy- five and eighty-one. Bassett ^ tells of an old woman who had twelve molar teeth at the age of eighty-eight. In France there is recorded dentition at eighty- five s and an account of an old man of seventy-three who had six new teeth. ^ Von Helmont relates an instance of triple dentition at the same age. There is recorded in Germany an account of a woman of ninety who had dentition at forty-seven and sixty-seven, each time a new set of teeth appearing ; Hunter and P6trequin have observed similar cases. Carter ' describes an ex- ample of third dentition. LisonJ makes a curious observation of a sixth dentition. Edentulousness. — We have already noticed the association of congenital alopecia with edentulousness, but, strange to say, Magitot has remarked that " I'homme-chien," was the subject of defective dentition. Borellus found atrophy of all the dental follicles in a woman of sixty who never had pos- sessed any teeth. Fanton-Touvet saw a boy of nine who had never had teeth, and Fox a woman who had but four in both jaws ; Tomes cites several similar instances. Hutchinson ^ speaks of a child who was perfectly edentulous as to temporary teeth, but who had the permanent teeth duly and fully erupted. Guilford' describes a man of forty-eight, who was edentulous from birth, who also totally lacked the sense of smell, and was almost without the sense a 534, 1784, iii., 105. ^ 524, Lond., 1787, viii., 370. c 368, 1860, xv., 585. d 460, XXXV., 316 (1766). e 302, vol. iv. f 524, 787. g 368, 1860. h 363, Oct. 9, 1875. i 133, 1876. J 235, xiii., 190. k 476, 1883, i., 894. 1296,1883. 244 MINOR TERATA. of taste ; the surface of his body was covered with fine hairs and he had never had visible perspiration. This is probably the same case quoted in the foregoing paragraph in regard to the anomalies of hair. Otto, quoted by Sedgwick, speaks of two brothers who were both totally edentulous. It might be interesting in this connection to note that Oudet found in a fetus at term all the dental follicles in a process of suppuration, leaving no doubt that, if the fetus had been born viable, it would have been edentulous. Giraldfes mentions the absence of teeth in an infant of sixteen months. Bronzet describes a child of twelve, with only half its teeth, in whom the alveolar borders receded as in age. Baumes remarks that he had seen a man who never had any teeth. The anomalies of excessive dentition are of several varieties, those of simple supernumerary teeth, double or triple rows, and those in anomalous positions. Ibbetson saw a child with five incisors in the inferior maxillary bone, and Fanton-Touvet describes a young lady who possessed five large in- cisors of the first dentition in the superior maxilla. Eayer "^ notes a case of dentition of four canines, which first made their appearance after pain for eight days in the jaws and associated with convulsions. In an Ethiopian Soem- mering has seen one molar too many on each side and in each jaw. Ploucquet and Tesmer have seen five incisors and Fanchard six. Many persons have the supernumerary teeth parallel with their neighbors, anteriorly or posteriorly. Costa *" reports a case in which there were five canine teeth in the upper jaw, two placed laterally on either side, and one on the right side behind the other two. The patient was twenty-six years of age, well formed and in good health. In some cases there is fusion of the teeth. Pliny, Bartholinus, and Melanthon pretend to have seen the union of all the teeth, making a continu- ous mass. In the " Mus§e de I'ficole dentaire de Paris " there are several milk-teeth, both of the superior and inferior maxilla, which are fused together. Bloch cites a case in which there were two rows of teeth in the superior maxilla. Hellwig *" has observed three rows of teeth, and the Ephemerides contain an account of a similar anomaly. Extraoral Dentition. — Probably the most curious anomaly of teeth is that in which they are found in other than normal positions. Albinus speal?s of teeth in the nose and orbit ; Borellus, in the palate ; Fabricius Hildanus,^^* under the tongue ; Schenck, from the palate ; and there are many similar modern records. Heister in 1743 wrote a dissertation on extraoral teeth. The following is a recent quotation :'^-^- "In the Norsk Magazin fur Lsegevidenskaben, January, 1895, it is reported that Dr. Dave, at a meeting of the Medical Society in Christiania, showed a tooth removed from the nose of a woman aged fifty-three. The patient had consulted him for ear-trouble, and the tooth was found acci- dentally during the routine examination. It was easily removed, having a 302, viii., 411. b 358, March, 1895. c 224, 1895, ii., 512. EXTRAORAL DENTITION. 245 been situated in a small depression at the junction of the floor and external wall of the nasal cavity, 22 mm. from the external nares. This patient had all her teeth ; they were placed somewhat far from each other. The tooth resembled a milk canine ; the end of the imperfect root was covered with a fold of mucous membrane, with stratified epithelium. The speaker suggested that part of the mucous membrane of the mouth with its tooth-germ had become impacted between the superior and premaxillary bones and thus cut off from the cavity of the mouth. Another speaker criticised this fetal dislocation and believed it to be due to an inversion — a development in the wrong direction — by which the tooth had grown upward into the nose. The same speaker also pointed out that the stratified epithelium of the mucous membrane did not prove a connection with the cavity of the mouth, as it is known that cylindric epithelium-cells after irritative processes are replaced by flat ones." Delpech saw a young man in 1829 who had an opening in the palatine vault occasioned by the extraction of a tooth. This opening communicated with the nasal fossa by a fracture of the palatine and maxillary bones ; the employment of an obturator was necessary. It is not rare to see teeth, generally canine, make their eruption from the vault of the palate ; and these teeth are not generally supernumerary, but examples of vice and devia- tion of position. Fanton-Touvet, however, gives an example of a super- numerary tooth implanted in the palatine arch. Branch " describes a little negro boy who had two large teeth in the nose ; his dentition was otherwise normal, but a portion of the nose was destroyed by ulceration. Roy '^ describes a Hindoo lad of fourteen who had a tooth in the nose, supposed to have been a tumor. It was of the canine type, and was covered with enamel to the junction with the root, which was deeply imbedded in the side and upper part of the antrum. The boy had a perfect set of permanent teeth and no deformity, swelling, or cystic formation of the jaw. This was clearly a case of extrafoUicular development and eruption of the tooth in an anomalous position, the peculiarity being that while in other similar cases the crown of the tooth shows itself at the floor of the nasal cavity from below upward, in this instance the dental follicle was transposed, the eruption being from above downward. Hall " cites an instance in which the right upper canine of a girl erupted in the nose. The subject showed marked evidence of hereditary syphilis. Carver"^ describes a child who had a tooth growing from the lower right eyelid. The number of deciduous teeth was perfect ; although this tooth was canine it had a somewhat bulbulous fang. Of anomalies of the head the first to be considered will be the anen- cephalous monsters who, strange to say, have been known to survive birth. Clericus " cites an example of life for five days in a child without a cere- a 548, 1884, i., 425. »> 476, 1883, ii., 772. <; 476, 1883, ii., 862. d476, 1887, ii., 763. e 215, 1781. 246 MINOR TERATA. brum. Heysham * records the birth of a child without a cerebrum and re- marks that it was kept alive for six days. There was a child born alive in Italy in 1831 without a brain or a cerebellum — in fact, no cranial cavity — and yet it lived eleven hours.'' A somewhat similar case is recorded in the last cen- tury. ^"^ In the Philosophical Transactions ° there is mentioned a child virtually born without a head who lived four days ; and Le Due records a case of a child born without brain, cerebellum, or medulla oblongata, and who lived half an hour. Brunet* describes an anencephalous boy born at term who survived his birth. Saviard ^^ delivered an anencephalous child at term which died in thirty-six hours. Lawrence " mentions a child with brain and cranium deficient that lived five days. Putnam^ speaks of a female nosencephalous monster that lived twenty-nine hours. Angell and Eisner in March, 1895,^^" reported a case of anencephaly, or rather pseudencephaly, associated with double divergent strabismus and limbs in a state of constant spastic contraction. The infant lived eight days. Geoffroy-Saint-Hilaire cites an example of anencephaly which lived a quarter of an hour. , Fauvel mentioned one that lived two hours, and Sue describes a similar instance in which life persisted for seven hours and distinct motions were noticed. Mala- carne saw life in one for twelve hours, and M6ry has given a description of a child born without brain that lived almost a full day and took nourishment. In the H6tel-Dieu in Paris in 1812 Serres saw a monster of this type which lived three days, and was fed on milk and sugared water, as no nurse could be found who was willing to suckle it. Fraser « mentions a brother and sister, aged twenty and thirty, respectively, who from birth had exhibited signs of defective development of the cere- bellum. They lacked power of coordination and walked with a drunken, staggering gait; they could not touch the nose with the finger when their eyes were shut, etc. The parents of these unfortunate persons were perfectly healthy, as were the rest of their family. Cruveilhier cites a case of a girl of eleven who had absolutely no cerebellum, with the same symptoms which are characteristic in such cases. There is also recorded the history of a man*" who was deficient in the corpus callosum ; at the age of sixty-two, though of feeble intelhgence, he presented no signs of nervous disorder. Claude Bernard made an autopsy on a woman who had no trace of olfactory lobes, and after a minute inquiry into her life he found that her sense of smell had been good despite her deficiency. Buhring relates the history of a case somewhat analogous to viability of anencephalous monsters. It was a bicephalous child that lived thirty-two hours after he had ligated one of its heads. ' WardJ mentions an instance of congenital absence of the corpora callo- a 524, iii., 250. b 476, 1832-3, i., 570. c 629, 1700, 23. d Progrfes de la MM., 1698. e 550, 1814. f Archiv. Scientif. and Prac. M. & S., 1873, 342. g 381, 1880, 199. t 212, 158. i 827, Oct., 1843. J 490, 1846, ii., 575. MICROCEPHALY. 247 sum. Paget "■ and Henry mention cases in which the corpora callosum, the fornix, and septum lucidum were imperfectly formed. Maunoir *> reports con- genital malformation of the brain, consisting of almost complete absence of the occipital lobe. The patient died at the twenty-eighth month. Combettes " reports the case of a girl who died at the age of eleven who had complete absence of the cerebellum in addition to other minor structural defects ; this was probably the case mentioned by Cruveilhier.'* Diminution in volume of the head is called microcephaly. Probably the most remarkable case on record is that mentioned by Lombroso. The Fig. 91. — Microcephalic "Aztec man." individual was called " I'homme-oiseau," or the human bird, and his cranial capacity was only 390 c. c. Lombroso speaks of another individual a 550, xxix., 55. b 242, 1876, i. , 163. <= 242, 1830, t., 148. d The argument that the brain is not the sole organ of the mind is in a measure sub- stantiated by a wonderful case of a decapitated rooster, reported from Michigan. ' A stroke of the knife had severed the larynx and removed the whole mass of the cerebrum, leaving the inner aspect and base of the skull exposed. The cerebrum was partly removed ; the external auditory meatus was preserved. Immediately after the decapitation the rooster was left to its supposed death struggles, but it ran headless to the barn, where it was secured and subsequently fed by pushing corn down its esophagus, and allowing water to trickle into this tube from the spout of an oil-can. The phenomena exhibited by the rooster were quite interesting. It made all the motions of pecking, strutted about, flapped its wings, attempted to crow, but, of course, without making any sound. It exhibited no signs of incoordination, but did not seem to hear. A ludicrous exhibition was the absurd, sidelong pas seul made toward the hens. » 632, 1880, ii., 5. 248 MINOR TERATA. called " rhomme-lapin," or man-rabbit, whose cranium was only slightly larger than that of the other, measuring 490 mm. in circumference. Castelli alludes to endemic microcephaly among some of the peoples of Asia. We also find it in the Caribbean Islands, and from the skulls and portraits of the ancient Aztecs we are led to believe that they were also microcephalic. Two creatures of celebrity were Maximo and Bartola, who for twenty- five years have been shown in America and in Europe under the name of the "Aztecs" or the "Aztec children" (Fig. 91). They were male and female and very short, with heads resembling closely the bas-reliefs on the ancient Aztec temples of Mexico. Their facial angle was about 45°, and they had jutting lips and little or no chin. They wore their hair in an enormous bunch to magnify the deformity. These curiosities were born in Central America and were possibly half Indian and Negro. They were little better than idiots in point of intelligence. Figure 92 represents a microcephalic youth known as the " Mexican wild boy," who was shown with the Wallace circus. Virchow " exhibited a girl of four- teen whose face was no larger than that of a new-born child, and whose head was scarcely as large as a man's fist. Magitot reported a case of a micro- cephalic woman of thirty who weighed 70 pounds. Hippocrates and Strabonius both speak of head-binding as a custom in- ducing artificial microcephaly, and some tribes of North American Indians still retain this custom. As a rule, microcephaly is attended with associate idiocy and arrested development of the rest of the body. Ossification of the fontanelles in a mature infant would necessarily prevent full development of the brain. Osiander and others have noticed this anomaly. There are cases on record in which the fontanelles have remained open until adulthood. Augmentation of the volume of the head is called macrocephaly, and there are a number of curious examples related. Benvenuti describes an individual, otherwise well formed, whose head began to enlarge at " Quoted 538, 1884, 522. Fig. 92. — Microcephalic boy. MACRO CEPHALY. 249 seven. At twenty-seven it measured over 37 inches in circumference and the man's face was 1 5 inches in height ; no other portion of his body increased abnormally ; his voice was normal and he was very intelligent. He died of apoplexy at the age of thirty.'' Fournier ^ speaks of a cranium in the cabinet of the Natural History Museum of Marseilles of a man by the name of Borghini, who died in 1616. At the time he was described he was fifty years old, four feet in height ; his head measured three feet in circumference and one foot in height. There was a proverb in Marseilles, " Apas mai de sen que Borghini," meaning in the local dialect, " Thou hast no more wit than Borghini." This man, whose fame became known all over France, was not able, as he grew older, to maintain the weight of his head, but carried a cushion on each shoulder to prop it up. Fournier also quotes the history of a man who died in the same city in 1807 at the age of sixty-seven. His head was enormous, and he never lay on a bed for thirty years, passing his nights in a chair, generally reading or writing. He only ate once in twenty-four or thirty hours, never warmed himself, and never used warm water. His knowledge was said to have been great and encyclopedic, and he pretended never to have heard the proverb of Borghini. There is related the account of a Moor, who was seen in Tunis early in this century, thirty-one years of age, of middle height, with a head so prodigious in dimensions that crowds flocked after him in the streets. His nose was quite long, and his mouth so large that he could eat a melon as others would an apple. He was an imbecile. William Thomas Andrews was a dwarf seventeen years old, whose head measured in circumference 35 inches ; from one external auditory meatus to another, 27^ inches ; from the chin over the cranial summit to the suboccipital protuberance, 37 J inches ; the distance from the chin to the pubes was 20 inches ; and from the pubes to the soles of the feet, 1 6 ; he was a monorchid." James Cardinal, who died in Guy's Hospital in 1825, and who was so celebrated for the size of his head, only measured 32^ inches in head-circumference. The largest healthy brains on record, that is, of men of prominence, are those of Cuvier, weighing 64^ ounces ; ^ of Daniel "Webster, weighing 63| ounces (the circumference of whose head was 23| inches) ; " of Abercrombie, weighing 63 ounces, and of Spurzheim, weighing 55 j^j- ounces. Byron and Cromwell had abnormally heavy brains, showing marked evidence of disease. A curious instance in this connection is that quoted by Pign^,'' who gives an account of a double brain found in an infant. Keen reports finding a fornix which, instead of being solid from side to side, consisted of two lateral halves with a triangular space between them. When the augmentation of the volume of the cranium is caused by an abundant quantity of serous fluid the anomaly is known as hydrocephaly. a Actes de la soci6t6 impfer. des curieux de la nature, torn. viii. ^ 302, iv., 142. 593, 1856, xiii., 778. d 678, Dec, 1883. e 124, 1853, 110. f 242, 1846, xxi., 144. 250 MINOR TERATA. In this condition there is usually no change in the size of the brain-structure itself, but often the cranial bones are rent far asunder. Minot speaks of a hydro- cephalic infant whose head measured 27 J inches in cir- cumference ; Bright describes one whose head measured 32 inches ; and Klein, one 43 inches. Figure 93 represents a child of six whose head cir- cumference was 36 inches. Figure 94 shows a hydro- cephalic adult who was ex- hibited through this country. There is a record * of a curious monster born of healthy half-caste African parents. The deformity was caused by a deficiency of osseous ma- terial of the bones of the head. There was considerable arrest of develop- Fig. 93. — Hydrocephalic child. Fig. 94.— Hydrocephaly in an adult. ment of the parietal, temporal, and superior maxillary bones, in consequence of which a very small amount of the cerebral substance could be protected by a 778, 1868, ix., 31. ANOMALIES OF TEE INFERIOR MAXILLA. 251 the membranous expansion of the cranial centers. The inferior maxilla and the frontal bone were both perfect ; the ears were well developed and the tongue strong and active ; the nos- trils were imperforate and there was no roof to the mouth nor floor to the nares. The eyes were curi- ously free from eyelashes, eyelids, or brows. The cornea threatened to slough. There was double hare- lip on the left side ; the second and -third fingers of both hands were webbed for their whole length ; the right foot wanted the distal phalanx of the great toe and the left foot was clubbed and drawn inward. The child swallowed when fed from a spoon, appeared to hear, but ex- hibited no sense of light. It died shortly after the accompanying sketch (Fig. 95) was made. Occasionally a deficiency in the osseous material of the cranium or an abnormal dilatation of the fon- tanelles gives rise to a hernia of the meninges, which, if accompanied by cerebrospinal fluid in any quantity, causes a large and peculiarly shaped tumor called meningocele (Fig. 96). If there is a protrusion of brain-substance itself, a condition known as hernia cerebri results. Complete absence of the inferior maxilla is much rarer in man than in animals. Nicolas and Prenant have described a curious case of this anomaly in a sheep. Gurlt has named subjects presenting the total or partial absence of the inferior maxilla, agna- thes or hemiagnathes. Simple atrophy of the inferior maxilla has been seen in man as well as in the lower animals, but is much less frequent than atrophy of the superior maxilla. Langenbeck reports the case of a young man who had the inferior maxilla so atrophied that in infancy it was impossible for him to take milk from the breaSt. He had also almost complete im- Boullard " reports a deformity of the visage, resulting in a deficiency of the condyles of the lower jaw. Maurice^ made an observa- a 242, 1849, xxiv., 281. "^ 146, 1861, i., 696. Fig. 95.— Monster from deficiency of the tones of the head. Fig. 96. — Meningocele. mobility of the jaws. 252 MINOR TEE ATA. tion on a vice of conformation of the lower jaw wiiich rendered lactation impossible, probably causing the death of the infant on this account. Tomes gives a description of a lower jaw the development of the left ramus of which had been arrested. Canton * mentions arrest of development of the left perpendicular ramus of the lower jaw combined with malformation of the external ear. Exaggerated prominence of the maxillaries is called prognathism ; that of the superior maxilla is seen in the North American Indians. Inferior prognathism is observed in man as well as in animals. The bull-dog, for example, displays this, but in this instance the deformity is really superior brachygnathism, the superior maxilla being arrested in development. Congenital absence of the nose is a very rare anomaly. Maisonneuve has seen an example in an individual in which, in place of the nasal appen- dix, there was a plane surface perforated by two small openings a little less than one ram. in diam- eter and three mm. apart. Exaggeration in volume of the nose is quite frequent. Ballonius ^^^ speaks of a nose six times larger than ordinary. Viewing the Roman celebri- ties, we find that Numa, to Avhom was given the surname Pompilius, had a nose which measured six inches. Plutarch, Lycurgus, and Solon had a 'gm^^ifW ■lllll''fll I similar enlargement, as had all the kings of Italy /* J^^W BT/I i except Tarquin the Superb. Early in the last century a man, Thomas Wed- ders (or Wadhouse), with a nose 7 J inches long, was exhibited throughout Yorksliire. This man expired as he had lived, in a condition of mind best de- scribed as the most abject idiocy. The accompany- ing illustration (Fig. 97) is taken from a reproduction of an old print and is supposed to be a true likeness of this unfortunate individual. There are curious pathologic formations about the nose which increase its volume so enormously as to interfere with respiration and even with alimen- tation ; but these will be spoken of in another chapter. There have been some celebrities whose noses were undersized. The Due de Guise, the Dauphin d'Auvergne, and William of Orange, celebrated in the romances of chivalry, had extremely short noses. There are a few recorded cases of congenital division of the nose. Bartholinus,'' Borellus, and the Ephemerides speak of duplex noses. Thomas of Tours has observed congenital fissure of the nose. Riker" reports the case of an infant of three weeks who possessed a supernumerary nose on the right nasal bone near the inner canthus of the eye. It was pear-shaped, with a 779, xii., 237. b 190, ceut. i., List. xxv. c 176, 1878, 196. Fig. 97.— Thomas Wedders. ANOMALIES OF THE MOUTH. 253 its base down, and was the size of the natural nose of an infant of that age, and air passed through it. Hubbell, Ronaldson,^ and Luscha speak of con- genital occlusion of the posterior nares. Smith'' and Jarvis" record cases of congenital occlusion of the anterior nares. Anomalies in size of the mouth are not uncommon. Fournier quotes the history of a man who had a mouth so large that when he opened it all his back teeth could be seen. There is a history of a boy of seventeen ^ who had a preternaturally-sized mouth, the transverse diameter being 6J inches. The mother claimed that the boy was born with his foot in his mouth and to this fact attributed his deformity. The negro races are noted for their large mouths and thick lips. A negro called " Black Diamond," recently exhibited in Philadelphia, could put both his fists in his mouth. Morgan^ reports two cases of congenital macrostoma accompanied by Fig. 98. — Macrostoma by ascending lateral fissare. Fig. 99.— Macrostoma by lateral malformation of the auricles and by auricular appendages. Van Duyse^ mentions congenital macrostoma with preauricular tumors and a dermoid of the eye. Macrostoma is sometimes produced by lateral fissures (Fig. 99). In other cases this malformation is unilateral and the fissure ascends (Fig. 98), in which instance the fissure may be accompanied by a fistula of the duct of Stensen. Sometimes there is associated with these anomalies curious termi- nations of the salivary ducts, either through the cheek by means of a fistula or on the anterior part of the neck. Microstoma. — There are a few cases on record in which the mouth has been so small or ill-defined as not to admit of alimentation. MoUi&re knew an individual of forty whose mouth was the exact size of a ten-centime piece. Buchnerus « records a case of congenital atresia of the mouth. Cayley, a 318, 1880, xxvi. , 1035. 1> 548, 1863, i. , 320. c 597, xlvi. , 536. d 206, vol. iv. , part iii. e 548, 1881, ii., 613. f Ann. Soc. de m6d. de Gand., 1882, 141. S 105, 1730, ii., 210. 254 MINOR TERATA. Smith," Sourrouille,'' and Stankiewicz of Warsaw discuss atresia of the mouth. Cancrum oris, scarlet fever, burns, scurvy, etc., are occasional causes that have been mentioned, the atresia in these instances taking place at any time of life. Anomalies of the Lips. — The aboriginal tribes are particularly noted for their large and thick lips, some of which people consider enormous lips signs of adornment. Elephantiasis or other pathologic hypertrophy of the labial tissues can produce revolting deformity, such as is seen in Figure 100, representing an individual who was exhibited several years ago in Philadel- phia. We have in English the expression, " pulling a long lip." Its origin is said to date back to a semimythical hero of King Arthur's time, who, " when sad at heart and melancholic," would let one of his lips drop below his waist, while he turned the other up like a cap on his head. Blot" records a case of monstrous congenital hypertrophy of the superior lip in an infant of eight months. Buck "^ successfully treated by surgical operations a case of congenital hypertrophy of the under lip, and Detmold ^ mentions a similar result in a young lady with hypertrophy of the lip and lower part of the nose. Murray ' reports an undescribed malforma- tion of the lower lip occurring in one family. Weiss has reported cases of exstrophy of the lips. Hare-lip may be unilateral or double, and may or may not include the palatine arch. In the worst cases it extends in fissures on both sides to the orbit (Fig. 101). In other cases the minimum degree of this deformity is seen (Fig. 102). Congenital absence of the tongue does not necessarily make speech, taste, or deglutition impossible. Jussieu cites the case of a girl who was born without a tongue but who spoke very distinctly, Berdot^ describes a case in which the tongue was deficient, without apparent disturbance of any of the functions. Riolan mentions speech after loss of the tongue from small-pox. Boddington ^ gives an account of Margaret Cutting, who spoke readily and intelligibly, although she had lost her tongue. Saulquin ' has an observation of a girl without a tongue who spoke, sang, and swallowed normally. Aur- ran, Bartholinus, Louis, Parsons, Tulpius, and others mention speech with- out the presence of a tongue. ■•^ 476, 1876, i., 13. b 363, ivi., 707. o Bull. Soc. de chir. de Par., 1873, ii. 332 d 773, 1882, 171. e 594, 1844, iii., 38. f 222, 1860, xxvi., 502. g 107, vol. viii.. 185. b 629, 1732-44, ix., 126. i 460, 1764, xx., 328. Fig. 100.— Elephantiasis of the face, with hypertrophy of the upper lip. ANOMALIES OF THE TONGUE. 255 Philib " reports a case in which mutism, almost simulating that of one con- genitally deaf, was due to congenital adhesions of the tongue to the floor of the buccal cavity. Speech was established after removal of the abnormal adhesion. Routier speaks of ankylosis of the tongue of seventeen years' duration. Jurist >> records such abnormal mobility of the tongue that the patient was able to project the tongue into the nasopharynx. Wherry and Winslow record similar instances. There have been individuals with bifid tongues, after the normal type of serpents and saurians, and others who possessed a supernumerary tongue. Eev. Henry Wharton, Chaplain to Archbishop Bancroft, in his journal, writ- ten in the seventeenth century, says that he was born with two tongues and Fig. 101.— Double hare-lip. Fig. 102.— Slight hare-lip, with fissure of the lower eyelid (Kraske). passed through life so, one, however, gradually atrophying. In the poly- clinic of Schnitzer in Vienna in 1892 Hajek observed in a lad of twelve an accessory tongue 2.4 cm. in length and eight mm. in breadth, forming a tumor at the base of the normal tongue. It was removed by scissors, and on histo- logic examination proved to be a true tongue with the typical tissues and constituents. Borellus, Ephemerides, Eschenbach, Mortimer," Penada, and Schenck speak of double tongues, and Avicenna and Schenck have seen fis- sured tongues. Dolaeus * records an instance of double tongue in a paper entitled "De puella bilingui," and Beaudry and Brothers" speak of cleft a 454, 1829, xxxiii., 265. 629, 486. 11280, 1755, iii., 411. l>538, xxviii., 539. e 538, xxxiii., 109. 256 MINOR TERATA. tongue. Braine " records a case in which there was a large hypertrophied fold of membrane coming from each side of the upper lip. In some cases there is marked augmentation of the volume of the tongue. Fournier ^ has seen a juggler with a tongue so long that he could extrude it six inches from his mouth. He also refers to a woman in Berlin with a long tongue, but it was thinner than that of a cat. When she laughed it hung over her teeth like a curtain, and was always extremely cold to the touch. In the same article there is a description of a man with a very long neck who could touch his tongue to his chest without reclining his head. Congenital and acquired hypertrophy of the tongue will be discussed later. Amatus Lusitanus " and Portal ^ refer to the presence of hair on the tongue, and later there was an account of a medical student ^ who com- plained of dyspepsia and a sticky sensation in the mouth. On examination a considerable growth of hair was found on the surface of the tongue. The hairs would be detached in vomiting but would grow again, and when he was last seen they were one inch long. Such are possibly nevoid in formation. The ordinary anomalies of the palate are the fissures, unilateral, bilal^ eral, median, etc. : they are generally associated with hare-lip. The median fissure commencing between the middle incisors is quite rare. Many curious forms of obturator or artificial palate are employed to remedy congenital defects. Sercombe ^ mentions a case in which destruction of the entire palate was successfully relieved by mechanical means. In some instances among the lower classes these obturators are simple pieces of wood, so fashioned as to fit into the palatine cleft, and not infrequently the obturator has been swallowed, causing obstruction of the air-passages or occluding the esophagus. Abnormalism of the Uvula. — Examples of double uvula are found in the older writers, and Hagendorn speaks of a man who was born without a uvula. The Ephemerides and Salmutli describe uvulse so defective as to be hardly noticeable. Bolster, Delius, Hodges, Mackenzie of Baltimore, Orr, Eiedel, Schufeldt, and Tidyman are among observers reporting bifurcated and double uvula, and they are quite common. Ogle e records instances of congenital absence of the uvula. Anomalies of the Epiglottis. — Morgagni mentions a man without an epiglottis who ate and spoke Avithout difficulty. He thought the arytenoids were so strongly developed that they replaced the functions of the missing organ. Enos of Brooklyn in 1854 reported absence of the epiglottis with- out interference with deglutition.'' Manifold ' speaks of a case of bifur- cated epiglottis. DebloisJ records an instance of congenital web of the - Proc. M. Soc. Lond., 1874-5, ii., 21. b 302 iv. 149. c 119, cent, vi., cur. 65. d 639, iv. , 507. « 611, Aug. 13, 1842. f 550, xxxix., 91. g 548, 1865, ii., 414. h 230, 1864, iv.', 353.' i 476, 1851, i., 10. j 597_ xxxix., 660. DOUBLE VOICE. 257 vocal bands. Mackenzie " removed a congenital papillomatous web which had united the vocal cords until the age of twenty-three, thus establish- ing the voice. Poore also recorded a case of congenital web in the larynx. Elsberg and Scheff mention occlusion of the rima glottidis by a membrane. Instances of duplication of the epiglottis attended with a species of double voice possess great interest. French'' described a man of thirty, by occupation a singer and contortionist, who became possessed of an extra voice when he was sixteen. In high and falsetto tones he could run the scale from A to F in an upper and lower range. The compass of the low voice was so small that he could not reach the high notes of any song with it, and in sing- ing he only used it to break in on the falsetto and produce a sensation. He was supposed to possess a double epiglottis." Roe ^ describes a young lady who could whistle at will with the lower part of her throat and without the aid of her lips. Laryngeal examination showed that the fundamental tones were produced by vibrations of the edges of the vocal cords, and the modifications were effected by a minute adjust- ment of the ventricular bands, which regulated the laryngeal opening above the cord, and pressing firmly down closed the ventricle and acted as a damper, preventing the vibrations of the cords except in their middle third. Morgan in the same journal mentions the case of a boy of nineteen, who seemed to be affected with laryngeal catarrh, and who exhibited distinct diphthongia. He was seen to have two glottic orifices with associate bands. The treatment was directed to the catarrh and consequent paresis of the posterior bands, and he soon lost his evidences of double voice. '^ Complete absence of the eyes is a very rare anomaly. Wordsworth '' describes a baby of seven weeks, otherwise well formed and healthy, which had congenital absence of both eyes. The parents of this child were in every respect healthy. There are some cases of monstrosities with closed, adherent eyelids and absence of eyes.s Holmes ^ reports a case of congenital absence of both eyes, the child otherwise being strong and perfect. The child died of a 224, 1874, i., 317. b Quoted 224, 1880, ii., 311. c 148, vol. ii., 271. d Archives of Laryngology, Jan. 1, 1882. e The followiag is a description of the laryngeal formation of a singer who has recently acquired considerable notice by her ability to sing notes of the highest tones and to display the greatest compass of voice. It is extracted from a Cleveland, Ohio, newspaper: "She has unusual development of the larynx, which enables her to throw into vibration and with different degrees of rapidity the entire length of the vocal cords or only a part thereof. But of greatest interest is her remarkable control over the muscles which regulate the division and modification of the resonant cavities, the laryngeal, pharyngeal, oral, and nasal, and upon this depends the quality of her voice. The uvula is bifurcated, and the two divisions some- times act independently. The epiglottis during the production of the highest notes rises upward and backward against the posterior pharyngeal wall in such a way as almost entirely to separate the pharyngeal cavities, at the same time that it gives an unusual conformation to those resonant chambers." f 476, 1881, ii., 875. % 240, 1828. Ii268, 1869, xxvi., 163. 17 258 MINOR TERATA. cholera infantum. He also reports a case very similar in a female child of American parents. In a girl of eight, of German parents, he reports defi- ciency of the external walls of each orbit, in addition to great deformity of the side of the head. He also gives an instance of congenital paralysis of the levator palpebrae muscles in a child whose vision was perfect and who was otherwise perfect. Holmes also reports a case of enormous congenital ex- ophthalmos, in which the right eye protruded from the orbit and was no longer covered by the cornea. Kinney" has an account of a child born without eyeballs. The delivery was normal, and there was no history of any maternal impression ; the child was otherwise healthy and well formed. Landes ** reports the case of an infant in which both eyes were absent. There were six fingers on each hand and six toes on each foot. The child lived a few weeks. In some instances of supposed absence of the eyeball the eye is present but diminutive and in the posterior portion of the orbit. There are instances of a single orbit with no eyes and also a single orbit containing two eyes." Again we may have two orbits with an absence of eyes but the presence of the lacrimal glands, or the eyes may be present or very imperfectly developed. Mackenzie mentions cases in which the orbit was more or less completely wanting and a mass of cellular tissue in each eye. Cases of living cyclopia, or individuals with one eye in the center of the forehead after the manner of the mythical Cyclops, are quite rare. Val- lentini in 1884'^ reports a case of a male cyclopic infant which lived for seventy-three hours. There were median fissures of the upper lip, pre- auricular appendages, oral deformity, and absence of the olfactory proboscis. The fetus was therefore a cyclops arrhynchus, or cyelocephalus. Blok " de- scribes a new-born infant which lived for six or seven hours, having but one eye and an extremely small mouth. The "Four-eyed Man of Cricklade" was a celebrated English mon- strosity of whom little reliable information is obtainable. He Avas visited by W. Drury, who is accredited with reporting the following : — " ' So wondrous a thing, such a lusus naturae, such a scorn and spite of nature I have never seen. It Avas a dreadful and shocking sight.' This unfortunate had four eyes placed in pairs, ' one eye above the other and all four of a dull brown, encircled with red, the pupils enormously large.'- The vision in each organ appeared to be perfect. ' He could shut any particular eye, the other three remaining open, or, indeed, as many as he chose, each several eye seeming to be controlled by his will and acting independently of ■ the remainder. He could also revolve each eye separately in its orbit, look- ing backward with one and forward with another, upward with one and a 218, 1854, li., 25. b 538, Nov. 3, 1894. c 418, 1751, 49. d Atti dell' Accad. med.-chir. di Perugia, vi., faisc. 3 & 4, 1894. e Weekblad van het Nederlandsch Tijdschr. voor Geneeskunde, xxx., 2d part, 414, Sept., 1894 ; also extracted in 759. MULTIPLE PUPILS. 259 downward with another simultaneously.' He was of a savage, malignant disposition, delighting in ugly tricks, teasing children, torturing helpless ani- mals, uttering profane and blasphemous words, and acting altogether like the monster, mental and physical, that he was. * He could play the fiddle, though in a silly sort, having his notes on the left side, while closing the right pair of eyes. He also sang, but in a rough, screeching voice not to be listened to without disgust.' " There is a recent report '^ of a child born in Paris with its eyes in the top of its head. The infant seemed to be doing well and crowds of people have flocked to see it. Recent reports speak of a child born in Portland, Ore- gon, which had a median rudimentary eye between two normal eyes. Four- nier describes an infant born with perfectly formed eyes, but with adherent eyelids and closed ocular aperture. Forlenze has seen the pupils adherent to the conjunctiva, and by dissection has given sight to the subject. Dubois •> cites an instance of supernumerary eyelid. At the external angle of the eyelid was a fold of conjunctiva which extended 0.5 cm. in front of the conjunctiva, to which it did not adhere, therefore constituting a fourth eyelid. Fano "^ presents a similar case in a child of four months, in whom no other anomaly, either of organs or of vision, was observed. On the right side, in front of the external half of the sclerotic, was observed a semilunar fold with the concavity inward, and which projected much more when the lower lid was depressed. When the eyelid rolled inward the fold rolled with the globe, but never reached so far as the circumference of the cornea and did not interfere with vision. Total absence of both irides has been seen in a man of eighteen. ^ Dixon reports a case of total aniridia with excellent sight in a woman of thirty-seven.® In Guy's Hospital there was seen a case of complete con- genital absence of the iris.^*^ Hentzschel ^ speaks of a man with congenital absence of the iris who had five children, three of whom exhibited the same anomaly while the others were normal. Benson, Burnett, Demaux, Lawson, Morison, Eeuling, Samelson, and others also report congenital deficiency of the irides in both eyes. Jeaffreson^' describes a female of thirty, living in India, who was affected with complete ossification of the iris. It was immovable and quite beautiful when seen through the transparent cornea ; the sight was only slightly impaired. No cause was traceable. Multiple Pupils. — More than one pupil in the eye has often been noticed, and as many as six have been seen. They may be congenital or due to some pathologic disturbance after birth. Marcellus Donatus ^"^ speaks of two pupils in one eye. Beer, Fritsche, and Heuermann are among the older writers who have noticed supernumerary pupils. Higgens in 1885 described a Amer. Med. Review, Dec, 1895. *> 145, vol. xxxiv. c 145, 1863, 1. d 476, 1882, i., 265. e 548, 1858, il., 35. f Quoted 476, 1830-1, i., 384. 260 MINOR TERATA. a boy whose right iris was perforated by four pupils, — one above, one to the inner side, one below, and a fourth to the outer side. The first three were slit-shaped ; the fourth was the largest and had the appearance as of the separation of the iris from its insertion. There were two pupils in the left eye, both to the outer side of the iris, one being slit-like and the other resem- bling the fourth pupil in the right eye. All six pupils commenced at the periphery, extended inward, and were of different sizes. The fundus could be clearly seen through all of the pupils, and there was no posterior staphy- loma nor any choroidal changes. There was a rather high degree of myopia. This peculiarity was evidently congenital, and no traces of a central pupil nor marks of a past iritis could be found. Clinical Sketches ^ contains quite an extensive article on and several illustrations of congenital anomalies of the iris. Double crystalline lenses are sometimes seen. Fritsch and Valisneri have seen this anomaly and there are modern references to it. Wordsworth ^ presented to the Medical Society of London six members of one family, all of whom had congenital displacement of the crystalline lens outward and upward. The family consisted of a woman of fifty, two sons, thirty-five and thirty-seven, and three grandchildren — a girl of ten and boys of five and seven. The irides were tremulous. Clark " reports a case of congenital dislocation of both crystalline lenses. The lenses moved freely through the pupil into the anterior cham- bers. The condition remained unchanged for four years, when glaucoma supervened. Differences in Color of the Two Eyes. — It is not uncommon to see people with different colored eyes. Anastasius I. had one black eye and the other blue, from whence he derived his name " Dicore," by which this Emperor of the Orient was generally known. Two distinct colors have been seen in an iris. Berry gives a colored illustration of such a case. The varieties of strabismus are so common that they will be passed with- out mention. Kuhn ^ presents an exhaustive analysis of 73 cases of congeni- tal defects of the movements of the eyes, considered clinically and didacti- cally. Some or all of the muscles may be absent or two or more may be amalgamated, with anomalies of insertion, false, double, or degenerated, etc; The influence of heredity in the causation of congenital defects of the eye is strikingly illustrated by De Beck.'' In three generations twelve members of one family had either coloboma iridis or irideremia. He per- formed two operations for the cure of cataract in two brothers. The opera- tions were attended with difficulty in all four eyes and followed by cyclitis. The result was good in one eye of each patient, the eye most recently blind. Posey *' had a case of coloboma in the macular region in a patient who had a a 275, April, 1895. b 476, 1878, i., 86. c 765, 1894. d Beit. z. Angenh., Heft xix., 1895. e Trans. 765, 1894. f 792, Nov., 1894. ANOMALIES OF THE EARS. 261 supernumerary tooth. He believes the defects were inherited, as the patient's mother also had a supernumerary tooth. ISTunnely'' reports cases of congenital malformation in three children of one family. The globes of two of them (a boy and a girl) were smaller than natural, and in the boy in addition were flattened by the action of the recti muscles and were soft ; the sclera were very vascular and the corne£e conical, the irides dull, thin, and tremulous ; the pupils were not in the axis of vision, but were to the nasal side. The elder sister had the same congeni- tal condition, but to a lesser degree. The other boy in the family had a total absence of irides, but he could see fairly well with the left eye. Anomalies of the Ears. — Bilateral absence of the external ears is quite rare, although there is a species of sheep, native of China, called the " Yung- ti," in which this anomaly is constant. Bartholinus, Lycosthenes, Pare, Schenck, and Oberteuffer have remarked on deficient external ears. Guys, the celebrated Marseilles litterateur of the eighteenth century, was born with only one ear. Chantreuil ^ mentions obliteration of the external auditory canal in the new-born. Bannofont reports a case of congenital imperforation of the left auditory canal existing near the tympanic membrane with total deaf- ness in that ear, Lloyd " described a fetus showing absence of the external auditory meatus on both sides. Munro ^ reports a case of congenital absence of the external auditory meatus of the right ear ; and Richardson " speaks of congenital malformation of the external auditory apparatus of the right side. There is an instance ^ of absence of the auditory canal with but par- tial loss of hearing. Mussey « reports several cases of congenitally deficient or absent aural appendages. One case was that in which there was con- genital absence of the external auditory meatus of both ears without much impairment of hearing. In neither ear of N. W. Goddard, aged twenty- seven, of Vermont, reported in 1834, was there a vestige of an opening or passage in the external ear, and not even an indentation. The Eustachian tube was closed. The integuments of the face and scalp were capable of receiving acoustic impressions and of transmitting them to the organs of hear- ing. The authors know of a student of a prominent New York University who is congenitally deficient in external ears, yet his hearing is acute. He hides his deformity by wearing his hair long and combed over his ears. The knowledge of anomalous auricles is lost in antiquity. Figure 103 represents the head of an ^gipan in the British Museum showing a super- numerary auricle. As a rule, supernumerary auricles are preauricular appendages. Warner, in a report of the examination of 50,000 children, quoted by Ballantyne, describes 33 with supernumerary auricles, represented by sessile or pedunculated outgrowths in front of the tragus. They are more commonly unilateral, always congenital, and can be easily removed, giving rise a 550, xlv., 43. ^ 242, 1867, xlii., 149. c 779, 1846, i., 139. d 476, 1869, ii., 41. e 476, 1882, i., 465. f 218, xi., 419. g 124, 1837, xxi., 378. 262 MINOR TERATA. to no unpleasant symptoms. They have a soft and elastic consistency, and are usually composed of a hyaline or reticular cartilaginous axis covered with connective or adipose tissue and skin bearing fine hairs ; sometimes both cartilage and fat are absent. They are often associated with some form of de- fective audition — harelip, ocular disturb- ance, club-feet, congenital hernia, etc. These supernumerary members vary from one to five in number and are sometimes hereditary. Reverdin describes a man having a supernumerary nipple on the right side of his chest, of whose five children three had preauricular append- ages. Figure 104 represents a girl with a supernumerary auricle in the neck, de- scribed in the Lancet, 1888." A little girl under Birketf s care in Guy's Hos- pital more than answered to Macbeth's requisition, " Had I three ears I'd hear thee ! " since she possessed two super- fluous ones at the sides of the neck, somewhat lower than the angle of the jaw, which were well developed as to their external contour and made up of fibrocartilage.'' There is mentioned the case of a boy of six months " Fig. 103.— JEgipan with supernumerary auricle (British Museum). Fig. 104. — Supernumerary auricle in the neck. Fig. 105. — Supernumerary auricle. on the left side of whose neck, over the middle anterior border of the sterno- cleidomastoid muscle, was a nipple-like projection J inch in length ; a rod of " 476, 1888, i., 312. b 548, 1858, 528. c 476, 1889, ii., 1003. ABSENCE OF THE LIMBS. 263 cartilage was prolonged into it from a thin plate, which was freely movable in the subcutaneous tissue, forming a striking analogue to an auricle (Fig. 105). Moxhay * cites the instance of a mother who was frightened by the sight of a boy with hideous contractions in the neck, and who gave birth to a child with two perfect ears and three rudimentary auricles on the right side, and on the left side two rudimentary auricles. In some people there is an excessive development of the auricular muscles, enabling them to move their ears in a manner similar to that of the lower animals. Of the celebrated instances the Abb6 de MaroUes, says Vigneul-Marville, bears witness in his " M6moires " that the Eegent Crassot could easily move his ears. Saint Augustine mentions this anomaly. Double tympanitic membrane is spoken of by Loeseke.**^ There is sometimes natural perforation of the tympanum in an otherwise perfect ear, which explaiiiis how some people can blow tobacco-smoke from the ear. Fournier '' has seen several Spaniards and Germans who could perform this feat, and knew one man who could smoke a whole cigar without losing any smoke, since he made it leave either by his mouth, his ears, or in both ways. Fournier in the same article mentions that he has seen a woman with ears over four inches long. Strange to say, there have been reports of cases in which the ossicles were deficient without causing any imperfection of hearing. Caldani" mentions a case with the incus and malleus deficient, and Scarpa '^^ and Torreau ■* quote instances of deficient ossicles. Thomka in 1895 reported a case of supernumerary tympanic ossicle, the nature of which was unknown, although it was neither an inflammatory product nor a remnant of Meckel's cartilage. Absence of the Limbs. — Those persons born without limbs are either the subjects of intrauterine amputation or of embryonic malformation. Prob- ably the most celebrated of this class was Marc Cazotte, otherwise known as " P6pin," who died in Paris in the last century at the age of sixty-two of a chronic intestinal disorder. He had no arms, legs, or scrotum, but from very jutting shoulders on each side were well-formed hands. His abdomen ended in a flattened buttock with badly-formed feet attached. He was exhibited before the public and was celebrated for his dexterity. He performed nearly all the necessary actions, exhibited skilfulness in all his movements, and was credited with the ability of coitus. He was quite intellectual, being able to write in several languages. His skeleton is preserved in the Mus6e Dupuy- tren (Fig. 106). Flachsland ® speaks of a woman who three times had borne children without arms and legs. Hastings'' describes a living child born without any traces of arms or legs (Fig. 107). Garlick s has seen a child with neither Upper nor lower extremities. In place of them were short stumps three or four inches long, closely resembling the ordinar}"- stiunps after a 224, 1870. l>302, iv., 148. c 401, vi., 142. 'i379_ vi., 321. e Observat. patholog. Anat., p. 44. f 776, 1826, ii., 39. g 656, 1849. 264 MINOR TEE ATA. amputation. The head, chest, body, and male genitals were well formed, and the child survived. Hutchinson ^ reports the history of a child born without extremities, probably the result of intrauterine amputa- tion. The flaps were healed at the deltoid insertion and just below the groin. Par^*" says he saw in Paris a man without arms, who by means of his head and neck could crack a whip or hold an axe. He ate by means of his feet, dealt and played cards, and threw dice with the same members, exhibiting such dex- terity that iinally his companions refused to play with him. He was proved to be a thief and a murderer and was finally hanged at Gueldres (Fig. 108). Par6 also relates having seen a woman in Paris who sewed, embroidered, and did other things with her feet. Jansen*™ speaks of a rnan in Spain, born without arms, who could use his feet as well as most people use their arms. Schenck and Lotichius give descriptions of armless people. Hulke " describes a child of four whose upper limbs were absent, a small dimple only being in their place. He had free movement of the shoulders in every direction, and could grasp objects between his cheeks and his acromian process ; the prehensile power of the toes was well developed, Fig. 106.— "P^pin" (Mus6e Dupuytren). Fig. 107.— Limbless child. as he could pick up a coin thrown to him. A monster of the same conforma- a 779, 1853, 343. b 618, 1020. o 550, 1877. 65. ABSENCE OF THE LIMBS. 265 tion was the celebrated painter, Ducornet (Fig. 109), who was born at Lille on the 10th of January, 1806. He was completely deprived of arms, but the rest of the body was well formed with the exception of the feet, of which the second toe was faulty. The deformity of the feet, however, had the happiest result, as the space between the great toe and its neighbor was much larger than ordinary and the toes much more mobile. He became so skilful in his adopted profession that he finally painted a picture eleven feet in height (repre- senting Mary Magdalene at the feet of Christ after the resurrection), which was purchased by the Government and given to the city of Lille. Broca describes James Leedgwood, who was deprived of his arms and had only one leg. He ex- hibited great dexterity with his single foot, wrote, discharged a pistol, etc. ; he was said to have been able to pick up a sewing-needle on a slippery surface with his eyes blindfolded. Capitan described to the Soci§t6 d'anthropologie de Paris a young man without arms, who was said to play a violin and cornet with his feet. He was able to take a kerchief from his pocket and to blow his nose ; he could make a cigarette, light it, and put it in his mouth, play cards, drink from a glass, and eat with a fork by the aid of his dexterous toes. There was a creature exhibited some time since in the principal cities of France, who was called the " I'homme tronc." He was totally deprived of all his members. Curran " describes a Hindoo, a prostitute of forty, with congenital absence of both upper extremities. A slight fleshy protuberance depended from the cicatrix of the humerus and shoulder-joint of the left side, and until the age of ten there was one on the right side. She performed many tricks with her toes (Fig. 110). Caldani speaks of a monster without arms, Davis ^ mentions one, and Smith " describes a boy of four with his upper limbs Breschet has seen a child of nine with only portions of the upper arms and deformity of lower extremities and pelvis. Par6 ^ says that a 536, 1887, i., 116. b 530, 1885, 338. c 757, 1873, 89. d 618, 1018. Fig. 108.— Armless man (after Par*). Fig. 109.— Csesar Ducornet. entirely absent. 266 MINOR TERATA. Fig. 110. — Hindoo armless woman (Curran). he saw in Paris in 1573, at the gate of St. Andrew des Arts, a boy of nine, a native of a small village near Guise, who had no legs and whose left foot was represented by a fleshy body hanging from the trunk ; he had but two fingers hanging on his right hand, and had between his legs what resembled a virile penis. Par6 attributes this anomaly to a de- fault in the quantity of semen. The figure and skeleton of Harvey Leach, called " Hervio Nono," is in the museum of the University- College in London. The pelvis was comparatively weak, the femurs hardly to be recognized, and the right tibia and foot defective ; the left foot was better developed, although far from being in due proportion to the trunk above. He was one of the most remarkable gymnasts of his day, and not- withstanding the distortion of his lower limbs had marvelous power and agility in them. As an arena- horseman, either standing or sitting, he was scarcely excelled. He walked and even ran quite well, and his power of leaping, partly with his feet and partly with his hands, was unusual. His lower limbs were so short that, erect, he touched the floor with his fingers, but he earned his livelihood as much with his lower as with his upper limbs. In his skeleton his left lower limb, between the hip and heel, measured 16 inches, while the right, between the same points, measured nine inches (Fig. 111)." Hare ^ mentions a boy of five and a half whose head and trunk were the same as in any other child of like age. He was 22J inches high, had no spinal curva- ture, but was absolutely devoid of lower extremities. The right arm was two inches long and the lefl; 2\. Each contained the head and a small adjoining por- tion of the humerus. The legs were represented by masses of cellular tissue and fat covered by skin which projected about an inch. He was intelligent, had a good memory, and exhibited considerable activity. He seemed to have had more than usual mobility and power of flexion of the lower lumbar region. When on his back he was unable to rise up, but resting on the lower part of the pelvis he was able to maintain himself erect. He usually picked up objects with his teeth, and could hold a coin in the axilla as he rolled from place to place, a 476, 1864, ii., 60. b 779^ 1858-9, x., 308. Fig. 111. — Harvey Leach. ABSENCE OF THE LIMBS. 267 His rolling was accomplished by a peculiar twisting of the thorax and bend- ing of the pelvis. There was no history of maternal impression during preg- nancy, no injury, and no hereditary disposition to anomalous members. Figure 112 represents a boy with congenital deficiency of the lower extremi- ties, who was exhibited a few years ago in Philadelphia. In Figure 113, wliich represents a similar case in a girl whose photograph is deposited in the Miitter Museum of the College of Physicians, Philadelphia, we see how cleverly the congenital defect may be remedied by mechanical contrivance. With her crutches and artificial legs this girl was said to have moved about easily. Parvin* describes a "turtle-man" as an ectromelian, almost entering the class of phocomelians or seal-like monsters ; the former term sig- nifies abortive or imperfect for- mation of the members. The hands and feet were normally de- veloped, but the arms, forearms, and legs are much shortened (see page 84). The " turtle-woman " of Demerara^ (Fig. 114) was so called because her mother when pregnant was frightened by a turtle, and also from the child's fancied resemblance to a turtle. The femur was six inches long ; the woman had a foot of six bones, four being toes, viz., the first and second phalanges of the first and second toes. She had an acetabulum, capsule, and liga- mentum teres, but no tibia or fibula ; she also had a defective right forearm. She was never the victim of rachitis or like disease, but died of syphilis in the Colonial Hospital. In her twenty-second year she was delivered of a full-grown child free of deformity. There was a woman living in Bavaria, under the observation of Buhl, •= who had congenital absence of both femurs and both fibulas. Almost all the muscles of the thigh existed, and the main attachment to the pelvis was by a large capsular articulation. Charpentier gives the portrait of a woman in whom there was a uniform diminution in the size of the limbs. Debout portrays a young man with almost complete absence of the thigh and leg, '- International Med. Mag. , Phila. , June, 1892. b 476, 1867, ii. , 578. c 368, 1 861, No. 48. jgjijyjj^ T^^P^ ■^^ i^pg^^J^^^j jpHj^ypp^ ^ ^ '^^^^l ^^k j| ^^^m ;1®^^ fl j^^f^^m^- ,i. 1^1 «K» ^^^^^ ^tt**'" At\ ^mHI Bm|SB^^^^\ > t / ^^k ^^^KW - ' ';>'''' '^^1 ^^Hyk P^^^^P'' ■J^Hk ^KtmBm^ij^^ '/ ^X^^kss^ 4;ffi(>, ^^^ / rfff, V -ii^ Fig. 112.— Congenital deficiency of the lower extremities. 268 MINOR TERATA. Fig. 113.— Congenital delieiency of the lower extremities with, remedial apparatus. Fig, 114.— The "turtle-woman Fig. 115. — Defective development of the right leg (Debout). SUPERNUMERARY LIMBS. 269 from whose right hip there depended a foot (Fig. 115). Accrell •'' describes a peasant of twenty-six, born without a hip, thigh, or leg on the right side. The external genital organs were in their usual place, but there was only one testicle in the scrotum. The man was virile. The rectum instead of open- ing outward and underneath was deflected to the right. Supernumerary Limbs. — Haller reports several cases of supernumerary extremities. Plancus'' speaks of an infant with a complete third leg, and Dumeril " cites a similar instance. GeofiFroy-Saint-Hilaire presented to the Academic des Sciences in 1830 a child with four legs and feet who was in good health. Amman saw a girl with a large thigh attached to her nates. Below the thigh was a single leg made by the fusion of two legs. No patella was found and the knee was anchylosed. One of the feet of the supernu- Fig. 116. — Gustav Evrard (after Gufirin). Fig. 117. — Eight-limbed monster (after Pare). merary limb had six toes, while the other, which was merely an outgrowth, had two toes on it. According to Jules Gu6rin, the child named Gustav Evrard was born with a thigh ending in two legs and two imperfect feet depending from the left nates (Fig. 116). Tucker'' describes a baby born in the Sloane Maternity in New York, October 1, 1894, who had a third leg hanging from a bony and fleshy union attached to the dorsal spine. The supernumerary leg was well formed and had a left foot attached to it. Larkin and Jones ^mention the removal of a meningocele and a supernumerary limb from an infant of four months. This a Med. Chirurg., Anat. Cases, London, 1758, 8°. b De monstris, etc., Venetii.s, 1749. = Bull, de la soc. philom., iii., 3. d 125, Jan., 1895. e 224, 1889, ii., 310. 270 MINOR TERATA. limb contained three fingers only, one of which did not have a bony skeleton. Par6 " says that on the day the Venetians and the Genevois made peace a monster was born in Italy which had four legs of equal proportions, and besides had two supernumerary arms from the elbows of the normal limbs. This creature lived and was baptized (Fig. 117). Anomalies of the Feet. — Hatte ^ has seen a woman who bore a child that had three feet. Bull " gives a description of a female infant with the left foot double or cloven. There was only one heel, but the anterior portion consisted of an anterior and a pos- terior- part. The anterior foot pre- sented a great toe and four smaller ones, but deformed like an example of talipes equinovarus. Contin- uous with the outer edge of the anterior part and curving beneath it was a posterior part, looking not unlike a second foot, containing Fig. 118.— Double foot (Bull). Fig. 119. -Examples of " Sirens," showing fusion of the- lower extremities. six well-formed toes situated directly beneath the other five. The eleven toes were all perfect and none of them were webbed ("Fig. 118). There is a class of monsters called " Sirens " on account of their resem- blance to the fabulous creatures of mythology of that name. Under the influence of compression exercised in the uterus during the early period of gestation fusion of the inferior extremities is effected. The accompanying illustration shows the appearance of these monsters (Fig. 119), which are thought to resemble the enchantresses celebrated by Homer. Anomalies of the Hand.— Blumenbach speaks of an officer who, having » 618, 1017. b 462, T. ii., 229. c 218, 1875, xciii., 1293. ABSENCE OF DIGITS. 271 lost his right hand, was subsequently presented by his wife with infants of both sexes showing the same deformity. Murray ^ cites the instance of a woman of thirty-eight, well developed, healthy, and the mother of normal children, who had a double hand. The left arm was ab- normal, the flexion of the elbow imperfect, and the forearm ter- minated in a double hand with only rudimentary thumbs. In working as a charwoman she leaned on the back of the flexed carpus. The double hand could grasp firmly, though the maximum power Avas not so •great as that of the right hand. Sensation was equally acute in all three of the hands. The middle and ring fingers of the supernumerary hand were web- bed as far as the proximal joints, and the movements of this hand were stiff" and imperfect. No single finger of the two hands could be extended while the other seven were flexed (Fig. 120). Giraldes saw an infant in 1864 with somewhat the same deformity, but in which the disposition of the muscles and tendons permitted the ordinary movements (Fig. 121). Absence of IMgits. — Maygrier'' describes a woman of twenty-four who instead of having a hand on each arm had only one finger, and each foot had but two toes. She was delivered of two female children in 1827 and one in 1829, each having exactly the same deformities. Her mother was perfectly formed, but the father had but one toe on his foot and one finger on his left hand. Kohler " gives photographs of quite a remarkable case of suppression and deformity of the digits of both the fingers and toes (Fig. 122). Figure 123 shows a man who was recently exhibited in Philadelphia. He had but two fingers on each hand and two toes on each foot, and resembles Kohler's case in the anomalous digital conformation. Figure 124 represents an exhibitionist with congenital suppression of four digits on each hand. Fig. 120. — Double hand (Murray). Fig. 121.— Double hand (GiraiaSs). " 650, 1861-4, iv., 163 ; also 550, xlvi. •> Essai sur les monstres humaines, Diss. Inaug. 199, March 6, 1893. 272 MINOR TERATA. Fig. 122. — Suppression and deformity of digits (Kohler). Fig. 123, — SuppressioD of digits Fig. 124.— Suppression of digits. SUPERNUMERARY DIGITS. 273 Tubby" has seen a boy of three in whom the first, second, and third toes of each foot were suppressed, the great toe and the little toe being so over- grown that they could be opposed. In this family for four generations 15 indi- viduals out of 22 presented this defect of the lower extremity. The patient's brothers and a sister had exactly the same deformity, which has been called " lobster-olaw foot." Falla of Jedburgh speaks of an infant who was born without forearms or hands ; at the elbow there was a single finger attached by a thin string of tissue. This was the sixth child, and it presented no other deformity. Falla also says that instances of intrauterine digital amputation are occasionally seen. According to Annandale, supernumerary digits may be classified as follows : — (1) A deficient organ, loosely attached by a narrow pedicle to the hand or foot (or to another digit). (2) A more or less developed organ, free at its extremity, and articu- lating with the head or sides of a metacarpal, metatarsal, or phalangeal bone. (3) A fully developed separate digit. (4) A digit intimately united along its whole length with another digit, and having either an additional metacarpal or metatarsal bone of its own, or articulating with the head of one which is common to it and another digit. Superstitions relative to supernumerary fingers have long been prevalent. In the days of the ancient Chaldeans it was for those of royal birth especially that divinations relative to extra digits were cast. Among the ancients we also occasionally see illustrations emblematic of wisdom in an individual with many fingers, or rather double hands, on each arm. Hutchinson,'' in his comments on a short-limbed, polydactylous dwarf (Fig. 125) which was dissected by Ruysch, the celebrated Amsterdam anat- omist, writes as follows : — "This quaint figure is copied from Theodore Kerckring's 'Spici- legium Anatomicum,' published in Amsterdam in 1670. The description states that the body was that of an infant found drowned in the river on October 16, 1668. It was dissected by the renowned Ruysch. A detailed description of the skeleton is given. My reason for now reproducing the plate is that it offers an important item of evidence in reference to the develop- ment of short-limbed dwarfs. Although we must not place too much reliance on the accuracy of the draughtsman, since he has figured some superfluous lumbar vertebrae, yet there can be no doubt that the limbs are much too short for the trunk and head. This remark especially applies to the lower limbs and pelvis. These are exactly like those of the Norwich dwarf and of the skeleton in the Heidelberg Museum which I described in a recent number of the ' Archives.' The point of extreme interest in the present case a 476, Feb. 17, 1894. l" 166, April, 1893. 18 274 MINOR TERATA. is that this dwarfing of the limbs is associated with polydactylism. Both the hands have seven digits. The right foot has eight and the left nine. The conditions are not exactly symmetrical, since in some instances a metacarpal or metatarsal bone is wanting ; or, to put it otherwise, two are welded together. It will be seen that the upper extremities are so short that the tips of the digits will only just touch the iliac crests. " This occurrence of short limbs with polydactylism seems to prove conclusively that the condition may be due to a modi- fication of development of a totally different nature from rickets. It is probable that the infant was not at full term. Among the points which the author has noticed in his description are that the fontanelle was double its usual size ; that the orbits were somewhat deformed ; that the two halves of the lower jaw were already united ; and that the ribs were short and badly formed. He also,. of course, draws attention to the shortness of the limbs, the stoutness of the long bones, and the supernumerary digits. I find no statement that the skeleton was deposited in any museum, but it is very pos- sible that it is still in existence in Amster- dam, and if so it is very desirable that it should be more exactly described." In Figure 126, A represents division of thumb after Guyot-Daub§s, B shows a typical case of supernumerary fingers, / ^ \ ^ and C pictures Morand's case of duplication of several toes. Forster gives a sketch of a hand with nine fin- gers and a foot with nine toes. Voight records an instance of 13 fingers on each hand and 12 toes on each foot. Saviard saw an infant at the Hotel-Dieu in Paris in 1687 which had 40 digits, ten on each member. Annandale relates the history of a woman who had six fingers and two thumbs on each hand, and another who had eight toes on one foot. Fig. 125. — Skeleton of a short-limbed, polydactylous dwarf. Fig. 126. — Supernumerary fingers and toes. SUPERNUMERARY DIGITS. 275 Meckel tells of a case in which a man had 12 fingers and 12 toes, all well formed, and whose children and grandchildren inherited the deformity. Mason ^ has seen nine toes on the left foot. There is recorded^ the account of a child who had 12 toes and six fingers on each hand, one fractured. Braid" describes talipes varus in a child of a few months who had ten toes. There is also on record ^ a collection of cases of from seven to ten fingers on each hand and from seven to ten toes on each foot. Scherer " gives an illus- tration of a female infant, otherwise normally formed, with seven fingers on each hand, all united and bearing claw-like nails. On each foot there was a double halux and five other digits, some of which were webbed. The influence of heredity on this anomaly is well demonstrated. E6au- mur was one of the first to prove this, as shown by the Kelleia family of Malta, and there have been many corroboratory instances reported ; it is shown to last for three, four, and even five generations ; intermarriage with normal persons finally eradicates it. It is particularly in places where consanguineous marriages are prevalent that supernumerary digits persist in a family. The family of Foldi in the tribe of Hyabites living in Arabia are very numerous and confine their marriages to their tribe. They all have 24 digits, and infants born with the normal number are sacrificed as being the offspring of adultery. The inhab- itants of the village of Eycaux in France, at the end of the last century, had nearly all supernumerary digits either on the hands or feet. Being isolated in an inaccessible and mountainous region, they had for many years intermarried and thus perpetuated the anomaly. Communication being opened, they emigrated or married strangers and the sexdigitism vanished. Mauper- tuis recalls the history of a family living in Berlin whose members had 24 digits for many generations. One of them being presented with a normal infant refused to acknowledge it. There is an instance in the Western United States^ in which supernumerary digits have lasted through five generations. Cameron s speaks of two children in the same family who were polydactylic, though not having the same number of supernumerary fingers. Smith and Norwell '' report the case of a boy of fifteen both of whose hands showed webbing of the middle and ring fingers and accessory nodules of bone between the metacarpals, and six toes on each foot. The boy's father showed similar malformations, and in five generations 21 out of 28 individ- uals were thus malformed, ten females and 11 males. The deformity was especially transmitted in the female line. Instances of supernumerary thumbs are cited by Panaroli,' Ephem- erides, Munconys, as well as in numerous journals since. This anomaly is a 705, 1879, n. s., ix., 37-42. b 476, 1832, ii., 673. o 225, 1848, i., 339. 4 562,1870. e ArcHvf. Kinderheilk., xvii., 1894, 244. f 130, No. 16. g Montreal Med. Jour., Dec, 1894. ^ 224, July 7, 1894. i 617, ill., obs. 48. 276 MINOR TERATA. not confined to man alone ; apes, dogs, and other lower animals possess it. Bucephalus, the celebrated horse of Alexander, and the horse of Csesar were said to have been cloven-hoofed. Hypertrophy of the digits is the result of many different processes, and true hypertrophy or gigantism must be differentiated from acromegaly, elephantiasis, leontiasis, and arthritis deformans, for which distinction the reader is referred to an article by Park.^ Park also calls attention to the difference between acquired gigantism, particularly of the finger and toes, and another condition of congenital gigantism, in which either after or before birth' there is a relatively disproportionate, sometimes enormous, overgrowth of perhaps one finger or two, perhaps of a limited portion of a hand or foot, or possibly of a part of one of the limbs. The best collection of this kind of specimens is in the College of Sur- geons in London. Curling** quotes a most peculiar instance of hypertrophy of the fingers in a sickly girl (Fig. 127). The mid- dle and ring fingers of the right hand were of unusual size, the middle fin- ger measuring 5 J inches in length and four inches in circumference. On the left hand the thumb and middle fin- gers were hypertrophied and the in- dex finger was as long as the middle one of the right hand. The middle finger had a lateral curvature out- ward, due to a displacement of the extensor tendon. This affection re- sembled acromegaly. Curling cites similar cases, one in a Spanish gentle- man, Governor of Luzon, in the Philippine Islands, in 1850, who had an extraordinary middle finger, which he concealed by carrying it in the breast of his coat. Hutchinson "19 exhibited a photograph showing the absence of the radius and thumb, with shortening of the forearm. Conditions more or less approaching this had occurred in several members of the same family. In some they were associated with defects of development in the lower extremi- ties also. The varieties of club-foot — talipes varus, valgus, equinus, equino-varus, etc. — are so well known that they will be passed with mention only of a few persons who have been noted for their activity despite their deformity. Tyrt^e, Parini, Byron, and Scott are among the poets who were club-footed; -- Inter. Med. Mag., Phila., July, 1895. b 550, 1845, xxviil., 623. ^■vr^ Fig. 127. — Hypertrophied fingers. HUMAN TAILS. 277 some writers say that Shakespeare suffered in a slight degree from this de- formity. Agesilas, Gens6rie, Eobert II., Duke of Normandy, Henry II., Emperor of the West, Otto II., Duke of Brunswick, Charles II., King of Naples, and Tamerlane were victims of deformed feet. Mile. Vallifei-e, the mistress of Louis XIV., was supposed to have both club-foot and hip-disease. Genu valgum and genu varum are ordinary deformities and quite common in all classes. Transpositions of the character of the vertebrje are sometimes seen. In man the lumbar vertebrsB have sometimes assumed the character of the sacral vertebrae, the sacral vertebrse presenting the aspect of lumbar vertebree, etc. It is quite common to see the first lumbar vertebra presenting certain characteristics of the dorsal. Numerical anomalies of the vertebrae are quite common, generally in the lumbar and dorsal regions, being quite rare in the cervical, although there have been instances of six or eight cervical vertebrse. In the lower animals the vertebrse are prolonged into a tail, which, however, is sometimes absent, particularly when hereditary influence exists. It has been noticed in the class of dogs whose tails are habitually amputated to improve their appearance that the tail gradually decreases in length. Some breeders deny this fact. Human Tails. — The prolongation of the coccyx sometimes takes the shape of a caudal extremity in man. Broca and others claim that the sacrum and the coccyx represent the normal tail of man, but examples are not infrequent in which there has been a fleshy or bony tail appended to the coccygeal region. Traditions of tailed men are old and widespread, and tailed races were supposed to reside in almost every country. There was at one time an ancient belief that all Cornishmen had tails, and certain men of Kent were said to have been afflicted with tails in retribution for their insults to Thomas a Becket. Struys, a Dutch traveler in Formosa in the seventeenth century, describes a wild man caught and tied for execution who had a tail more than a foot long, which was covered with red hair like that of a cow. The Niam Niams of Central Africa are reported to have tails smooth and hairy and from two to ten inches long. Hubsch of Constantinople remarks that both men and women of this tribe have tails. Carpus, or Berengarius Carpensis, as he is called, in one of his Commentaries said that there were some people in Hibernia with long tails, but whether they were fleshy or cartilaginous could not be known, as the people could not be approached. Certain supposed tailed races which have been described by sea-captains and voyagers are really only examples of people who wear artificial appendages about the waists, such as palm-leaves and hair. A certain Wesleyan mission- ary, George Brown, in 1876 spoke of a formal breeding of a tailed race in Kali, off the coast of New Britain. Tailless children were slain at once, as they would be exposed to public ridicule. The tailed men of Borneo are 278 MINOR TERATA. people afflicted with hereditary malformation analogous to sexdigitism. A tailed race of princes have ruled Eajoopootana, and are fond of their ances- tral mark.^^* There are fabulous stories told of canoes in the East Indies which have holes in their benches made for the tails of the rowers. At one time in the East the presence of tails was taken as a sign of brute force. There was reported from Caracas" the discovery of a tribe of Indians in Paraguay who were provided with tails. The narrative reads somewhat after this manner : One day a number of workmen belonging to Tacura Tuyn while engaged in cutting grass had their mules attacked by some Guayacuyan In- dians. The workmen pursued the Indians but only succeeded in capturing a boy of eight. He was taken to the house of Seiior Francisco Galeochoa, at Posedas, and was there discovered to have a tail ten inches long. On inter- rogation the boy stated that he had a brother who had a tail as long as his own, and that all the tribe had tails. Aetius, Bartholinus, Falk, Harvey, Kolping, Hesse, Paulinus, Strauss, and Wolff give descriptions of tails. Blanchard ^'^ says he saw a tail fully a span in length ; and there is a description in 1690 of a man by the name of Emanuel Konig, a son of a doctor of laws,^™ who had a tail half a span long, which grew directly downward from the coccyx and was coiled on the perineum, causing much discomfort. Jacob'' describes a pouch of skin resembling a tail which hung from the tip of the coccyx to the length of six inches. It was removed and was found to be thicker than the thumb, consisted of distinctly jointed portions with synovial capsules. Gosselin saw at his clinic a caudal appendix in an infant which measured about ten cm. (Fig. 128). Lissner says that in 1872 he assisted in the delivery of a young girl who had a tail consisting of a coccyx prolonged and covered with skin, and in 1884 he saw the same girl, at this time the tail measuring nearly 13 cm. Virchow received for examination a tail three inches long amputated from a boy of eight weeks. Ornstein, chief physician of the Greek army, describes a Greek of twenty-six who had a hairless, conical tail, free only at the tip, two inches long and containing three vertebrae. He also remarks that other instances have been observed in recruits. Thirk of Broussa in 1820 de- scribed the tail of a Kurd of twenty-two which contained four vertebrae. Belinovski " gives an account of a hip-joint amputation and extirpation of a fatty caudal extremity, the only one he had ever observed. Before the Berlin Anthropological Society there were presented two adult male Papuans, in good health and spirits, who had been brought from New a 476, 1885, ii., 452. l'3i],1827. c 270, 1892. Fig. 128.— Caudal appendix obserred in a child in the clinic of M, Gosselin. HUMAN TAILS. 279 Guinea ; their coccygeal bones projected 1 J inches. Oliver Wendell Holmes in the Atlantic Monthly, June, 1890, says that he saw in London a photo- graph of a boy with a considerable tail. The " Moi Boy " was a lad of twelve, who was found in Cochin China, with a tail a foot long which was simply a mass of flesh. Miller " tells of a West Point student who had an elongation of the coccyx, forming a protuberance which bulged very visibly under the skin. Exercise at the riding school always gave him great dis- tress, and the protuberance would often chafe until the skin was broken, the blood trickling into his boots. Bartels'' presents a very complete article in which he describes 21 per- sons born with tails, most of the tails being merely fleshy protuberances. Darwin ^^^ speaks of a person with a fleshy tail and refers to a French arti- cle on human tails." Science ^ contains a description of a negro child born near Louisville, eight weeks old, with a pedunculated tail 2 J inches long, with a base \\ inches in circumference. The tail resembled in shape a pig's tail and had grown \ inch since birth. It showed no signs of cartilage or bone, and had its origin from a point slightly to the left of the median line and about an inch above the end of the spinal column. Dickinson " recently reported the birth of a child with a tail (Fig. 129). It was a well-developed female between 5J and six pounds in weight. The coccyx was covered with the skin on both the anterior and posterior surfaces. It thus formed a tail of the size of the nail of the little finger, with a length of nearly ^ inch on the inner surface and f inch on the rear surface. This little tip could be raised from the body and it slowly sank back. In addition to the familiar caudal projection of the human fetus, Dickin- son mentions a group of other vestigial remains of a former state of things. Briefly these are : — (1) The plica semilunaris as a vestige of the nictitating membrane of certain birds. (2) The pointed ear, or the turned-down tip of the ears of many men. (3) The atrophied muscles, such as those that move the ear, that are well developed in certain people, or that shift the scalp, resembling the action of a horse in ridding itself of flies. (4) The supracoridyloid foramen of the humerus. (5) The vermiform appendix. (6) The location and direction of the hair on the trunk and limbs. (7) The dwindling wisdom-teeth. (8) The feet of the fetus strongly deflected inward, as in the apes, and persisting in the early months of life, together with great mobility and a dis- tinct projection of the great toe at an angle from the side of the foot. a 545, 1881, 165. b 157, 1880. <= 669, 1867-8, p. 625. d 727, June 6, 1884. « 227, viii. , 568, 1894. 280 MINOR TERATA. (9) The remarkable grasping power of the hand at birth and for a few weeks thereafter, that permits young babies to suspend their whole weight on a cane for a period varying from half a minute to two minutes. Horrocks '^ ascribes to these anal tags a pathologic importance. He claims that they may be productive of fistula in ano, superficial ulcerations, fecal con- cretions, fissure in ano, and that they may hypertrophy and set up tenesmus and other troubles. The presence of human tails has given rise to discussion between friends and opponents of the Darwinian theory. By some it is outline of raised coccyx. Fig. 129.— Skin-covered coccyx forming a rudimentary tail in a female child at birth: C, coccyx; A, anus (Dickinson). considered a reversion to the lower species, while others deny this and claim it to be simply a pathologic appendix. Anomalies of the Spinal Canal and Contents. — When there is a default in the spinal column, the vice of conformation is called spina bifida. This is of two classes : first, a simple opening in the vertebral canal, and, second, a large cleft sufficient to allow the egress of spinal membranes and substance. Figure 130 represents a large congenital sacral tumor. Achard ^ speaks of partial duplication of the central canal of the spinal cord. De Cecco " reports a singular case of duplication of the lumbar seg- » Quar. Med. Jour., July, 1894. ^ 242, 1888, 922. ^ Morgagni, Napoli, 1857, i., 307. CURVATURES OF THE SPINE. 281 Fig. 130. -Sacral tu- mor (Mutter Mus., Col. of Phys.). ment of the spinal cord. Wagner speaks of duplication of a portion of the spinal cord. Foot '^ records a case of amyelia, or absence of the spinal cord, in a fetus with hernia cerebri and complete fissure of the spinal column. NicoU and Arnold "" describe an anencephalous fetus with absence of spinal marrow ; and Smith also records the birth of an amyelitic fetus." In some persons there are exaggerated curvatures of the spine. The first of these curvatures is called kyphosis, in which the curvature is posterior ; second, lor- dosis, in which the curvature is anterior ; third, scoliosis, in which it is lateral, to the right or left. Kyphosis is the most common of the deviations in man and is most often found in the dorsal region, although it may be in the lumbar region. Congenital kyphosis is very rare in man, is generally seen in monsters, and when it does exist is usually accompanied by lordosis or spina bifida. We sometimes observe a condition of anterior curvature of the lumbar and sacral regions, which might be taken for a congenital lordosis, but this is really a deformity produced after birth by the physiologic weight of the body. Figure 131 represents a case of lordosis caused by paralysis of the spinal muscles. Analogous to this is what the accoucheurs call spondy- lolisthesis. Scoliosis may be a cervicodorsal, dorso- lumbar, or lumbosacral curve, and the inclination of the vertebral column may be to the right or left (Figs. 132 and 133). The pathologists divide scoliosis into a myo- pathic variety, in which the trouble is a physiologic an- tagonism of the muscles ; or osteopathic, ordinarily asso- ciated with rachitis, which latter variety is generally accountable for congenital scoliosis. In some cases the diameter of the chest is shortened to an almost incredible degree, but may yet be compatible with life. Glover "^ speaks of an extraordinary deformity of the chest with lateral curvature of the spine, in which the diameter from the pit of the stomach to the spinal integument was only 5 J inches. Supernumerary ribs are not at all uncommon in man, nearly every medical museum having some examples. Cervical ribs are not rare. Gordon ^ describes a young man of seventeen Fig. 131. — Lordosis, — paralysis of spinal muscle (Hirst). a 536, Dublin, 1865, xi., 435. \ d 476, 1857, i., 263. \ b 124, xxii., 253. -^ 476, 1848, ii., 400. e 355, Oct. 15, 1894. 282 MINOR TERATA. in whom there was a pair of supernumerary ribs attached to the cervical vertebrae. Bernhardt " mentions an instance in which cervical ribs caused motor and sensory disturbances. Dumerin of Lyons showed an infant of eight days which had an arrested development of the 2d, 3d, 4th, and 5th ribs. Cases of deficient ribs are occasionally met. Wistar in 1818 gives an account of a person in whom one side of the thorax was at rest while the other performed the movements of breathing in the usual manner. In some cases we see fissure of the sternum, caused either by deficient union or absence of one of its constituent parts. In the most exaggerated cases these fissures permit the exit of the heart, and as a general rule ecto- Fig. 132.— Non-rachitic scoliosis (Charpentier). Fig. 133.— Same woman, back view (Charpentier). pies of the heart are thus caused. Pavy '' has given a most remarkable case of sternal fissure in a young man of twenty-five, a native of Hamburg. He exhibited himself in one medical clinic after another all over Europe, and was always viewed with the greatest interest. In the median line, corre- sponding to the absence of sternum, was a longitudinal groove bounded on either side by a continuous hard ridge which articulated with the costal carti- lages. The skin passed naturally over the chest from one side to another, but was raised at one part of the groove by a pulsatile swelling which occu- pied the position of the right auricle. The clavicle and the two margins of the sternum had no connections whatever, and below the groove was a hard =• 199, 1894. b548, 1857, ii., 522. FISSUBE OF THE STERNUM. 283 substance corresponding to the ensiform cartilage, which, however, was very elastic, and allowed the patient, under the influence of the pectoral muscles, when the upper extremity was fixed, to open the groove to nearly the extent of three inches, which was more than twice its natural width. By approxi- mating his arms he made the ends of his clavicles overlap. When he coughed, the right lung suddenly protruded from the chest through the groove and ascended a considerable distance above the clavicle into the neck. Between the clavicles another pulsatile swelling was easily felt but hardly seen, which was doubtless the arch of the aorta, as by putting the fingers on it one could feel a double shock, synchronous with distention and recoil of a vessel or opening and closing of the semilunar valves. Madden » pictures (Figs. 134 and 135) a Swede of forty with congenital Fig. 134.— Congenital fissure of sternum (Madden). Fig. 135. -^Congenital fissure of the sternum. absence of osseous structure in the middle line of the sternum, leaving a fis- sure 5-| X 1|- X 2 inches, the longest diameter being vertical. Madden also mentions several analogous instances on record. Groux's case was in a person of forty-five, and the fissure had the vertical length of four inches. Hodgen ** of St. Louis reports a case in which there was exstrophy of the heart through the fissure. Slocum " reports the occurrence of a sternal fissure 3 X 1|- inches in an Irishman of twenty-five. Madden also cites the case of Abbott in an adult negress and a mother. Obermeier mentions several cases.'* Gibson and Malet " describe a presternal fissure uncovering the base of the heart. Ziemssen, Wrany, and Williams also record congenital fissures of the sternum. a 597, 1885, 406. d 161, 1869, xlvi., 209. b 133, Oct., 1878. c 768, 1860, iii., 310. e 451, xiv., 1. 284 MINOR TERATA. Thomson" has collected 86 cases of thoracic defects and summarizes his paper by saying that the structures deficient are generally the hair in the mammary and axillary regions, the subcutaneous fat over the muscles, nip- ples, and breasts, the pectorals and adjacent muscles, the costal cartilages and anterior ends of ribs, the hand and forearm ; he also adds that there may be a hernia of the lung, not hereditary, but probably due to the pressure of the arm against the chest. De Marque ^"^ gives a curious instance in which the chin and chest were congenitally fastened together. Muirhead ^ cites an instance in which a firm, broad strip of cartilage resembling sternomastoid extended from below the left ear to the left upper corner of the sternum, being entirely separate from the jaw. Some preliminary knowledge of embryology is essential to understand the formation of branchial fissures, and we refer the reader to any of the standard works on embryology for this information. Dzondi was one of the first to recognize and classify congenital fistulas of the neck. The proper classification is into lateral and median fissures. In a case studied by F6v- rier'= the exploration of a lateral pharyngeal fistula produced by the intro- duction of the sound violent reflex phenomena, such as pallor of the face and irregular, violent beating of the heart. The rarest of the lateral class is the preauricular fissure, which has been observed by F4vrier, Le Dentu, Marchand, Peyrot, and Routier. The median congenital fissures of the neck are probably caused by defec- tive union of the branchial arches, although Arndt thinks that he sees in these median fistulas a persistence of the hypobranchial furrow which exists normally in the amphioxus. They are less frequent than the preceding variety. The most typical form of malf orEQation of the esophagus is imperfora- tion or obliteration. Van Cuyck of Brussels in 1824 delivered a child which died on the third day from malnutrition. Postmortem it was found that the inferior extremity of the esophagus to the extent of about two inches was converted into a ligamentous cord. Porro * describes a case of con- genital obliteration of the esophagus which ended in a cecal pouch about one inch below the inferior portion of the glottidean aperture and from this point to the stomach only measured an inch ; there was also tracheal com- munication. The child was noticed to take to the breast with avidity, but after a little suckling it would cough, become livid, and reject most of the milk through the nose, in this way almost suffocating at each paroxysm ; it died on the third day. In some cases the esophagus is divided, one portion opening into the bronchial or other thoracic organs. Brentano" describes an infant dying ten days after birth whose esophagus was divided into two portions, one a 759, Jan., 1855. / b 224, 1887, 177, Society de Chirurgie, 1892. d 151, 1871. / e 242 1894. ANOMALIES OF THE LUNGS. 285 terminating in a culdesac, the other opening into the bronchi ; the left kidney was also displaced downward. Blasius^" describes an anomalous case of duplication of the esophagus. Grashuys, and subsequently Vicq d'Azir, saw a dilatation of the esophagus resembling the crop of a bird. Anomalies of the Lungs. — Carper describes a fetus of thirty-seven weeks in whose thorax he found a very voluminous thymus gland but no lungs. These organs were simply represented by two little oval bodies hav- ing no lobes, with the color of the tissue of the liver. The heart had only one cavity but all the other organs were perfectly formed. This case seems to be unique. Tichomiroif '^ records the case of a woman of twenty-four who died of pneumonia in whom the left lung was entirely missing. No traces of a left bronchus existed. The subject was very poorly developed physically. Tichomiroff finds four other cases in literature, in all of which the left lung was absent. Theremin and Tyson record cases of the absence of the left lung. Supplementary pulmonary lobes are occasionally seen in man and are taken by some authorities to be examples of retrogressive anomalies tending to prove that the derivation of the human race is from the quadrupeds which show analo- gous pulmonary malformation. Eckley'' reports an instance of supernumerary lobe of the right lung in close connection with the vena azygos major (Fig. 136). Collins " mentions a similar case instances of four lobes in the right lung, description of a lung with six lobes. Anomalies of the Diaphragm. — Diemerbroeck is said to have dissected a human subject in whom the diaphragm and mediastinum were apparently missing, but such cases must be very rare, although we frequently find marked deficiency of this organ. Bouchaud ^ reports an instance of absence of the right half of the diaphragm in an infant born at term. Lawrence ^ mentions con- genital deficiency of the muscular fibers of the left half of the diaphragm with Fig. 136.— Supernumerary lung: 1, upper lobe of right lung; 2, middle or cuneate lobe; 3, lower lobe; 4, super- numerary lobe; 5, vena azygos major; 6, descending vena cava ; 7, phrenic nerve (Eckley). Bonnet and Edwards speak of Testut and Marcondes ** report a a Inter-Monatschr. f. Anat. u. Physiol., 1895. *> Chicago M. Times, June, 1895. o 310, Iviii., 252. d Gaz. hebd. d. sc. med. de Bordeaux, 1880, i., 1045. e 242, xxxviii., 344. \, f 476, 1852, it., 327. 286 MINOR TERATA. displacement of the stomach. The patient died of double pneumonia. Car- ruthers, McClintock, Polaillon, and van Geison also record instances of con- genital deficiency of part of the diaphragm. Recently Dittel* reported unilateral defect in the diaphragm of an infant that died soon after birth. The stomach, small intestines, and part of the large omentum lay in the left pleural cavity ; both the phrenic nerves were normal. Many similar cases of diaphragmatic hernia have been observed. In such cases the opening may be large enough to allow a great part of the visceral constituents to pass into the thorax, sometimes seriously interfering with respiration and circulation by the pressure which ensues. Alderson'' reports a fatal case of diaphragmatic hernia with symptoms of pneumothorax. The stomach, spleen, omentum, and transverse colon were found lying in the left pleura. Berchon " mentions double perforation of the diaphragm with hernia of the epiploon. The most extensive paper on this subject was contributed by Bodwitch,^ who, besides reporting an instance in the Massachusetts General Hospital, gives a numerical analysis of all the cases of this affection found recorded in the writings of medical authors between the years 1610 and 1846. Hillier " speaks of an instance of congenital diaphragmatic hernia in which nearly all the small intestines and two-thirds of the large passed into the right side of the thorax. Macnab ^ reports an instance in which three years after the cure of empyema the whole stomach constituted the hernia. Recently Joly ^ described a congenital hernia of the stomach in a man of thirty- seven, who died from collapse following lymphangitis, persistent vomit- ing, and diarrhea. At the postmortem there was found a defect in the diaphragm on the left side, permitting herniation of the stomach and first part of the duodenum into the left pleural cavity. There was no history of traumatism to account for strangulation. Longworth ^ cites an instance of inversion of the diaphragm in a human subject. Bartholinus ^ mentions coalition of the diaphragm and liver ; and similar cases are spoken of by Morgagni and the Ephemerides. Hoffman ^^ describes diaphragmatic junction with the lung. Anomalies of the Stomach. — The Ephemerides contains the account of a dissection in which the stomach was found wanting, and also speaks of two instances of duplex stomach. Bartholinus,"" Heister, Hufeland, Morgagni, Riolan, and SandifortJ cite examples of duplex stomach. Bonet speaks of a case of vomiting which was caused by a double stomach. Struthers ^ reports two cases in which there were two cavities to the stomach. Struthers also mentions that Morgagni, Home, Monro, Palmer, Larry, Blasius, Hufeland, and Walther also record instances in which there was contraction in the a 261, May 19, 1894. b 476, 1858, ii., 396. c 363, xxxv., 447. ^231, ix. « 476, 1861, i., 301 i f 476, 1878, i., 11. g 342, Jan., 1894. h 274, 1877, xii., 279. / i 190, cent, iv., n. 20. J Observ. anat. path., L. iv., pp. 27, 45. k Month. J./M. Sc, Lond., 1851, xii., 121. / DILATATION OF THE COLON. 287 middle of the stomach, accounting for their instances of duplex stomach, Musser " reports an instance of hour-glass contraction of the stomach. Hart ^ dissected the stomach of a woman of thirty which resembled the stomach of a predaceous bird, with patches of tendon on its surface. The right extremity instead of continuously contracting ended in a culdesac one-half as large as the greater end of the stomach. The duodenum proceeded from the depression marking the lesser arch of the organ midway between the cardiac orifice and the right extremity. Crooks " speaks of a case in which the stomach of an infant terminated in a culdesac. Hernia of the stomach is not uncommon, especially in diaphragmatic or umbilical deficiency. There are many cases on record, some terminating fatally from strangulation or exposure to traumatism. Paterson ^ reports a case of congenital hernia of the stomach into the left portion of the thoracic cavity. It was covered with fat and occupied the whole left half of the thoracic cavity. The spleen, pancreas, and transverse colon were also superior to the diaphragm. Death was caused by a well-defined round perforation at the cardiac curvature the size of a sixpence. Anomalies of the Intestines. — The Ephemerides contains the account of an ex- ample of double cecum, and Alexander " speaks of a double colon, and there are other cases of duplication of the bowel recorded. There is an instance of coalition of the jejunum with the liver,^"* and Treuner^ parallels this case. Aubery, Charrier, Poel- ,,. ,„- ^ ,,, . ^ J ' ' Fig. 137.— Double stomacli. man, and others speak of congenital division of the intestinal canal. Congenital occlusion is quite frequently reported. Dilatation of the colon frequently occurs as a transient affection, and by its action in pushing up the diaphragm may so seriously interfere with the action of the heart and lungs as to occasionally cause heart-failure. Fenwick has mentioned an instance of this nature. According to Osier there is a chronic form of dilatation of the colon in which the gut may reach an enormous size. The coats may be hypertrophied without evidence of any special organic change in the mucosa. The most remarkable instance has been reported by Formad. The patient, known as the "balloon-man," aged twenty-three at the time of his death, had had a distended abdomen from in- fancy. Postmortem the colon was found as large as that of an ox, the cir- cumference ranging from 15 to 30 inches. The weight of the contents Avas 47 pounds. Cases are not uncommon in children. Osier s reports three well- marked cases under his care. Chapman ^ mentions a case in which the liver a 547, 1883-1884, xiv., 331. \ b 311, iv., 326. c 776, 1826, ii., 38. d 381, 1854, ii., 26. e 272, 1880, n. s., iv., 511. ^ 160, Band ii., 90. g 165, 1893. h 224, 1878, i., 566. 288 MINOR TERATA. Fig. 138. — Anus absent ; the rectum ends in the hiadder (after Ball). was displaced by dilatation of the sigmoid flexure. Mya " reports two cases of congenital dilatation and hypertrophy of the colon (megacolon congenito). Hirschsprung, Genersich, Faralli, Walker, and Griffiths all record similar in- stances, and in all these cases the clinical features were obstinate constipation and marked meteorismus. Imperforate Anus. — Cases in which the anus is imperforate or the rectum ends in a blind pouch are occasionally seen. In some instances the rectum is entirely absent, the colon being the termination of the intestinal tract. There are cases on record in which the rectum communicated with the anus solely by a fibromuscular cord. Anorectal atresia is the ordinary imperforation of the anus, in which the rectum terminates in the middle of the sacral cavity. The rectum may be deficient from the superior third of the sacrum, and in this position is quite inacces- sible for operation. A compensatory coalition of the bowel with the bladder or urethra is sometimes present, and in these cases the feces are voided by the urinary passages. Huxham •" mentions the fusion of the rectum and colon with the bladder, and similar instances are reported by Dumas " and Baillie. Zacutus Lusitanus *^^ describes an infant with an imperforate membrane over its anus who voided feces through the urethra for three months. After puncture of the membrane, the discharge came through the natural passage and the child lived ; Morgagni mentions a somewhat similar case in a little girl living in Bologna, and other modern instances have been reported. The rectum may terminate in the vagina (Fig. 139). Masters ^ has seen a child who lived nine days in whom the sigmoid flexure of the colon terminated in the fundus of the bladder. Guinard ^'° pictures a case in which there was communication between the rectum and the bladder. In Figure 140 a represents the rectum ; b the bladder ; c the point of communication ; g shows the cellular tissue of the scrotum. There is a description « of a girl of fourteen, other- wise well constituted and healthy, who had neither external genital organs nor anus. There was a plain dermal covering over the genital and anal region. She ate regularly, but every three days she experienced pain in the umbilicus and much intestinal irritation, followed by severe vomiting of stercoraceous matter ; the pains then ceased and she cleansed her mouth with aromatic washes, remaining well until the following third day. Some of the Fig. 139.— Anus is absent ; rectum ends in the vagina (after Ball). » 747, An. 48, 1894, 215. 4 224, 1862, ii., 555. b 629, u. 422. / c 664, T. iii. e 463, viii. n. 55, p. 288. IMPERFORATE ANUS. 289 urine was evacuated by the mammae. The examiners displayed much desire to see her after puberty to note the disposition of the menstrual flow, but no further observation of her case can be found. Fournier " narrates that he was called by three students, who had been try- ing to deliver a woman for five days. He found a well-constituted woman of twenty-two in horrible agony, who they said had not had a passage of the bowels for eight days, so he prescribed an enema. The student who was directed to give the enema found to his surprise that there was no anus, but by putting his finger in the vagina he could discern the floating end of the rectum, which was full of feces. There was an opening in this suspended rectum about the size of an undistended anus. Lavage was practised by a cannula introduced through the opening, and a great number of cherry stones Fig. 140. — Abnormal junction of the rectum and bladder. agglutinated with feces followed the water, and labor Avas soon terminated. The woman afterward confessed that she was perfectly aware of her deformity, but was ashamed to disclose it before. There was an analogue of this case found by Mercurialis ^ in a child of a Jew called Teutonicus. Gerster " reports a rare form of imperforate anus, with malposition of the left ureter, obliteration of the ostia of both ureters, with consequent hydrone- phrosis of a confluent kidney. There was a minute opening into the bladder, which allowed the passage of meconium through the urethra. Burge "^ men- tions the case of what he calls " sexless child," in which there was an imper- forate anus and no pubic arch ; the ureters discharged upon a tumor the size of a teacup extending from the umbilicus to the pubes. A postmortem examination confirmed the diagnosis of sexless child. a 302, iv., 155. b De morb. pud^., L. 1. <= 597, 1878, xxviii., 516. d 597, 1870, 39. 19 \ 290 MINOR TERATA. The Liver. — The Ephemerides, Frankenau,* von Home, Molinetti, Schenck,^ and others speak of deficient or absent liver. Zacutus Lusitanus "" says that he once found a mass of flesh in place of the liver. Lieutaud ^ is quoted as describing a postmortem examination of an adult who had died of hydropsy, in whom the liver and spleen were entirely missing. The portal vein discharged immediately into the vena cava ; this case is probably unique, as no authentic parallel could be found. Laget ^ reports an instance of supernumerary lobe in the liver. Van Buren^ describes a supernumerary liver. Sometimes there is rotation, real or apparent, caused by transposition of the characteristics of the liver. Handy s mentions such a case. Kirmisson'' reports a singular anomaly of the liver which he calls double displacement by interversion and rota- tion on the vertical axis. Actual displacements of the liver as well as what is known as wandering liver are not uncommon. The operation for floating liver will be spoken of later. Hawkins * reports a case of congenital obliteration of the ductus com- munis choledochus in a male infant which died at the age of four and a half months. Jaundice appeared on the eighth day and lasted through the short life. The hepatic and cystic ducts were pervious and the hepatic duct obliterated. There were signs of hepatic cirrhosis and in addition an inguinal hernia. The Gail-Bladder. — Harle J mentions the case of a man of fifty, in whom he could find no gall-bladder ; Patterson'' has seen a similar instance in a man of twenty-five. Purser ' describes a double gall-bladder. The spleen has been found deficient or wanting by Lebby, Ramsay, and others, but more frequently it is seen doubled. Cabrolius,^*" Morgagni, and others have found two spleens in one subject ; Cheselden and Fallopius report three ; Fantoni mentions four found in one subject ; Guy-Patin has seen five, none as large as the ordinary organ ; HoUerius, Kerckringius, and others have remarked on multiple spleens. There is a possibility that in some of the cases of multiple spleens reported the organ is really single but divided into several lobes. Albrecht ™ mentions a case shown at a meeting of the Vienna Medical Society of a very large number of spleens found in the meso- gastrium, peritoneum, on the mesentery and transverse mesocolon, in Douglas' pouch, etc. There was a spleen "the size of a walnut" in the usual position, with the splenic artery and vein in their normal position. Every one of these spleens had a capsule, was covered by peritoneum, and exhibited the histo- logic appearance of splenic tissue. According to the review of this article, Toldt explains the case by assuming that other parts of the celomic epithelium, a 350, n. 7. b 718, L. iii. c 831, L. ii., obs. 3. d 302, iv., 154. e 242, 1874, 42. i iST. York M. Times, 1853-1854a "i-, 126. g 526, 1850, vi., 204. 11242, 1880, 112. i 476, April 6, 1895.;' j 476, 1856, ii., 304. k 548, 1864, ii., 476. 1 476, 1886, ii., lO'^. ■ m 476, 1895, i., 1346. / TRANSPOSITION OF THE VISCERA. 291 besides that of the mesogastrium, are capable of forming splenic tissue. Jame- son * reports a case of double spleen and kidneys. Bainbrigge ^ mentions a case of supernumerary spleen causing death from the patient being placed in the supine position in consequence of fracture of the thigh. Peevor " men- tions an instance of second spleen. B6clard and Guy-Patin have seen the spleen congenitally misplaced on the right side and the liver on the left ; Borellus and Bartholinus with others have observed misplacement of the spleen. The Pancreas. — Lieutaud has seen the pancreas missing and speaks of * a double pancreatic duct that he found in a man who died from starvation ; Bonet ^'^ speaks of a case similar to this last. There are several cases of complete transposition of the viscera on record. This bizarre anomaly was probably observed first in 1650 by Riolanus, but the most celebrated case was that of Morand in 1660, and M6ry described the instance later which was the subject of the following quatrain : — " La nature, peu sage et sans doute en d^bauche, Plaga le foie au c6t6 gauche, Et de mgme, vice versa, Le coeur h, le droite plaga." Young " cites an example in a woman of eighty-five who died at Ham- mersmith, London. She was found dead in bed, and in a postmortem exami- nation, ordered to discover if possible the cause of death, there was seen complete transposition of the viscera. The heart lay with its base toward the left, its apex toward the right, reaching the lower border of the 4th rib, under the right mamma. The vena cava was on the left side and passed into the pulmonary cavity of the heart, which was also on the left side, the aorta and systemic ventricle being on the right. The left splenic vein was lying on the superior vena cava, the liver under the left ribs, and the spleen on the right side underneath the heart. The esophagus was on the right of the aorta, and the location of the two ends of the stomach was reversed ; the sigmoid flexure was on the right side. Davis ' describes a similar in- stance in a man. Herrick s mentions transposition of viscera in a man of twenty-five. Barbieux ^ cites a case of transposition of viscera in a man who was wounded in a duel. The liver was to the left and the spleen and heart to the right, etc. Albers, Baron, B6clard, Boyer, Bull, Mackensie, Hutchinson, Hunt, Murray, Dareste, Curran, Duchesne, Musser, Sabatier, Shrady, Vulpian, Wilson, and Wehn are among others reporting instances of transposition and inversion of the viscera. " 435, 1874, ix., 11. \ 490, xxxviii., 1052. » 435, 1885, xx., 216. d Hist. Anat. Med., i., 248. e\476, 1861, i., 630. f 476, 1879, i., 789. g 538, July 28, 1894. \ ^ Ann. de la ni6d. physiol.. Par., xiii.,518. 292 MINOR TEE ATA. Congenital extroversion or eventration is the result of some congenital deficiency in the abdominal wall ; instances are not uncommon, and some patients live as long as do cases of umbilical hernia proper. Ramsey* speaks of entire want of development of the abdominal parietes. Robertson, Rizzoli, Tait, Hamilton, Brodie, Denis, Dickie, Goyrand, and many others mention extroversion of viscera from parietal defects. The different forms of hernia will be considered in another chapter. There seem to be no authentic cases of complete absence of the kidney except in the lowest grades of monstrosities. Becker, Blasius, Rhodius, Baillie, Portal, Sandifort, Meckel, Schenck, and StoU are among the older writers who have observed the absence of one kidney. In a recent paper Ballowitz has collected 213 cases, from which the following extract has been made by the British Medical Journal : — " Ballowitz (Virchow's Archiv, August 5, 1895) has collected as far as possible all the recorded cases of congenital absence of one kidney. Exclud- ing cases of fused kidney and of partial atrophy of one kidney, he finds 213 cases of complete absence of one kidney, upon which he bases the following conclusions : Such deficiency occurs almost twice as often in males as in females, a fact, however, which may be partly accounted for by the greater frequency of necropsies on males. As to age, 23 occurred in the fetus or newly born, most having some other congenital deformity, especially imperforate anus ; the rest were about evenly distributed up to seventy- years of age, after which only seven cases occurred. Taking all cases together, the deficiency is more common on the left than on the right side ; but while in males the left kidney is far more commonly absent than the right, in females the two sides show the defect equally. The renal vessels were generally absent, as also the ureter, on the abnormal side (the latter in all except 15 cases); the suprarenal was missing in 31 cases. The solitary kidney was almost always normal in shape and position, but much enlarged. Microscopically the enlargement would seem to be due rather to hyperplasia than to hypertrophy. The bladder, except for absence of the opening of one ureter, was generally normal. In a large number of cases there were associated deformities of the organs of generation, especially of the female organs, and these were almost invariably on the side of the renal defect ; they affected the conducting portion much more than the glandular portion — that is, uterus, vagina, and Fallopian tubes in the female, and vas deferens or vesiculse seminales in the male, rather than the ovaries or testicles. Finally, he points out the practical bearing of the subject — for example, the proba- bility of calculus causing sudden suppression of urine in such cases — and also the danger of surgical interference, and suggests the possibility of diagnosing the condition by ascertaining the, absence of the opening of one ureter in the bladder by means of the cyst^scope, and also the likelihood a Northwest Med. and Surg. Jour., Cihicago, 1857, xiv., 450. / ANOMALIES OF THE KIDNEYS. 293 of its occurring where any abnoi'mality of the genital organs is found, especially if this be unilateral." Green" reports the case of a female child in which the right kidney and right Fallopian tube and ovary were absent without any rudimentary struc- tures in their place. Guit6ras and Riesman**^ have noted the absence of the right kidney, right ureter, and right adrenal in an old woman who had died of chronic nephritis. The left kidney although cirrhotic was very much enlarged. Tompsett^ describes a necropsy made on a coolie child of nearly twelve Fig. 141.— Renal symphysis and supernumerary kidney (Rayer). months, in which it was seen that in the place of a kidney there were two left organs connected at the apices by a prolongation of the cortical substance of each ; the child had died of neglected malarial fever. Sandifort<= speaks of a case of double kidneys and double ureters, and cases of supernume- rary kidney are not uncommon, generally being segmentation of one of the normal kidneys. Rayer has seen three kidneys united and formed like a horseshoe (Fig. 141). We are quite familiar with the ordinary "horse- shoe kidney," in which two 'normal kidneys are connected. a 224, Feb. 23, 1895. \ b224, 1879, ii., 602. c 710, fasc. iii. 294 MINOR TERATA. There are several forms of displacement of the kidneys, the most com- mon being the "floating kidney," which is sometimes successfully re- moved or iixed ; Rayer has made an extensive study of this anomaly. The kidney may be displaced to the pelvis, and Guinard ^^ quotes an instance in which the left kidney was situated in the pelvis, to. the left of the rectum and back of the bladder. The ureter of the left side was very short. The left renal artery came from the bifurcation of the aorta and the primitive iliacs. The right kidney was situated normally, and received from the aorta two arteries, whose volume did not surpass the two arteries supply- ing the left suprarenal capsule, which was in its ordinary place. Displace- ments of the kidney anteriorly are very rare. The ureters have been found multiple ; Griffon " reports the history of a male subject in whom the ureter on the left side was double throughout its whole length ; there were two vesical orifices on the left side one above the other ; and Morestin, in the same journal, mentions ureters double on both sides in a female subject. Molinetti ^''^ speaks of six ureters in one person. Littre in 1705 described a case of coalition of the ureters. Allen'' de- scribes an elongated kidney with two ureters. Coeyne " mentions duplica- tion of the ureters on both sides. Lediberder * reports a case in which the ureter had double origin. Tyson ® cites an instance of four ureters in an infant. Penrose^ mentions the absence of the upper two-thirds of the left ureter, with a small cystic kidney, and there are parallel cases on record. The ureters sometimes have anomalous terminations either in the rectum, vagina, or directly in the urethra. This latter disposition is realized nor- mally in a number of animals and causes the incessant flow of urine, result- ing in a serious inconvenience. Flajani speaks of the termination of the ureters in the pelvis ; Nebel « has seen them appear just beneath the umbil- icus ; and Lieutaud describes a man who died at thirty-five, from another cause, whose ureters, as large as intestines, terminated in the urethral canal, causing him to urinate frequently ; the bladder was absent. In the early part of this century ^ there was a young girl examined in New York whose ureters emptied into a reddish carnosity on the mons veneris. The urine dribbled continuously, and if the child cried or made any exertion it came in jets. The genital organs participated but little in the deformity, and with the exception that the umbilicus was low and the anus more anterior than natural, the child was well formed and its health good. Colzi ' reports a case in which the left ureter opened externally at the left side of the hymen a little below the normal meatus urinarius. There is a case described J of a man who evidently suffered from a patent urachus, as the urine passed in jets a 242, 1894. b 547^ 1873-4, iv., 220. c 242, 1874, xliii., 55. d 242, 1834-5, ix., 187. e 629, Lond., 1731, iil., 146. f 779, xl., 161. g Comment. Acad. Palat., vol. v., n. xii. / t 302 iv. 159. 1 747, May, 1895. j m;4i. de I'Acad. de'chir., vol. xxx. / ANOMALIES OF THE BLADDER. 295 Fig. 142.— Triple bladder (Scibelli). as if controlled by a sphincter from his umbilicus. Littre mentions a patent urachus in a boy of eighteen. Congenital dilatation of the ureters is occa- sionally seen in the new-born. Shattuck " describes a male fetus showing reptilian characters in the sexual ducts. There was ectopia vesicse and pro- lapse of the intestine at the umbilicus ; the right kidney was elongated ; the right vas deferens opened into the ureter. There was persistence in a separate condition of the two Miillerian ducts which opened externally inferior- ly, and there were two ducts near the openings which represented anal pouches. Both testicles were in the abdomen. Ord* describes a man in whom one of the Miillerian ducts was persistent. Anomalies of the Bladder. — Blanchard, Blasius, Haller, Nebel, and Rhodius mention cases in which the bladder has been found absent and we have already mentioned some cases, but the instances in which the bladder has been duplex are much more frequent. Bourienne, Oberteuffer, Ruysch, Bartholinus, Morgagni, and Franck speak of vesical duplication. There is a description'' of a man who had two blad- ders, each receiving a ureter. Bussiere* de- scribes a triple bladder, and Scibelli of Naples® mentions an instance in a subject who died at fifty-seven with symptoms of re- tention of urine. In the illustration (Fig. 142), B represents the normal bladder, A and C the supplementary bladders, with D and E their respective points of entrance into B. As will be noticed, the ureters terminate in the supplementary bladders. Fantoni^^'^ and Malgetti cite instances of quintuple blad- ders. The Ephemerides speaks of a case of coalition of the bladder with the os pubis and another case of coalition with the omentum. Prochaska ^^^ men- tions vesical fusion with the uterus, and we have already described union with the rectum and intestine. Exstrophy of the bladder is not rare, and is often associated with hypo- » Jour, of Path, and Bacter., \uly, 1895- ''491, 1880, 109. c Jour, de Trevoux, 1702. \ ^629, n. 268. « 222, 1864, ii., 328. Fig. 143.— Dilatation of the fetal bladder. 296 MINOR TEE ATA. spadias, epispadias, and other malformations of the genitourinary tract. It consists of a deficiency of the abdominal wall in the hypogastric region, in which is seen the denuded bladder. It is remedied by many different and ingenious plastic operations. In an occasional instance in which there is occlusion at the umbilicus and again at the neck of the bladder this organ becomes so distended' as to produce a most curious deformity in the fetus. Figure 143 shows such a case. The Heart. — Absence of the heart has never been recorded in human beings except in the case of monsters, as, for example, the omphalosites, although there was a case reported and firmly believed by the ancient authors, — a Roman soldier in whom Telasius said he could discover no vestige of a heart." The absence of one ventricle has been recorded. Schenck ^ has seen the left ventricle deficient, and the Ephemerides, Behr, and Kerckring" speak of a single ventricle only in the heart. Riolan^*^ mentions a heart in which both ventricles were absent. Jurgens reported in Berlin, February 1, 1882, an autopsy on a child who had lived some days after birth, in which the left ventricle of the heart was found completely absent. Playfair * showed the heart of a child which had lived nine months in which one ventricle was absent. In King's College Hospital in London there is a heart of a boy of thirteen in which the cavities consist of a single ventricle and a single auricle. Duplication of the heart, notwithstanding the number of cases reported, has been admitted with the greatest reserve by Geoffroy-Saint-Hilaire and by a number of authors. Among the celebrated anatomists who describe duplex heart are Littre, Meckel, Collomb, Panum, Behr, Paullini, Rhodius, Winslow, and Zacutus Lusitanus. The Ephemerides " cites an instance of triple heart, and Johnston ^ has seen a triple heart in a goose. The phenomenon of " blue-disease," or congenital cyanosis, is due to the patency of the foramen ovale, which, instead of closing at birth, persists sometimes to adult life. Perhaps the most unique collection of congenital malformations of the heart from persons who have reached the age of puberty was to be seen in London in 1895.®^^ In this collection there was an adult heart in which the foramen ovale remained open until the age of thirty-seven ; there were but two pulmonary valves ; there was another heart showing a large patent fora- men ovale from a man of forty-six ; and there was a septum ventriculorum of an adult heart from a woman of sixty-three, who died of carcinoma of the breast, in which the foramen ovale was still open and would admit the fore- a 302, xxxiv., 207. b 719, L. ii., obs. 184. c 47^^ obs. 469. d 778, vol. xii., 169. e 104, dec. i., an. 9, obs. 108. f "Med. Bem/srk. und Untersucb.," Band ii., 103. / ANOMALIES OF THE BREASTS. 297 finger. This woman had shown no symptoms of- the malformation. There were also hearts in Avhich the interventricular septum was deficient, the ductus arteriosus patent, or some valvular malformation present. All these persons had reached puberty. Displacements of the heart are quite numerous. Deschamps of Laval made an autopsy on an old soldier which justified the expression, " He had a heart in his belly." This organ was found in the left lumbar region ; it had, with its vessels, traversed an anomalous opening in the diaphragm. Franck observed in the Hospital of Colmar a woman with the heart in the epigastric region. Eamel* and Vetter speak of the heart under the diaphragm. Inversion of the heart is quite frequent, and we often find reports of cases of this anomaly. Fournier^ describes a soldier of thirty years, of middle height, well proportioned and healthy, who was killed in a duel by receiving a wound in the abdomen ; postmortem, the heart was found in the position of the right lung ; the two lungs were joined and occupied the left chest. The anomalies of the vascular system are so numerous that we shall dismiss them with a slight mention. Malacarne in Torino in 1784 de- scribed a double aorta, and Hommelius" mentions an analogous case. The following case is quite an interesting anatomic anomaly : A woman since infancy had difficulty in swallowing, which was augmented at the epoch of menstruation and after exercise ; bleeding relieved her momentarily, but the diificulty always returned. At last deglutition became impossible and the patient died of malnutrition. A necropsy revealed the presence of the sub- clavicular artery passing between the tracheal artery and the esophagus, com- pressing this latter tube and opposing the passage of food. Anomalies of the Breasts. — The first of the anomalies of the generative apparatus to be discussed, although not distinctly belonging under this head, will be those of the mammae. Amazia, or complete absence of the breast, is seldom seen. Pilcher "^ de- scribes an individual who passed for a female, but who was really a male, in whom the breasts were absolutely wanting. Foerster, Froriep, and Ried cite instances associated with thoracic malformation. Greenhow'' reports a case in which the mammae were absent, although there were depressed rudimentary nipples and areolae. There were no ovaries and the uterus was congenitally imperfect. There was a negress spoken of in 1842 in whom the right breast was missing, and there are cases of but one breast, mentioned by King,' PauU, s and others."^ Scanzoni has observed absence of the left mamma with ab- sence of the left ovary. » 462, tome xlix., p. 423. 1 b 302, iv., 150. c 282, 1737. H m HOTTENTOT WOMEN. 307 the deficiency in development of the labia majora, mons veneris, and genital hair. In this respect they present an approximation to the genitals of the anthropoid apes, among whom the orang-outang alone shows any tendency to formation of the labia majora. The labial appendages of the Hottentot female have been celebrated for many years. Blumenbach and others of the earlier travelers found that the apron-like appearance of the genitals of the Hottentot women was due to abnormal hypertrophy of the labia and nymphse (PI. 5). According to John Knott, the French traveler, Le Vaillant, said that the more coquettish among the Hottentot girls are excited by extreme vanity to practise artificial elongation of the nympha and labia. They are said to pull and rub these parts, and even to stretch them by hanging weights to them. Some of them are said to spend several hours a day at this process, which is considered one of the important parts of the toilet of the Hottentot belle, this malformation being an attrac- tion for the male members of the race. Merensky says that in Basuto- land the elder women begin to practise labial manipulation on their female children shortly after infancy, and Adams has found this custom to prevail in Dahomey ; he says that the King's seraglio includes 3000 members, the elect of his female subjects, all of whom have labia up to the standard of recognized length. Cameron found an analogous practice among the women of the shores of Lake Tanganyika. The females of this nation manipulated the skin of the lower part of the abdomens of the female children from infancy, and at puberty these women exhibit a cutaneous curtain over the genitals which reaches half-way down the thighs. A corresponding development of the preputian clitorides, attaining the length of 18 mm. or even more, has been observed among the females of Bechuanaland. The greatest elongation measured by Barrow was five inches, but it is quite probable that it was not possible for him to examine the longest, as the females so gifted generally occupied very high social positions. Morgagni describes a supernumerary left nympha, and Petit is accred- ited with seeing a case which exhibited neither nymphse, clitoris, nor urinary meatus. Mauriceau performed nymphotomy on a woman whose nymphse were so long as to render coitus difficult. Morand ^^^ quotes a case of congenital malformation of the nymphae, to which he attributed impotency. There is sometimes coalition of the labia and nymphae, which may be so firm and extensive as to obliterate the vulva. Debout* has reported a case of absence of the vulva in a woman of twenty upon whom he operated, which was the result of the fusion of the labia minora, and this with an en- larged clitoris gave the exteral appearance of an hermaphrodite. The absence of the clitoris coincides with epispadias in the male, and in atrophy of the vulva it is common to find the clitoris rudimentary ; but a more frequent anomaly is hypertrophy of the clitoris. » 23^ 3864, 26, tome xlv. 308 MINOR TERATA. Among the older authorities quoting instances of enlarged clitorides are Bartholinus, Schenck, Hellwig, Rhodius, Riolanus, and Zacchias. Albu- casis"^ describes an operation for enlarged clitoris, Chabert ligated one, and Riedlin " gives an instance of an enlarged clitoris, in which there appeared a tumor synchronous with the menstrual epoch. We learn from the classics that there were certain females inhabiting the borders of the jEgean Sea who had a sentimental attachment for one another which was called " Lesbian love," and which carried them to the highest degree of frenzy. The immortal effusions of Sappho contain refer- ences .to this passion. The solution of this peculiar ardor is found in the fact that some of the females had enlarged clitorides, strong voices, robust figures, and imitated men. Their manner was imperative and authoritative to their sex, who worshiped them with perverted devotion. We find in Martial ^ mention of this perverted love, and in the time of the dissolute Greeks and Romans ridiculous jealousies for unfaithfulness between these women prevailed. Aetius said that the Egyptians practised amputation of the clitoris, so that enlargement of this organ must have been a common vice of conformation along the Nile. It was also said that the Egyptian women practised circumcision on their females at the age of seven or eight, the time chosen being when the Nile was in flood. Bertherand ° cites examples of enlarged clitorides in Arab women ; Bruce testifies to this circumstance in Abyssinia, and Mungo Park has observed it in the Mandingos and the Ibbos. Sonnini ^ says that the women of Egypt had a natural excrescence, fleshy in consistency, quite thick and pendulous, coming from the skin of the mons veneris. Sonnini says that in a girl of eight he saw one of these caruncles which was J inch long, and another on a woman of twenty which was four inches long, and remarks that they seem peculiar only to women of distinct Egyptian origin. Duhouset ^ says that in circumcision the Egyptian women not only remove a great part of the body of the clitoris with the prepuce, but also adjacent portions of the nymphse ; Gallieni ^ found a similar operation cus- tomary on the upper banks of the Niger. Otto at Breslau in 1824 reports seeing a negress with a clitoris 4 J inches long and IJ inches in the transverse diameter ; it projected from the vulva and when supine formed a complete covering for the vaginal orifice. The clitoris may at times become so large as to prevent coitus, and in France has constituted a legitimate cause for divorce. This organ is very sensitive, and it is said that in cases of supposed catalepsy a woman cannot bear titilla- tion of the clitoris without some visible movement. Columbus cites an example of a clitoris as long as a little finger ; Haller a 683, 1695, 295. b 509, L. i., epigram 91. c " m6(J. et Hygifene des Arabes," p. 190. 261, 1895, No. 4, p. 375. \ \ \ 312 MINOR TERATA. Fig. 150. — Bipartite uterus with double vagina. Fig. 151.— Didelphic uterus and divided vagina: a, right segment; 6, left segment; c, d, right ovary and round ligament ; /, e, left ovary and round ligament ; g,j, left cervix and vagina; k, vaginal septum; A, i, right cervix and vagina. Fig. 152.— Complete prolapse of the uterus, with eversi(>Q of vagina (Keen and White). HERNIA OF THE UTERUS. 313 with its adnexa ; connected with this uterus was another one, anterior to it. The two uteruses had a common cervix ; the anterior of the two organs had no adnexa, though there were lateral peritoneal ligaments ; it had become pregnant." Hollander explains the anomaly by stating that probably the Miillerian ducts or one of them had grown excessively, leading to a folding off of a portion which developed into the anterior uterus. Other cases of double uterus with pregnancy are mentioned on page 49. When there is simultaneous pregnancy in each portion of a double uterus a complication of circumstances arises. Debierre quotes an instance of a woman who bore one child on July 16, 1870, and another on October 31st of the same year, and both at full term. She had only had three menstrual periods between the confinements. The question as to whether a case like this would be one of superfetatibn in a normal uterus, or whether the uterus was double, would immediately arise. There would also be the possibility that one of the children was of pro- tracted gestation or that the other was of premature birth. Article 312 of the Civil Code of France accords a minimum of one hundred and eighty and a maximum of three hundred days for the gestation of a viable child. (See Protracted Gestation.) Voight " is accredited with having seen a triple uterus, and there are several older parallels on record. Thilow mentions a uterus which was divided into three small portions. Of the different anomalous positions of the uterus, most of which are acquired, the only one that will be mentioned is that of complete prolapse of the uterus (Fig. 152). In this instance the organ may hang entirely out of the body and even forbid locomotion. Of 19 cases of hernia of the uterus quoted by Debierre 13 have been ob- served in the inguinal region (Fig. 153), five on the right and seven on the left side. In the case of Eoux in 1891 the hernia existed on both sides. The uterus has been found twice only in crural hernia and three times in umbilical hernia. There is one case recorded, according to Debierre, in which the uterus was one of the constituents of an obturator hernia. Sometimes its appendages are found with it. Doring, L^desma, Eektorziclc, and Scazoni have found the uterus in the sac of an inguinal hernia ; L6otaud, Murray, and Hagner in an umbilical hernia. TB^. accompanying illustration (Fig. 154) represents a hernia of the gravid womb\through the liuea alba. \ ". 503, iii., 175. Fig. 153.— Inguinal hernia containing a gravid womb (Winckel). 314 MINOR TERATA. Absence of the penis is an extremely rare anomaly, although it has been noted by Schenck/ Borellus, Bouteiller, N^laton, and others. Fortu- natus Fidelis ^ and E,6volat describe a newly born child with absence of external genitals, with spina bifida and umbilical hernia. N^laton " describes a child of two entirely without a penis, but both testicles were found in the scrotum ; the boy urinated by the rectum. Ashby and Wright ^ mention complete absence of the penis, the urethra opening at the margin of the anus outside the external sphincter ; the scrotum and testicles were well developed. Murphy " gives the description of a well-formed infant apparently without a penis ; the child passed urine through an opening in the lower part of the abdomen just above the ordinary location of the penis ; the scrotum was present. Incisions were made into a small swelling just below the urinary Fig. 154.— Hernia of the gravid womb through the linea alba. opening in the abdomen which brought into view the penis, the glans being normal but the body very small. The treatment consisted of pressing out the glans daily until the wound healed ; the penis receded spontaneously. It is stated that the organ would doubtless be equal to any requirements de- manded of it. Demarquay quotes a somewhat similar case in an infant, but it had no urinary opening until after operation. Among the older writers speaking of deficient or absent penis are Bar- tholinus,i8° Bauhinus, Cattierus, the Ephemerides, Frank, Panaroli,"'' van der Wiel, and others. Renauldin ^ describes a man with a small penis and enormous mammse. Goschler,s quoted by Jacobson, speaks of a well-de- veloped man of twenty-two, with abundant hair on his chin and suprapubic a 718, lib. iv., chap. 9. b De relationibus medi^brum, no. 357. c 363^ 1854. d ' ' Dis. of Children, ' ' p. 53. e 224, 1885, ii. , 62. f /'565, tome i. , p. 294. g SOa ISS?! RUDIMENTARY DEVELOPMENT OF THE PENIS. 315 region and the scrotum apparently perfect, with median raphe ; a careful search failed to show any trace of a penis ; on the anterior wall of the rectum four lines above the anus was an orifice which gave vent to urine ; the right testicle and cord were normal, but there was an acute orchitis in the left. Starting from just in front of the anal orifice was a fold of skin IJ inches long and f inch high continuous with the raphe, which seemed to be formed of erectile tissue and which swelled under excitement, the enlarge- ment lasting several minutes with usually an emission from the rectum. It was possible to pass a sound through the opening in the rectum to the blad- der through a urethra 1 J inches wide ; the patient had control of the bladder and urinated from every three to five hours. Many instances of rudimentary development of the penis have been recorded, most of them complicated with cryptorchism or other abnormality of the sexual organs. In other instances the organ is present, but the infantile type is present all through life ; sometimes the subjects are weak in intellect and in a condition similar to cretinism. Kaufmann quotes a case in a weakly boy of twelve whose penis was but f inch long, about as thick as a goose-quill, and feeling as limp as a mere tube of skin ; the corpora cavernosa were not entirely absent, but ran only from the ischium to the junction of the fixed portion of the penis, suddenly terminating at this point. Nothing indicative of a prostate could be found. The testicles were at the entrance of the inguinal canal and the glans was only slightly developed. Binet" speaks of a man of fifty-three whose external genitalia were of the size of those of a boy of nine. The penis was of about the size of the little finger, and contained on each side testicles not larger than a pea. There was no hair on the pubes or the face, giving the man the aspect of an old woman. The prostate was almost exterminated and the seminal vesicles were very primitive in conformation. Wilson was consulted by a gentleman of twenty-six as to his ability to perform the marital function. In size his penis and testicles hardly exceeded those of a boy of eight. He had never felt desire for sexual intercourse until he became acquainted with his intended wife, since when he had erections and nocturnal emissions. The patient married and became the father of a family ; those parts which at twenty-six were so much smaller than usual had increased at twenty-eight to normal adult size. There are three cases on record in the older literature of penises extremely primitive in development. They are quoted by the Ephemerides, Plater,^^^ Schenck,*' and Zacchias. The result in these cases was impotency. In the Army and Medical Museum at "Washington are two injected speci- mens of the male organ divested of skin. From the meatus to the pubis they measure 6 J and 5^ inches ; from the extremity to the termination of either crus 9| and 8| inches, and the circumferences are 4| and 4J inches. Between these two we can syike an average of the size of the normal penis. a 242j 1883. \ ^ 718, lib. iv., obs. 12. \ 316 MINOR TERATA. In some instances the penis is so large as to forbid coitus and even inconveni- ence its possessor, measuring as much as ten or even more inches in length. Extraordinary cases of large penis are reported by Albinus ^^* (who mentions it as a cause for sterility), Bartholinus,'*^ Fabricius Hildanus, Paullini, Payer, Plater, Schurig, ^ Sinibaldus,'^' and Zacchias. Several cases of enormous penises in the new-born have been observed by Wolffs and others. " The penis palme, or suture de la verge of the French, is the name given to those examples of single cutaneous envelope for both the testicles and penis ; the penis is adherent to the scrotum by its inferior face ; the glans only is free and erection is impossible. Chretien cites an instance in a man of twenty-five, and Schrumpf of Wesserling "^ describes an example of this rare anomaly. The penis and testes were inclosed in a common sac, a slight pro- jection not over ^ inch long being seen from the upper part of this curious scrotum. When the child was a year old a plastic operation was performed on this anomalous member with a very satisfactory result. Petit describes an instance in which the penis was slightly fused with the scrotum. There are many varieties of torsion of the penis. The glans itself may be inclined laterally, the curvature may be total, or there may be a veritable rotation, bringing the inferior face above and the superior face below. Gay " describes a child with epispadias whose penis had undergone such torsion on its axis that its inferior surface looked upward to the left, and the child passed urine toward the left shoulder. Follin ' mentions a similar instance in a boy of twelve with complete epispadias, and Verneuil and GuerHn also record cases, both complicated with associate maldevelopment. Caddy s mentions a youth of eighteen who had congenital torsion of the penis with- out hypospadias or epispadias. There was a complete half-turn to the left, so that the slit-like urinary meatus was reversed and the frenum was above. Among the older writers who describe incurvation or torsion of the penis are Arantius,*" the Ephemerides, Haenel,*"! Petit,' Schurig, Tulpius,J and Zacchias.^'" Zacutus Lusitanus ^ speaks of torsion of the penis from freezing. Paul- lini ■ mentions a case the result of masturbation, and Hunter ™ speaks of torsion of the penis associated with arthritis. Ossification of the Penis. — MacClellan " speaks of a man of fifty-two whose penis was curved and distorted in such a manner that urine could not be passed without pain and coitus was impossible. A bony mass was dis- covered in the septum between the corpora cavernosa ; this was dissected out with much hemorrhage and the upward curvature was removed, but there » " Spermatologia," p. 109. b " Lect. Memorab.," tome i., p. 34. « " M6moires concernant les Arts, " 1672, 27. d 369, 1882. e 779, xvi., 189. I 789, 1862. g 476, Sept. 15, 1894. . h 718, L. iv., no. 14. i 625, Supplement. j 842, L. iii., no. 39. ■ k 831, L. iii., obs. 118. 1 620, cent, iv., obs. 92. m " References on Venereal Diseases," etc. D Nouveau Journal des Sciences M6dicales, March, 1878. / ANOMALIES OF THE URETHRA. 317 resulted a slight inclination in the opposite direction. The formation of bone and cartilage in the penis is quite rare. Velpeau, Kauifmann, Lenhoseck, and Duploy are quoted by Jacobson as having seen this anomaly. There is an excellent preparation in Vienna figured by Demarquay, but no description is given. The Ephemerides and PauUini " describe osseous penises. The complete absence of the frenum and prepuce has been observed in animals but is very rare in man. The incomplete or irregular develop- ment is more frequent, but most common is excessive development of the pre- puce, constituting phimosis, when there is abnormal adherence with the glans. Instances of phimosis, being quite common, will be passed without special mention. Deficient or absent prepuce has been observed by Blasius,^^* Mar- cellus Donatus,^"^ and Gilibert. Partial deficiency is described by Petit, Severinus, and others. There may be imperforation or congenital occlusion of some portion of the urethra, causing enormous accumulation of urine in the bladder, but fortu- nately there is generally in such cases some anomalous opening of the ure- thra giving vent to the excretions. Tulpius ^ mentions a case of deficient urethra. In the Ephemerides there is an account of a man who had a con- stant flow of semen from an abnormal opening in the abdomen. La Pey- ronia '^ describes a case of impotence due to ejaculation of the spermatic ducts into the bladder instead of into the urethra, but remarks that there was a cicatrix of a wound of the neighboring parts. There are a number of instances in which the urethra has terminated in the rectum. Congenital dilatation of the urethral canal is very rare, and generally accompanied by other malformation. Duplication of the urethra or the existence of two permeable canals is not accepted by all the authors, some of whom contend that one of the canals either terminates in a culdesac or is not separate in itself. Verneuil has pub- lished an article clearly exposing a number of cases, showing that it is possi- ble for the urethra to have two or more canals which are distinct and have separate functions. Fabricius Hildanus ^ speaks of a double aperture to the urethra ; Marcellus Donatus " describes duplicity of the urethra, one of the apertures being in the testicle ; and there is another case on record ' in which there was a urethral aperture in the groin. A case of double urethra in a man of twenty-five living in Styria « who was under treatment for gonorrhea is described, the supernumerary urethra opening above the natural one and receiving a sound to the depth of 17 cm. There was purulent gonorrhea in both urethrse. Vesalius ^ has an account of a double urethral aperture, one of which was supposed to give spermatic fluid and the other urine. Borellus, Testa, and Cruveilhier have reported similar instances. Instances of double penis have been discussed under the head of diphallic terata, page 194. a 620, cent, i, obs. 72. \ b 842, L. xliv., cap. 36. " 563, i., 427. d 334, cent, i., obs. 76. \ e 306, L. vi., c. ii., 619. f 524, vol. ii., 440. g 536, 18S7, vol. ii. \ l" 804, L. v., c. 18. 318 MINOR TERATA. Hypospadias and epispadias (Fig. 155) are names given to malforma- tions of the urethra in which the wall of the canal is deficient either above or below. These anomalies are particularly interesting, as they are nearly always found in male hermaphrodites, the fissure giving the appearance of a vulva, as the scrotum is sometimes included, and even the perineum may be fissured in continuity with the other parts, thus exaggerating the deception. There seems to be an element of heredity in this malformation, and this allegation is exemplified by Sedgwick, who quotes a case from Heuremann in which a family of females had for generations given birth to males with hypospadias. Belloc ^ mentions a man whose urethra terminated at the base of the frenum who had four sons with the same deformity. Picardat ^ men- tions a father and son, both of whom had double urethral orifices, one above the other, from one of which issued urine and from the other semen — a fact that shows the possibility of inheritance of this malformation. Patients in whom the urethra opens at the root of the penis, the meatus being imperforate, are not necessarily impotent ; as, for instance, Fournier " knew of a man whose urethra opened posteriorly who was the father of four children. Fournier supposed that the semen ejaculated vigorously and followed the fissure on the back of the penis to the uterus, the membrane of the vagina supplanting the deficient wall of the urethra. The penis was short, but about as thick as ordinary. Gray ^ mentions a curious case in a man afflicted with hypospadias who, suffering with delusions, was confined in the insane asylum at Utica. When he determined to get married, fully appreciating his physical defect, he re- solved to imitate nature, and being of a very ingenious turn of mind, he busied himself with the construction of an artificial penis. While so en- gaged he had seized every opportunity to study the conformation of this organ, and finally prepared a body formed of cotton, six inches in length, and shaped like a penis, minus a prepuce. He sheathed it in pig's gut and gave it a slight vermilion hue. To the touch it felt elastic, and its shape was maintained by a piece of gutta-percha tubing, around which the cotton was firmly wound. It was fastened to the waist-ban^ by means of straps, a cen- tral and an upper one being so arranged that the penis could be thrown into a 302, xxiv. b Thes§ de Paris, 1858, No. 91. c 302, iv., 162. d 773, 1870 Fig. 155.— Complete epispadias. ABSENCE OF THE TESTICLES. 319 an erect position and so maintained. He had constructed a flesh-colored cov- ering which completely concealed the straps. With this artificial member he was enabled to deceive his wife for fifteen months, and was only discovered when she undressed him while he was in a state of intoxication. To further the deception he had told his wife immediately after their marriage that it was quite indecent for a husband to undress in the presence of his wife, and therefore she had always retired first and turned out the light. Partly from fear that his virile power would be questioned and partly from ignorance, the duration of actual coitus would approach an hour. When the discovery was made, his wife hid the instrument with which he had perpetrated a most successful fraud upon her, and the patient subsequently attempted coitus by contact with unsuccessful results, although both parties had incomplete orgasms. Shortly afterward evidences of mental derangement appeared and the man became the subject of exalted delusions. His wife, at the time of report, had filed application for divorce. Haslam " reports a case in which loss of the penis was compensated for by the use of an ivory succedaneum. Parallel instances of this kind have been recorded by Ammann *" and Jonston." Entire absence of the male sexual apparatus is extremely rare, but Blondin and Velpeau have reported cases. Complete absence of the testicles, or anorchism,is a comparatively rare anomaly, and it is very difficult to distinguish between anorchism and arrest of development, or simple atrophy, which is much more common. Fisher of Boston "1 describes the case of a man of forty-five, who died of pneumonia. From the age of puberty to twenty-five, and even to the day of death, his voice had never changed and his manners were decidedly eifeminate. He always sang soprano in concert with females. After the age of twenty-five, however, his voice became more grave and he could not accompany females with such ease. He had no beard, had never shaved, and had never exhibited amorous propensities or desire for female society. When about twenty-one he became associated with a gay company of men and was addicted to the cup, but would never visit houses of ill-fame. On dissection no trace of testicles could be found ; the scrotum was soft and flabby. The cerebellum was the exact size of that of a female child. Individuals with one testicle are called monorchids, and may be divided into three varieties : — (1) A solitary testicle divided in the middle by a deep fissure, the two lobes being each provided Avith a spermatic cord on the same side as the lobe. (2) Testicles of the same origin, but with coalescence more general. (3) A single testicle and two cords. Gruber of St. Petersburg "= held a postmortem on a man in January, a 476, 1828, ii., 182. b ' ^ffrenicum Numse, " p. 133. 1= 445, p. 406. d 124, Feb., 1839. \ ' 553, Heft i., 1868. 320 MINOR TERATA. 1867, in whom the right half of the scrotum, the right testicle, epididymis, and the scrotal and inguinal parts of the right vas deferens were absent. Gruber examined the literature for thirty years up to the time of his report, and found 30 recorded postmortem examinations in which there was absence of the testicle, and in eight of these both testicles were missing. As a rule, natural eunuchs have feeble bodies, are mentally dull, and live only a short time. The penis is ordinarily defective and there is sometimes another associate mal- formation. They are not always disinclined toward the opposite sex. Polyorchids are persons who have more than two testicles. For a long time the abnormality was not believed to exist, and some of the observers denied the proof by postmortem examination of any of the cases so diagnosed ; but there is at present no doubt of the fact, — three, four, and five testicles having been found at autopsies. Russell, one of the older writers on the testicle, mentions a monk who was a triorchid, and was so salacious that his indomitable passion prevented him from keeping his vows of chastity. The amorous propensities and generative faculties of polyorchids have always been supposed greater than ordinary. Russell reports another case of a man with a similar peculiarity, who was prescribed a concubine as a reasonable allow- ance to a man thus endowed. Morgagni and Meckel say that they never discovered a third testicle in dissections of reputed triorchids, and though Haller •'' has collected records of a great number of triorchids, he has never been able to verify the presence of the third testicle on dissection. Some authors, including Haller, have demonstrated heredity in examples of polyorchism. There is an old instance ^ in which two testicles, one above the other, were found on the right side and one on the left. Macann <= describes a recruit of twenty, Avhose scrotum seemed to be much larger on the right than on the left side, although it was not pendulous. On dissection a right and left testicle were found in their normal positions, but situated on the right side between the groin and the normal testicle was a supernumerary organ, not in contact, and having a separate and short cord. Prankard ^ also describes a man with three testicles. Three cases of triorchidism were found in recruits in the British Army.^ Lane ^ reports a, supernumerary testis found in the right half of the scrotum of a boy of fifteen. In a necropsy held on a man killed in battle, Hohlberg s discovered three fully developed testicles, two on the right side placed one above the other. The London Medical Record of 1884 quotes Jdanoff of St. Petersburg in men- tioning a soldier of twenty-one M'ho had a supernumerary testicle erroneously diagnosed as inguinal hernia. Quoted by the same reference, Bulatoff men- tions a soldier who had a third testicle, which diagnosis was confirmed by several of his confreres. They recommended dismissal of the man from the service, as the third testicle, usually resting in some portion of the inguinal canal, caused extra exposure to traumatic influence. " 400, L. xxvii., 412. b 504, xviii., 362. ' c 656, 1842. d 654, 1842. 476, 1865, ii., 501. f 224, Dec. 1, 1894. /' g 812, 1882, 38, 642. CR YPTOR CHIDS. 321 Venette * gives an instance of four testicles, and ScharfP, in the Ephe- merides, mentions five ; Blasius ^i* mentions more than three testicles, and, without citing proof, Buffon admits the possibility of such occurrence and adds that such men are generally more vigorous. Russell *> mentions four, five, and even six testicles in one individual ; ail were not verified on dissection. He cites an instance of six testicles, four of which were of usual size and two smaller than ordinary. Baillie, the Ephemerides, and Schurig mention fusion of the testicles, . or synorchidism, somewhat after the manner of the normal disposition of the batrachians and also the kangaroos, in the former of which the fusion is ab- dominal and in the latter scrotal. Kerckring " has a description of an indi- vidual in whom the scrotum was absent. In those cases in which the testicles are still in the abdominal cavity the individuals are termed cryptorchids. Johnson '^ has collected the re- sults of postmortem examinations of 8 9 supposed cryptorchids. In eight of this number no testicles were found postmortem, the number found in the abdomen was uncertain, but in 18 instances both testicles were found in the inguinal canal, and in eight only one was found in the inguinal canal, the other not appearing. The number in which the semen was examined microscopically was 16, and in three spermatozoa were found in the semen ; one case was dubious, spermatozoa being found two weeks afterward on a boy's shirt. The number having children was ten. In one case a monorchid generated a cryptorchid child. Some of the cryptorchids were effeminate, although others were manly with good evidences of a beard. The morbid, hypochon- driac, the voluptuous, and the imbecile all found a place in Johnson's statis- tics ; and although there are evidences of the possession of the generative function, still, we are compelled to say that the chances are against fecundity of human cryptorchids. In this connection might be quoted the curious case mentioned by Geoffroy-Saint-Hilaire, of a soldier who was hung for rape. It was alleged that no traces of testicles were found externally or internally, yet semen containing spermatozoa was found in the seminal vesicles. Sper- matozoa have been found days and weeks after castration, and the individuals during this period were capable of impregnation, but in these cases the reser- voirs were not empty, although the spring had ceased to flow. Beigel, in Virchow's Archives, mentions a cryptorchid of twenty-two who had noctur- nal emissions containing spermatozoa and who indulged in sexual congress. Partridge " describes a man of twenty- four who, notwithstanding his condi- tion, gave evidences of virile seminal flow. In some cases there is anomalous position of the testicle. Hough ^ mentions an instance in which, from the great pain and sudden appearance, a small tumor lying against the right pubic bone was supposed to be a strangu- a 215, au. ii., , 38. b "Obs. oV Testicles," Edinburgh, 1833. >-■ 473, obs. xii. d 775, 1884. e 476, 186(\i., 66. r 545, 1884. 21 \ \ 322 MINOR TERATA. lated hernia. There were t\vo well-developed testicles in the scrotum, and the hernia proved to be a third. McEImail ^ describes a soldier of twenty-nine, who two or three months before examination felt a pricking and slight burn- ing pain near the internal aperture of the internal inguinal canal, succeeded by a swelling until the tumor passed into the scrotum. It was found in the upper part of the scrotum above the original testicle, but not in contact, and was about half the size of the normal testicle ; its cord and epididymis could be distinctly felt and caused the same sensation as pressure on the other testicle did. Marshall'' mentions a boy of sixteen in whom the right half of the scrotum was empty, although the left was of normal size and contained a testicle. On close examination another testicle was found in the perineum ; the boy said that while running he fell down, four years before, and on get- ting up suffered great pain in the groin and this pain recurred after exertion. This testicle was removed successfully to the scrotum. Horsley collected 20 instances of operators who made a similar attempt, Annandale being the first one ; his success was likely due to antisepsis, as previously the testicles had always sloughed. There is a record of a dog remarkable for its salacity who had two testicles in the scrotum and one in the abdomen ; some of the older authors often indulged in playful humor on this subject. Brown '^ describes a child with a swelling in the perineum both painful and elastic to the touch. The child cried if pressure was applied to the tumor and there was every evidence that the tumor was a testicle. Hutche- son, quoted by Russell,'^ has given a curious case in an English seaman who, as was the custom at that time, v/as impressed into service by H. M. S. Druid in 1807 from a trading ship off the coast of Africa. The man said he had been examined by dozens of ship-surgeons, but was invariably re- jected on account of rupture in both groins. The scrotum was found to be an empty bag, and close examination showed that the testicles occupied the seats of the supposed rupture. As soon as the discovery M'as made the man became unnerved and agitated, and on re-examining the parts the testicles were found in the scrotum. When he found that there was no chance for escape he acknowledged that he was an impostor and gave an exhibition in which, with incredible facility, he pulled both testes up from the bottom of the scrotum to the external abdominal ring. At the word of command he could pull up one testicle, then another, and let them drop simultaneously ; he performed other like feats so rapidly that the movements could* not be dis- tinguished. In this connection Russell speaks of a man whose testicle was elevated every time the east wind blew, which caused him a sense of languor and re- a 523, 1856, ix., 91. b 541 c 436, 1891, ii., 546. d "/)bs. on Testicles." Edinb., 1833. 548, 1883. "/Jbs. on : INVERSION OF THE TESTICLE. 323 laxation ; the same author describes a man whose testicles ascended into the inguinal canal every time he was in the company of women. Inversion of the testicle is of several varieties and quite rare ; it has been recognized by Sir Astley Cooper, Beyer, Maisonneuve, Royet, and other writers. The anomalies of the vas deferens and seminal vesicles are of little in- terest and will be passed with mention of the case of Weber,^ who found the seminal vesicles double ; a similar conformation has been seen in hermaphrodites. a 559, May, 1811, 88. CHAPTEE VII. A'^OMALIES OF STATURE, SIZE, AND DEYELOPMENT. Giants. — The fables of mythology contain accounts of horrible monsters, terrible in ferocity, whose mission was the destruction' of the life of the in- dividuals unfortunate enough to come into their domains. The ogres known as the Cyclops, and the fierce anthropophages, called Lestrygons, of Sicily, who were neighbors of the Cyclops, are pictured in detail in the " Odyssey " of Homer. Nearly all the nations of the earth have their fairy tales or super- stitions of monstrous beings inhabiting some forest, mountain, or cave ; and pages have been written in the heroic poems of all languages describing battles between these monsters and men with superhuman courage, in which the giant finally succumbs. The word giant is derived indirectly from the old English word " geant," which in its turn came from the French of the conquering Normans. It is of Greek derivation, "yifaz" — or the Latin, "gigas." The Hebrew parallel is " nophel," or plural, " nephilim." Ancient Giants. — We are told in the Bible " that the bedstead of Og, King of Basham, was 9 cubits long, which in English measure is 16 J feet. Goliath of Gath, who was slain by David, stood 6 cubits and a span tall — about 11 feet. The body of Orestes, according to the Greeks, was 11 J feet long. The mythical Titans, 45 in number, were a race of Giants who warred against the Gods, and their descendants were the Gigantes. The height attributed to these creatures was fabulous, and they were supposed to heap up mountains to scale the sky and to help them to wage their battles. Hercules, a man of incredible strength, but who is said to have been not over 7 feet high, was dispatched agaiiist the Gigantes. Pliny describes Gabbaras, who was brought to Eome by Claudius Caesar from Arabia and was between 9 and 10 feet in height, and adds that the re- mains of Posio and Secundilla, found in the reign of Augustus Caesar in the Sallustian Gardens, of which they were supposed to be the guardians, meas- ured 10 feet 3 inches each. In common with Augustine, Pliny believed that the stature of man has degenerated, but from the remains of the ancients so far discovered it would appear that the moderiji stature is about the same as a Deuteronomy iii., ll. 324 - DISCOVERIES OF " GIANTS' BONES." 325 the ancient. The beautiful alabaster sarcophagus discovered near Thebes in 1817 and now in Sir John Soane's Museum in Lincoln's Inn Fields in London measures 9 feet 4 inches long. This unique example, the finest extant, is well worth inspection by visitors in London. Herodotus says the shoes of Perseus measured an equivalent of about 3 feet, English standard. Josephus tells of Eleazar, a Jew, among the hostages sent by the King of Persia to Rome, who was nearly 11 feet high. Saxo, the grammarian, mentions a giant 13 J feet high and says he had 12 companions who were double his height. Ferragus, the monster supposed to have been slain by Roland, the nephew of Charlemagne, was said to have been nearly 1 1 feet high. It was said that there was a giant living in the twelfth century under the rule of King Eugene II. of Scotland who was 11 J feet liigh. There are fabulous stories told of the Emperor Maximilian. Some accounts say that he was between 8J and 9 feet high, and used his wife's bracelet for a finger-ring, and that he ate 40 pounds of flesh a day and drank six gallons of wine. He was also accredited with being a great runner, and in his earlier days was said to have conquered single-handed eight soldiers. The Emperors Charlemagne and Jovianus were also accredited with great height and strength. In the olden times there were extraordinary stories of the giants who lived in Patagonia. Some say that Magellan gave the name to this country because its inhabitants measured 5 cubits. The naturalist Turner says that on the river Plata near the Brazilian coast he saw naked savages 12 feet high ; and in his description of America, Th6venot confirms this by saying that on the coast of Africa he saw on a boat the skeleton of an American giant who had died in 1559, and who was 11 feet 5 inches in height. He claims to have measured the bones himself. He says that the bones of the leg measured 3 feet 4 inches, and the skull was 3 feet and 1 inch, just about the size of the skull of Borghini, who, however, was only of ordinary height. In his account of a voyage to the Straits of Magellan, Jacob Lemaire says that on December 17, 1615, he found at Port Desire several graves covered with stones, and beneath the stones were skeletons of men which measured between 10 and 11 feet. The ancient idea of the Spaniards was that the men of Patagonia were so tall that the Spanish soldiers could pass under their arms held out straight ; yet we know that the Patagonians exhibit no exaggeration of height — in fact, some of the inhabitants about Terra del Fuego are rather diminutive. This superstition of the voyagers was not limited to America ; there were accounts of men in the neighborhood of the Peak of Teneriffe who had 80 teeth in their head and bodies 15 feet in height. / Discoveries of "Giantk' Bones." — Riolan,^*^ the celebrated anatomist, says that there was to be see\i at one time in the suburbs of Saint Gerniain the tomb of the giant Isoret, Mio was reputed to be 20 feet tall ; and that in \ 326 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT. 1509, in digging ditches at Rouen, near the Dominicans, they found a stone tomb containing a monstrous skeleton, the skull of which would hold a bushel of corn ; the shin-bone measured about 4 feet, which, taken as a guide, would make his height over 17 feet. On the tomb was a copper plate which said that the tomb contained the remains of " the noble and puissant lord, the Chevalier Eigon de Vallemont." Plater,^^^ the famous physician, declares that he saw at Lucerne the true human bones of a subject that must have been at least 19 feet high. Valence in Dauphin6 boasted of possessing the bones of the giant Bucart, the tyjant of the Vivarias, who was slain by his vassal. Count de Cabillon. The Dominicans had the shin-bone and part of the knee-articulation, which, substantiated by the frescoes and inscriptions in their possession, showed him to be 22J feet high. They claimed to have an os frontis in the medical school of Leyden measuring 9.1 X 12.2 X .5 inches, which they deduce must have belonged to a man 11 or 12 feet high. It is said that while digging in France in 1613 there was disinterred the body of a giant bearing the title " Theutobochus Rex," and that the skeleton measured 25 feet long, 10 feet across the shoulders, and 5 feet from breast to back. The shin-bone was about 4 feet long, and the teeth as large as those of oxen. This is likely another version of the finding of the remains of Bucart. Near Mezarino in Sicily in 1516 there was found the skeleton of a giant whose height was at least 30 feet ; his head was the size of a hogshead, and each tooth weighed 5 ounces; and in 1548 and in 1550 there were others found of the height of 30 feet. The Athenians found near their city skele- tons measuring 34 and 36 feet in height. In Bohemia in 758 it is recorded that there was found a human skeleton 26 feet tall, and the leg-bones are still kept in a medieval castle in that country. In September, 1691, there was the skull of a giant found in Macedonia which held 210 pounds of corn. General Opinions. — All the accounts of giants originating in the finding of monstrous bones must of course be discredited, as the remains were likely those of some animal. Comparative anatomy has only lately obtained a hold in the public mind, and in the Middle Ages little was known of it. The pre- tended giants' remains have been those of mastodons, elephants, and other animals. From Suetonius we learn that Augustus Caesar pleased himself by adorning his palaces with so-called giants' bones of incredible size, prefer- ring these to pictures or images. From their enormous size we must be- lieve they were mastodon bones, as no contemporary animals show such measurements. Bartholinus " describes a large tooth for many years exhib- ited as the canine of a giant which proved to be nothing but a tooth of a spermaceti whale (Cetus dentatus), quite a common fish. Hand ^ described an alleged giant's skeleton shown in London early in the eighteenth century, a 190, cent, i., hist. 98. b 629, No. 168. / / GENERAL OPINIONS. 327 -and which was composed of the bones of the fore-fin of a small whale or of a porpoise. The celebrated Sir Hans Sloane, who treated this subject very learnedly, arrived at the conclusion that while in most instances the bones found were those of mastodons, elephants, whales, etc., in some instances accounts were given by connoisseurs who could not readily be deceived. However, modern scientists will be loath to believe that any men ever existed who measured over 9 feet ; in fact, such cases with authentic references are extremely rare. Quetelet considers that the tallest man whose stature is authentically recorded was, the. ,*j' Scottish Giant " of Frederick the Great's regiment of giants. This person was not quite 8 feet 3 inches tall. ,jBuffon, ordinarily a reliable au- thority, comes to a loose conclusion that "there is no doubt that men have lived who were 10, 12, and even 15 feet tall ; but modern statisticians can- not accept this deduction from the references offered. From the original estimation of the height of Adam (Henrion once calcu- lated that Adam's height was 123 feet and that of Eve 118) we gradually come to 10 feet, which seemed to be about the favorite height for giants in the Middle Ages. Approaching this century,we still have stories of men from 9 to 10 feet high, but no authentic cases. It was only in the latter part of the last century that we began to have absolutely authentic heights of giants, and to-day the men showing through the country as measuring 8 feet generally exaggerate their height several inches, and exact measurement would show that but few men commonly called giants are over 7 J feet or weigh over 350 pounds. I)ana* says that the number of giants figuring as public characters since 1700 is not more than 100, and of these about 20 were advertised to be over 8 feet. If we confine ourselves to those ac- curately and scientifically measured the list is surprisingly small. Topinard measured the tallest man in the Austrian army and found that he was 8 feet A^ inches. The giant Winckelmeyer measured 8 feet 6 inches in height. Ranke measured Marianne Wehde, who was born in Germany in the present century, and found that she measured 8 feet 4J inches when only sixteen and a half years old. In giants, as a rule, the great stature is due to excessive growth of the lower extremities, the size of the head and that of the trunk being nearly the same as those of a man or boy of the same age. On the other hand, in a natural dwarf the proportions are fairly uniform, the head, however, being always larger in proportion to the body, just as we find in infants. Indeed, the proportions of " General Tom Thumb " were those of an ordinary infant of from thirteen to fifteen months old. Figure 156 shows a portrait of two well-known exhibitionists of about the same age, and illustrates the possible extremes of anomalies in stature. Recently, the association of acromegaly with gigantism has been \ a 723, Feb., 1895. \ \ \ \ 328 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT. noticed, and in these instances there seems to be an acquired uniform enlarge- ment of all the bones of the body. Brissaud and Meige" describe the case of a male of forty-seven who presented nothing unusual before the age of sixteen, when he began to grow larger, until, having reached his majority, he measured 7 feet 2 inches in height and weighed about 340 pounds. He remained well and very strong until the age of thirty-seven, when he overlifted, and following this he developed an extreme deformity of the spine and trunk, the latter " tele- scoping into itself" until the nipples were on a level with the anterior superior spines of the ilium. For two years he suffered with debility, fatigue, bron- chitis, night-sweats, head- ache, and great thirst. Mentally he was dull ; the bones of the face and extremities showed the hypertrophies character- istic of acromegaly, the soft parts not being in- volved. The circumfer- ence of the trunk at the nipples was 62 inches, and over the most promi- nent portion of the ky- phosis and pigeon-breast, 74 inches. The authors agree with Dana and others that there is an intimate relation between acromegaly and gigan- tism, but they go further and compare both to the growth of the body. They call attention to the strik- ing resemblance to acromegaly of the disproportionate growth of the boy at adolescence, which corresponds so well to Marie's terse description of this disease : " The disease manifests itself by preference in the bones of the extremities and in the extremities of the bones," and conclude with this rather striking and aphoristic proposition : " Acromegaly is gigantism of the adult ; gigantism is acromegaly of adolescence." The many theories of the cause of gigantism will not be discussed here, the reader being referred to volumes exclusively devoted to this subject. Celebrated Giants.— Mention of some of the most famous giants will be made, together with any associate points of iMerest. a Jour, de M§d. et de Chir. prat, Jan. 25, 1895. Fig. 166.— Giantess aEd dwarf of the same age. CELEBRATED GIANTS. 329 Becanus, physician to Charles V., says that he saw a youth 9 feet high and a man and a woman almost 10 feet. Ainsworth says that in 1553 the Tower of London was guarded by three brothers claiming direct descent from Henry VIII., and surnamed Og, Gog, and Magog, all of whom were over 8 feet in height. In his " Chronicles of Holland" in 1557 Hadrianus Barlandus said that in the time of John, Earl of Holland, the giant Nicho- las was so large that men could stand under his arms, and his shoe held 3 ordinary feet. Among the yeoman of the guard of John Frederick, Duke of Hanover, there was one Christopher Munster, 8| feet high, who died in 1676 in his forty-fifth year, The giant porter of the Duke of Wiirtemberg was 7 J feet high. " Big Sam," the porter at Carleton Palace, when George IV. was Prince of Wales, was 8 feet high. The porter of Queen Elizabeth, of whom there is a picture in Hampton Court, painted by Zucchero, was 7 J feet high ; and Walter Parson, porter to James I., was about the same height. William Evans, who served Charles I., was nearly 8 feet ; he carried a dwarf in his pocket. In the seventeenth century, in order to gratify the Empress of Austria, Guy- Patin made a congress of all the giants and dwarfs in the Germanic Empire. A peculiarity of this congress was that the giants complained to the authorities that the dwarfs teased them in such a manner as to make their lives miserable. Plater speaks of a girl in Basle, Switzerland, five years old, whose body was as large as that of a full-grown woman and who weighed when a year old as much as a bushel of wheat. He also mentions a man living in 1613, 9 feet high, whose hand was 1 foot 6 inches long. Peter van den Broecke speaks of a Congo negro in 1640 who was 8 feet high. Daniel, the porter of Cromwell, was 7 feet 6 inches high ; he became a lunatic. Frazier speaks of Chilian giants 9 feet tall. There is a chronicle which says one of the Kings of Norway was 8 feet high. Merula says that in 1538 he saw in France a Flemish man over 9 feet. Keysler mentions see- ing Hans Brau in Tyrol in 1550, and says that he was nearly 12 feet high. Jonston **' mentions a lad in Holland who was 8 feet tall. Pasumot ^ mentions a giant of 8 feet. Edmund Mallone was said to have measured 7 feet 7 inches. Wierski, a Polander, presented to Maximilian II., was 8 feet high. At the age of thirty-two there died in 1798 a clerk of the Bank of England who was said to have been nearly 7 J feet high. The Daily Advertiser for February 23, 1745, says that there was a young colossus exhibited opposite the Man- sion House in London who was 7 feet high, although but fifteen years old. In the same paper on January 31, 1753, is an account of MacGrath, whose skeleton is still preserved in Dublin. In the reign of George I., during the time of the Bartholomew Fair at Smithfield, there was exhibited an English- man seventeen years old wh4 was 8 feet tall. " " Voyaged physiques dans les Pyr6ii6es." 330 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT. Mcephorus tells of Antonius of Syria, in the reign of Theodosius, who died at the age of twenty-five with a height of 7 feet 7 inches. Artacaecas, in great favor with Xerxes, was the tallest Persian and measured 7 feet. John Middleton, born in 1752 at Hale, Lancashire, humorously called the " Child of Hale," and whose portrait is in Brasenose College, Oxford, measured 9 feet 3 inches tall. In his " History of Ripton," in Devonshire, 1854, Bigsby gives an account of a discovery in 1687 of a skeleton 9 feet long. In 1712 in a village in Holland there died a fisherman named Ge'rrit Bastiaansen who was 8 feet high and weighed 500 pounds. During Queen Anne's reign there was shown in London and other parts of England a most peculiar anomaly — a German giantess without hands or feet who threaded a needle, cut gloves; etc. About 1821 there was issued an engraving of Miss Angelina Melius, nineteen years of age and 7 feet high, attended by her page, Senor Don San- tiago de los Santos, from the Island of Manilla, thirty-five years old and 2 feet 2 inches high. " The Annual Register " records the death of Peter Tuchan at Posen on June 18, 1825, of dropsy of the chest. He was twenty-nine years old and 8 feet 7 inches in height ; he began to grow at the age of seven. This monster had no beard ; his voice was soft ; he was a moderate eater. There was a giant exhibited in St. Petersburg, June, 1829, 8 feet 8 inches in height, who was very thin and emaciated. Dr. Adam Clarke, who died in 1832, measured a man 8 feet 6 inches tall. Frank Buckland, in his " Curiosities of Natural History," says that Brice, the French giant, was 7 feet 7 inches. Early in 1837 there was exhibited at Parma a young man formerly in the service of the King of the Nether- lands who was 8 feet 10 inches high and weighed 401 pounds. Robert Hale, the " Norfolk Giant," who died in Yarmouth in 1843 at the age of forty-three, was 7 feet 6 inches high and weighed 452 pounds. The skeleton of Cornelius McGrath, now preserved in the Trinity College Museum, Dublin, is a striking example of gigantism. At sixteen years he measured 7 feet 10 inches. O'Brien or Byrne, the Irish giant, was supposed to be 8 feet 4 inches in height at the time of his death in 1783 at tbe age of twenty-two. The story of his connection with the illustrious Joh^ii Hunter is quite interesting. Hunter had vowed that he would have the skeleton of O'Brien, and O'Brien Fig. 157. -Skeleton of the " Irish Giant " in the Royal Col- lege of Surgeons, London. / CELEBRATED 01 ANTS. 331 was equally averse to being boiled in the distinguished scientist's kettle. The giant was tormented all his life by the constant assertions of Hunter and by his persistence in locating him. Finally, when, following the usual early decline of his class of anomalies, O'Brien came , to his death-bed, he bribed some fishermen to take his body after his death to the middle of the Irish Channel and sink it with leaden weights. Hunter, it is alleged, was informed of this and overbribed the prospective undertakers and thus secured the body. It has been estimated that it cost Hunter nearly 500 pounds sterling to gain possession of the skeleton of the " Irish Giant." The kettle in which the body was boiled, together with some interesting literature relative to the cir- cumstances, are preserved in the Museum of the Royal College of Surgeons in Lon- don, and were exhibited at the meeting of the British Medical Association in 1895 with other Hunterian relics. The skeleton, which is now one of the feat- ures of the Museum, is reported to meas- ure 92f inches in height, and is mounted alongside that of Caroline Crachami, the Sicilian dwarf, who was exhibited as an Italian princess in London in 1824. She did not grow after birth and died at the age of nine (Fig. 157). Patrick Cotter, the successor of O'Brien, and who for awhile exhibited under this name, claiming that he was a lineal descendant of the famous Irish King, Brian Boru, who he declared was 9 feet in height, was born in 1761, and died in 1806 at the age of forty-five. His shoe was 17 inches long, and he was 8 feet 4 inches tall at his death. In the Museum of Madame Tussaud in London there is a wax figure of Loushkin, said to be the tallest man of his time. It measures 8 feet 5 inches, and is dressed in the military uniform of a drum-major of the Im- perial Preobrajensky Regiment of Guards. To magnify his height there is a figure of the celebrated dwarf, " General Tom Thumb," in the palm of his hand. Figure 158 represents a well-known American giant, Ben Hicks, who was called " the Denver Steeple." BuiFon refers to a Swedish • giantess who he affirms was 8 feet 6 inches tall. Chang, the " Chinese Qiant," whose smiling face is familiar to nearly Fig. 168.— Ben Hioks. 332 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT. all the modern world, was said to be 8 feet tall. In 1865, at the age of nineteen, he measured 7 feet 8 inches. At Hawick, Scotland, in 1870, there was an Irishman 7 feet 8 inches in height, 52 inches around the chest, and who weighed 22 stone. Figure 159 shows an American giantess known as " Leah, the Giantess." At the age of nineteen she was 7 feet 2 inches tall and weighed 165 pounds. On June 17, 1871, there were married at Saint-Martins-in-the-Field in London Captain Martin Van Buren Bates of Kentucky and Miss Anna Swann of Nova Scotia, two celebrated exhibitionists, both of whom were over 7 feet. Captain Bates, familiarly known as the "Kentucky Giant," years ago was a familiar figure in many Northern cities, where he exhibited him- self in company with his wife, the combined height of the two being greater than that of any couple known to history. Captain Bates was born in Whites- burg, Letcher County, Ky., on November 9, 1845. He enlisted in the South- ern army in 1861, and though only sixteen years old was admitted to the service because of his size. At the close of the war Captain Bates had attained his great height of 7 feet 2i inches. His body was well proportioned and his weight increased until it reached 450 pounds. He traveled as a curiosity from 1866 to 1880, being connected with various amusement organizations. He visited nearly all the large cities and towns in the United States, Canada, Great Britain, France, Spain, Germany, Switzer- land, Austria, and Russia. While in England in 1871 the Captain met Miss Anna H. Swann, known as the " Nova Scotia Giantess," who was two years the junior of her giant lover. Miss Swann was justly proud of her height, 7 feet 5J inches. The two were married soon afterward. Their combined height of 14 feet 8 inches marked them as the tallest married couple known to mankind. Fig. 189.—" Leah, the Giantess." DWARFS. 333 Captain Bates' parents were of medium size. His father, a native of Virginia, was 5 feet 10 inches high and weighed 160 pounds. His mother was 5 feet '3 inches tall and weighed 125 pounds. The height of the father of Mrs. Anna Swann Bates was 6 feet and her mother was 5 feet and 2 inches high, weighing but 100 pounds. A recent newspaper dispatch says : " Captain M. V. Bates, whose remarkable height at one time attracted the attention of the world, has recently retired from his conspicuous position and lives in comparative obscurity on his farm in Guilford, Medina County, O., half a mile east of Seville." In 1845 there was shown in Paris Joachim Eleiceigui, the Spanish giant, who weighed 195 kilograms (429 pounds) and whose hands were 42 cm. (16J inches) long and of great beauty. In 1882 at the Alhambra in London there was a giantess by the name of Miss Marian, called the " Queen of the Amazons," aged eighteen years, who measured 2.45 meters (96J inches). William Campbell, a Scotchman, died at Newcastle in May, 1878. He was so large that the window of the room in which the deceased lay and the brick-work to the level of the floor had to be taken out, in order that the coffin might be lowered with block and tackle three stories to the ground. On January 27, 1887, a Greek, although a Turkish subject, recently died of phthisis in Simferopol. He was 7 feet 8 inches in height and slept on three beds laid close together. Giants of History. — A number of persons of great height, particularly sovereigns and warriors, are well-known characters of history, viz., William of Scotland, Edward III., Godefroy of Bouillon, Philip the Long, Fairfax, Moncey, Mortier, Kl6ber ; there are others celebrated in modern times. Rochester, the favorite of Charles II. ; Pothier, the jurist; Bank, the English naturalist ; Gall, Billat-Savarin, Benjamin Constant, the painter David, Bel- lart, the geographer Delamarche, and Care, the founder of the Gentleman's Magazine, were all men of extraordinary stature. Dwarfs. — The word "dwarf" is of Saxon origin (dwerg, dweorg) and corresponds to the " pumilio " or " nanus " of the Romans. The Greeks believed in the pygmy people of Thrace and Pliny speaks of the Spitha- miens. In the " Iliad " Homer writes of the pygmies and Juvenal also de- scribes them ; but the fantasies of these poets have given these creatui'es such diminutive stature that they have deprived the traditions of credence. Herodotus relates that in the deserts of Lybia there Avere people of extreme shortness of stature. The Bible " mentions that no dwarf can officiate at the altar. Aristotle and Philostratus speak of pygmy people descended from Pygmseus, son of Dorus. In the seventeenth century van Helmont supposed that there were pygmies m\ the Canary Islands, and Abyssinia, Brazil, and Japan in the older times werc\ repeatedly said to contain pygmy races. Relics \ a Lev. xxi., 20. 334 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT. of what must have been a pygmy race have been found in the Hebrides, and in this country in Kentucky and Tennessee. Dr. Schweinfurth, the distinguished African traveler, confirms the state- ments of Homer, Herodotus, and Aristotle that there was a race of pygmies near the source of the Nile. Schweinfurth says that they live south of the country occupied by the Niam-Niam, and that their stature varies from 4 feet to 4 feet 10 inches. These people are called the Akkas, and wonderful tales are told of their agility and cunning, characteristics that seem to com- pensate for their small stature. In -1860 Paul DuChaillu speaks of the existence of an African people called the Obongos, inhabiting the country of the Ashangos, a little to the south of the equator, who were about 1.4 meters in height. There have been people found in the Esquimaux region of very diminutive stature. Battel discovered another pygmy people near the Obongo who are called the Dongos. Kolle describes the Kenkobs, who are but 3 to 4 feet high, and another tribe called the Eeebas, who vary from 3 to 5 feet in height. The Portuguese speak of a race of dwarfs whom they call the Bakka-bakka, and of the Yogas, who inhabit territory as far as the Loango. Nubia has a tribe of dwarfs called the Sukus, but little is known of them. Throughout India there are stories of dwarf tribes descended from the monkey-God, or Hoonuman of the myth- ologic poems. In the works of Humboldt and Burgoa there is allusion to the tradition of a race of pygmies in the unexplored region of Chiapas near the Isthmus of Tehuantepec in Central America. There is an expedition of anthropolo- gists now on the way to discover this people. Professor Starr of Chicago on his return from this region reported many colonies of undersized people, but did not discover any pygmy tribes answering to the older legendary de- scriptions. Figure 160 represents two dwarf Cottas measuring 3 feet 6 inches in height. The African pygmies who were sent to the King of Italy and shown in Rome resembled the pygmy travelers of Akka that Schweinfurth saw at the court of King Munza at Monbuttu. These two pygmies at Rome were found in Central Africa and were respectively about ten and fifteen years old. They spoke a dialect of their own and different from any known African tongue ; they were partly understood by an Egyptian sergeant, a native of Soudan, who accompanied them as the sole survivor of the escort with which their donor, Miani, penetrated Monbuttu. Miani, like Living- stone, lost his life in African travel. These dwarfs had grown rapidly in recent years and at the time of report measured 1.15 and 1.02 meters. In 1874 they were under the care of the Royal Geographical Society of Italy. They were intelligent in their manner, but resented being lionized too much, and were prone to scratch ladies who attempted/ to kiss them." a 476, 1874, i., 896.' ARTIFICIAL PRODUCTION OF DWARFS. 335 The "Aztec Children" in 1851, at the ages of seven and six years, an- other pair of alleged indigenous pygmies, measured 33f and 29J inches in height and weighed 20| and 17 pounds respectively. The circumference of their heads did not equal that of an ordinary infant at birth. It is known that at one time the ancients artificially produced dwarfs Fig. 160.— Dwarf Cottas. by giving them an insufficient alimentation when very young. They soon became rachitic from their ideprivation of lime-salts and a great number perished, but those who su^ived were very highly prized by the Roman Emperors for their grotesqueVappearance. There were various recipes fol dwarfing children. One of the^most efficient in the olden times was said to 336 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT. ^ have been anointing the backbone with the grease of bats, moles, dormice, and such animals ; it was also said that puppies were dwarfed by frequently washing the feet and backbone, as the consequent drying and hardening of the parts were alleged to hinder their extension. To-day the growth of boys intended to be jockeys is kept down by excessive sweating. Ancient Popularity of Dwarfs. — ^At one time a dwarf was a necessary appendage of every noble family. The Roman Emperors all had their dwarfs. Julia, the niece of Augustus, had a couple of dwarfs, Conopas and Andromeda, each of whom was 2 feet 4 inches in height. It was the fashion at one time to have dwarfs noted for their wit and wisdom. Philos of Cos, tutor of Ptolemy Philadelphus, was a dwarf, as were Carachus, the friend of Saladin ; Alypius of Alexandria, who was only 2 feet high ; Lucinus Calvus, who was only 3 feet high, and ^sop, the famous Greek fabulist. Later in the Middle Ages and even to the last century dwarfs were seen at every Court. Lady Montagu describes the dwarfs at the Viennese Court as " devils bedaubed with diamonds." They had succeeded the Court Jester and exercised some parts of this ancient office. At this time the English ladies kept monkeys for their amusement. The Court dwarfs were allowed unlimited freedom of speech, and in order to get at truths other men were afraid to utter one of the Kings of Denmark made one of his dwarfs Prime Minister. Charles IX. in 1572 had nine dwarfs, of which four had been given to him by King Sigismund- Augustus of Poland and three by Maximilian II. of Germany. Catherine de M4dicis had three couples of dwarfs at one time, and in 1579 she had still five pygmies, named Merlin, Mandricart, Pelavine, Rodomont, and Majoski. Probably the last dwarf in the Court of France was Balthazar Simon, who died in 1662. Sometimes many dwarfs were present at great and noble gatherings. In Rome in 1566 the Cardinal Vitelli gave a sumptuous banquet at which the table-attendants were 34 dwarfs. Peter the Great of Russia had a passion for dwarfs, and in 1710 gave a great celebration in honor of the mar- riage of his favorite, Valakoff, with the dwarf of the Princess Prescovie Theodorovna. There were 72 dwarfs of both sexes present to form the bridal party. Subsequently, on account of dangerous and difficult labor, such marriages were forbidden in Russia. In England and in Spain the nobles had the portraits of their dwarfs painted by the celebrated artists of the day. Velasquez has represented Don Antonio el Ingles, a dwarf of fine appearance, with a large dog, probably to bring out the dwarf's inferior height. This artist also painted a great num- ber of other dwarfs at the Court of Spain, and in one of his paintings he portrays the Infanta Marguerite accompanied by' her male and female dwarfs. Reproductions of these portraits have been given by Gamier.^ In the pic- " " Les Nains et les G6ants." Paris, 1884. INTELLECTUAL DWARFS. 337 tures of Eaphael, Paul Veronese, and Dominiquin, and in the " Triumph of Csesar" by Mantegna, representations of dwarfs are found, as well as in other earlier pictures representing Court events. At the present time only Russia and Turkey seem to have popular sympathy for dwarfs, and this in a limited degree.- Intellectual Dwarfs. — It must be remarked, however, that many of the dwarfs before the public have been men of extraordinary intelligence, possi- bly augmented by comparison. In a postmortem discussed at a meeting of the Natural History Society at Bonn in 1868 it was demonstrated by Schauf hausen that in a dwarf subject the brain weighed Jg- of the body, in contradistinction to the average proportion of adults, from 1 to 30 to 1 to 44. The subject was a dwarf of sixty-one who died in Coblentz, and was said to have grown after his thirtieth year. His height was 2 feet 10 inches and his weight 45 pounds. The circumference of the head was 520 mm. and the brain weighed 1183.33 gm. and was well convoluted. This case was one of simple arrest of development, affecting all the organs of the body ; he was not virile. He was a child of large parents ; had two brothers and a sister of ordinary size and two brothers dwarfs, one 5 inches higher and the other his size. Several personages famous in history have been dwarfs. Attila, the his- torian Procopius, Gregory of Tours, P6pin le Bref, Charles III., King of Naples, and Albert the Grand were dwarfs. About the middle of the seven- teenth century the French episcopacy possessed among its members a dwarf renowned for his intelligence. This diminutive man, called Godeau, made such a success in literature that by the grace of Richelieu he was named the Archbishop of Grasse. He died in 1672. The Dutch painter Doos, the English painter Gibson (who was about 3 feet in height and the father of nine infants by a wife of about the same height), Prince Eugene, and the Spanish Admiral Gravina were dwarfs. Fleury and Garry, the actors ; Hay, a member of Parliament from Sussex in the last century ; Hussein- Pasha, celebrated for his reforms under Selim III. ; the Danish antiquarian and voyager, Arendt, and Baron Denon were men far below the aA^erage size. Varro says that there were two gentlemen of Rome who from their decorations must have belonged to an Equestrian Order, and who were but 2 Roman cubits (about 3 feet) high. Pliny also speaks of them as preserved in their coffins. It may be remarked that perhaps certain women are predisposed to give birth to dwarfs. Borwilaski had a brother and a sister who were dwarfs. In the middle of the seventeenth century a woman brought forth four dwarfs, and in the eighteenth century a dwarf named Hopkins had a sister as small as he was. Tilh6r6se Souvray, the dwarf fiancee of B6b§, had a dwarf sister 41 inches high. Virey has examined a German dwarf of eight who was only 18 inches tall, i\. e., about the length of a newly-born infant. The parents were of ordinary &ii^, but had another child who was also a dwarf. 22 338 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT. There are two species of dwarfs, the first coming into the world under normal conditions, but who in their infancy become afflicted with a sudden arrest of development provoked by some malady ; the second are born very small, develop little, and are really dwarfs from their birth ; as a rule they are well conformed, robust, and intelligent. These two species can be dis- tinguished by an important characteristic. The rachitic dwarfs of the first class are incapable of perpetuating their species, while those of the second category have proved more than once their virility. A certain number of dwarfs have married with women of normal height and have had several children, though this is not, it is true, an indisputable proof of their generative faculties ; but we have instances in which dwarfs have married dwarfs and had a family sometimes quite numerous. Kobert Skinner (25 inches) and Judith (26 inches), his wife, had 14 infants, well formed, robust, and of normal height. Celebrated Dwarfs. — Instances of some of the most celebrated dwarfs will be cited with a short descriptive mention of points of interest in their lives : — Vladislas Cubitas, who was King of Poland in 1305, was a dwarf, and was noted for his intelligence, courage, and as a good soldier. Geoffrey Hudson, the most celebrated English dwarf, was born at Oakham in England in 1619. At the age of eight, when not much over a foot high, he was pre- sented to Henriette Marie, wife of Charles I., in a pie ; he afterward became her favorite. Until he was thirty he was said to be not more than 18 inches high, when he suddenly increased to about 45 inches. In his youth he fought several duels, one with a turkey cock, which is celebrated in the verse of Davenant. He became a popular and graceful courtier, and proved his bravery and allegiance to his sovereign by assuming command of a royalist company and doing good service therein. Both in moral and physical capaci- ties he showed his superiority. At one time he was sent to France to secure a midwife for the Queen, who was a Frenchwoman. He afterward chal- lenged a gentleman by the name of Croft to fight a duel, and would accept only deadly weapons ; he shot his adversary in the chest ; the quarrel grew out of his resentment of ridicule of his diminutive size. He was accused of participation in the Papist Plot and imprisoned by his political enemies in the Gate House at Westminster, where he died in 1682 at the advanced age of sixty-three. In Scott's " Peveril of the Peak " Hudson figures prominently. This author seemed fond of dwarfs. About the same epoch Charles I. had a page in his court named Rich- ard Gibson, who was remarkable for his diminutive size and his ability as a miniature painter. This little artist espoused another of his class, Anne Shepherd, a dwarf of Queen Henriette Marie, about his size (45 inches). Mis- tress Gibson bore nine children, five of whom arrived at adult age and were of ordinary proportions. She died at the age of eighty ; her husband after- CELEBRATED DWARFS. 339 ward became the drawing master of Princesses Mary and Anne^ daughters of James II.; he died July 23, 1690, aged seventy-five years. In 1730 there was born of poor fisher parents at Jelst a child named Wybrand Lokes. He became a very skilful jeweler, and though he was of diminutive stature he married a woman of medium height, by whom he had several children. He was one of the smallest men ever exhibited, meas- uring but 25 J inches in height. To support his family better, he abandoned his trade and with great success exhibited himself throughout Holland and England. After having amassed a great fortune he returned to his country, where he died in 1800, aged seventy. He was very intelligent, and proved his power of paternity, especially by one son, who at twenty-three was 5 feet 3 inches tall, and robust. Another celebrated dwarf waS Nicolas Ferry, otherwise known as B6be. He was born at Plaine in the Yosges in 1741 ; he was but' 22 cm. (8J inches) long, weighed 14 ounces at birth, and was carried on a plate to the church for baptism. At five B§b6 was presented to King Stanislas of Poland. At fifteen he measured 29 inches. He was of good constitution, but was almost an idiot ; for example, he did not recognize his mother after fifteen days' separation. He was quite lax in his morals, and exhibited no evidences of good nature except his lively attachment for his royal master, who was himself a detestable character. He died at twenty-two in a very decrepit condition, and his skeleton is preserved in the Museum of Natural History in Paris. Shortly before his death B6b6 became engaged to a female dwarf named Th^rSse Souvray, who at one time was exhibited in Paris at the Theatre Conti, together with an older sister. Th6rese lived to be seventy- three, and both she and her sister measured only 30 inches in height. She died in 1819. Aldrovandus ^^^ gives a picture of a famous dwarf of the Due de Cr6qui who was only 30 inches tall, though perfectly formed ; he also speaks of some dwarfs who were not over 2 feet high. There was a Polish gentleman named Joseph Borwilaski, born in 1739, who was famed all over Europe. He became quite a scholar, speaking French and German fairly well. In 1860, at the age of twenty-two, and 28 inches in height, he married a woman of ordinary stature, who bore him two infants well conformed. He was exhibited in many countries, and finally settled at Durham, England, where he died in 1837 at the almost incredible age of ninety-eight, and is buried by the side of the Falstaffian Stephen Kemble. Mary Jones of Shropshire, a dwarf 32 inches tall and much deformed, died in 1773 at the age of one hundred. These two instances are striking ex- amples of great age in dwarfs and are therefore of much interest. Bor- wilaski's parents were tall in stature and three of his brothers were small ; three of the other children measured 5 feet 6 inches. Diderot has written a history of this family. 340 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT. Richeborg,^^* a dwarf only 23 inches in height, died in Paris in 1858 aged ninety years. In childhood he had been a servant in the House of Orleans and afterward became their pensioner. During the Revolution he passed in and out of Paris as aia infant in a nurse's arms, thus carrying dispatches memorized which might have proved dangerous to carry in any other manner. At St. Philip's, Birmingham, there is the following inscription on a tomb : " In memory of Mannetta Stocker, who quitted this life on the 4th day of May, 1819, at the age of thirty-nine years, the smallest woman in the kingdom, and one of the most accomplished." She was born in Krauma, in the north of Austria, under normal con- ditions. Her growth stopped at the age of four, when she was 33 inches tall. She was shown in many villages and cities over Europe and Great Britain ; she was very gay, played well on the piano, and had divers other accomplish- ments. In 1742 there was shown in London a dwarf by the name of Robert Skinner, .63 meters in height, and his wife, Judith, who was a little larger. Their exhibition was a great success and they amassed a small fortune ; during twenty- three years they had 14 robust and well-formed- chil- dren. Judith died in 1763, and Robert grieved so much after her that he himself expired two years later. Figure 161 shows a female dwarf with her husband and child, all of whom were exhibited some years since in the Eastern United States. The likeness of the child to the mother is already noticeable. BufPon speaks of dwarfs 24, 21, and 18 inches high, and mentions one individual, aged thirty-seven, only 16 inches tall, whom he considers the smallest person on record. Virey in 1818 speaks of an English child of eight or nine who was but 18 inches tall. It had the intelligence of a child of three or four ; its dentition was delayed until it was two years old and it did not walk until four. The parents of this child were of ordinary stature. Fig. 161. — Female dwarf with her husband and child. CELEBRATED DWARFS. 341 At the "Cosmorama" in Eegent Street in 1848" there was a Dutch boy of ten exhibited. He was said to be the son of an apothecary and at the time of his birth weighed nine pounds. He continued to grow for six months and at the expiration of that time weighed 12 pounds; since then, how- ever, he had only increased four pounds. The arrest of development seemed to be connected with hydrocephalus ; although the head was no larger than that of a child of two, the anterior fontanelle was widely open, indicating that there was pressure within. He was strong and muscular ; grave and sedate in his manner ; cheer- ful and aifectionate ; his manners were polite and en- gaging ; he was expert in many kinds of handicraft; he possessed an ardent de- sire for knowledge and apti- tude for education. Rawdon * described a boy of five and a half, at the Liverpool Infirmary for Children, who weighed lOJ pounds and whose height was 28 or 29 inches. He uttered no articulate sound, but evidently possessed the sense of hearing. His eyes were large and well formed, but he was apparently blind. He suckled, cut his teeth normally, but had tonic con- tractions of the spine and was an apparent idiot. Hardie" mentions a girl of sixteen and a half whose height was 40 inches and weight 35 J pounds, includ- ing her clothes. During intrauterine life her mother had good health and both her parents had always been healthy. She seemed to stop growing at her fourth year. Her intellect was on a par with the rest of her body. Some- times she would talk and again she would preserve rigid silence for a long time. She had a shuffling walk with a tendency to move on her toes. Her temporary teeth were shed in the usual manner and had been replaced by canines and right first molar and incisors on the right side. There was no a 476, 1848, ii., 490. *> 224, 1879, i., 386. <= 224, 1887, i., 730. Fig. 162.— Dwarf, height 34 inches, weight 309 pounds. 342 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT. indication of puberty except a slight development of the hips. She was almost totally imbecile, but could tell her letters and spell short words. The cir- cumference of the head was 19 inches, and Ross pointed out that the tendon- reflexes were well marked, as well as the ankle-clonus ; he diagnosed the case as one of parencephalus. Figure 162 represents a most curious case of a dwarf named Carrie Akers, who, though only 34 inches tall, weighed 309 pounds. In recent years several dwarfs have commanded the popular attention, but none so much as " General Tom Thumb," the celebrated dwarf of Bar- num's' Circus. Charles Stratton, surnamed "Tom Thumb," was born at Bridgeport, Conn., on January 11, 1832 ; he was above the normal weight of the new-born. He ceased growing at about five months, when his height was less than 21 inches. Barnum, hearing of this phenomenon in his city, en- gaged him, and he was shown all over the world under his assumed name. He was presented to Queen Victoria in 1844, and in the following year he was received by the Royal Family in France. His success was wonderful, and even the most conservative journals described and commented on him. He gave concerts, iti which he sang in a nasal voice ; but his " drawing feat " was embracing the women who visited him. It is said that in England alone he kissed a million females ; he prided himself on his success in this function, although his features were anything but inviting. After he had received numerous presents and had amassed a large fortune he returned to America in 1864, bringing with him three other dwarfs, the "Sisters War- ren " and " Commodore Nutt." He married one of the Warrens, and by her had one child, Minnie, who died some months after birth of cerebral con- gestion. In 1883 Tom Thumb and his wife, Lavinia, were still living, but after that they dropped from public view and have since died. In 1895 the wife of a dwarf named Morris gave birth to twins at Blaen- avon, North Wales. Morris is only 35 inches in height and his wife is even smaller. They were married at Bartholmey Church and have since been traveling through England under the name of " General and Mrs. Small," being the smallest married couple in the world. At the latest reports the mother and her twins were doing well. The Rossow Brothers have been recently exhibited to the public. These brothers, Franz and Carl, are twenty and eighteen years respectively. Franz is the eldest of 16 children and is said to weigh 24 pounds and measure 21 inches in height ; Carl is said to weigh less than his brother but is 29 inches tall. They give a clever gymnastic exhibition and are appa- rently intelligent. They advertise that they were examined and still re- main under the surveillance of the Faculty of Gottingen. Next to the success of " Tom Thumb " probably no like attraction has been so celebrated as the "Lilliputians," whose antics and wit so many Americans have in late years enjoyed. They were a troupe of singers and PRECOCIOUS DEVELOPMENT. 343 comedians composed entirely of dwarfs ; they exhibited much talent in all their performances, which were given for several years and quite recently in all the large cities of the United States. They showed themselves to be worthy rivals for honors in the class of entertainments known as burlesques. As near as could be ascertained, partly from the fact that they all spoke Ger- man fluently and originally gave their performance entirely in German, they were collected from the German and Austrian Empires. The "Princess Topaze" was born near Paris in 1879. According to a recent report she is perfectly formed and is intelligent and vivacious. She is 23| inches tall and weighs 14 pounds. Her parents were of normal stature. Not long since the papers recorded the death of Lucia Zarete, a Mexican girl, whose exact proportions were never definitely known ; but there is no doubt that she was the smallest midget ever exhibited in this country. Her exhibitor made a fortune with her and her salary was among the highest paid to modern " freaks." Miss H. Moritz, an American dwarf (Fig. 163), at the age of twenty weighed 36 pounds and was only 22 inches tall. Precocious development is charac- terized by a hasty growth of the subject, who at an early period of life attains the dimensions of an adult. In some of these instances the anomaly is associated with precocious puberty, and after acquiring the adult growth at an early age there is an apparent cessation of the devel- opment. In adult life the individual shows no distinguishing characters. The first to be considered will be those cases, sometimes called " man- boys," characterized by early puberty and extraordinary development in infancy. Histories of remarkable children have been transmitted from the time of Vespasian. We read in the "Natural History" of Pliny that in Salamis, Euthimedes had a son who grew to 3 Roman cubits (4J feet) in three years ; he was said to have little wit, a dull mind, and a slow and heavy gait ; his voice was manly, and he died at three of general debility. Phlegon" says that Craterus, the brother of King Antigonus, was an infant, a young man, a mature man, an old man, and married and begot children all in the space of seven years. It is said that King Louis II. of Hungary was born so long before his time that he had no skin ; in his second year he a "DeMirab.," cap. 32. Fig. 163.— Dwarf, 22 inches tall. 844 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT. was crowned, in his tenth year he succeeded, in his fourteenth year he had a complete beard, in his fifteenth he was married, in his eighteenth he had gray hair, and in his twentieth he died. Rhodiginus ^ speaks of a boy who when he was ten years impregnated a female. In 1741 there was a boy born at Willingham, near Cambridge,'' who had the external marks of puberty at twelve months, and at the time of his death at five years he had the appearance of an old man. He was called " prodigium Willinghamense." The Ephemerides and some of the older journals record instances of penile erection immediately after birth. It was said that Philip Howarth, who was born at Quebec Mews, Port- man Square, London, February 21, 1806, lost his infantile rotundity of form and feature after the completion of his first year and became pale and extremely ugly, appearing like a growing boy. His penis and testes increased in size, his voice altered, and hair grew on the pubes. At the age of three he was 3 feet 4J inches tall and weighed 51J pounds. The length of his penis when erect was 4J inches and the circumference 4 inches ; his thigh- measure was 13 J inches, his waist-measure 24 inches, and his biceps 7 inches. He was reported to be clever, very strong, and muscular. An old chronicle says that in Wisnang Parish, village of Tellurge, near Tygure, in Lordship Kiburge, there was born on the 26th of May, 1548, a boy called Henry Walker, who at five years was of the height of a boy of fourteen and pos- sessed the genitals of a man. He carried burdens, did men's work, and in every way assisted his parents, who were of usual size. There is a case cited by the older authors " of a child born in the Jura region who at the age of four gave proof of his virility, at seven had a beard and the height of a man. The same journal also speaks of a boy of six, 1.62 meters tall, who was perfectly proportioned and had ex- traordinary strength. His beard and general appearance, together with the marks of puberty, gave him the appearance of a man of thirty. In 1806 Dupuytren presented to the Medical Society iji Paris a child 3J feet high, weighing 57 pounds, who had attained puberty. There are on record six modern cases of early puberty in boys,^^^ one of whom died at five with the signs of premature senility ; at one year he had shown signs of enlargement of the sexual organs. There was another who at three was 3 feet 6| inches high, weighed 50 pounds, and had seminal dis- charges. One of the cases was a child who at birth resembled an ordi- nary infant of five months. From four to fifteen months his penis enlarged, until at the age of three it measured when erect 3 inches. At this age he was 3 feet 7 inches high and weighed 64 pounds. The last case mentioned was an infant who experienced a change of voice at twelve months and showed hair on the pubes. At three years he was 3 feet 41 inches tall and weighed 51J pounds. Smith, in Brewster's Journal, 1829, records the =■ 679, L. Tiii., cap. 8. t 629, 1745. c " Recueil de l'Acad6mie des Sciences," 1668. PRECOCIOUS PUBERTY. 345 case of a boy who at the age of four was well developed ; at the age of six he was 4 feet 2 inches tall and weighed 74 pounds ; his lower extremities were extremely short proportionally and his genitals were as well developed as those of an adult. He had a short, dark moustache but no hair on his chin, although his pubic hair was thick, black, and curly. Ruelle ^ describes a child of three and a quarter years who was as strong and muscular as one at eight. He had full-sized male organs and long black hair on the pubes. Under excitement he discharged semen four or five times a day ; he had a deep male voice, and dark, short hair on the cheek and upper lip. Stone ^ gives an account of a boy of four who looked like a child of ten and exhibited the sexual organs of a man with a luxuriant growth of hair on the pubes. This child was said to have been of great beauty and a minia- ture model of an athlete. His height was 4 feet J inch and weight 70 pounds ; the penis when semiflaccid was 4i inches long ; he was intelligent and lively, and his back was covered with the acne of puberty. A peculiar fact as regards this case was the statement of the father that he himself had had sexual indulgence at eight. Stone parallels this case by several others that he has collected from medical literature. Breschet in 1821 reported the case of a boy born October 20, 1817, who at three years and one month was 3 feet 6f inches tall ; his penis when flaccid measured 4 inches and when erect 5J inches, but the testicles were not developed in propor- tion. Lopez " describes a mulatto boy of three years ten and a half months whose height was 4 feet J inch and weight 82 pounds ; he measured about the chest 27J inches and about the waist 27 inches ; his penis at rest was 4 inches long and had a circumference of 3|^ inches, although the testes were not descended. He had evidences of a beard and his axillse were very hairy ; it is said he could with ease lift a man weighing 140 pounds. His body was covered with acne simplex and had a strong spermatic odor, but it was not known whether he had any venereal appetite. Johnson "^ mentions a boy of seven with severe gonorrhea complicated with buboes which he had contracted from a servant girl with whom he slept. At the Hopital des Enfans Malades children at the breast have been observed to masturbate. Fournier and others assert having seen infan- tile masturbators, and cite a case of a girl of four who was habitually addicted to masturbation from her infancy but was not detected until her fourth year ; she died shortly afterward in a frightful state of marasmus. Vogel alludes to a girl of three in whom repeated attacks of epilepsy oc- curred after six months' onanism. Van Bambeke mentions three children from ten to twenty months old, two of them females, who masturbated. Bidwell describes a boy of five years and two months who during the year previous had erections and seminal emissions. His voice had changed and he had a downy moustache on his upper lip and hair on the pubes ; his a 233, Feb. 28, 1843. b 124, 1852. c 124, 1843. a 476, 1860, i., Feb. 346 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT. height was 4 feet 3^ inches and his weight was 82J pounds. His penis and testicles were as well developed as those of a boy of seventeen or eighteen, but from his facial aspect one would take him to be thirteen. He avoided the company of women and would not let his sisters nurse him when he was sick. Pryor'' speaks of a boy of three and a half who masturbated and who at five and a half had a penis of adult size, hair on the pubes, and was known to have had seminal emissions. Woods'* describes a boy of six years and seven months who had the appearance of a youth of eighteen. He was 4 feet 9 inches tall and was quite muscular. He first exhibited signs of precocious growth at the beginning of his second year and when three years old he had hair on the pubes. There is an instance " in which a boy of thirteen had intercourse with a young woman at least a dozen times and succeeded in impregnating her. The same journal mentions an instance in which a boy of fourteen succeeded in impregnating a girl of the same age. Chevers ^^^ speaks of a young boy in India who was sentenced to one year's imprisonment for raping a girl of three. Douglass * describes a boy of four years and three months who was 3 feet 10§^ inches tall and weighed 54 pounds ; his features were large and coarse, and his penis and testes were of the size of those of an adult. He was unusually dull, mentally, quite obstinate, and self-willed. It is said that he masturbated on all opportunities and had vigorous erections, although no spermatozoa were found in the semen issued. He showed no fondness for the opposite sex. The history of this rapid growth says that he was not unlike other children until the third year, when after wading in a small stream several hours he was taken with a violent chill, after which his voice began to change and his sexual organs to develop. Blanc ^1^ quotes the case described by Cozanet in 1875 of Louis Beran, who was born on September 29, 1869, at Saint-Gervais, of normal size. At the age of six months his dimensions and weight increased in an extra- ordinary fashion. At the age of six years he was 1.28 meters high (4 feet 2^ inches) and weighed 80 pounds. His puberty was completely manifested in every way ; he eschewed the society of children and helped his parents in their labors. Campbell " showed a lad of fourteen who had been under his observation for ten years. When fifteen months old this prodigy had hair on his pubes and his external genitals were abnormally large, and at the age of two years they were fully developed and had not materially changed in the following years. At times he manifested great sexual excitement. Between four and seven years he had seminal discharges, but it was not determined whether the semen contained spermatozoa. He had the muscular development of a man of twenty-five. He had shaved several years. The boy's education was defective from his failure to attend school. a 778, xxii., 521. b 476, 1882, ii., 377. c 224, 1887, i., 918. d 597, 1889. e 536, No. 2591, 551. Missing Page Missing Page LARGE INFANTS. 349 a similar instance. Eddowes " speaks of the birth of a child at Crewe, a male, which weighed 20 pounds 2 ounces and was 23 inches long. It was 14 J inches about the chest, symmetrically developed, and likely to live. The mother, who was a schoolmistress of thirty-three, had borne two previous children, both of large size. In this instance the gestation had not been prolonged, the delivery was spontaneous, and there was no laceration of the parts. Chubb'* says that on Christmas Day, 1852, there was a child delivered weighing 21 pounds. The labor was not severe and the other children of the family were exceptionally large. Dickinson *= describes a woman, a terti- para, who had a most difficult labor and bore an extremely large child. She had been thirty-six hours in parturition, and by evisceration and craniotomy was delivered of a child weighing 16 pounds. Her first child weighed 9 pounds, her second 20, and her third, the one described, cost her her life soon after delivery. There is a history of a Swedish woman in Boston ^ who was delivered by the forceps of her first child, which weighed 19f pounds and which was 25| inches long. The circumference of the head was 16f inches, of the neck 9f, and of the thigh 10| inches. Rice " speaks of a child weighing 20|- pounds at birth. Johnston ^ de- scribes a male infant who was born on November 26, 1848, weighing 20 pounds, and Smith ^ another of the same weight. Baldwin ^ quotes the case of a woman who after having three miscarriages at last had a child that weighed 23 pounds. In the delivery there was extensive laceration of the anterior wall of the vagina ; the cervix and perineum, together with an inch of the rectum, were completely destroyed. Beach ' describes a birth of a young giant weighing 23f pounds. Its mother was Mrs. Bates, formerly Anna Swann, the giantess who married Captain Bates. Labor was rather slow, but she was successfully delivered of a healthy child weighing 23f pounds and 30 inches long. The secun- dines weighed ten pounds and there were nine quarts of amniotic fluid. There is a recent record ■> of a Cesarian section performed on a woman of forty in her twelfth pregnancy and one month beyond term. The fetus, which was almost exsanguinated by amputation, weighed 22J pounds. Bumm^ speaks of the birth of a premature male infant weighing 4320 gm. (9 J pounds) and measuring 54 cm. long. Artificial labor had been induced at the thirty-fifth week in the hope of delivering a living child, the three preceding infants having all been still-born on account of their large size. Although the mother's pelvis was wide, the disposition to bear huge infants was so great as to render the woman virtually barren. » 476, 1884, ii., 941. b 224, 1879, i., 143. c 227, 1894, 225. d 381, 1879, i., 255. e 218, 1876. f 124, 1881. g 545, 1878, 512. ^ 227, 1894, 228. i 538, March 22, 1879. J Repertoire d'Obstet. et de Gynfec, May 25, 1891. k Cor.-Bl. f. schweiz. Aerzte, p. 117, Feb. 15, 1895. 360 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT. Congenital asymmetry and hemihypertrophy of the body are most peculiar anomalies and must not be confounded with acromegaly or myxe- dema, in both of which there is similar lack of symmetric development. There seems to be no satisfactory clue to the causation of these abnormalisms. Most frequently the left side is the least developed, and there is a decided difference in the size of the extremities. Finlayson " reports a case of a child affected with congenital unilateral hypertrophy associated with patches of cutaneous congestion. Logan* men- Fig. 165.— Case of hemihypertropliy (Adams). tions hypertrophy in the right half of the body in a child of four first noticed shortly after birth ; Langlet" also speaks of a case of congenital hypertrophy of the right side. Broca" and Tr6lat = were among the first observers to discuss this anomaly. Tilanus of Munich in 1893 reported a case of hemihypertrophy in a girl of ten. The whole right half of the body was much smaller and better developed than the left, resulting in a limping gait. The electric reaction » 381, 1884, xxi., 327. b n. Orl. J. M., 1868, xxi., 733. Union m6d. et scient. dii nord-est, Reims, 1882, vi., 276. d 368, 1859, xi v., 445. e 1 62, 1869, i., 536, 676. HEMIHYPER TR OPHY. 351 and the reflexes showed no abnormality. The asymmetry was first observed when the child was three. Mobius and Demme report similar cases. Adams " reports an unusual case of hemihypertrophy in a boy of ten. There was nothing noteworthy in the family history, and the patient had suffered from none of the diseases of childhood. Deformity was noticeable at birth, but not to such a degree relatively as at a later period. The in- creased growth affected the entire right half of the body, including the face, but was most noticeable in the leg, thigh, and buttock. Numerous telangiec- Fig. 166. — Unilateral hypertrophy (Milne). Fig. 167. — The Tompkins child, age thirteen mouths. tatic spots were scattered irregularly over the body, but most thickly on the right side, especially on the outer surface of the leg. The accompanying illustration (Fig. 165) represents the child's appearance at the time of report. Jacobson ^ reports the history of a female child of three years with nearly universal giant growth (Riesenwuchs). At first this case was erroneously diagnosed as acromegaly. The hypertrophy affected the face, the genitals, the left side of the trunk, and all the limbs. Milne ° records a case of hemihypertrophy in a female child of one year a 165, Dec, 1894. b 161, 1895, cxxxix., 104. c Quarterly Med. Jour., April, 1895. 352 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT. (Fig. 166). The only deviation from uniform excess of size of the right side was shown in the forefinger and thumb, which were of the same size as on the other hand ; and the left side showed no overgrowth in any of its inembers except a little enlargement of the second toe. While hypertrophy of one side is the usual description of such cases, the author suggests that there may be a condition of defect upon the other side, and he is inclined to think that in this case the limb, hand, and foot of the left side seemed rather below the average of the child's age. In this case, as in others previously reported, there were numerous telangiectatic spots of congestion scattered irregularly over the body. Milne" also reported later to the Sheffield Medido-Chirurgical Society an instance of unilateral hypertrophy in a female child of nineteen months. The right side was involved and the anomaly was believed to be due to a deficiency of growth of the left side as well as over-development of the right. There were six teeth on the right side and one on the left. Obesity. — The abnor- mality of the adipose system, causing in consequence an • augmentation of the natural volume of the subject, should be described with other ano- malies of size and stature. Obesity may be partial, as seen in the mammae or in the abdomen of both women and men, or may be general ; and it is of general obesity that we shall chiefly deal. Lipomata, being distinctly pathologic formations, will be left for another chapter. The cases of obesity in infancy and childhood are of considerable interest, and we sometimes see cases that have been termed examples of " congenital corpulency." Figure 167 represents a baby of thirteen months that weighed 75 pounds. Figure 168 shows another example of infantile obesity, known as " Baby Chambers." Elliotson ^22 describes a female infant not a year old M'hich weighed 60 pounds. There is an instance on record of a girl of four who weighed 256 pounds.^ Tulpius " mentions a girl of five who weighed 150 pounds and had the strength of a man. He says that the a 476, March 23, 1895. b 629, No. 185. c 842, 283. Fig. 168.— Baby Chambers. OBESITY IN CHILDREN. 353 acquisition of fat did not commence until some time after birth. Ebstein reports an instance given to him by Fisher of Moscow of a child in Pomera- nia who at the age of six weighed 137 pounds and was 46 inches tall ; her girth was 46 inches and the circumference of her head was 24 inches. She was the offspring of ordinary-sized parents, and lived in narrow and some- times needy circumstances. The child was intelligent and had an animated expression of countenance. Bartholinus mentions a girl of eleven who weighed over 200 pounds. There is an instance recorded of a young girl in Russia who weighed nearly 200 pounds when but twelve. Wulf, quoted by Ebstein, describes a child which died at birth weighing 295 ounces. It was well proportioned and looked like a child three months old, except that it had an enormous devel- opment of fatty tissue. The parents were not excessively large, and the mother stated that she had had children before of the same proportions. GrisoUes" mentions a child who was so fat at twelve months that there was constant danger of suffocation ; but, marvelous to relate, it lost all its obesity when two and a half, and later was remarkable for its slender figure. Figure 169 shows a girl born in Carbon County, Pa., who weighed 201 pounds when nine years old. McNaughton^ describes Susanna Tripp, who at six years of age weighed 203 j)ounds and was 3 feet 6 inches tall and measured 4 feet 2 inches around the waist. Her younger sister, Deborah, weighed 119 pounds ; neither of the two weighed over 7 pounds at birth and both began to grow at the fourth month. On October, 1788, there died at an inn in the city of York the surprising " Worcestershire Girl " at the age of five. She had an exceedingly beautiful face and was quite active. She was 4 feet in height and larger around the breast and waist ; her thigh measured 1 8 inches and she weighed nearly 200 pounds. In February, 1814, Mr. S. Pauton was married to the only daughter of Thomas AUanty of Yorkshire ; although she was but thirteen she was 13 stone weight (182 pounds). At seven years she had weighed 7 stone (98 pounds). Williams'*^ mentions several instances of fat children. The first was a German girl who at birth weighed 13 pounds; at six months, 42 pounds; at four years, 150 pounds; and at twenty years, 450 pounds. Isaac Butterfield, born near Leeds in 1781, weighed 100 pounds in 1782 and was 3 feet 13 inches tall. There was a child named Everitt, exhibited in London in 1780, who at eleven months was 3 feet 9 inches tall and measured around the loins over 3 feet. William Abernethy" at the age of thirteen weighed 22 stone (308 pounds) and measured 57 inches around the waist. He was 5 feet 6 inches tall. There was a girl of ten'^ who was 1.45 meters (4 feet 9 inches) high and weighed 175 pounds. Her manners were infantile and her intellectual development a "Vorlesungen iiber specielle Pathologie und Therapie, Deutsche Ausgabe," Leipzig, 1848, ii., 265. b 599, 1829. 548, 1862, i., 363. d 677, 1869, No. 2. 23 354 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT. was much retarded. She spoke with difficulty in a deep voice ; she had a most voracious appetite. At a meeting of the Physical Society of Vienna on December 4, 1894, " there was shown a girl of five and a half who weighed 250 pounds. She was just shedding her first teeth ; owing to the excess of fat on her short limbs she toddled like an infant. There was no tendency to obesity in her family. Up to the eleventh month she was nursed by her mother, and sub- Fig. 169.— Age nine, weight 201 pounds. sequently fed on cabbage, milk, and vegetable soup. This child, who was of Russian descent, was said never to perspire. Cameron'' describes a child who at birth weighed 14 pounds, at twelve months she weighed 69 pounds, and at seventeen months 98 pounds. She was not weaned until two years old and she then commenced to walk. The parents were not remarkably large. There is an instance of a boy of thirteen and a half who weighed 214 pounds." Kaestner speaks of a child of four a 476, 1875, i., 72. b778, xviii., 115. c 292, Ixvi. GENERAL REMARKS ON OBESITY. 355 who weighed 82 pounds, and Benzenberg noted a child of the same age who weighed 137. Hildman, quoted by Picat, speaks of an infant three years and ten months old who had a girth of 30 inches. Hillairet " knew of a child of five which weighed 125 pounds. Botta'^ cites several instances of preternaturally stout children. One child died at the age of three weighing 90 pounds, another at the age of five weighed 100 pounds, and a third at the age of two weighed 75 pounds. Figure 170 represents Miss "Millie Josephine" of Chicago, a recent ex- Fig. 170.— Age thirteen, weigbt 422 pounds. hibitionist, who at the reputed age of thirteen was 5 feet 6 inches tall and weighed 422 pounds. General Remarks. — It has been chiefly in Great Britain and in Hol- land that the most remarkable instances of obesity have been seen, especially in the former country colossal weights have been recorded. In some coun- tries corpulency has been considered an adornment of the female sex. Hesse- . Wartegg " refers to the Jewesses of Tunis, who when scarcely ten years old are subjected to systematic treatment by confinement in narrow, dark rooms, where they are fed on farinaceous foods and the flesh of young puppies until a 233, 1881. •> Cincin. Med. News, 1877, 321. « Tunis, "Vienna, 1881. 356 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT. they are almost a shapeless mass of fat. According to Ebstein, the Moorish women reach with astonishing rapidity the desired embonpoint on a diet of dates and a peculiar kind of meal. In some nations and families obesity is hereditary, and generations come and go without a change in the ordinary conformation of the representa- tives. In other people slenderness is equally persistent, and efforts to over- come this peculiarity of nature are without avail. Treatment of Obesity. — Many persons, the most famous of whom was Banting, have advanced theories to reduce corpulency and to improve slen- derness ; but they have been uniformly unreliable, and the whole subject of stature-development presents an almost unexplored field for investigation. Recently, Leichtenstein," observing in a case of myxedema treated with the thyroid gland that the subcutaneous fat disappeared with the continuance of the treatment, was led to adopt this treatment for obesity itself and reports striking results. The diet of the patient remained the same, and as the appetite was not diminished by the treatment the loss of weight was evidently due to other causes than altered alimenta,tion. He holds that the observations in myxedema, in obesity, and psoriasis warrant the belief that the thyroid gland eliminates a material having a regulating influence upon the consti- tution of the panniculus adiposus and upon the nutrition of the skin in general. There were 25 patients in all ; in 22 the effect was entirely satisfactory, the loss of weight amounting to as much as 9.5 kilos (21 pounds). Of the three cases in which the result was not satisfactory, one had nephritis with severe Graves' disease, and the third psoriasis. Charrin '' has used the injections of thyroid extract with decided benefit. So soon as the administration of the remedy was stopped the loss of weight ceased, but with the renewal of the remedy the loss of weight again ensued to a certain point, beyond which the extract seemed powerless to act. Ewald also reports good results from this treatment of obesity. Remarkable Instances of Obesity. — From time immemorial fat men and women have been the object of curiosity and the number who have exhibited themselves is incalculable. Nearly every circus and dime museum has its example, and some of the most famous have in this way been able to accumulate fortunes. Athenseus " has written quite a long discourse on persons of note who in the olden times were distinguished for their obesity. He quotes a description of Denys, the tyrant of Heraclea, who was so enormous that he was in con- stant danger of suffocation ; most of the time he was in a stupor or asleep, a peculiarity of very fat people. His doctors had needles put in the back of his chairs to keep him from falling asleep when sitting up and thus incur- ring the danger of suffocation. In the same work Athenteus ^ speaks of a 300, No. 50, 1894. b Compt rend, de la Soc. de Biol., Dec. 29, 1894. c " Banquet des savants, " edition of Lefebvre, etc. d L. xii., chap. 12. REMARKABLE INSTANCES OF OBESITY. 357 several sovereigns noted for their obesity ; among others he says that Ptol- emy VII., son of Alexander, was so fat that, according to Posidonius, when he walked he had to be supported on both sides. Nevertheless, when he was excited at a repast, he would mount the highest couch and execute with agility his accustomed dance. According to old chronicles the cavaliers at Rome who grew fat were condemned to lose their horses and were placed in retirement. During the Middle Ages, according to Guillaume in his " Vie de Suger," obesity was considered a grace of God. Among the prominent people in the olden time noted for their embonpoint were Agesilas, the orator C. Licinius Calvus, who several times opposed Cicero, the actor Lucius, and others. Among men of more modern times we can mention William the Conqueror ; Charles le Gros ; Louis le Gros ; Humbert II., Count of Maurienne ; Henry I., King of Navarre ; Henry III., Count of Champagne ; Conan III., Duke of Brittany ; Sancho I., King of Leon ; Alp house II., King of Portugal ; the Italian poet Bruni, who died in 1635 ; Vivonne, a general under Louis XIV. ; the celebrated German botanist Dil- lenius ; Haller ; Frederick I., King of Wiirtemberg, and Louis XVIII. Probably the most famous of all the fat men was Daniel Lambert, born March 13, 1770, in the parish of Saint Margaret, Leicester. He did not differ from other youths until fourteen. He started to learn the trade of a die-sinker and engraver in Birmingham. At about nineteen he began to believe he would be very heavy and developed great strength. He could lift 500 pounds with ease and could kick seven feet high while standing on one leg. In 1793 he weighed 448 pounds ; at this time he became sensitive as to his appearance. In June, 1809, he weighed 52 stone 11 pounds (739 pounds), and measured over 3 yards around the body and over 1 yard around the leg. He had many visitors, and it is said that once, when the dwarf Borwilaski came to see him, he asked the little man how much cloth he needed for a suit. When told about | of a yard, he replied that one of his sleeves would be ample. Another famous fat man was Edward Bright, sometimes called "the fat man of Essex." He weighed 616 pounds.'' In the same journal that records Brighf s weight is an account of a man ex- hibited in Holland who weighed 503 pounds. Wadd, a physician, himself an enormous man, wrote a treatise on obesity and used his own portrait for a frontispiece. He speaks of Doctor Beddoes, who was so uncomfortably fat that a lady of Clifton called him a " walking feather bed." He mentions Doctor Stafford, who was so enormous that this epitaph was ascribed to him : — " Take heed, O good traveler ! and do not tread hard, For here lies Dr. Staiford, in all this churchyard. ' ' Wadd has gathered some instances, a few of which will be cited. At a 476, 1827, 361. 368 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT. Staunton, January 2, 1816, there died Samuel Sugars, Gent., who weighed with a single wood coffin 50 stone (700 pounds). Jacob Powell died in 1754, weighing 560 pounds. It took 16 men to carry him to his grave.'^ Mr. Baker of Worcester, supposed to be larger than Bright, was interred in a coffin that was larger than an ordinary hearse. In 1797 there was buried Philip Hayes, a professor of music, who was as heavy as Bright (616 pounds). Mr. Spooner, an eminent farmer of Warwickshire, who died in 1775, aged fifty-seven, weighed 569 pounds, and measured over 4 feet across the shoulders. The two brothers Stoneclift of Halifax, Yorkshire, together weighed 980 pounds.'' Keysler in his travels speaks of a corpulent Englishman who in passing through Savoy had to use 12 chairmen ; he says that the man weighed 550 pounds. It is recorded on the tombstone of James Parsons, a fat man of Ted- dington, who died March 7, 1743, that he had often eaten a whole shoulder of mutton and a peck of hasty pudding. Keysler mentions a young English- man living in Lincoln Avho was accustomed to eat 18 pounds of meat daily. He died in 1724 at the age of twenty-eight, weighing 530 pounds. In 1815 there died in Trenaw, in Cornwall, a person known as " Giant Chillcot." He measured at the breast 6 feet 9 inches and weighed 460 pounds. One of his stockings held 6 gallons of wheat. In 1822 there was reported to be a Cambridge student who could not go out in the daytime without exciting as- tonishment. The fat of his legs overhung his shoes like the fat in the legs of Lambert and Bright. Dr. Short mentions a lady who died of corpulency in her twenty-fifth year weighing over 50 stone (700 pounds). Catesby speaks of a man who weighed 500 pounds, " and Coe mentions another who weighed 584 pounds.'^ Eabricius and Godart speak of obesity so excessive as to cause death. There is a case reported from the French of a person who weighed 800 pounds.^ Smetius' speaks of George Fredericus, an office-holder in Brandenburgh, who weighed 427 pounds. Dupuytren s gives the history of Marie Fran9oise-Clay, Avho attained such celebrity for her obesity. She was born in poverty, reached puberty at thir- teen, and married at twenty-five, at which age she was already the stoutest woman of her neighborhood notwithstanding her infirmity. She followed her husband, who was an old-clothes dealer, afoot from town to town. She bore six children, in whom nothing extraordinary was noticed. The last one was born when she was thirty-five years old. Neither the births, her travels, nor her poverty, which sometimes forced her to beg at church doors, arrested the progress of the obesity. At the age of forty she was 5 feet 1 inch high and one inch greater about the waist. Her head was small and her neck was entirely obliterated. Her breasts were over a yard in circumference and " 374, vol. xxiv., 483. b 629, vol. xliv., 100. c 629, No. 479. 747, Nov., 1884. c 504, xviii. <1809, 1879-80. = 406, iii., 44. f 189, Epis. i., 718. g 462, T. xxxii., 222, and T. xxv., 62. ^AQZ, xii., 455. i " Sialographia, " 49. 392 PHYISIOLOGIC AND FUNCTIONAL ANOMALIES. and Balthazaar also mentions excretion of milk from the thigh. Bourdon *™ mentions milk from the thigh, labia, and vulva. Klein * speaks of the metastasis of the milk to the lochia. Gardane ^^' speaks of metastasis to the lungs, and there is another case on record in which this phenomenon caused asphyxia. Schenck '' describes excretion of milk from the bladder and uterus. Jaeger in 1770 at Tubingen describes the metastasis of milk to the umbili- cus, Haen ^^^ to the back, and Schurig ^^* to a wound in the foot. Knack- stedt has seen an abscess of the thigh which contained eight pounds of milk. Hauser " gives the history of a case in which the kidneys secreted milk vicari- ously.^ There is the history of a woman who suffered from metastasis of milk to the stomach, and who, with convulsive action of the chest and abdomen, vomited it daily. '^ .A peculiar instance of milk in a tumor is that of a Mrs. Reed, who, when pregnant with twins, developed an abdominal tumor from which 25 pounds of milk was drawn off.** There is a French report ^ of secretion of milk in the scrotum of a man of twenty-one. The scrotum was tumefied, and to the touch gave the sensa- tion of a human breast, and the parts were pigmented similar to an engorged breast. Analysis showed the secretion to have been true human milk. Cases of lactation in the new-born are not infrequent. Bartholinus, Baricelli, Muraltus, Deusingius, Rhodius, Schenck, and Schurig mention instances of it. Cardanus describes an infant of one month whose breasts were swollen and gave milk copiously. Battersby s cites a description of a male child three weeks old whose breasts were full of a fluid, analysis proving it to have been human milk ; Darby, in the same journal, mentions a child of eight days whose breasts were so engorged that the nurse had to milk it. Faye ^ gives an interesting paper in which he has collected many instances of milk in the breasts of the new-born. Jonston ' details a description of lacta- tion in an infant. Yariot-i mentions milk-secretion in the new-born and says that it generally takes place from the eighth to the fifteenth day and not in the first week. He also adds that probably mammary abscesses in the new-born could be avoided if the milk were squeezed out of the breasts in the first days. Variot says that out of 32 children of both sexes, aged from six to nine months, all but six showed the presence of milk in the breasts. Gibb '^ mentions copious milk-secretion in an infant, and Sworder' and Menard™ have seen young babes with abundant milk-secretion. Precocious Lactation. — Bochut" says that he saw a child whose breasts were large and completely developed, offering a striking contrast to the slight development of the thorax. They were as large as a stout man's fist, pear- " 490, L. v., 202. b 718, L. ii., No. 285. c Oglethorpe, Med. and Surg. Jour., Savannah, Ga., 1859-60, il., 408. d Allgem. Medic. Aunal., Jan., 1815. e 2I8, 1833, vii., 13. f 368, 1835. g 312, 1850. 11602, 1876, viii., 1-10. i 447, 461. J 237, July 25, 1890. 1^476,1859. 1536,1877,348. m 233, 1839, iv., 77. n 363, 1878. LACTATION IN THE AGED. 393 shaped, with a rosy areola, in the center of which was a nipple. These pre- cocious breasts increased in size at the beginning of the menstrual epoch (which was also present) and remained enlarged while the menses lasted. The vulva was covered with thick hair and the external genitalia were well developed. The child was reticent, and with a doll was inclined to play the role of mother. Baudelocque mentions a girl of eight who suckled her brother with her extraordinarily developed breasts. In 1783 this child milked her breasts in the presence of the Royal Academy at Paris. Belloc spoke of a similar case. There is another of a young negress who was able to nourish an infant ;" and among the older writers we read accounts of young virgins who induced lacta- tion by applying infants to their breasts. Bartholinus, Benedictus, Hippocrates, Lentilius, Salmuth, and Schenck mention lactation in virgins. De la Coide describes a case in which lactation was present, though menstruation had always been deficient. Dix, at the Derby Infirmary,'' has observed two females in whom there was continued lactation, although they had never been pregnant. The first was a chaste female of twenty-five, who for two years had abundant and spontaneous discharge of milk that wetted the linen ; and the other was in a prostitute of twenty, who had never been preg- nant, but who had, nevertheless, for several months an abundant secretion of healthy milk. Zoologists know that a nonpregnant bitch may secrete milk in abundance. Delafond and de Sinngty have cited instances. Lactation in the aged has been frequently noticed. Amatus Lusi- tanus ^^* and Schenck have observed lactation in old women ; in recent years Dunglison has collected some instances. Semple " relates the history of an elderly woman who took charge of an infant the mother of Avhich had died of puerperal infection. As a means of soothing the child she allowed it to take the nipple, and, strange to say, in thirty-six hours milk appeared in her breasts, and soon she had a flow as copious as she had ever had in her early married life. The child thrived on this production of a sympathetic and spontaneous lactation. Sir Hans Sloane mentions a lady of sixty-eight who, though not having borne a child for twenty years, nursed her grandchildren, one after another. Montegre '^' describes a woman in the Department of Charente who bore two male children in 1810. Not having enough milk for both, and being too poor to secure the assistance of a midwife, in her desperation she sought an old woman named Laverge, a widow of sixty-five, whose husband had been dead twenty- nine years. This old woman gave the breast to one of the children, and in a few days an abundant flow of milk was present. For twenty-two months she nursed the infant, and it thrived as well as its brother, who was nursed by their common mother — in fact, it was even the stronger of the two. Dargan ^ tells of a case of remarkable rejuvenated lactation in a woman of a 302, XXX., 386. b 548, 1856, i., 89. <= 629, ix., 1674. a 264, 1874. 394 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. sixty, who, in play, placed the child to her breast, and to her surprise after three weeks' nursing of this kind there appeared an abundant supply of milk, even exceeding in amount that of the young mother. Blanchard * mentions milk in the breasts of a woman of sixty, and Krane ^ cites a similar instance. In the Philosophical Transactions " there is an in- stance of a woman of sixty-eight having abundant lactation. Warren, Boring, Buzzi, Stack, Durston, Egan, Scalzi, Fitzpatrick, and Gillespie mention rejuvenation and renewed lactation in aged women. Ford * has collected several cases in which lactation was artificially induced by women who, though for some time not having been pregnant themselves, nursed for others. Prolonged lactation and galactorrhea may extend through several pregnancies. Green " reports the case of a woman of forty-seven, the mother of four children, who after each weaning had so much milk constantly in her breasts that it had to be drawn until the next birth. At the time of report the milk was still secreting in abundance. A similar and oft^quoted case was that of Gomez Pamo,^ who described a woman in whom lactation seemed in- definitely prolonged ; she married at sixteen, two years after the establishment of menstruation. She became pregnant shortly after marriage, and after de- livery had continued lactation for a year without any sign of returning men- struation. Again becoming pregnant, she weaned her first child and nursed the other without delay or complication. This occurrence took place fourteen times. She nursed all 14 of her children up to the time that she found her- self pregnant again, and during the pregnancies after the first the flow of milk never entirely ceased ; always after the birth of an infant she was able to nurse it. The milk was of good quality and always abundant, and during the period between her first pregnancy to seven years after the birth of her last child the menses had never reappeared. She weaned her last child five years before the time of report, and since then the milk had still persisted in spite of all treatment. It was sometimes so abundant as to necessitate draw- ing it from the breast to relieve painful tension. Kennedy s describes a woman of eighty-one who persistently menstruated through lactation, and for forty-seven years had uninterruptedly nursed many children, some of which were not her own. Three years of this time she was a widow. At the last reports she had a moderate but regular secretion of milk in her eighty-first year. In regard to profuse lacteal flow, Remy is quoted '^ as having seen a young woman in Japan from whom was taken 12 J pints of milk each day, which is possibly one of the most extreme instance of continued galactorrhea on record. Galen refers to gynecomastia or gynecomazia ; Aristotle says he has a 213, cent, ii., No. 83. b 452, L. v., 243. 629, No. 453. d 579, 1869, 39. e 594, 1844, 188. f Quoted 494, Aug. 4, 1883. g 549, 1832. ^ 548, 1883 ii., 581. GYNECOMAZIA. 395 seen men with mammae " which were as well developed as those of a woman, and Paulus ^gineta recognized the fact in the ancient Greeks. Subsequently Albucasis discusses it in his writings. Bartholinus, Behr, Benedictus, Borel- lus, Bonet, the Ephemerides, Marcellus Donatus, Schenck, Vesalius, Schacher, Martineau, and Buffon all discuss the anomalous presence of milk in the male breast. Puech says that this condition is found in one out of 13,000 con- scripts. To B6dor, a marine surgeon,'' we owe the first scientific exposition of this subject, and a little later Villeneuve published his article in the French dic- tionary.^"^ Since then many observations have been made on this subject, and quite recently Laurent*'^ has published a most exhaustive treatise upon it. Robert " describes an old man who suckled a child, and Meyer discusses the case of a castrated' man who was said to suckle chil- dren. It is said that a Bishop of Cork, who gave one-half crown to an old Frenchman of seventy, was rewarded by an exhibition of his breasts, which were larger than the Bishop had ever seen in a woman. P6trequin speaks of a male breast 18 inches long which he amputated, and Laurent gives the photograph of a man whose breasts measured 30 cm. in cir- cumference at the base, and hung like those of a nursing woman (Fig. 178). In some instances whole families with supernumerary breasts are seen. Handyside gives two instances of quadruple breasts in brothers. Blanchard ^ speaks of a father who had a supernumerary nipple on each breast and his seven sons had the same deformities ; it was not noticed in the daughters. The youngest son transmitted this anomaly to his four sons. P6trequin " describes a man with three mammaj, two on the left side, the third being beneath the others. He had three sons with accessory mammae on the right side and two daughters with the same anomaly on the left side. Savitzky ' reports a case of gynecomazia in a peasant of twenty-one whose father, elder brother, and a cousin were similarly endowed. The patient's breasts were 33 cm. in circum- Fig. 178.— Man with fully-developed mamniEe (Laurent). " 169, " Hist, animal, d 243, 1886, 485. lib. iii., cli t 461, Oct., 1812. e 368, 1837, 195. c 629, No. 461. f 703, Feb., 1894. 396 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. ference and 15 cm. from the nipple to the base of the gland ; they resembled normal female mammae in all respects. The penis and the other genitalia were normal, but the man had a female voice and absence of facial hair. There was an abundance of subcutaneous fat and a rather broad pelvis. Wiltshire ^ said that he knew a gynecomast in the person of a distinguished naturalist who since the age of puberty observed activity in his breasts, accom- panied with secretion of milky fluid which lasted for a period of six weeks and occurred every spring. This authority also mentions that the French call husbands who have well-developed mammse " la couvade ; " the Germans call male supernumerary breasts " bauchwarze," or ventral nipples. Hutchinson ^ describes several cases of gynecomazia, in which the external genital organs decreased in propor- tion to the size of the breast and the manners became eifeminate. Cameron, quoted by Sned- den, speaks of a fellow-student who had a super- numerary nipple, and also says he saw a case in a little boy who had an extra pair of nipples much wider than the ordinary ones. Ansiaux, surgeon of LiSge, saw a conscript of thirteen whose left mamma was well developed like that of a woman, and whose nipple was surrounded by a large are- ola. He said that this breast had always been larger than the other, but since puberty had grown greatly ; the genital organs were well formed. Morgan " examined a seaman of twenty- one, admitted to the Eoyal N.aval Hospital at Hong Kong, whose right mamma, in size and conformation, had the appearance of the well- developed breast of a full-grown woman. It was lobulated and had a large, brown-colored areola ; the nipple, however, was of the same size as that on the left breast (Fig. 179). The man stated that he first ob- served the breast to enlarge at sixteen and a half years ; since that tune it had steadily increased, but there was no milk at any time from the nipple ; the external genital organs were woll and fully developed. He complained of no pain or uneasiness except when in drilling aloft his breast came in contact with the ropes. Gruger of St. Petersburg "i divides gynecomazia into three classes : — (1) That in which the male generative organs are normal ; (2) In which they are deformed ; (3) In which the anomaly is spurious, the breast being a mass of fat or a new growth. a 224, 1884, i., 654. b ]66, iii., 326. >= 476, 1875, ii., 767. d Quoted 224, 1886, ii., 172. Fig. 179.— Abnormal development of right breast in a young man (Morgan). MEN SUCKLING INFANTS. 397 The same journal quotes an instance (possibly Morgan's case) in a young man of twenty-one with a deep voice, excellent health, and genitals well developed, and who cohabited with his wife regularly. When sixteen his right breast be- gan to enlarge, a fact that he attributed to the pressure of a rope. Glandular substance could be distinctly felt, but there was no milk-secretion. The left breast was normal. Schuchardt has collected 272 cases of gynecomazia. Instances of Men Suckling Infants. — These instances of gynecomazia are particularly interesting when the individuals display ability to suckle in- fants. Hunter refers to a man of fifty who shared equally with his wife the suckling of their children. There is an instance of a sailor who, having lost his wife, took his son to his own breast to quiet him, and after three or four days was able to nourish him.^ Humboldt describes a South American peasant of thirty-two who, when his wife fell sick immediately after delivery, sustained the child with his own milk, which came soon after the application to the breast ; for five months the child took no other nourishment. In Franklin's " Voyages to the Polar Seas " he quotes the instance of an old Chippewa who, on losing his wife in childbirth, had put his infant to his breast and earnestly prayed that milk might flow ; he was fortunate enough to eventually produce enough milk to rear the child. The left breast, with which he nursed, afterward retained its unusual size. According to Mehliss some missionaries in Brazil in the six- teenth century asserted that there was a whole Indian nation whose women had small and withered breasts, and whose children owed their nourishment entirely to the males. Hall exhibited to his class in Baltimore a negro of fifty-five who had suckled all his mistress' family. Dunglison reports this case in 1837, and says that the mammae projected seven inches from the chest, and that the external genital organs were well developed. PauUini and Schenck cite cases of men suckling infants, and Blumenbach has described a male-goat which, on account of the engorgement of the mammse, it was neces- sary to milk every other day of the year. Ford *• mentions the case of a captain who in order to soothe a child's cries put it to his breast, and who subsequently developed a full supply of milk. He also quotes an instance of a man suckling his own children, and mentions a negro boy of fourteen who secreted milk in one breast. Hornor and Pulido y Fernandez " also mention similar instances of gynecomazia. Human Odors. — Curious as it may seem, each individual as well as each species is in life enveloped with an odor peculiarly its own, due to its exhaled breath, its excretions, and principally to its insensible perspiration. The fac- ulty of recognizing an odor in different individuals, although more developed in savage tribes, is by no means unknown in civilized society. Fournier quotes the instance of a young man who, like a dog, could smell the enemy by scent, and who by smell alone recognized his own wife from other persons. ^ a 302, XXX., 384. >> 579, 169, 39. - Independ. med., Barcel., xi., 274, 297, 309. d 302, iv. 398 PHYSIOLOOIC AND FUNCTIONAL ANOMALIES. Fournier also " mentions a French woman, an inhabitant of Naples, who had an extreme supersensitiveness of smell. The sUghtest odor was to her intoler- able; sometimes she could not tolerate the presence of certain individuals. She could tell in a numerous circle which women were menstruating. This woman could not sleep in a bed which any one else had made, and for this reason discharged her maid, preparing her own toilet and her sleeping apart- ments. Cadet de Gassicourt witnessed this peculiar instance, and in con- sultation with several of the physicians of Paris attributed this excessive sensitiveness to the climate. There is a tale told of a Hungarian monk ^^^ who affirmed that he was able to decide the chastity of females by the sense of smell alone. It is well known that some savage tribes with their large, open nostrils not only recognize their enemies but also track game the same as hounds. Individual Odors. — Many individuals are said to have exhaled particu- larly strong odors, and history is full of such instances. We are told by Plutarch that Alexander the Great exhaled an odor similar to that of violet flowers, and his undergarments always smelled of this natural perfume. It is said that Cujas offered a particular analogy to this. On the contrary, there are certain persons spoken of who exhaled a sulphurous odor. Martial ^"^ said that Thais was an example of the class of people whose odor was insupportable. Schmidt has inserted in the Ephemerides an account of a journeyman sad- dler, twenty-three years of age, of rather robust constitution, whose hands exhaled a smell of sulphur so powerful and penetrating as to rapidly fill any room in which he happened to be. Rayer was once consulted by a valet-de- chambre who could never keep a place in consequence of the odor he left behind him in the rooms in which he worked. Hammond ** is quoted with saying that when the blessed Venturni of Ber- gamons officiated at the altar people struggled to come near him in order to enjoy the odor he exhaled. It was said that St. Francis de Paul, after he had subjected himself to frequent disciplinary inflictions, including a fast of thirty- eight to forty days, exhaled a most sensible and delicious odor. Hammond attributes the peculiar odors of the saints of earlier days to neglect of washing and, in a measure, to affections of the nervous system. It may be added that these odors were augmented by aromatics, incense, etc., artifically applied. In more modern times Malherbe and Haller were said to diffiise from their bodies the agreeable odor of musk. These " human flowers," to use Goethe's expres- sion, are more highly perfumed in Southern latitudes. Modifying Causes. — According to Brieude, sex, age, climate, habits, ail- ments, the passions, the emotions, and the occupations modify the difference in the humors exhaled, resulting in necessarily diff'erent odors. Nursing infants have a pecuhar sourish smell, caused by the butyric acid of the milk, while bottle- fed children smell like strong butter. After being weaned the odors of the a302, iv., 96. b 491 _ 1878, 279. HUMAN ODORS. 399 babies become less decided. Boys when they reach puberty exhibit peculiar odors which are similar to those of animals when in heat. These odors are leading symptoms of what Borden calls "seminal fever" and are more strongly marked in those of a voluptuous nature. They are said to be caused by the absorption of spermatic fluid into the circulation and its subsequent elimination by the skin. This peculiar circumstance, however, is not seen in girls, in whom menstruation is sometimes to be distinguished by an odor somewhat similar to that of leather. Old age produces an odor similar to that of dry leaves, and there have been persons who declared that they could tell approximately the age of individuals by the sense of smell. Certain tribes and races of people have characteristic odors. Ne- groes have a rank ammoniacal odor, unmitigated by cleanliness; according to Pruner-Bey it is due to a volatile oil set free by the sebaceous follicles. The Esquimaux and Greenlanders have the odors of their greasy and oily foods, and it is said that the Cossacks, who live much with their horses, and who are principally vegetarians, will leave the atmosphere charged with odors several hours after their passage in numbers through a neighborhood. The lower race of Chinamen are distinguished by a peculiar musty odor, which may be noticed in the laundry shops of this country. Some people, such as the low grade of Indians, have odors, not distinctive, and solely due to the filth of their persons. Food and drink, as have been mentioned, markedly influence the odor of an individual, and those perpetually addicted to a special diet or drink have a particular odor. Odor after Coitus. — Preismann in 1877 makes the statement that for six hours after coitus there is a peculiar odor noticeable in the breath, owing to a peculiar secretion of the buccal glands. He says that this odor is most perceptible in men of about thirty-five, and can be discerned at a distance of from four to six feet. He also adds that this fact would be of great medico- legal value in the early arrest of those charged with rape. In this connection the analogy of the breath immediately after coitus to the odor of chloroform has been mentioned.* The same article states that after coitus naturally foul breath becomes sweet. The emotions are said to have a decided influence on the odor of an individual. Gambrini, quoted by Monin,^ mentions a young man, unfortunate in love and violently jealous, whose whole body exhaled a sickening, pernicious, and fetid odor. Orteschi met a young lady who, without any possibility of fraud, exhaled the strong odor of vanilla from the commissures of her fingers. Rayer speaks of a woman under his care at the H6pital de la Charity afFected with chronic peritonitis, who some time before her death exhaled a verj^ decided odor of musk. The smell had been noticed several days, but was thought to be due to a bag of musk put purposely into the bed to overpower other bad smells. The woman, however, gave full assurance that she had no "■ 536, 1883, i., 374. b "Sur les Odeurs du Corps Humain." Paris, 1885. 400 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. kind of perfume about her and that her clothes had been frequently changed. The odor of musk in this case was very perceptible on the arms and other portions of the body, but did not become more powerful by friction. After continuing for about eight days it grew fainter and nearly vanished before the, patient's death. Speranza" relates a similar case. Complexion. — Par6 ^^* states that persons of red hair and freckled com- plexion have a noxious exhalation ; the odor of prussic acid is said to come from dark individuals, while blondes exhale a secretion resembling musk. Fat persons frequently have an oleaginous smell. The disorders of the nervous system are said to be associated with peculiar odors. F^vre says, the odor of the sweat of lunatics resembles that of yellow deer or mice, and Knight remarks that the absence of this symptom would enable him to tell whether insanity was feigned or not. Bur- rows declares that in the absence of further evidence he would not hesitate to pronounce a person insane if he could perceive certain associate odors. Sir William Gull and others are credited with asserting that they could detect syphilis by smell. Weir Mitchell has observed that in lesions of nerves the corresponding cutaneous area exhaled the odor of stagnant water. Hammond refers to three cases under his notice in which specific odors were the results of affections of the nervous system. One of these cases was a young woman of hysterical tendencies who exhaled the odor of violets, which pervaded her apartments. This odor was given off the left half of the chest only and could be obtained concentrated by collecting the perspiration on a handker- chief, heating it with four ounces of spirit, and distilling the remaining mixture. The administration of the salicylate of soda modified in degree this violaceous odor. Hammond also speaks of a young lady subject to chorea whose insensible perspiration had an odor of pineapples ; a hypochondriac gentleman under his care smelled of violets. In this connection he mentions a young woman who, when suffering from intense sick headache, exhaled an odor resembling that of Limburger cheese. Barbier met a case of disordered innervation in a captain of infantry, the upper half of whose body was subject to such offensive perspiration that despite all treatment he had to finally resign his commission. In lethargy and catalepsy the perspiration very often has a cadaverous odor, which has probably occasionally led to a mistaken diagnosis of death. Schaper and de Meara ^^^ speak of persons having a cadaveric odor during their entire life. Various ingesta readily give evidence of themselves by their influence upon the breath. It has been remarked that the breath of individuals who have recently performed a prolonged necropsy smells for some hours of the odor of the cadaver. Such things as copaiba, cubebs, sandalwood, alcohol, coffee, etc., have their recognizable fragrance. There is an instance of a a 162, T. XXX., 399. ODORS OF DISEASES. 401 young woman taking Fowler's solution who had periodic offensive axillary sweats that ceased when the medicine was discontinued. Henry of Navarre was a victim of bromidrosis ; proximity to him was insufferable to his courtiers and mistresses, who said that his odor was like that of carrion. Tallemant says that when his wife, Marie de M6dicis, approached the bridal night with him she perfumed her apartments and her person with the essences of the flowers of her country in order that she might be spared the disgusting odor of her spouse. Some persons are afflicted with an excessive perspiration of the feet which often takes a disgusting odor. The inguinoscrotal and inguinovulvar perspirations have an aromatic odor like that of the genitals of either sex. During menstruation, hyperidrosis of the axillae diffuses an aromatic odor similar to that of acids or chloroform, and in suppression of menses, according to the Ephemerides, the odor is as of hops. Odors of Disease. — The various diseases have their own peculiar odors. The " hospital odor," so well known, is essentially variable in character and chiefly due to an aggregation of cutaneous exhalations. The wards containing women and children are perfumed with butyric acid, while those containing men are influenced by the presence of alkalies like ammonia. Gout, icterus, and even cholera (Drasch and Porker) have their own odors. Older observers, confirmed by Doppner, say that all the plague-patients at Vetlianka diffused an odor of honey. In diabetes there is a marked odor of apples. The sweat in dysentery unmistakably bears the odor of the dejecta. Behier calls the odor of typhoid that of the blood, and Berard says that it attracts flies even before death. Typhus has a mouse-like odor, and the fol- lowing diseases have at different times been described as having peculiar odors, — measles, the smell of freshly plucked feathers ; scarlatina, of bread hot from the oven ; eczema and impetigo, the smell of mold ; and rupia, a decidedly offensive odor. The hair has peculiar odors, differing in individuals. The hair of the Chinese is known to have the odor of musk, which cannot be washed away by the strongest of chemicals. Often the distinctive odor of a female is really due to the odor of great masses of hair. It is said that wig-makers simply by the sense of smell can tell whether hair has been cut from the living head or from combings, as hair loses its odor when it falls out. In the paroxysms of hysteroepilepsy the hair sometimes has a specific odor of ozone. Taenia favosa gives to the scalp an odor resembling that of cat's urine. Sexual Influence of Odors. — In this connection it may be mentioned that there is a peculiar form of sexual perversion, called by Binet ' ' f etich- ism," in which the subject displays a perverted taste for the odors of hand- kerchiefs, shoes, underclothing, and other articles of raiment worn by the opposite sex. Binet maintains that these articles play the part of the " fetich " in early theology. It is said that the favors given by the ladies to the knights 26 402 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. in the Middle Ages were not only tokens of remembrance and apiDreciation, but sexual excitants as well. In his remarkable " Osphr^siblogie," Cloquet calls attention to the sexual pleasure excited by the odors of flowers, and tells how Eichelieu excited his sexual functions by living in an atmosphere loaded with these perfumes. In the Orient the harems are perfumed with intense extracts and flowers, in accordance with the strong belief in the aphrodisiac effect of odors. Krafft-Ebing* quotes several interesting cases in which the connection between the olfactory and sexual functions is strikingly verified. ." The case of Henry III. shows that contact with a person's perspiration may be the exciting cause of passionate love. At the betrothal feast of the King of Navarre and Margaret of Valois he accidentally dried his face with a garment of Maria of Cleves which was moist with her perspiration. Although she was the bride of the Prince of Cond6, Henry immediately con- ceived such a passion for her that he could not resist it, and, as history shows, made her very unhappy. An analogous instance is related of Henry IV., whose passion for the beautiful Gabrielle is said to have originated at the instant when, at a ball, he wiped his brow with her handkerchief." Krafi^Ebing also says that " one learns from reading the work of Ploss (' Das Weib ') that attempts to attract a person of the opposite sex by means of the perspiration may be discerned in many forms in popular psychology. In reference to this a custom is remarkable which holds among the natives of the Philippine Islands when they become engaged. When it becomes neces- sary for the engaged pair to separate they exchange articles of wearing apparel, by means of which each becomes assured of faithfulness. These objects are carefully preserved, covered with kisses, and smelled." The love of perfumes by libertines and prostitutes, as well as sensual women of the higher classes, is quite marked. Heschl reported a case of a man of forty-five in whom absence of the olfactory sense was associated with imperfect development of the genitals ; it is also well known that olfactory hallucinations are frequently associated with psychoses of an erotic type. Garnier ^ has recently collected a number of observations of fetichism, in which he mentions individuals who have taken sexual satisfaction from the odors of shoes, night-dresses, bonnets, drawers, menstrual napkins, and other objects of the female toUet. He also mentions creatures who have gloated over the odors of the blood and excretions from the bodies of women, and gives instances of fetichism of persons who have been arrested in the streets of Paris for clipping the long hair from young girls. There are also on record instances of homosexual fetichism, a type of disgusting inversion of the sexual instinct, which, however, it is not in the province of this work to discuss. Among animals the influence of the olfactory perceptions on the sexual sense is unmistakable. According to KrafPt-Ebing, Althaus shows that ani- a " Psychopathia Sexualis." t "Les F6tichistes," etc. Paris, 1896. BULIMIA. . 403 mals of opposite sexes are drawn to each other by means of olfactory percep- tions, and that almost all animals at the time of rutting emit a very strong odor from their genitals. It is said that the dog is attracted in this way to the bitch several miles away. An experiment by Schiff is confirmatory. He extir- pated the olfactory nerves of puppies, and found that as they grew the male was unable to distinguish the female. Certain animals, such as the musk-ox, civet-cat, and beaver, possess glands on their sexual organs that secrete mate- rials having a very strong odor. Musk, a substance possessing the most pene- trating odor and used in therapeutics, is obtained from the preputial follicles of the musk-deer of Thibet ; and castor, a substance less penetrating, is ob- tained from the preputial sacs of the beaver. Virgin moths (Bombyx) carried in boxes in the pockets of entomologists will on wide commons cause the appearance of males of the same species. Bulimia is excessive morbid hunger, also called canine appetite. While sometimes present in healthy people, it is most often seen in idiots and the insane, and is a symptom of diabetes mellitus. Mortimer ^ mentions a boy of twelve who, while laboring under this affliction, in six days devoured food to the extent of 384 pounds and two ounces. He constantly vomited, but his craving for food was so insatiable that if not satisfied he would devour the flesh off his own bones. Martyn,* Professor of Botany at Cambridge in the early part of the last century, tells of a boy ten years old whose appetite was enormous. He consumed in one week 373 pounds of food and drink. His urine and stools were voided in normal quantities, the excess being vomited. A pig was fed on what he vomited, and was sold in the market. The boy continued in this condition for a year, and at last reports was fast failing. Burroughs " mentions a laborer at Stanton, near Bury, who ate an ordinary leg of veal at a meal, and fed at this extravagant rate for many days together. He would eat thistles and other similar herbs greedily. At times he would void worms as large as the shank of a clay-pipe, and then for a short period the bulimia would disappear. Johnston* mentions a case of bulimia in a man who devoured large quantities of raw flesh. There is an instance on record * of a case of canine appetite in which nearly 400 pounds of solid and fluid elements were taken into the body in six days and again ejected. A recovery was effected by giving very concentrated food, frequently repeated in small quantities. Mason*' mentions a woman in St. Bartholomew's Hospital in London in the early part of this century who was wretched unless she was always eating. Each day she consumed three quartern-loaves, three pounds of beef-steak, in addition to large quantities of vegetables, meal, etc., and water. Smith s describes a boy of fourteen who ate continuously fifteen hours out of the twenty-four, and who had eight bowel movements each day. One year previous his weight a 629, 1743, 1066. b 629, 1743. <= 629, No. 598. d 535, 1800, iii., 209. e 564, iii., 501. f 476, 1870, i., 701. e 545, 1880, xlii., 385. 404 PHYSIOLOOIC AND FUNCTIONAL ANOMALIES. was 105 pounds, but when last seen he weighed 284 pounds and was increas- ing a half pound daily. Despite his continuous eating, this boy constantly complained of hunger. Polydipsia is an abnormal thirst ; it may be seen in persons otherwise normal, or it may be associated with diseases — such as diabetes mellitus or diabetes insipidus. Mackenzie ^ quotes a case from Trousseau, in which an individual afflicted with diabetes insipidus passed 32 liters of urine daily and drank enormous quantities of water. This patient subjected himself to severe regimen for eight months, — although one day, in his agonies, he seized the chamber-pot and drank its contents at once. Mackenzie also mentions an infant of three who had polydipsia from birth and drank daily nearly two pailfuls of water. At the age of twenty-two she married a cobbler, unaware of her propensity, who found that his earnings did not suffice to keep her in water alone, and he was compelled to melt ice and sndw for her. She drank four pailfuls a day, the price being 12 sous ; water in the community was scarce and had to be bought. This woman bore 11 children. At the age of forty she appeared before a scientific commission and drank in their presence 14 quarts of water in ten hours and passed ten quarts of almost colorless urine. Dickinson mentions that he has had patients in his own practice who drank their own urine. Mackenzie also quotes Trousseau's history of a man who drank a liter of strong French brandy in two hours, and habitually drank the same quantity daily. He stated that he was free from the effects of alcohol ; on several occasions on a wager he took 20 liters of wine, gaining his wager without visibly affecting his nervous system. There is an instance of a man of fifty-eight ^ who could not live through the night without a pail of water, although his health was otherwise good. Atkinson in 1856 reported a young man who in childhood was a dirt- eater, though at that time complaining of nothing but excessive thirst. He was active, industrious, enjoyed good health, and was not addicted to alcoholics. His daily ration of water was from eight to twelve gallons. He always placed a tub of water by his bed at night, but this sometimes proved insufficient. He had frequently driven hogs from mudholes to slake his thirst with the water. He married in 1829 and moved into Western Ten- nessee, and in 1854 he was still drinking the accustomed amount ; and at this time he had grown-up children. Ware <= mentions a young man of twenty who drank six gallons of water daily. He was tormented with thirst, and if he abstained he became weak, sick, and dizzy. Throughout a long life he continued his habit, sometimes drinking a gallon at one draught ; he never used spirits. There are three cases of polydipsia reported from London in 1792.« Field « describes a boy with bilious remittent fever who would drink until a 548, 1878, ii., 268. b 218, 1856. c 539, 1815. ■1528, 1792. Western Jour. Med., 1869, iv., 714. PERVERTED APPETITES. 405 his stomach was completely distended and then call for more. Emesis was followed by cries for more water. Becoming frantic, he would jump from his bed and struggle for the water bucket ; failing in this, he ran to the kitchen and drank soapsuds, dish-water, and any other liquid he could find. He had swallowed a mass of mackerel which he had not properly masticated, a fact proved later by ejection of the whole mass. There is a case on record " in which there was intolerable thirst after retiring, lasting for a year. There was apparently no polydipsia during the daytime. The amount of water drunk by glass-blowers in a day is almost incredi- ble. McElroy ^ has made observations in the glass-factories in his neighbor- hood, and estimates that in the nine working hours of each day a glass-blower drinks from 50 to 60 pints of water. In addition to this many are addicted to the use of beer and spirits after working hours and at lunch-time. The excreta and urine never seem to be perceptibly increased. When not working these men do not drink more than three or four pints of Avater. Occasionally a man becomes what is termed " blown-up with water ;" that is, the perspira- tion ceases, the man becomes utterly helpless, has to be carried out, and is disabled until the sweating process is restored by vigorously applied friction. There is little deleterious change noticed in these men ; in fact, they are rarely invalids. Hydroadipsia is a lack of thirst or absence of the normal desire for water. In some of these cases there is a central lesion which accounts for the symp- toms. McElroy, among other cases, speaks of one in a patient who was con- tinually dull and listless, eating little, and complaining of much pain after the least food. This, too, will be mentioned under abstinence. Perverted appetites are of great variety and present many interesting as well as disgusting examples of anomalies. In some cases the tastes of people differ so that an article considered by one race as disgusting would be held as a delicacy by another class. The ancients used asafetida as a seasoning ; and what we have called "stercus diaboli," the Asiatics have named the "food of the gods." The inhabitants of Greenland drink the oil of the whale with as much avidity as we would a delicate wine, and they eat blubber the mere smell of which nauseates an European. In some nations of the lower grade, insects, worms, serpents, etc., are considered edible. The inhabitants of the interior of Africa are said to relish the flesh of serpents and eat grubs and worms. The very earUest accounts of the Indians of Florida and Texas show that " for food, they dug roots, and that they ate spiders, ants' eggs, worms, lizards, sala- manders, snakes, earth, wood, the dung of deer, and many other things." " Gomara, in his " Historia de les Indias," says this loathsome diet was particu- lar to one tribe, the Yaguaces of Florida. It is said that a Russian peasant prefers a rotten egg to a fresh one ; and there are persons who prefer game partly spoiled. a 476, 1869, i., 285, etc. b 272, 1877, 9 et seq. » " De Vaca in Ternaux," vii., 144. 406 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. Bourke * recalls that the drinking of human urine has often been a re- ligious rite, and describes the urine-dance of the Zuflis of New Mexico, in which the participants drink freely of their urine ; he draws an analogy to the Feast of the Fools, a religious custom of Pagan origin which did not disap- pear in Europe until the time of the Reformation. It is still a practice in some parts of the United States to give children fresh urine for certain dis- eases. It is said that the ordure of the Grand Lama of Thibet was at one time so venerated that it was collected and worn as amulets. The disgusting habit of eating human excrement is mentioned by Schurig,'* who gives numerous examples in' epileptics, maniacs, chlorotic young women, pregnant women, children who have soiled their beds and, dreading detection, have swallowed their ejecta, and finally among men and women with abnormal appetites. The Indians of North America consider a broth made from the dung of the hare and caribou a dainty dish, and according to Abbe Dome- nech, as a means of imparting a flavor, the bands near Lake Superior mix their rice with the excrement of rabbits. De Bry mentions that the negroes of Guinea ate filthy, stinking elephant-meat and buffalo-flesh infested with thou- sands of maggots, and says that they ravenously devoured dogs' guts raw. Spencer, in his "Descriptive Sociology," describes a "Snake savage" of Aus- tralia Avho devoured the contents of entrails of an animal. Some authors have said that within the last century the Hottentots devoured the flesh and the entrails of wild beasts, uncleansed of their filth and excrement, and whether sound or rotten. In a personal letter to Captain Bourke, the Rev- erend J. Owen Dorsey reports that while among the Ponkas he saw a woman and child devour the entrails of a beef with their contents. Bourke also cites instances in which human ordure was eaten by East Indian fanatics. Nu- merous authorities are quoted by Boui-ke to prove the alleged use of ordure in food by the ancient Israelites. Pages of such reference are to be found in the works on Scatology, and for further reference the reader is referred to books on this subject, of which prominent in English literature is that of Bourke.'' Probably the most revolting of all the perverted tastes is that for human flesh. This is called anthropophagy or cannibalism, and is a time-hon- ored custom among some of the tribes of Africa. This custom is often prac- tised more in the spirit of vengeance than of real desire for food. Prisoners of war were killed and eaten, sometimes cooked, and among some tribes raw. In their religious frenzy the Aztecs ate the remains of the human beings who were sacrificed to their idols. At other times cannibalism has been a neces- sity. In a famine in Egypt, as pictured by the Arab Abdallatif, the putrefy- ing debris of animals, as well as their excrement, was used as food, and finally the human dead were used ; then infants were Idlled and devoured, so great was the distress. In many sieges, shipwrecks, etc., cannibalism has been •^ ' ' Scatologic Rites of All Nations. " b " Chy lologia. ' ' Dresden, 1725. '^ "Scatologic Eites of All Nations." ANTHROPOPHAGY OR CANNIBALISM. 407 practised as a last resort for sustaining life. When supplies have given out several Arctic explorers have had to resort to eating the bodies of their com- rades. In the famous Wiertz Museum in Brussels is a painting by this ec- centric artist in which he has graphically portrayed a woman driven to insanity by hunger, who has actually destroyed her child with a view to cannibalism. At the siege of Rochelle it is related that, urged by starvation, a father and mother dug up the scarcely cold body of their daughter and ate it. At the siege of Paris by Henry IV. the cemeteries furnished food, for the starving. One mother in imitation of what occurred at the siege of Jerusalem roasted the limbs of her dead child and died of grief under this revolting nourishment. St. Jerome states that he saw Scotchmen in the Roman armies in Gaul whose regular diet was human flesh, and who had " double teeth all around;" Cannibalism, according to a prominent New York journal, has been recently made a special study by the Bureau of Ethnology at Washington, D. C. Data on the subject have been gathered from all parts of the world, which are particularly interesting in view of discoveries pointing to the con- clusion that this horrible practice is far more widespread than was imagined. Stanley claims that 30,000,000 cannibals dwell in the basin of the Congo to-day — people who relish human flesh above all other meat. Perah, the most peculiar form of cannibalism, is found in certain mountainous districts of northeast Burmah, where there are tribes that follow a life in all important respects like that of wild beasts. These people eat the congealed blood of their enemies. The blood is poured into bamboo reeds, and in the course of time, being corked up, it hardens. The filled reeds are hung under the roofs of the huts, and when a person desires to treat his friends very hospitably the reeds are broken and the contents devoured. " The black natives of Australia are all professed cannibals. Dr. Carl Lum- holtz, a Norwegian scientist, spent many months in studying them in the wilds, of the interior. He was alone among these savages, who are extremely treach- erous. Wearing no clothing whatever, and living in nearly every respect as. monkeys do, they know no such thing as gratitude, and have no feeling that can be properly termed human. Only fear of the traveler's weapons pre- vented them from slaying him, and more than once he had a narrow escape. One of the first of them whom he employed looked more like a brute than a man. ' When he talked,' says the doctor, ' he rubbed his belly with com- placency, as if the sight of me made his mouth water.' This individual was regarded with much respect by his fellows because of his success in procuring human flesh to eat. These aborigines say that the white man's flesh is salt and occasions nausea. A Chinaman they consider as good for eating as a black man, his food being chiefly vegetable. "The most horrible development of cannibalism among the Australian blacks is the eating of defunct relatives. When a person dies there follows an elaborate ceremony, which terminates with the lowering of the corpse into the 408 PHYSIOLOOIC AND FUNCTIONAL ANOMALIES. grave. In the grave is a man not related to the deceased, who proceeds tjo cut oif the fat adhering to the muscles of the face, thighs, arms, and stomach, and passes it around to be swallowed by some of the near relatives. All those who have eaten of the cadaver have a black ring of charcoal powder and fat drawn around the mouth. The order in which the mourners partake of their dead relatives is duly prescribed. The mother eats of her children and the children of their mother. A man eats of his sister's husband and of his brother's wife. Mothers' brothers, mothers' sisters, sisters' children, mothers' parents, and daughters' children are also eaten by those to whom the deceased persgn stands in such relation. But the father does not eat of his children, nor the children of their sire. " The New Zealanders, up to very recent times, were probably the most anthropophagous race that ever existed. As many as 1000 prisoners have been slaughtered by them at one time after a successful battle, the bodies being baked in ovens underground. If the individual consumed had been a redoubt- able enemy they dried his head as a trophy and made flutes of his thigh bones. "Among the Monbuttos of Africa human fat is commonly employed for a variety of purposes. The explorer Schweinfurth speaks of writing out in the evenings his memoranda respecting these people by the light of a little oil-lamp contrived by himself, which was supplied with some questionable-looking grease furnished by the natives. The smell of this grease, he says, could not fail to arouse one's worst suspicions against the negroes. According to his account the Monbuttos are the most confirmed cannibals in Africa. Sur- rounded as they are by a number of peoples who are blacker than themselves, and who, being inferior to them in culture, are held in contempt, they carry on expeditions of war and plunder which result in the acquisition of a booty especially coveted by them — namely, human flesh. The bodies of all foes who fall in battle are distributed on the field among the victors, and are prepared by drying for transportation. The savages drive their prisoners before them, and these are reserved for killing at a later time. During Schweinfurth's residence at the Court of Munza it was generally understood that nearly every day a little child was sacrificed to supply a meal for the ogre potentate. For centuries past the slave trade in the Congo Basin has been conducted largely for the purpose of furnishing human flesh to consumers. Slaves are sold and bought in great numbers for market, and are fattened for slaughter. "The Mundurucus of the Upper Amazon, who are exceedingly ferocious, have been accused of cannibalism. It is they who preserve human heads in such a remarkable way. When one of their warriors has killed an enemy he cuts off" the head with his bamboo knife, removes the brain, soaks the head in a vegetable oil, takes out bones of the skull, and dries the remaining parts by putting hot pebbles inside of it. At the same time. care is taken to preserve all the features and the hair intact. By repeating the process with the hot pebbles many times the head finally becomes shrunken to that of a small doll. ANCIENT CUSTOMS. 409 though still retaining its human aspect, so that the effect produced is very weird and uncanny. Lastly, the head is decorated with brilliant feathers, and the lips are fastened together with a string, by which the head is suspended from the rafters of the council-house." Ancient Customs. — According to Herodotus the ancient Lydians and Medes, and according to Plato the islanders in the Atlantic, cemented friend- ship by drinking human blood. Tacitus speaks of Asian princes swearing allegiance with their own blood, which they drank. Juvenal says that the Scythians drank the blood of their enemies to quench their thirst. Occasionally a religious ceremony has given sanction to cannibalism. It is said that in the Island of Chios there was a rite by way of sacrifice to Dionysius in which a man was torn limb from limb, and Faber tells us that the Cretans had an annual festival in which they tore a living bull with their teeth. Spencer quotes that among the Bacchic orgies of many of the tribes of North America, at the inauguration of one of the Clallum chiefs on the north- west coast of British America, the chief seized a small dog and began to devour it alive, and also bit the shoulders of bystanders. In speaking of these cere- monies. Boas, quoted by Bourke, says that members of the tribes practising Hamatsa ceremonies show remarkable scars produced by biting, and at cer- tain festivals ritualistic cannibalism is practised, it being the duty of the Ha- matsa to bite portions of flesh out of the arms, legs, or breast of a man. Another cause of cannibalism, and the one which deserves discussion here, is genuine perversion or depravity of the appetite for human flesh among civil- ized persons, — the desire sometimes being so strong as to lead to actual murder. Several examples of this anomaly are on record. Gruner of Jena speaks of a man by the name of Goldschmidt, in the environs of Weimar, who developed a depraved appetite for human flesh. He was married at twenty-seven, and for twenty-eight years exercised his calling as a cow-herd. Nothing extraordinary was noticed in him, except his rudeness of manner and his chol- eric and gross disposition. In 1771, at the age of fifty-five, he met a young traveler in the woods, and accused him of frightening his cows ; a discussion arose, and subsequently a quarrel, in which Goldschmidt killed his antagonist by a blow with a stick which he used. To avoid detection he dragged the body to the bushes, cut it up, and took it home in sections. He then washed, boiled, and ate each piece. Subsequently, he developed a further taste for human flesh, and was finally detected in eating a child which he had enticed into his house and killed. He acknowledged his appetite before his trial. Hector Boetius says that a Scotch brigand and his wife and children were condemned to death on proof that they killed and ate their prisoners. The extreme youth of one of the girls excused her from capital punishment ; but at twelve years she was found guilty of the same crime as her father and suffered capital punishment. This child had been brought up in good surroundings, yet her inherited appetite developed. Gall tells of an individual who, instigated 410 PHYSIOLOOIC AND FUNCTIONAL ANOMALIES. by an irresistible desire to eat human flesh, assassinated many persons ; and his daughter, though educated away from him, yielded to the same craving. At Bicfitre* there was an individual who had a horribly depraved appetite for decaying human flesh. He would haunt the graveyards and eat the putre- fying remains of the recently buried, preferring the intestines. Having re- galed himself in a midnight prowl, he would fill his pockets for future use. When interrogated on the subject of his depravity he said it had existed since childhood. He acknowledged the greatest desire to devour children he would meet playing ; but he did not possess the courage to kill them. Prochaska quotes the case of a woman of Milan who attracted children to her home in order that she might slay, salt, and eat them. About 1 600, there is the record of a boy named Jean Granier, who had repeatedly killed and devoured several young children before he was discovered. Rodericus h Q&s- tro^^' tells of a pregnant woman who so strongly desired to eat the shoulder of a baker that she killed him, salted his body, and devoured it at intervals. There is a record of a woman who in July, 1817, was discovered in cooking an amputated leg of her little child. Gorget in 1827 reported the celebrated case of Leger the vine dresser, who at the age of twenty- four wandered about a forest for eight days during an attack of depression. Coming across a girl of twelve, he violated her, and then mutilated her genitals, and tore out her heart, eating of it, and drinking the blood. He finally confessed his crime with calm indifference. After Leger's execution Esquirol found morbid adhe- sions between the brain and the cerebral membranes. Mascha relates a simi- lar instance in a man of fifty-five who violated and killed a young girl, eating of her genitals and manunse. At the trial he begged for execution, saying that the inner impulse that led him to his crime constantly persecuted him. A modern example of lust-murder and anthropophagy is that of Menes- clou, who was examined by Brouardel, Motet, and others, and declared to be mentally sound ; he was convicted. This miscreant was arrested with the fore- arm of a missing child in his pocket, and in his stove were found the head and entrails in a half-burnt condition. Parts of the body were found in the water- closet, but the genitals were missing ; he was executed, although he made no confession, saying the deed was an accident. Morbid changes were found in his brain. Kraffil^Ebing cites the case of Alton, a clerk in England, who lured a child into a thicket, and after a time returned to his office, where he made an entry in his note-book : " Killed to-day a young girl ; it was fine and hot." The child was missed, searched for, and found cut into pieces. Many parts, and among them the genitals, could not be found. Alton did not show the slightest trace of emotion, and gave no explanation of the motive or circumstances of his horrible deed ; he was executed. D' Amador'' tells of persons who went into slaughter-houses and waste- places to dispute with wolves for the most revolting carrion. It is also men- a 162, March, 1825. b " La Vie du Sang," note 7. FURTHER EXAMPLES OF DEPRAVED APPETITES. 411 tioned that patients in hospitals have been detected in drinking the blood of patients after venesections, and in other instances frequenting dead-houses and sucking the blood of the recently deceased. Du Saulle* quotes the case of a chlorotic girl of fourteen who eagerly drank human blood. She preferred that flowing fresh from a recent wound. Further Examples of Depraved Appetites. — Bijoux *> speaks of a por- ter or garyon at the Jardin des Plantes in Paris who was a prodigious glutton. He had eaten the body of a lion that had died of disease at the menagerie. He ate with avidity the most disgusting things to satiate his depraved appe- tite. He showed further signs of a perverted mind by classifying the animals of the menagerie according to the form of their excrement, of which he had a col- lection. He died of indigestion following a meal of eight pounds of hot bread. Percy " saw the famous Tarrare, who died at Versailles, at about twenty- six years of age. At seventeen he weighed 100 pounds. He ate a quarter of beef in twenty-four hours. He was fond of the most revolting things. He particularly relished the flesh of serpents and would quickly devour the largest. In the presence of Lorenze he seized a live cat with his teeth, eventrated it, sucked its blood, and ate it, leaving the bare skeleton only. In about thirty minutes he rejected the hairs in the manner of birds of prey and carnivorous animals. He also ate dogs in the same manner. On one occasion it was said that he swallowed a living eel without chewing it ; but he had first bitten off its head. He ate almost instantly a dinner that had been prepared for 15 vigorous workmen and drank the accompanying water and took their aggre- gate allowance of salt at the same time. After this meal his abdomen was so swollen that it resembled a balloon. He was seen by Courville, a surgeon- major in a military hospital, where he had swallowed a wooden box wrapped in plain white paper. This he passed the next day with the paper intact. The General-in-chief had seen him devour thirty pounds of raw liver and lungs. Nothing seemed to diminish his appetite. He waited around butcher-shops to eat what was discarded for the dogs. He drank the bleedings of the hos- pital and ate the dead from the dead-houses. He was suspected of eating a child of fourteen months, but no proof could be>produced of this. He was of middle height and was always heated and sweating. He died of a puru- lent diarrhea, all his intestines and peritoneum being in a suppurating condi- tion. Fulton ^ mentions a girl of six who exhibited a marked taste for feeding on slugs, beetles, cockroaches, spiders, and repulsive insects. This child had been carefully brought up and was one of 13 children, none of whom displayed any similar depravity of appetite. The child was of good dispo- sition and slightly below the normal mental standard for her age. At the age of fourteen her appetite became normal. In the older writings many curious instances of abnormal appetite are » Med. Critic, 1862, ii., 711. b 302, iv., 199. c 302, iv., 200 d 180, 1879. 412 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. seen. Borellus speaks of individuals swallowing stones, horns, serpents, and toads. Plater * mentions snail-eating and eel-eating, two customs still extant. Rhodius is accredited with seeing persons who swallowed spiders and scor- pions. Jonston**' says that Avicenna, Rufus, and Gentilis relate instances of young girls who acquired a taste for poisonous animals and substances, who could ingest them with impunity. Colonia Agrippina was supposed to have eaten spiders with impunity. Van WoenseP is said to have seen persons who devoured live eels. The habit of dirt-eating or clay-eating, called pica, is well authenticated in many countries. The Ephemerides contains mention of it; Hunter speaks of the blacks who eat potters' clay ; Bartholinus"" describes dirt-eating as does also h Castro.'' Properly speaking, dirt-eating should be called geophagism ; it is common in the Antilles and South America, among the low classes, and is seen in the negroes and poorest classes of some portions of the Southern United States. It has also been reported from Java, China, Japan, and is said to have been seen in Spain and Portugal. Peat-eating or bog- eating is still seen in some parts of Ireland. There were a number of people in the sixteenth and seventeenth centuries who had formed the habit of eating small pebbles after each meal. They formed the habit from seeing birds swallowing gravel after eating. A number of such cases are on record.*^ There is on record the account of a man living in Wiirtemberg who with much voracity had eaten a suckling pig, and sometimes devoured an entire sheep. He swallowed dirt, clay, pebbles, and glass, and was addicted to intoxication by brandy. He lived sixty years in this manner and then he became abstemious ; he died at seventy-nine. His omentum was very lean, but the liver covered all his abdominal viscera. His stomach was very large and thick, but the intestines were very narrow. Ely " had a patient who was addicted to chalk-eating ; this he said in- variably relieved his gastric irritation. In the twent3'-five years of the habit he had used over J ton of chalk ; but notwithstanding this he always enjoyed good health. The Ephemerides contains a similar instance, and Verzascha mentions a lime-eater. Adams * mentions a child of three who had an in- stinctive desire to eat mortar. This baby was rickety and had carious teeth. It would pick its preferred diet out of the wall, and if prevented would cry loudly. When deprived of the mortar it would vomit its food until this substance was given to it again. At the time of report part of the routine duties of the sisters of this boy was to supply him with mortar containing a little sand. Lime-water was substituted, but he insisted so vigorously on the solid form of food that it had to be replaced in his diet. He suifered from small-pox ; on waking up in the night with a fever, he always cried for a 635, L. i. and L. ii. b 105, 1748, viii., 62-64. c 257, L. iii., 399. '1629,1700. e 218, 1868, 101. f 476, 1885, i., 235. FASTING. 413 a piece of mortar. The quantity consumed in twenty-four hours was about J teacupfiil. The child had never been weaned. Arsenic Eaters. — It has been frequently stated that the peasants of Styria are in the habit of taking from two to five grains of arsenious acid daily for the purpose of improving the health, avoiding infection, and raising the whole tone of the body. It is a well-substantiated fact that the quanti- ties taken habitually are quite sufficient to produce immediate death ordi- narily. But the same might be easily said of those addicted to opium and chloral, a subject that will be considered later. Perverted appetites during pregnancy have been discussed on pages 80 and 81. Glass-eaters, penknife-swallowers, and sword-swallowers, being exhibi- tionists and jugglers, and not individuals with perverted appetites, will be con- sidered in Chapter XII. Fasting. — The length of time which a person can live Avith complete abstinence from food is quite variable. Hippocrates admits the possibility of fasting more than six days without a fatal issue ; but Pliny and others allow a much longer time, and both the ancient and modern literature of medicine are replete with examples of abstinence to almost incredible lengths of time. Formerly, and particularly in the Middle Ages when religious frenzy was at its highest pitch, prolonged abstinence was prompted by a desire to do pen- ance and to gain the approbation of Heaven. In many religions fasting has become a part of worship or religious cere- mony, and from the earliest times certain sects have carried this custom to extremes. It is well known that some of the priests and anchorites of the East now subsist on the minimum amount of food, and from the earliest times before the advent of Christianity we find instances of prolonged fasting associated with religious worship. The Assyrians, the Hebrews, the Egyp- tians, and other Eastern nations, and also the Greeks and Romans, as well as feasting days, had their times of fasting, and some of these were quite pro- longed. At the present day religious fervor accounts for but few of our remark-| able instances of abstinence, most of them being due to some form of nervous disorder, varying from hysteria and melancholia to absolute insanity. The ability seen in the Middle Ages to live on the Holy Sacrament and to resist starvation may possibly have its analogy in some of the fasting girls of the present day. In the older times these persons were said to have been nour- ished by angels or devils ; but according to Hammond many cases both of diabolical abstinence from food and of holy fasting exhibited manifest signs of hysteric symptoms. Hammond, in his exhaustive treatise on the subject of " Fasting Girls," also remarks that some of the chronicles detail the exact symptoms of hysteria and without hesitation ascribe them to a devilish agency. For instance, he speaks of a young girl in the valley of Calepino who had all her limbs twisted and contracted and had a sensation in her esophagus as if a 414 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. ball was sometimes rising in her throat or falling into the stomach — a rather lay description of the characteristic hysteric " lump in the throat," a frequent sign of nervous abstinence. Abstinence, or rather anorexia, is naturally associated with numerous dis- eases, particularly of the febrile type ; but in all of these the patient is main- tained by the use of nutrient enemata or by other means, and the abstinence is never complete. A peculiar type of anorexia is that striking and remarkable digestive dis- turbance of hysteria which Sir William Gull has called anorexia nervosa. In thig malady there is such annihilation of the appetite that in some cases it seems impossible ever to eat again. Out of it grows an antagonism to food which results at last, and in its worst forms, in spasm on the approach of food, and this in its turn gives rise to some of those remarkable cases of survival for long periods without food. As this goes on there may be an extreme de- gree of muscular restlessness, so that the patients wander about until exhausted. According to Osier, who reports a fatal case in a girl who, at her death, only weighed 49 pounds, nothing more pitiable is to be seen in medical practice than an advanced case of this malady. The emaciation and exhaustion are extreme, and the patient is as miserable as one with carcinoma of the esopha- gus, food either not being taken at all or only upon urgent compulsion. Gull " mentions a girl of fourteen, of healthy, plump appearance, who in the beginning of February, 1887, without apparent cause evinced a great repug- nance to food and soon afterward declined to take anything but a half cup of tea or ' coffee. Gull saw her in April, when she was much emaciated ; she persisted in walking through the streets, where she was the object of remark of passers-by. At this time her height was five feet four inches, her weight 63 pounds, her temperature 97° F., her pulse 46, and her respiration from 12 to 14. She had a persistent wish to be moving all the time, despite her emaciation and the exhaustion of the nutritive functions. There is another class of abstainers from food exemplified in the exhibi- tionists who either for notoriety or for wages demonstrate their ability to forego eating, and sometimes drinking, for long periods. Some have been clever frauds, who by means of artifices have carried on skilful deceptions ; others have been really interesting physiologic anomalies. Older Instances. — Democritus in 323 B. C. is said to have lived forty days by simply smelling honey and hot bread. Hippocrates remarks that most of those who endeavored to abstain five days died within that period, and even if they were prevailed upon to eat and drink before the termination of their fast they still perished. There is a possibility that some of these cases of Hippocrates were instances of pyloric carcinoma or of stenosis of the pylorus. In the older writings there are instances reported in which the period of abstinence has varied from a short time to endurance beyond the » 476, 1888, i., 321. OLDER INSTANCES OF FASTING. 415 bounds of credulity. Hufeland mentions total abstinence from food for seventeen days, and there is a contemporary case of abstinence for forty days in a maniac who subsisted solely on water and tobacco. Bolsot " speaks of abstinence for fourteen months, and Consbruch'' mentions a girl who fasted eighteen months. Miiller " mentions an old man of forty-five who lived six weeks on cold water. There is an instance of a person living in a cave twenty-four days without food or drink,'' and another of a man who survived five weeks' burial under ruins. '^ Ramazzini speaks of fasting sixty-six days ; Willian, sixty days (resulting in death) ; von Wocher, thirty-seven days (associated with tetanus) ; Lantana, sixty days ; Hobbes, ^ forty days ; Marcardier,^ six months ; Cruikshank,'' two months ; the Ephe- merides, thirteen months ; Gerard/ sixty-nine days (resulting in death) ; and in 1722 there was recorded an instance of abstinence lasting twenty-five months.J Desbarreaux-Bernard ^ says that Guillaume Grani6 died in the prison of Toulouse in 1831, after a voluntary suicidal abstinence of sixty-three days. Haller' cites a number of examples of long abstinence, but most ex- traordinary was that of a girljo f Confolens, descri bed by Citois of PoitierSi_ Z-" who published a history of the case in the beginning of the seventeenth cen- tury. This girl is said to have passed three entire years, from eleven to four- teen, without taking any kind of aliment. In the " Harleian Miscellanies " is a copy of a paper humbly offered to the Royal Society by John Reynolds, containing a discourse upon prodigious abstinence, occasioned by the twelve months' fasting of a woman named Martha Taylor, a damsel of Derbyshire. Plot^'^ gives a great variety of curious anecdotes of prolonged abstinence. Ames ™ refers to " the true and admirable history of the maiden of Con- folens," mentioned by Haller. In the Annual Register, vol. i., is an account of three persons who were buried five weeks in the snow ; and in the same journal, in 1762, is the history of a girl who is said to have sub- sisted nearly four years on water. In 1684 four miners were buried in a coal-pit in Horstel, a half mile from Li6ge, Belgium, and lived twenty-four days without food, eventually making good recoveries. An analysis of the water used during their confinement showed an almost total absence of organic matter and only a slight residue of calcium salts.'' Joanna Crippen lay six days in the snow without nutriment, being over- come by the cold while on the way to her house ; she recovered despite her exposure.'' Somis, physician to the King of Sardinia, gives an account of three women of Piedmont, Italy, who were saved from the ruins of a stable a 470, 1685. 1>452, L. ix., 115. c 452, L. xxiv. '1629,158. e 586, XV., 45. f 629, 1668. S 462. T. xxiii. li " Anat. of the Absorbent Vessels," 101. i 462, T. vi., 147. J 708, 1722. ^ 789, 1880, xxx., 350. 1 400, T. vi., 171 et seq. m " Topographical Antiquities." n 629, 1684. 629, 1700-20, v., 358. 416 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. where they had been buried by an avalanche of snow, March 19, 1755, thirty-seven days before. Thirty houses and 22 inhabitants were buried in this catastrophe, and these three women, together with a child of two, were sheltered in a stable over which the snow lodged 42 feet deep. They were in a manger 20 inches broad and upheld by a strong arch. Their enforced position was with their backs to the wall and their knees to their faces. One woman had 15 chestnuts, and, fortunately, there were two goats near by, and within reach some hay, sufficient to feed them for a short time. By milking one of the goats which had a kid, they obtained about two pints daily, upon which they subsisted for a time. They quenched their thirst with melted sno^t liquefied by the heat of their hands. Their sufferings were greatly in- creased by the filth, extreme cold, and their uncomfortable positions ; their clothes had rotted. When they were taken out their eyes were unable to endure the light, and their stomachs at first rejected all food. While returning from Cambridge, February 2, 1799, Elizabeth Wood- cock dismounted from her horse, which ran away, leaving her in a violent snow- storm. She was soon overwhelmed by an enormous drift six feet high. The sensation of hunger ceased after the first day and that of thirst predominated, which she quenched by sucking snow. She was discovered on the 10th of February, and although suffering from extensive gangrene of the toes, she recovered. Hamilton^ says that at a barracks near Oppido, celebrated for its earthquakes, there were rescued two girls, one sixteen and the other eleven ; the former had remained under the ruins without food for eleven days. This poor creature had counted the days by a light coming through a small opening. The other girl remained six days under the ruin in a confined and distressing posture, her hands pressing her cheek until they had almost made a hole in it. Two persons were buried under earthquake ruins at Messina for twenty-three and twenty-two days each. Thomas Greaser ''gives the history of Joseph Lockier of Bath, who, while going through a woods between 6 and 7 p. M., on the 18th of August, was struck insensible by a violent thunderbolt. His senses gradually re- turned and he felt excessively cold. His clothes were wet, and his feet so swollen that the power of the lower extremities was totally gone and that of the arms was much impaired. For a long time he was unable to articulate or to summon assistance. Early in September he heard some persons in the wood and, having managed to summon them in a feeble voice, told them his story. They declared him to be an impostor and left him. On the evening of the same day his late master came to his assistance and removed him to Swan Inn. He affirmed that during his exposure in the woods he had nothing to eat ; though distressing at first, hunger soon subsided and yielded to thirst, which he appeased by chewing grass having beads of water thereon. He slept during the warmth of the day, but the cold kept him a 629, Ixxiil. b " Case Joseph Lockier." 8°, Bath, 1806. OLDER INSTANCES OF FASTING. 417 awake at night. During his sleep he dreamt of eating and drinking. On November 17, 1806, several surgeons of Bath made an affidavit, in which they stated that this man was admitted to the Bath City Dispensary on September 15th, almost a month after his reputed stroke, in an extremely emaciated condition, with his legs and thighs shriveled as \Yell as motionless. There were several livid spots on his legs and one toe was grangrenous. After some time they amputated the toe. The power in the lower extremities soon returned. In relating his travels in the Levant, Hasselquist mentions 1000 Abyssini- ans who became destitute of provisions while en route to Cairo, and who lived two months on gum arable alone, arriving at their destination without any unusual sickness or mortality. Dr. Franklin lived on bread and water for a fortnight, at the rate of ten pounds per week, and maintained himself stout and healthy. Sir John Pringle knew a lady of ninety who lived on pure fat meat. Gower of Chelmsford had a patient who lived ten years on a pint of tea daily, only now or then chewing a half dozen raisins or almonds, but not swallowing them. Once in long intervals she took a little bread. Brassavolus describes a younger daughter of Frederick King of Naples, who hved entirely without meat, and could not endure even the taste of it ; as often as she put any in her mouth she fell fainting. The monks of Monte Santo (Mount Athos) never touched animal food, but lived on vegetables, olives, and cheese. In 1806 one of them at the age of one hundred and twenty was healthy. Sometimes in the older writings we find records of incredible abstinence. Jonston"' speaks of a man in 1460 who, after an unfortunate matrimonial experience, lived alone for fifteen years, taking neither food nor drink. Petrus Aponensis cites the instance of a girl fasting for eight years. According to Jonston, Hermolus lived forty years on air alone. This same author has also collected cases of abstinence lasting eleven, twenty-two, and thirty years, and cites Aristotle as an authority in substantiating his instances of fasting girls. Wadd, the celebrated authority on corpulence, quotes Pennant in mentioning a woman in Rosshire who lived one and three-quarters years without meat or drink. Granger had under observation a woman by the name of Ann Moore, fifty-eight years of age, who fasted for two years. Fabricius Hildanus^^* re- lates of ApoUonia Schreiera that she lived three years without meat or drink. He also tells of Eva Flegen, who began to fast in 1 596, and from that time on, for sixteen years, lived without meat or drink. According to the Rev. Thos. Steill, Janet Young fasted sixteen years and partially prolonged her absti- nence for fifty years. The Edinburgh Medical and Surgical Journal,*" which contains a mention of the foregoing case, also describes the case of Janet Macleod, who fasted for four years, showing no signs" of emaciation. Benja- " 447, 444. b 318, 1813, ix., 157. 27 418 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. mill Eush speaks of a case mentioned in a letter to St. George Tucker, from J. A. Stuart, of a man who, after receiving no benefit from a year's treatment for hemiplegia, resolved to starve himself to death. He totally abstained from food for sixty days, living on water and chewing apples, but spitting out the pulp ; at the expiration of this time he died. Eccles * relates the history of a beautiful young woman of sixteen, who upon the death of a most indulgent father refused food for thirty-four days, and soon afterward for fifty-four days, losing all her senses but that of touch. There is an account'' of a French adventurer, the Chevalier de Saini^ Lubin, who had a loathing for food and abstained from every kind of meat and drink for fifty-eight days. Saint-Sauver, at that time Lieutenant of the Bastille, put a close watch on this man and certified to the verity of the fast. The European Magazine in 1783 contained an account of the Calabria earth- quake, at which time a girl of eighteen was buried under ruins for six days. The edge of a barrel fell on her ankle and partly separated it, the dust and mortar effectually stopping the hemorrhage. The foot dropped off and the wound healed without medical assistance, the girl making a complete re- covery. There is an account taken from a document in the Vatican of a man living in 1306, in the reign of Pope Clement V., who fasted for two years." McNaughton ^ mentions Rubin Kelsey, a medical student afflicted with melancholia, who voluntarily fasted for fifiby-three days, drinking copiously and greedily of water. For the first six weeks he walked about, and was strong to the day of his death. Hammond has proved many of the reports of " fasting girls " to have been untrustworthy. The case of Miss Faucher of Brooklyn, who was sup- posed to have taken no food for fourteen years, was fraudulent. He says that Ann Moore was fed by her daughter in several ways ; when washing her mother's face she used towels wet with gravy, milk, or strong arrow-root meal. She also conveyed food to her mother by means of kisses. One of the " fast- ing girls," Margaret "Weiss, although only ten years old, had such powers of deception that after being watched by the priest of the parish. Dr. Bucol- dianus, she was considered free from juggling, and, to everybody's astonish- ment, she grew, walked, and talked like other cliildren of her age, still maintaining that she used neither food nor drink. In several other cases reported all attempts to discover imposture failed. As we approach more modern times the detection is more frequent. Sarah Jacobs, the Welsh fast- ing girl who attained such celebrity among the laity, was taken to Guy's Hospital on December 9, 1869, and after being watched by eight experienced nurses for eight days she died of starvation. A postmortem examination of Anna Garbero of Eacconis, in Piedmont,^ who died on May 19, 1828, after having endured a supposed fast of two years, eight months, and eleven days, a 527, 1774, v., part ii., 471 et seq. b 328, 1790, 124. e Journal de Pharmacia, etc., de Lisboa. d 763, 1830, i., 113. e 151, 1828. MODERN INSTANCES OF FASTING. 419 revealed remarkable intestinal changes. The serous membranes were all callous and thickened, and the canal of the sigmoid flexure was totally obliter- ated. The mucous membranes were all soft and friable, and presented the appearance of incipient gangrene. Modern Cases. — Turning now to modem literature, we have cases of mar- velous abstinence well substantiated by authoritative evidence. Dickson * describes a man of sixty-two, sufiPering from monomania, who refused food for four months, but made a successful recovery. Eichardson'' mentions a case, happening in 1848, of a man of thirty-three who voluntarily fasted for fifty-five days. His reason for fasting, which it was impossible to combat, was that he had no gastric juice and that it was utterly useless for him to take any nutrition, as he had no means of digesting it. He lived on water until the day of his death. Richardson gives an interesting account of the changes noticed at the necropsy. There is an account of a religious mendi- cant of the Jain caste" who as a means of penance fasted for ninety-one days. The previous year he had fasted eighty-six days. He had spent his life in strict asceticism, and during his fasting he was always engrossed in prayer. Collins ^ describes a maiden lady of eighty, always a moderate eater, who was attacked by bronchitis, during which she took food as usual. Two days after her recovery, without any known cause, she refused all food and con- tinued to do so for thirty-three days, when she died. She was delirious throughout this fast and slept daily seven or eight hours. As a rule, she drank about a wineglassful of water each day and her urine was scanty and almost of the consistency of her feces. There is a remarkable case of a girl of seventeen" who, suffering with typhoid fever associated with engorgement of the abdomen and suppression of the functions of assimilation, fasted for four months without visible diminution in weight. Pierce ' reports the history of a woman of twenty-six who fasted for three months and made an excellent recovery. Grants describes the " Market Harborough fasting-girl," a maiden of nineteen, who abstained from food from April, 1874, until December, 1877, although continually using morphia. Throughout her fast she had periodic convulsions, and voided no urine or feces for twelve months before her death. There was a middle-aged woman in England in 1860 who for two years lived on opium, gin, and water. Her chief symptoms were almost daily sickness and epileptic fits three times a week. She was absolutely constipated, and at her death her abdomen was so distended as to present the appearance of ascites. After death, the distention of the abdomen was found to be due to a coating of fat, four inches thick, in the parietes. There was no obstruction to the intestinal canal and no fecal or other accumulation within it. » 476, 1853, i., 512. b 173, 1890. >: 536, 1882, i., 11. d 224, 1880, ii., 214. e 276, 1828-9, iii., 283. f 124, 1852, 571. g 224, 1878, i., 152. 420 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. Christina Marshall,* a girl of fourteen, went fifteen and one-half months without taking solid nourishment. She slept very little, seldom spoke, but occasionally asked the time of day. She took sweets and water, with beef tea at intervals, and occasionally a small piece of orange. She died April 18, 1882, after having been confined to her bed for a long while. King,'' a surgeon, U. S. A., gives an account of the deprivation of a squad of cavalry numbering 40. While scouting for Indians on the plains they went for eighty-six hours without water ; when relieved their mouths and throats were so dry that even brown sugar would not dissolve on their tongues. Many were delirious, and all had drawn fresh blood from their horses. Despite repeated vomiting, some drank their own urine. They were nearly all suffering from overpowering dyspnea, two were dead, and two were missing. The suffering was increased by the acrid atmosphere of the dry plains ; the slightest exercise in this climate provoked a thirst. MacLoughlin," the surgeon in charge of the S. S. City of Chester, speaks of a young stow- away found by the stevedores in an insensible condition after a voyage of eleven days. The man was brought on deck and revived sufficiently to be sent to St. Vincent's Hospital, N. Y., about one and one-half hours after discovery, in an extremely emaciated, cold, and nearly pulseless condi- tion. He gave his name as John Donnelly, aged twenty, of Dumbarton, Scotland. On the whole voyage he had nothing to eat or drink. He had found some salt, of which he ate two handfuls, and he had in his pocket a small flask, empty. Into this flask he voided his urine, and afterward drank it. Until the second day he was intensely hungry, but after that time was consumed by a burning thirst ; he shouted four or five hours every day, hoping that he might be heard. After this he became insensible and re- membered nothing until he awakened in the hospital where, under careful treatment, he finally recovered. Fodere mentions some workmen who were buried alive fourteen days in a cold, damp cavern under a ruin, and yet all lived. There is a modern instance of a person being buried thirty-two days beneath snow, without food.'^ The Lancet ^ notes that a pig fell off Dover Cliff and was picked up alive one hundred and sixty days after, having been partially imbedded in debris. It was so surrounded by the chalk of the cliff that little motion was possible, and warmth was secured by the enclosing material. This animal had there- fore lived on its own fat during the entire period. Among the modern exhibitionists may be mentioned Merlatti, the fast- ing Italian, and Succi, both of whom fasted in Paris ; Alexander Jacques, who fasted fifty days ; and the American, Dr. Tanner, who achieved great notoriety by a fast of forty days, during which time he exhibited progressive emaciation. Merlatti, who fasted in Paris in 1886, lost 22 pounds in a a 224, 1882, i., 631. b 124, April, 1878. - 476, 1878, ii., 646. d 556, 1861, i., 67. e 476, 1890, i., 978. ANOMALIES OF TEMPERATURE. 421 month ; during his fast of fifty days he drank only pure filtered water. Prior to the fast his farewell meal consisted of a whole fat goose, including the bones, two pounds of roast beef, vegetables for two, and a plate of walnuts, the lat- ter eaten whole. Alexander Jacques "■ fasted fifty days and Succi fasted forty days. Jacques lost 28 pounds and 4 ounces (from 142 pounds, 8 ounces to 114 pounds, 4 ounces), while Succi' s loss was 34 pounds and 3 ounces. Succi diminished in height from 65f to 64J inches, while Jacques increased from 64J to 65J inches. Jacques smoked cigarettes incessantly, using 700 in the fifty days, although, by professional advice, he stopped the habit on the forty-second day. Three or four times a day he took a powder made of herbs, to which he naturally attributed his power of prolonging life without food. Succi remained in a room in which he kept the temperature at a \ery high point. In speaking of Succi' s latest feat a recent report says : " It has come to light in his latest attempt to go for fifty days without food that he privately regaled himself on soup, beefsteak, chocolate, and eggs. It was also discovered that one of the ' committee,' who were supposed to watch and see that the experiment was conducted in a bona fide manner, ' stood in ' with the faster and helped him deceive the others. The result of the Vienna ex- periment is bound to cast suspicion on all previous fasting accomplishments of Signer Succi, if not upon those of his predecessors." Although all these modern fasters have been accused of being jugglers and deceivers, throughout their fasts they showed constant decrease in weight, and inspection by visitors was welcomed at all times. They invariably invited medical attention, and some were under the closest surveillance ; although we may not implicitly believe that the fasts were in every respect bona fide, yet we must acknowledge that these men displayed great endurance in their apparent indifference for food, the deprivation of which in a normal individual for one day only causes intense suffering. Anomalies of Temperature. — In reviewing the reports of the highest recorded temperatures of the human body, it must be remembered that no matter how good the evidence or how authentic the reference there is always chance for malingering. It is possible to send the index of an ordinary ther- mometer up to the top in ten or fifteen seconds by rubbing it between the slightly moistened thumb and the finger, exerting considerable pressure at the time. There are several other means of artificially producing enormous tem- peratures with little risk of detection, and as the sensitiveness of the ther- mometer becomes greater the easier is the deception. Mackenzie ^ reports the temperature-range of a woman of forty-two who suffered with erysipelatous inflammation of a stump of the leg. Throughout a somewhat protracted illness, lasting from February 20 to April 22, 1879, the temperature many times registered between 108° and 111° F. About a year later she was again troubled with the stump, and this time the tempera- a 224, 1890, i., 1444. ^ 476, 1881, ii., 796. 422 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. ture reached as high as 114°. Although under the circumstances, as any rational physician would, Mackenzie suspected fraud, he could not detect any method of deception. Finally the woman confessed that she had pro- duced the temperature artificially by means of hot-water bottles, poultices, etc. MacNab '^ records a case of rheumatic fever in which the temperature was 111.4° F. as indicated by two thermometers, one in the axilla and the other in the groin. This high degree of temperature was maintained after death. Before the Clinical Society of London, Teale ^ reported a case in which, at dif- ferent times, there were recorded temperatures from 110° to 120° F. in the mouth, rectum, and axilla. According to a comment in the Lancet, there was no way that the patient could have artificially produced this temperature, and during convalescence the thermometer used registered normal as well as sub- normal temperatures. Csesar " speaks of a girl of fifteen with enteric fever, whose temperature, on two occasions 110° F., reached the limit of the mer- cury in the thermometer. There have been instances mentioned in which, in order to escape duties, prisoners have artificially produced high temperatures, and the same has occa- sionally been observed among conscripts in the army or navy. There is an account'^ of a habit of prisoners of introducing tobacco into the rectum, thereby reducing the pulse to an alarming degree and insuring their exemp- tion from labor. In the Adelaide Hospital in Dublin " there was a case in which the temperature in the vagina and groin registered from 120° to 130°, and one day it reached 130.8° F.; the patient recovered. Ormerod^ men- tions a nervous and hysteric woman of thirty-two, a sufferer with acute rheumatism, whose temperature rose to 115.8° F. She insisted on leaving the hospital when her temperature was still 104°. Wunderlich mentions a case of tetanus in which the temperature rose to 46.40° C. (115.5° F.), and before death it was as high as 44.75° C. Ober- niers mentions 108° F. in typhoid fever. Kartulus'' speaks of a child of five, with typhoid fever, Avho at different times had temperatures of 107°, 108°, and 108.2° F. ; it finally recovered. He also quotes a case of pyemia in a boy of seven, whose temperature rose to 107.6° F. He also speaks of Wunderlich's case of remittent fever, in which the temperature reached 107.8° F. Wilson Fox, in mentioning a case of rheumatic fever, says the tempera- ture reached 110° F. Philipson' gives an account of a female servant of twenty-three who suffered from a neurosis which influenced the vasomotor nervous system, and caused hysteria assoc'iated with abnormal temperatures. On the evening of July 9th her temperature was 112° F. ; on the 16th, it was 111° ; on the 18th, 112° ; on the 24th, 117° (axilla); on the 28th, in the left axilla it " 476, 1873, ii., 341. b 476, 1875, ii., 107. 470, 1879, i., 868. 548, 1853. "Physiologie Pathologique." Paris, 1828. 31 482 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. There are certain so-called antipathies that in reality are idiosyncrasies, and which are due to peculiarities of the ideal and emotional centers. The organ of sense in question and the center that, takes cognizance of the image brought to it are in no way disordered. In some cases the antipathy or the idiosyncrasy develops to such an extent as to be in itself a species of mono- mania. The fear-maladies, or " phobias," as they are called, are examples of this class, and, belonging properly under temporary mental derangements, the same as hallucinations or delusions, will be spoken of in another chapter. Possibly the most satisfactory divisions under which to group the material on this subject collected from literature are into examples of idiosyncrasies in which, although the effect is a mystery, the sense is perceptible and the cause distinctly defined and known, and those in which sensibility is latent. The former class includes all the peculiar antipathies which are brought about through the special senses, while the latter groups all those strange instances in which, without the slightest antipathy on the part of the subject, a certain food or drug, after ingestion, produces an untoward effect. The first examples of idiosyncrasies to be noticed will be those manifested through the sense of smell. On the authority of Spigelius, whose name still survives in the nomenclature of the anatomy of the liver, Mackenzie quotes an extraordinary case in a Eoman Cardinal, Oliver Caraffa, who could not endure the smell of a rose. This is confirmed from personal observation by another writer, Pierius,'' who adds that the Cardinal was obliged every year to shut himself up during the rose season, and guards were stationed at the gates of his palace to stop any visitors who might be wearing the dreadful flower. It is, of course, possible that in this case the rose may not have caused the disturbance, and as it is distinctly stated that it was the smell to which the Cardinal objected, we may fairly conclude that what annoyed him was simply a manifestation of rose-fever excited by the pollen. There is also an instance of a noble Venetian who was always confined to his palace during the rose season. However, in this connection Sir Kenelm Digby re- lates that so obnoxious was a rose to Lady Heneage, that she blistered her cheek while accidentally lying on one while she slept. Ledelius ^ records the description of a woman who fainted before a red rose, although she was accustomed to wear white ones in her hair. Cremer describes a Bishop who died of the smell of a rose from what might be called " aromatic pain." The organ of smell is in intimate relation with the brain and the organs of taste and sight ; and its action may thus disturb that of the esophagus, the stomach, the diaphragm, the intestines, the organs of generation, etc. Odor- ous substances have occasioned syncope, stupor, nausea, vomiting, and some- times death. It is said that the Hindoos, and some classes who eat nothing but vegetables, are intensely nauseated by the odors of European tables, and for this reason they are incapable of serving as dining-room servants. a "Hieroglyphica." Francofurti, 1678. b 104, dec, ii., and ann. x., obs. 8. IDIOSYNCRASY TO ODORS. 483 Fabricius Hildanus ^^* mentions a person who fainted from the odor of vine- gar. The Ephemerides contains an instance of a soldier who fell insensible from the odor of a peony. Wagner knew a man who was made ill by the odor of bouillon of crabs. The odors of blood, meat, and fat are repugnant to herbivorous animals. It is a well-known fact that horses detest the odor of blood. Schneider," the father of rhinology, mentions a woman in whom the odor of orange-flowers produced syncope. Odier has known a woman who was affected with aphonia whenever exposed to the odor of musk, but who im- mediately recovered after taking a cold bath. Dejean has mentioned a man who could not tolerate an atmosphere of cherries. Highmore knew a man in whom the slightest smell of musk caused headache followed by epistaxis. Lanzonius ^™ gives an account of a valiar t soldier who could neither bear the sight nor smell of an ordinary pink. There is an instance on record in which the odor coming from a walnut tree excited epilepsy. It is said that one of the secretaries of Francis I. was forced to stop his nostrils with bread if apples were on the table. He would faint if one was held near his nose. Schenck ''* says that the noble family of Fystates in Aquitaine had a similar peculiarity — an innate hatred of apples. Bruyerinus knew a girl of sixteen who could not bear the smell of bread, the slightest particle of which she would detect by its odor. She lived almost entirely on milk. Bierling ^** mentions an antipathy to the smell of musk, and there is a case on record in which it caused convulsions. Boerhaave bears witness that the odor of cheese caused nasal hemorrhage. Whytt mentions an instance in which to- bacco became repugnant to a woman each time she conceived, but after delivery this aversion cTianged to almost an appetite for tobacco fumes. Panaroli ^^' mentions an instance of sickness caused by the smell of sassa- fras, and there is also a record of a person who fell helpless at the smell of cinnamon. Wagner had a patient who detested the odor of citron. Ignorant of this repugnance, he prescribed a potion in which there was water of balm- mint, of an odor resembling citron. As soon as the patient took the first dose he became greatly agitated and much nauseated, and this did not cease until Wagner repressed the balm-mint. There is reported *" the case of a young woman, rather robust, otherwise normal, who always experienced a desire to go to stool after being subjected to any nasal irritation sufficient to excite sneezing. It has already been remarked that individuals and animals have their special odors, certain of which are very agreeable to some people and ex- tremely unpleasant to others. Many persons are not able to endure the emanations from cats, rats, mice, etc., and the mere fact of one of these ani- mals being in their vicinity is enough to provoke distressing symptoms. Mile. Contat, the celebrated French actress, was not able to endure the odor a " De osse cribriformi," 367. ^ 302, xxiii., 501. 484 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. of a hare. Stanislaus, King of Poland and Duke of Lorraine, found it im- possible to tolerate the smell of a cat. The Ephemerides mentions the odor of a little garden-frog as causing epilepsy. Ab Heers *"' mentions a similar anomaly, fainting caused by the smell of eels. Habit had rendered Haller insensible to the odor of putrefying cadavers, but according to Zim- merman the odor of the perspiration of old people, not perceptible to others, was intolerable to him at a distance of ten or twelve paces. He also had an extreme aversion for cheese. According to Dejan, Gaubius knew a man who was unable to remain in a room with women, having a great repugnance to the female odor. Strange as it may seem, some individuals are incapable of appreciating certain odors. Blumenbach mentions an Englishman whose sense of smell was otherwise very acute, but he was unable to perceive the perfume of the mignonette. The impressions which come to us through the sense of . hearing cause sensations agreeable or disagreeable, but even in this sense we see marked examples of idiosyncrasies and antipathies to various sounds and tones. In some individuals the sensations in one ear differ from those of the other. Everard Home ^^^ has cited several examples, and Heidmann of Vienna has treated two musicians, one of whom always perceived in the affected ear, during damp weather, tones an octave lower than in the other ear. The other musician perceived tones an octave higher in the affected ear. Cheyne * is quoted as mentioning a case in which, when the subject heard the noise of a drum, blood jetted from the veins with considerable force. Sauvages ^ has seen a young man in whom intense headache and febrile paroxysm were only relieved by the noise from a beaten drum. Esparron has mentioned an infant in whom an ataxic fever was established by the noise of this instru- ment. Ephemerides contains an account of a young man who became nerv- ous and had the sense of suffocation when he heard the noise made by sweep- ing. Zimmerman speaks of a young girl who had convulsions when she heard the rustling of oiled silk. Boyle, the father of chemistry, could not conquer an aversion he had to the sound of water running through pipes. A gentleman of the Court of the Emperor Ferdinand suffered epistaxis when he heard a cat mew. La Mothe Le Vayer could not endure the sounds of musical instruments, although he experienced pleasurable sensations when he heard a clap of thunder. It is said that a chaplain in England "^^ always had a sensation of cold at the top of his head when he read the 53d chapter of Isaiah and certain verses of the Kings. There was an unhappy wight who could not hear his own name pronounced without being thrown into convulsions." Marguerite of Valois, sister of Francis I., could never utter the words " mort " or " petite verole," such a horrible aversion had she to death and small-pox. According to Campani, the Chevalier Alcantara could never say " lana," or words pertaining to woolen clothing. Hippo- a 302, xxiii., 503. b "Nosol. Method." Paris, 1771. c 110 v., obs. 15, 60. THERAPEUTIC VALUE OF MUSIC. 485 crates says that a certain Nicanor had the greatest horror of the sound of the flute at night, although it delighted him in the daytime. Rousseau '^ reports a Gascon in whom incontinence of urine was produced by the sound of a bag- pipe. Frisch, Managetta, and Rousse speak of a man in whom the same effect was produced by the sound of a hurdy-gurdy. Even Shakespeare alludes to the effects of the sound of bagpipes. Tissot mentions a case in which music caused epileptic convulsions, and Forestus ^^^ mentions a beggar who had convulsions at the sound of a wooden trumpet similar to those used by chil- dren in play. Rousseau mentions music as causing convulsive laughter in a woman. Bayle mentions a woman who fainted at the sound of a bell. Paullini cites an instance of vomiting caused by music, and Marcellus Dona- tus mentions swooning from the same cause. Many people are unable to bear the noise caused by the grating of a pencil on a slate, the filing of a saw, the squeak of a wheel turning about an axle, the rubbing of pieces of paper together, and certain similar sounds. Some persons find the tones of music very disagreeable, and some animals, particularly dogs, are unable to endure it. In Albinus the younger the slightest perceptible tones were sufiicient to produce an inexplicable anxiety. There was a certain woman of fifty ^ who was fond of the music of the clarionet and flute, but was not able to listen to the sound of a bell or tambourine. Frank knew a man who ran out of church at the beginning of the sounds of an organ, not being able to tolerate them. Pope could not imagine music producing any pleasure. The har- monica has been noticed to produce fainting in females. Fischer " says that music provokes sexual frenzy in elephants. Gutfeldt ^ speaks of a peculiar idiosyncrasy of sleep produced by hearing music. Delisle ® mentions a young person who during a whole year passed pieces of ascarides and tenia, during which time he could not endure music. Autenreith ^ mentions the vibrations of a loud noise tickling the fauces to such an extent as to provoke vomiting. There are some emotional people who are particularly susceptible to certain expressions. The widow of Jean Galas always fell in a faint when she heard the words of the death-decree sounded on the street. There was a Hanoverian officer in the Indian war against Typoo-Saib, a good and brave soldier, who would feel sick if he heard the word " tiger " pronounced. It was said that he had experienced the ravages of this beast. The therapeutic value of music has long been known. For ages war- riors have been led to battle to the sounds of martial strains. David charmed away Saul's evil spirit with his harp. Horace in his 32d Ode, Book 1, concludes his address to the lyre : — " laborum, Dulce lenimen, mihicumque salve, Rite vocanti ;" a " Diet, de Musique." ^ 302, xxiii. <= 559, 1803, 7. d 159, 1806. e 476, 1828-9, 720. ' 181, 1023. 486 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. or, as Kiessling of Berlin interprets : — ' ' laborum, Dulce lenimen medicumque, salve, Rite vocanti. ' ' — " O, of our troubles the sweet, the healing sedative, etc." Homer, Plu- tarch, Theophrastus, and Galen say that music cures rheumatism, the pests, and stings of reptiles, etc. Diemerbroeck,^"* Bonet, Baglivi, Kercher, and Desault mention the efficacy of melody in phthisis, gout, hydrophobia, the bites of venomous reptiles, etc. There is a case in the Lancet "^ of a patient in convulsions who was cured in the paroxysm by hearing the tones of music. Before the French Academy of Sciences in 1708, and again in 1718, there was an instance of a dancing-master stricken with violent fever and in a condition of delirium, who recovered his senses and health on hearing melo- dious music. There is little doubt of the therapeutic value of music, but particularly do we find its value in instances of neuroses. The inspiration offered by music is well-known, and it is doubtless a stimulant to the intel- lectual work. Bacon, Milton, Warburton, and Alfieri needed music to stimulate them in their labors, and it is said that Bourdaloue always played an air on the violin before preparing to write. According to the American Medico-Surgical Bulletin, " Professor Tarch- anoff of Saint Petersburg has been investigating the influence of music upon man and other animals. The subject is by no means a new one. In recent times Dagiel and F6r6 have investigated the effect of music upon the respira- tions, the pulse, and the muscixlar system in man. Professor Tarchanoff made use of the ergograph of Mosso, and found that if the fingers were completely fatigued, either by voluntary efforts or by electric excitation, to the point of being incapable of making any mark except a straight line on the registering cylinder, music had the power of making the fatigue disappear, and the fin- ger placed in the ergograph again commenced to mark lines of different heights, according to the amount of excitation. It was also found that music of a sad and lugubrious character had the opposite effect, and could check or entirely inhibit the contractions. Professor Tarchanoff does not profess to give any positive explanation of these facts, but he inclines to the view that ' the voluntary muscles, being furnished with excitomotor and depressant fibers, act in relation to the music similarly to the heart — that is to say, that joyful music resounds along the excitomotor fibers, and sad music along the depressant or inhibitory fibers.' Experiments on dogs showed that music was capable of increasing the elimination of carbonic acid by 16.7 per cent., and of increasing the consumption of oxygen by 20.1 per cent. It was also found that music increased the functional activity of the skin. Professor Tarchanoff claims as the result of these experiments that music may fairly be regarded as a serious therapeutic agent, and that it exer- a 476, 1828-9, 720. IDIOSYNCEAiSIES OF THE VISUAL ORGANS. 487 cises a genuine and considerable influence over the functions of the body. Facts of this kind are in no way surprising, and are chiefly of interest as pre- senting some physiologic basis for phenomena that are sufiiciently obvious. The influence of the war-chant upon the warrior is known even to savage tribes. We are accustomed to regard this influence simply as an ordinary case of psychic stimuli producing physiologic effects. " Professor Tarchanoff" evidently prefers to regard the phenomena as being all upon the same plane, namely, that of physiology ; and until we know the difference between mind and body, and the principles of their interaction, it is obviously impossible to controvert this view successfully. From the im- mediately practical point of view we should not ignore the possible value of music in some states of disease. In melancholia and hysteria it is probably capable of being used with benefit, and it is worth bearing in mind in deal- ing with insomnia. Classical scholars will not forget that the singing of birds was tried as a remedy to overcome the insomnia of Maecenas. Music is certainly a good antidote to the pernicious habit of introspection and self- analysis, which is often a curse both of the hysteric and of the highly cultured. It would seem obviously preferable to have recourse to music of a lively and cheerful character." Idiosyncrasies of the visual organs are generally quite rare. It is well- known that among some of the lower animals, e. g., the turkey-cocks, buffaloes, and elephants, the color red is unendurable. Buchner^ and Tissot^ mention a young boy who had a paroxysm if he viewed anything red. Certain in- dividuals become nauseated when they look for a long time on irregular lines or curves, as, for examples, in caricatures. Many of the older examples of idiosyncrasies of color are nothing more than instances of color-blindness, which in those times was unrecognized. Prochaska" knew a woman who in her youth became unconscious at the sight of beet-root, although in her later years she managed to conquer this antipathy, but was never able to eat the vegetable in question. One of the most remarkable forms of idiosyncrasy on record is that of a student who was deprived of his senses by the very sight of an old woman. On one occasion he was carried out from a party in a dying state, caused, presumably^isy^he abhorred aspect of the chaperons. The Count of Caylus '^ was always horror-stricken at the sight of a Capuchin friar. He cured himself by a wooden image dressed in the costume of this order placed in his room and constantly before his view. It is common to see persons who faint at the sight of blood. Analogous are the individuals who feel nausea in an hospital ward. All Robert Boyle's philosophy could not make him endure the sight of a spider, although he had no such aversion to toads, venomous snakes, etc. Par§ mentions a man who fainted at the sight of an eel, and another who had convulsions at the sight of a carp. There is a record of a young lady a"Derachitideperfecta." 1754. t)"Der6pilepsie." o "Annot. Acad." dSOa.xxili. 488 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.. in France who fainted on seeing a boiled lobster. Millingen ^ cites the case of a man who fell into convulsions whenever he saw a spider. A waxen one was made, which equally terrified him. When he recovered, his error was pointed out to him, and the wax figure was placed in his hand without caus- ing dread, and henceforth the living insect no longer disturbed him. Amatus Lusitanus "^ relates the case of a monk who fainted when he beheld a rose, and never quitted his cell when that flower was in bloom. Scaliger, the great scholar, who had been a soldier a considerable portion of his life, confesses that he could not look on a water-cress without shuddering, and remarks : " I, who despise not only iron, but even thunderbolts, who in two sieges (in one of which I commanded) was the only one who did not com- plain of the food as unfit and horrible to eat, am seized with such a shudder- ing horror at the sight of a water-cress that I am forced to go away." '' One of his children was in the same plight as regards the inoffensive vegetable, cabbage. Scaliger " also speaks of one of his kinsmen who fainted at the sight of a lily. Vaughheim, a great huntsman of Hanover, would faint at the sight of a roasted pig. Some individuals have been disgusted at the sight of eggs. There is an account of a sensible man who was terrified at the sight of a hedgehog, and for two years was tormented by a sensation as though one was gnawing at his bowels. According to Boyle, Lord Barry- more, a veteran warrior and a person of strong mind, swooned at the sight of tansy. The Duke d'fipernon swooned on beholding a leveret, although a hare did not produce the same effect. Schenck tells of a man who swooned at the sight of pork. The Ephemerides contains an account of a person who lost his voice at the sight of a crab, and also cites cases of antipathy to partridges, a white hen, to a serpent, and to a toad. Lehman speaks of an antipathy to horses ; and in his observations Lyser ^^ has noticed aversion to the color purple. It is a strange fact that the three greatest generals of recent years, Wellington, Napoleon, and Roberts, could never tolerate the sight of a cat, and Henry III. of France could not bear this animal in his room. We learn "* of a Dane of herculean frame who had a horror of cats. He was asked to a supper at which, by way of a practical joke, a live cat was put on the table in a covered dish. The man began to sweat and shudder with- out knowing why, and when the cat was shown he killed his host in a paroxysm of terror. Another man could not even see the hated form even in a picture without breaking into a cold sweat and feeling a sense of oppres- sion about the heart. Quercetanus •'"^ and Smetius mention fainting at the sight of cats. Marshal d'Abret was supposed to be in violent fear of a pig. As to idiosyncrasies of the sense of touch, it is well known that some people cannot handle velvet or touch the velvety skin of a peach without a "Curiosities of Medical Experience," London, 1837, ii., 246. b "De Subtilat. Exercit." Hanover, 1634. c "Exercit.," 142. "1570, dec. i., ann. iii., obs. 46. IDIOSYNCRASIES TO FOODS. 489 having disagreeable and chilly sensations come over them. Prochaska knew a man who vomited the moment he touched a peach, and many people, other- wise very fond of this fruit, are unable to touch it. The Ephemerides speaks of a peculiar idiosyncrasy of skin in the axilla of a certain person, which if tickled would provoke vomiting. It is occasionally stated in the older writ- ings that some persons have an idiosyncrasy as regards the phases of the sun and moon. Baillou speaks of a woman who fell unconscious at sunset and did not recover till it reappeared on the horizon. The celebrated Chancellor Bacon, according to Mead, was very delicate, and was accustomed to fall into a state of great feebleness at every moon-set without any other imaginable cause. He never recovered from his swooning until the moon reappeared. Nothing is more common than the idiosyncrasy which certain people display for certain foods. The trite proverb, " What is one man's meat is another man's poison," is a genuine truth, and is exemplified by hundreds of instances. Many people are unable to eat fish without subsequent dis- agreeable symptoms. Prominent among the causes of urticaria are oysters, crabs, and other shell fish, strawberries, raspberries, and other fruits. The abundance of literature on this subject makes an exhaustive collection of data impossible, and only a few of the prominent and. striking instances can be reported. Amatus Lusitanus ^'^ speaks of vomiting and diarrhea occurring each time a certain Spaniard ate meat. Haller knew a person who was purged violently by syrup of roses. The son of one of the friends of Wagner would vomit immediately after the ingestion of any substance containing honey. Bayle " has mentioned a person so susceptible to honey that by a plaster of this sub- stance placed upon the skin this untoward effect Was produced. Whytt knew a woman who was made sick by the slightest bit of nutmeg. Tissot*" observed vomiting in one of his friends after the ingestion of the slightest amount of sugar. Ritte *^^ mentions a similar instance. Roose " has seen vomiting produced in a woman by the slightest dose of distilled water of linden. There is also mentioned a person in whom orange-flower water pro- duced the same effect. Dejean cites a case in which honey taken internally or applied externally acted like poison. It is said that the celebrated Haen ^ would always have convulsions after eating half a dozen strawberries. Earle and Halifax attended a child for kidney-irritation produced by strawberries, and this was the invariable result of the ingestion of this fruit. The authors personally know of a family the male members of which for several genera- tions could not eat strawberries without symptoms of poisoning. The female members were exempt from the idiosyncrasy. A little boy of this family was killed by eating a single berry. Whytt mentions a woman of delicate con- stitution and great sensibility (4f the digestive tract in whom foods difficult " " De utilitat. physic, experiment." b " Maladies des Nerfs." " " Ueber die Krankheiten der Gesunden." ^ 302, xxiii., 499. 490 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. of digestion provoked spasms, which were often followed by syncopes. Bayle describes a man who vomited violently after taking coffee. Wagner mentions a person in whom a most insignificant dose of manna had the same effect. Preslin speaks of a woman who invariably had a hemorrhage after swallow- ing a small quantity of vinegar. According to Zimmerman, some people are unable to wash their faces on account of untoward symptoms. According to Gaubius, the juice of a citron applied to the skin of one of his acquaintances produced violent rigors. Brasavolus says that Julia, wife of Frederick, King of Naples, had such an aversion to meat that she could not carry it to her mouth without fainting. The anatomist Gavard was not able to eat apples without convulsions and vomiting. It is said that Erasmus was made ill by the ingestion of fish ; but this same philosopher, who was cured of a malady by laughter, expressed his appreciation by an elegy on the folly. There is a record of a person who could not eat almonds without a scarlet rash immediately appearing upon the face. Marcellus Donatus knew a young man who could not eat an egg with- out his lips swelling and purple spots appearing on his face. Smetius * men- tions a person in whom the ingestion of fried eggs was often followed by syncope. Brunton '' has -seen a case of violent vomiting and purging after the slightest bit of egg. On one occasion this person was induced to eat a small morsel of cake on the statement that it contained no egg, and, although fully believing the words of his host, he subsequently developed prominent symptoms, due to the trace of egg that was really in the cake. A letter from a distinguished liiMrateur to Sir Morell Mackenzie gives a striking example of the idiosyncrasy to eggs transmitted through four generations. Being from such a reliable source, it has been deemed advisable to quote the account in full : " My daughter tells me that you are interested in the ill- effects which the eating of eggs has upon her, upon me, and upon my father before us. I believe my grandfather, as well as my father, could not eat eggs with impunity. As to my father himself, he is nearly eighty years old ; he has not touched an egg since he was a young man ; he can, therefore, give no precise or reliable account of the symptoms the eating of eggs produce in him. But it was not the mere ' stomach-ache ' that ensued, but much more immediate and alarming disturbances. As for me, the peculiarity was dis- covered when I was a spoon-fed child. On several occasions it was noticed (that is my mother's account) that I felt ill without apparent cause ; after- ward it was recollected that a small part of a yolk of an egg had been given to me. Eclaircissement came immediately after taking a single spoonM of egg. I fell into such an alarming state that the doctor was sent for. The effect seems to have been just the same that it produces upon my daughter now, — something that suggested brain-congestion and convulsions. From time to time, as a boy and a young man, I have eaten an egg by way of try- a " Miscellan.," etc., 566. b 643, 1885, ii., 113. IDIOSYNCRASIES TO FOODS 491 ing it again, but always with the same result — a feeling that I had been poisoned ; and yet all the while I liked eggs. Then I never touched them for years. Later I tried again, and I find the ill-eifects are gradually wear- ing off. With my daughter it is different ; she, I think, becomes more sus- ceptible as time goes on, and the effect upon her is more violent than in my case at any time. Sometimes an egg has been put with coffee unknown to her, and she has been seen immediately afterward with her face alarmingly changed — eyes swollen and wild, the face crimson, the look of apoplexy. This is her own account : ' An egg in any form causes within a few minutes great uneasiness and restlessness, the throat becomes contracted and painful, the face crimson, and the veins swollen. These symptoms have been so severe as to suggest that serious consequences might follow.' To this I may add that in her experience and my own, the newer the egg, the worse the consequences." Hutchinson " speaks of a Member of Parliament who had an idiosyncrasy as regards parsley. After the ingestion of this herb in food he always had alarming attacks of sickness and pain in the abdomen, attended by swelling of the tongue and lips and lividity of the face. This same man could not take the smallest quantity of honey, and certain kinds of fruit always pois- oned him. There was a collection of instances of idiosyncrasy in the British Medical Journal, 1859, which will be briefly given in the following lines : One patient could not eat rice in any shape without extreme distress. From the description given of his symptoms, spasmodic asthma seemed to be" the cause of his discomfort. On one occasion when at a dinner-party he felt the symptoms of rice-poisoning come on, and, although he had partaken of no dish ostensibly containing rice, was, as usual, obliged to retire from the table. Upon investigation it appeared that some white soup with which he had ' com- menced his meal had been thickened with ground rice. As in the preceding case there was another gentleman who could not eat rice without a sense of suffocation. On one occasion he took lunch with a friend in chambers, partak- ing only of simple bread and cheese and bottled beer. On being seized with the usual symptoms of rice-poisoning he informed his friend of his peculiar- ity of constitution, and the symptoms were explained by the fact that a few grains of rice had been put into each bottle of beer for the purpose of excit- ing a secondary fermentation. The same author speaks of a gentleman under treatment for stricture who could not eat figs without experiencing the most unpleasant formication of the palate and fauces. The fine dust from split peas caused the same sensation, accompanied with running at the nose ; it was found that the father of the patient suffered from hay-fever in certain seasons. He also says a certain young lady after eating eggs suffered from swelling of the tongue and throat, accompanied by " alarming illness," and there is recorded in the same paragraph a history of another young girl in a 166, iv., 78. 492 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. whom the ingestion of honey, and especially honey-comb, produced swelling of the tongue, frothing of the mouth, and blueness of the fingers. The authors know of a gentleman in whom sneezing is provoked on the ingestion of chocolate in any form. There was another instance — in a member of the medical profession — who suffered from urticaria after eating veal. Veal has the reputation of being particularly indigestible, and the foregoing instance of the production of urticaria from its use is doubtless not an uncom- mon one. Overton » cites a striking case of constitutional peculiarity or idiosyn- crasy in which wheat flour in any form, the staff of life, an article hourly prayed for by all Christian nations as the first and most indispensable of earthly blessings, proved to one unfortunate individual a prompt and dreadful poison. The patient's name was David Waller, and he was born in Pittsyl- vania County, Ya., about the year 1780. He was the eighth child of his parents, and, together with all his brothers and sisters, was stout and healthy. At the time of observation "Waller was about fifty years of age. He had dark hair, gray eyes, dark complexion, was of bilious and irascible tempera- ment, well formed, muscular and strong, and in all respects healthy aa any man, with the single exception of his peculiar idiosyncrasy. He had been the subject of but few diseases, although he was attacked by the epidemic of 1816. From the history of his parents and an inquiiy into the health of his ancestry, nothing could be found which could establish the fact of heredity in his peculiar disposition. Despite every advantage of stature, constitution, and heredity, David Waller was through life, from his cradle to his grave, the victim of what is possibly a unique idiosyncrasy of constitu- tion. In his own words he declared : " Of two equal quantities of tartar and wheat flour, not more than a dose of the former, he would rather swallow the tartar than the wheat flour." If he ate flour in any form or however combined, in the smallest quantity, in two minutes or less he would have painful itching over the whole body, accompanied by severe colic and tormina in the bowels, great sickness in the stomach, and continued vomiting, which he declared was ten times as distressing as the symptoms caused by the ingestion of tartar emetic. In about ten minutes after eating the flour the itching would be greatly intensified, especially about the head, face, and eyes, but tormenting all parts of the body, and not to be appeased. These symptoms continued for two days with intolerable violence, and only declined on the third day and ceased on the tenth. In the convalescence, the lungs were affected, he coughed, and in expectoration raised great quantities of phlegm, and really resembled a phthisical patient. At this time he was con- fined to his room with great weakness, similar to that of a person recovering from an asthmatic attack. The mere smell of wheat produced distressing symptoms in a minor degree, and for this reason he could not, without suf- a Southern Journal of Medical and Physical Sciences, ill., 1855. FOOD-SUPERSTITIONS. 493 fering, go into a mill or house where the smallest quantity of wheat flour was kept. His condition was the same from the earliest times, and he was laid out for dead when an infant at the breast, after being fed with " pap " thickened with wheat flour. Overton remarks that a case of constitutional peculiarity so little in harmony with the condition of other men could not be received upon vague or feeble evidence, and it is therefore stated that Waller was known to the society in which he lived as an honest and truthful man. One of his female neighbors, not believing in his infirmity, but considering it only a whim, put a small quantity of flour in the soup which she gave him to eat at her table, stating that it contained no flour, and as a consequence of the deception he was bed-ridden for ten days with his usual symptoms. It was also stated that Waller was never subjected to militia duty because it was found on full examination of his infirmity that he could not live upon the rations of a soldier, into which wheat flour enters as a necessary ingredient. In explanation of this strange departure from the condition of other men. Waller himself gave a reason which was deemed equivalent in value to any of the"" others offered. It was as follows : His father being a man in humble circumstances in life, at the time of his birth had no wheat with which to make flour, although his mother during gestation "longed" for wheat- bread. The father, being a kind husband and responsive to the duty imposed by the condition of his wife, procured from one of his opulent neighbors a bag of wheat and sent it to the mill to be ground. The mother was given much uneasiness by an unexpected delay at the mill, and by the time the flour arrived her strong appetite for wheat^bread had in a great degree subsided. Notwithstanding this, she caused some flour to be imme- mediately baked into bread and ate it, but not so freely as she had expected. The bread thus taken caused intense vomiting and made her violently and painfully ill, after which for a considerable time she loathed bread. These facts have been ascribed as the cause of the lamentable infirmity under which the man labored, as no other peculiarity or impression in her gestation was noticed. In addition it may be stated that for the purpose of avoiding the smell of flour Waller was in the habit of carrying camphor in his pocket and using snuff, for if he did not smell the flour, however much might be near him, it was as harmless to him as to other men. The authors know of a case in which the eating of any raw fruit would produce in a lady symptoms of asthma ; cooked fruit had no such effect. Food-Superstitions. — The superstitious abhorrence and antipathy to various articles of food that have been prevalent from time to time in the history of the human race are of considerable interest and well deserve some mention here. A writer in a prominent journal has studied this subject with the following result : — " From the days of Adam and Eve to the present time there has been not only forbidden fruit, but forbidden meats and vegetables. For one reason or 494 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. another people have resolutely refused to eat any and all kinds of flesh, fish, fowl, fruits, and plants. Thus, the apple, the pear, the strawberry, the quince, the bean, the onion, the leek, the asparagus, the woodpecker, the pigeon, the goose, the deer, the bear, the turtle, and the eel — these, to name only a few eatables, have been avoided as if unwholesome or positively in- jurious to health' and digestion. "As we all know, the Jews have long had an hereditary antipathy to pork. On the other hand, swine's flesh was highly esteemed by the ancient Greeks and Eomans. This fact is revealed by the many references to pig as a dainty bit of food. At the great festival held annually in honor of De- meter, roast pig was the pi^ce de rSsistanoe in the bill of fare, because the pig was the sacred animal of Demeter. Aristophanes in 'The Frogs' makes one of the characters hint that some of the others ' smell of roast pig.' These people undoubtedly had been at the festival ( known as the Thesmo- phoria ) and had eaten freely of roast pig. Those who took part in another Greek mystery or festival ( known as the Eleusinia ) abstained from certain food, and above all from beans. " Again, as we all know, mice are esteemed in China and in some parts of India. But the ancient Egyptians, Greeks, and Jews abhorred mice and would not touch mouse-meat. Rats and field-mice were sacred in Old Egypt, and were not to be eaten on this account. So, too, in some parts of Greece, the mouse was the sacred animal of Apollo, and mice were fed in his temples. The chosen people were forbidden to eat ' the weasel, and the mouse, and the tortoise after his kind.' These came under the designation of unclean animals, which were to be avoided. " But people have abstained from eating kinds of flesh which could not be called unclean. For example, the people of Thebes, as Herodotus tells us, ab- stained from sheep. Then, the ancients used to abstain from certain vegetables. In his ' Roman Questions ' Pluf arch asks : ' Why do the Latins abstain strictly from the flesh of the woodpecker ? ' In order to answer Plutarch's question correctly it is necessary to have some idea of the peculiar custom and belief called ' totemism.' There is a stage of society in which people claim descent from and kinship with beasts, birds, vegetables, and other objects. This object, which is a ' totem,' or family mark, they religiously abstain from eating. The members of the tribe are divided into clans or stocks, each of which takes the name of some animal, plant, or object, as the bear, the buffalo, the woodpecker, the asparagus, and so forth. No member of the bear family would dare to eat bear-meat, but he has no objection to eating buffalo steak. Even the marriage law is based on this belief, and no man whose family name is "Wolf may marry a woman whose family name is also Wolf. " In a general way it may be said that almost all our food prohibitions spring from the extraordinary custom generally called totemism. Mr. Swan, who was missionary for many years in the Congo Free State, thus de- FOOD-SUPERSTITIONS. 495 scribes the custom : ' If I were to ask the Yeke people why they do not eat zebra flesh, they would reply, 'Chijila,' i.e., ' It is a thing to which we have an antipathy ; ' or better, ' It is one of the things which our fathers taught us not to eat.' So it seems the word ' Bashilang ' means ' the people who have an antipathy to the leopard ; ' the ' Bashilamba,' ' those who have an antipathy to the dog,' and the ' Bashilanzefu,' ' those who have an antipathy to the ele- phant.' In other words, the members of these stocks refuse to eat their totems, the zebra, the leopard, or the elephant, from which they take their names. " The survival of antipathy to certain foods was found among people as highly civilized as the Egyptians, the Greeks, and the Romans. Quite a list of animals whose flesh was forbidden might be drawn up. For example, in Old Egypt the sheep could not be eaten in Thebes, nor the goat in Mendes, nor the cat in Bubastis, nor the crocodile at Ombos, nor the rat, which was sacred to Ra, the sun-god. However, the people of one place had no scruples about eating the forbidden food of another place. And this often led to re- ligious disputes. " Among the vegetables avoided as food by the Egyptians may be men- tioned the onion, the garlic, and the leek. Lucian says that the inhabitants of Pelusium adored the onion. According to Pliny the Egyptians relished the leek and the onion. Juvenal exclaims : ' Surely a very religious nation, and a blessed place, where every garden is overrun with gods ! ' The survivals of totemism among the ancient Greeks are very interesting. Families named after animals and plants were not uncommon. One Athe- nian gens, the loxidse, had for its ancestral plant the asparagus. One Roman geTis, the Piceni, took a woodpecker for its totem, and every member of this family refused, of course, to eat the flesh of the woodpecker. In the same way as the nations of the Congo Free State, the Latins had an antipathy to certain kinds of food. However, an animal or plant forbidden in one place was eaten without any compunction in another place. ' These local rites in Roman times,' says Mr. Lang, ' caused civil brawls, for the customs of one town naturally seemed blasphemous to neighbors with a diiferent sacred ani- mal. Thus when the people of dog-town were feeding on the fish called oxyrrhyncus, the citizens of the town which revered the oxyrrhyncus began to eat dogs. Hence arose a riot.' The antipathy of the Jews to pork has given rise to quite diflferent explanations. The custom is probably a relic of totemistic belief. That the unclean animals — animals not to be eaten — such as the pig, the mouse, and the weasel, were originally totems of the children of Israel, Professor Robertson Smith believes is shown by various passages in the Old Testament. " When animals and plants ceased to be held sacred they were endowed with sundry magical or mystic properties. The apple has been supposed to possess peculiar virtues, especially in the way of health. ' The relation of 496 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. the apple to health,' says Mr. Conway, ' is traceable to Arabia. Sometimes it is regarded as a bane. In Hessia it is said an apple must not be eaten on New Year's Day, as it will produce an abscess. But generally it is curative. In Pomerania it is eaten on Easter morning against fevers ; in Westphalia (mixed with saffron) against jaundice ; while in Silesia an apple is scraped from top to stalk to cure diarrhea, and upward to cure costiveness.' According to an old English fancy, if any one who is suffering from a wound in the head should eat strawberries it will lead to fatal results. In the South of England the folk say that the devil puts his cloven foot upon the blackberries on Michaelmas Day, and hence none should be gathered or eaten after that day. On the other hand, in Scotland the peasants say that the devil throws his cloak over the blackberries and makes them unwhole- some after that day, while in Ireland he is said to stamp on the berries. Even that humble plant, the cabbage, has been invested with some mystery. It was said that the fairies were fond of its leaves, and rode to their midnight dances on cabbage-stalks. The German women used to say that ' Babies come out of the cabbage-heads.' The Irish peasant ties a cabbage-leaf around the neck for sore throat. According to Gerarde, the Spartans ate watercress with their bread, iirmly believing that it increased their wit and wisdom. The old proverb is, ' Eat cress to learn more wit.' " There is another phase to food-superstitions, and that is the theory that the qualities of the eaten pass into the eater. Mr. Tylor refers to the habit of the Dyak young men in abstaining from deer-meat lest it should make them timid, while the warriors of some South American tribes eat the meat of tigers, stags, and boars for courage and speed. He mentions the story of an English gentleman at Shanghai who at the time of the Taeping attack met his Chinese servant carrying home the heart of a rebel, which he intended to eat to make him brave. There is a certain amount of truth in the theory that the quality of food does affect the mind and body. Buckle in his ' His- tory of Civilization ' took this view, and tried to prove that the character of a people depends on their diet." Idiosyncrasies to Drugs. — In the absorption and the assimilation of drugs idiosyncrasies are often noted ; in fact, they are so common that we can almost say that no one drug acts in the same degree or manner on differ- ent individuals. In some instances the untoward action assumes such a serious aspect as to render extreme caution necessary in the administration of the most inert substances. A medicine ordinarily so bland as cod-liver oil may give rise to disagreeable eruptions. Christison speaks of a boy ten years old who was said to have been killed by the ingestion of two ounces of Epsom salts Avithout inducing purgation ; yet this common purge is universally used without the slightest fear or caution. On the other hand, the extreme toler- ance exhibited by certain individuals to certain drugs offers a new phase of this subject. There are well-authenticated cases on record in which death IDIOSYNCRASIES TO DRUGS. 497 has been caused in children by the ingestion of a small fraction of a grain of opium. While exhibiting especial tolerance from peculiar disposition and long habit, Thomas De Quincey, the celebrated English litterateur, makes a state- ment in his *' Confessions " that with impunity he took as much as 320 grains of opium a day, and was accustomed at one period of his life to call every day for " a glass of laudanum negus, warm, and without sugar," to use his own expression, after the manner a toper would call for a " hot-Scotch." The individuality noted in the assimilation and the ingestion of drugs is functional as well as anatomic. Numerous cases have been seen by all physi- cians. The severe toxic symptoms from a whiff of cocain-spray, the acute distress from the tenth of a grain of morphin, the gastric crises and profuse urticarial eruptions following a single dose of quinin, — all are proofs of it. The " personal equation " is one of the most important fectors in therapeutics, reminding us of the old rule, " Treat the patient, not the disease." The idiosyncrasy may be either temporary or permanent, and there are many conditions that influence it. The time and place of administration ; the degree of pathologic lesion in the subject ; the difference in the physio- logic capability of individual organs of similar nature in the same body ; the degree of human vitality influencing absorption and resistance ; the peculiar epochs of life ; the element of habituation, and the grade and strength of the drag, influencing its virtue, — all have an important bearing on untoward action and tolerance of poisons. It is not in the province of this work to discuss at length the explanations offered for these individual idiosyncrasies. Many authors have done so, and Lewin * has devoted a whole volume to this subject, of which, fortunately, an English translation has been made by Mulheron,^ and to these the inter- ested reader is referred for further information. In the following lines examples of idiosyncrasy to the most common remedial substances will be cited, taking the drugs up alphabetically. Acids. — Ordinarily speaking, the effect of boric acid in medicinal doses on the human system is nil, an exceptionally large quantity causing diuresis. Binswanger, according to Lewin, took eight gm. in two doses within an hour, which was followed by nausea, vomiting, and a feeling of pressure and fulness of the stomach which continued several hours. Molodenkow " mentions two fatal cases from the external employment of boric acid as an antiseptic. In one case the pleural cavity was washed out with a five per cent, solution of boric acid and was followed by distressing symptoms, vomiting, weak pulse, erythema, and death on the third day. In the second case, in a youth of sixteen, death occurred after washing out a deep abscess of the nates with the same solution. The autopsy revealed no change or signs indicative of the cause of death. Hogner ^ mentions two instances of death from the employ- » "Die Nebenwirkungen der Arzneimittel." b "The Untoward Effect of Drugs." Detroit, 1884. <= 704, 1881, No. 42. d 720, ccii., 38. 32 498 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. ment of 2 J per cent, solution of boric acid in washing out a dilated stomach. The symptoms were quite similar to those mentioned by Molodenkow. In recent years the medical profession has become well aware that in its application to wounds it is possible for carbolic acid or phenol to exercise exceedingly deleterious and even fatal consequences. In the earlier days of antisepsis, when operators and patients were exposed for some time to an atmosphere saturated with carbolic spray, toxic symptoms were occasionally noticed. Von Langenbeck * spoke of severe carbolic-acid intoxication in a boy in whom carbolic paste had been used in the treatment of abscesses. The same author reports two instances of death following the employment of dry carbolized dressings after slight operations. Kohler ^ mentions the death of a man suffering from scabies who had applied externally a solution containing about a half ounce of phenol. Kose spoke of gangrene of the finger after the application of carbolized cotton to a wound thereon. In some cases phenol acts with a rapidity equal to any poison. Taylor speaks of a man who fell unconscious ten seconds after an ounce of phenol had been in- gested, and in three minutes was dead. There is recorded an account of a man of sixty-four who was killed by a solution containing slightly over a dram of phenol. A half ounce has frequently caused death ; smaller quantities have been followed by distressing symptoms, such as intoxication (which Olshausen has noticed to follow irrigation of the uterus), delirium, singultus, nausea, rigors, cephalalgia, tinnitus aurium, and anasarca. Hind " mentions recovery after the ingestion of nearly six ounces of crude phenol of 14 per cent, strength. There was a case at the Liverpool Northern Hospital ^ in which recovery took place after the ingestion with suicidal intent of four ounces of crude carbolic acid. Quoted by Lewin, Busch accurately describes a case which may be mentioned as characteristic of the symptoms of carbol- ism. A boy, suffering from abscess under the trochanter, was operated on for its relief. During the few minutes occupied by the operation he was kept under a two per cent, carbolic spray, and the wound was afterward dressed with carbolic gauze. The day following the operation he was seized with vomiting, which was attributed to the chloroform used as an anesthetic. On the following morning the bandages were removed under the carbolic spray ; during the day there was nausea, in the evening there was collapse, and car- bolic acid was detected in the urine. The pulse became small and frequent and the temperature sank to 35.5° C. The frequent vomiting made it im- possible to administer remedies by the stomach, and, in spite of hypodermic injections and external application of analeptics, the boy died fifty hours after operation. Recovery has followed the ingestion of an ounce of officinal hydrochloric acid." Black ^ mentions a man of thirty-nine who recovered after swallow- 1 199, 1878, No. 48. b 720, civ., 276. c 476, 1884, i., 659. a 548, 1875, ii., 597. e 218, xv. f 476, 1886, ii., 14. ANTIMONY. 499 ing IJ ounces of commercial hydrochloric acid. Johnson" reports a case of poisoning from a dram of hydrochloric acid. Tracheotomy was performed, but death resulted. Burman^ mentions recovery after the ingestion of a dram of dilute hydrocyanic acid of Scheele's strength (2.4 gm. of the acid). In this instance insensibility did not ensue until two minutes after taking the poison, the retarded digestion being the means of saving life. Quoting Taafe, in 1862 Taylor speaks of the case of a man who swallowed the greater part of a solution containing an ounce of potassium cyanid. In a few minutes the man was found insensible in the street, breathing ster- torously, and in ten minutes after the ingestion of the drug the stomach-pump was applied. In two hours vomiting began, and thereafter recovery was rapid. Mitscherlich speaks of erosion of the gums and tongue with hemorrhage at the slightest provocation, following the long administration of dilute nitric acid. This was possibly due to the local action. According to Taylor, the smallest quantity of oxalic acid causing death is one dram. Ellis ° describes a woman of fifty who sAvallowed an ounce of oxalic acid in beer. In thirty minutes she complained of a burning pain in the stomach and was rolling about in agony. Chalk and water was immediately given to her and she recovered. Woodman ^ reports recovery after taking ^ ounce of oxalic acid. Salicylic acid in medicinal doses frequently causes untoward symptoms, such as dizziness, transient delirium, diminution of vision, headache, and profuse perspiration ; petechial eruptions and intense gastric symptoms have also been noticed. Sulphuric acid causes death from its corrosive action, and when taken in excessive quantities it produces great gastric disturbance ; however, there are persons addicted to taking oil of vitriol without any apparent untoward effect. There is mentioned a boot-maker " who constantly took J ounce of the strong acid in a tumbler of water, saying that it relieved his dyspepsia and kept his bowels open. Antimony. — It is recorded that f grain of tartar emetic has caused death in a child and two grains in an adult. Falot ^ reports three cases in which after small doses of tartar emetic there occurred vomiting, delirium, spasms, and such depression of vitality that only the energetic use of stimu- lants saved life. Beau s mentions death following the administration of two doses of IJ gr. of tartar emetic. Preparations of antimony in an ointment applied locally have caused necrosis, particularly of the cranium, and Hebra*"' has long since denounced the use of tartar emetic ointment in affections of the scalp. Carpenter^ mentions recovery after ingestion of two a 224, 1871, i., 221. t 476, 1854, i., 39. ^ 476, 1864, 265. a 548, 1864, ii., 386. e 548, 1861, i., 295. f 789, 1852, 245. g 548, 1857, i., 320. h 491, 1893, 514. 500 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. drains of tartar emetic. Behrends * describes a case of catalepsy with mania, in which a dose of 40 gr. of tartar emetic was tolerated, and Mor- gagni speaks of a man who swallowed two drams, immediately vomited, and recovered. Instances like the last, in which an excessive amount of a poison by its sudden emetic action induces vomiting before there is absorp- tion of a sufficient quantity to cause death, are sometimes noticed. McCreery ^ mentions a case of accidental poisoning with half an ounce of tartar emetic successfully treated with green tea and tannin. Mason " reports recovery after taking 80 gr. of tartar emetic. , Arsenic. — The sources of arsenical poisoning are so curious as to de- serve mention. Confectionery, wall-paper, dyes, and the like are examples. In other cases we note money-counting,* the colored candles of a Christmas tree,** paper collars,^ ball-wreaths of artificial flowers,^ ball-dresses made of green tarlatan,*" playing cards,* hat-lining, J and fly-papers.^ Bazin has reported a case in which erythematous pustules appeared after the exhibition during fifteen days of the |- gr. of arsenic. Macnal ' speaks of an eruption similar to that of measles in a patient to whom he had given but three drops of Fowler's solution for the short period of three days. Pareira says that in a gouty patient for whom he prescribed ^ gr. of potassium arseniate daily, on the third day there appeared a bright red eruption of the face, neck, upper part of the trunk and flexor surfaces of the joints, and an edematous condition of the eyelids. The symptoms were preceded by rest- lessness, headache, and heat of the skin, and subsided gradually after the second or third day, desquamation continuing for nearly two months. After they had subsided entirely, the exhibition of arsenic again aroused them, and this time they were accompanied by salivation. Charcot and other French authors have noticed the frequent occurrence of suspension of the sexual instinct during the administration of Fowler's solution. Jackson ™ speaks of recovery after the ingestion of two ounces of arsenic by the early employ- ment of an emetic. Walsh" reports a case in which 600 gr. of arsenic were taken without injury. The remarkable tolerance of arsenic eaters is well known. Taylor asserts that the smallest lethal dose of arsenic has been two gr., but Tardieu mentions an instance in which ten cgm. (IJ gr.) has caused death. Mackenzie " speaks of a man who swallowed a large quantity of arsenic in lumps, and received no treatment for sixteen hours, but recovered. It is added that from two masses passed by the anus 105 gr. of arsenic were obtained. In speaking of the tolerance of belladonna, in 1859 Fuller mentioned a a 587, ix., 199. b 124, 1853. c 224, 1877, i., 674. d 491, 1883, 526. e 536, 1889, i., 287. f 224, 1880, ii., 240. g 548, 1862, i., 137, h 476, 1875, ii., 758. 1 224, 1879, ii., 630. J 224, 1879, ii., 746. k 476, 1884, i., 408. 1548,1868. m 124, July, 1858. n AnnaMst, N. Y., 1849, 136. o 435, 1872. BELLADONNA. 601 child of fourteen who in eighteen days took 37 grains of atropin ; a child of ten who took seven grains of extract of belladonna daily, or more than two ounces in twenty-six days ; and a man who took 64 grains of the extract of belladonna daily, and from whose urine enough atropin was extracted to kill two white mice and to narcotize two others. Bader has observed grave symptoms following the employment of a vaginal suppository containing three grains of the extract of belladonna. The dermal manifestations, such as urticaria and eruptions resembling the exanthem of scarlatina, are too well known to need mention here. An enema containing 80 grains of belladonna root has been followed in five hours by death, and Taylor ^57 has mentioned recovery after the ingestion of three drams of belladonna. In 1864 Chambers reported to the Lancet the recovery of a child of four years who took a solution containing J grain of the alkaloid. In some cases the idiosyn- crasy to belladonna is so marked that violent symptoms follow the application of the ordinary belladonna plaster. Maddox " describes a case of poisoning in a music teacher by the belladonna plaster of a reputable maker. She had obscure eye-symptoms, and her color-sensations were abnormal. Locomotor equilibration was also affected. Golden '' mentions two cases in which the application of belladonna ointment to the breasts caused suppression of the secretion of milk. Goodwin " relates the history of a case in which an in- fant was poisoned by a belladonna plaster applied to its mother's breast and died within twenty-four hours after the first application of the plaster. In 1881 Betancourt spoke of an instance of inherited susceptibility to belladonna, in which the external application of the ointment produced all the symptoms of belladonna poisoning. Cooper ^ mentions the symptoms of poisoning fol- lowing the application of extract of belladonna to the scrotum. Davison reports poisoning by the application of belladonna liniment. Jenner and Lyman also record belladonna poisoning from external applications. Rosenthal ^ reports a rare case of poisoning in a child eighteen months old who had swallowed about a teaspoonful of benzin. Fifteen minutes later the child became unconscious. The stomach-contents, which were promptly removed, contained flakes of bloody mucus. At the end of an hour the radial pulse was scarcely perceptible, respiration was somewhat increased in fre- quency and accompanied with a rasping sound. The breath smelt of benzin. The child lay in quiet narcosis, occasionally throwing itself about as if in pain. The pulse gradually improved, profuse perspiration occurred, and normal sleep intervened. Six hours after the poisoning the child was still stupefied. The urine was free from albumin and sugar, and the next morning the little one had perfectly recovered. There is an instance mentioned ^ of a robust youth of twenty who by a mistake took a half ounce of cantharides. He was almost immediately a 124, 1893. ^ 476, 1856. " 545, 1871, 346. d224, 1877, i., 164. e Therap. Gaz., July 16, 1894. f 476, 1825, 333. 502 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. seized with violent heat in the throat and stomach, pain in the head, and intense burning on urination. These symptoms progressively increased, were followed by intense sickness and almost continual vomiting. In the evening he passed great quantities of blood from the urethra with excessive pain in the urinary tract. On the third day all the symptoms were less violent and the vomiting had ceased. Recovery was complete on the fifteenth day. Digitalis has been frequently observed to produce dizziness, fainting, disturbances of vision, vomiting, diarrhea, weakness of the pulse, and depres- sion of temperature. These phenomena, however, are generally noticed after continued administration in repeated doses, the result being doubtless due to cumulative action caused by abnormally slow elimination by the kid- neys. Traube ^ observed the presence of skin-affection after the use of digi- talis in a case of pericarditis. Tardieu has seen a fluid-dram of the tincture of digitalis cause alarming symptoms in a young woman who was pregnant. He also quotes cases of death on the tenth day from ingestion of 20 grains of the extract, and on the fifth day from 2 J grams of the infusion. Kohnhorn ^ mentions a death from what might be called chronic digitalis poisoning. There is a deleterious practice of some of the Irish peasantry connected with their belief in fairies, which consists of giving a cachetic or rachitic child large doses of a preparation of fox-glove (Irish — luss-more, or great herb), to drive out or kill the fairy in the child. It was supposed to kill an unhal- lowed child and cure a hallowed one. In the Hebrides, likewise, there were many cases of similar poisoning. Epidemics of ergotism have been recorded from time to time since the days of Galen, and were due to poverty, wretchedness, and famine, resulting in the feeding upon ergotized bread. According to "Wood,*^^ gangrenous er- gotism, or "Ignis Sacer" of the Middle Ages, killed 40,000 persons in Southwestern France in 922 A. D., and in 1128-29, in Paris alone, 14,000 persons perished from this malady. It is described as commencing with itchings and formications in the feet, severe pain in the back, contractions in the muscles, nausea, giddiness, apathy, with abortion in pregnant women, in suckling women drying of milk, and in maidens with amenorrhea. After some time, deep, heavy aching in the limbs, intense feeling of coldness, with real coldness of the surfaces, profound apathy, and a sense of utter weari- ness develop ; then a dark spot appears on the nose or one of the extremi- ties, all sensibility is lost in the affected part, the skin assumes a livid red hue, and adynamic symptoms in severe cases deepen as the gangrene spreads, until finally death ensues. Very generally the appetite and digestion are preserved to the last, and not rarely there is a most ferocious hunger. "Wood also mentions a species of ergotism characterized by epileptic paroxysms, which he calls " spasmodic ergotism." Prentiss •= mentions a brunette of forty- two, under the influence of ergot, who exhibited a peculiar depression of a 263, i., 622. b 476, 1876, i., 583. - 450, 1889, No. 26, 912. LEAD-POISONING. 503 spirits with hysteric phenomena, although deriving much benefit from the administration of the drug from the hemorrhage caused by uterine fibroids. After taking ergot for three days she felt like crying all the time, became irritable, and stayed in bed, being all day in tears. The natural disposition of the patient was entirely opposed to these manifestations, as she was even- tempered and exceptionally pleasant. In addition to the instance of the fatal ingestion of a dose of Epsom salts already quoted, Lang ^ mentions a woman of thirty-five who took four ounces of this purge. She experienced burning pain in the stomach and bowels, together with a sense of asphyxiation. There was no purging or vomiting, but she became paralyzed and entered a state of coma, dying fifteen minutes after ingestion. lodin Preparations. — The eruptions following the administration of small doses of potassium iodid are frequently noticed (Fig. 189), and at the same time large quantities of albumin have been seen in the urine. Potassium iodid, al- though generally spoken of as a poisonous drug, by gradually in- creasing the dose can be given in such enormous quantities as to be almost beyond the bounds of credence, several drams being given at a dose. On the other hand, eight grains have produced alarming symptoms.*" In the extensive use of iodoform as a dressing instances of untoward effects, and even fatal ones, have been noticed, the majority of them being due to careless and injudicious application. In a French journal " there is mentioned the history of a man of twenty-five, suspected of urethral ulcer- ation, who submitted to the local application of one gram of iodoform. Deep narcosis and anesthesia were induced, and two hours after awakening his breath smelled strongly of iodoform. There are two similar instances recorded in England.'^ Pope ^ mentions two fatal cases of lead-poisoning from diachylon plaster, self-administered for the purpose of producing abortion. Lead water-pipes, the use of cosmetics and hair-dyes, coloring matter in confectionery and in pastry, tabitual biting of silk threads, imperfectly burnt pottery, and cooking bread with painted wood ^ have been mentioned as causes of chronic lead- poisoning. Fig. 189. — A somewhat rare form of eruption from tlie in- gestion of iodin compounds (after J. C. McGuire). » 476, 1891. d 476, May 31, 1879. b 133, xxvi., 197. e 224, 1893. ■; Le Practicien, Mar. 17, 1879. t 653, 1877, 349. 504 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. Mercury. — Armstrong" mentions recovery after ingestion of 1^^ drams of corrosive sublimate, and Lodge '' speaks of recovery after a dose contain- ing 100 grains of the salt. It is said " that a man swallowed 80 grains of mercuric chlorid in whiskey and water, and vomited violently about ten minutes afterward. A mixture of albumin and milk was given to him, and in about twenty-five minutes a bolus of gold-leaf and reduced iron ; in eight days he perfectly recovered. Severe and even fatal poisoning may result from the external application of mercury. Meeres ^ mentions a case in which a solution (two grains to the fluid-ounce) applied to the head of a child of nine for the relief of tinea tonsurans caused diarrhea, profuse salivation, marked prostration, and finally death. Washing out the vagina with a solu- tion of corrosive sublimate, 1 : 2000, has caused severe and even fatal poison- ing.^ Bonet ^^* mentions death after the inunction of a mercurial ointment, and instances of distressing salivation from such medication are quite common. There are various dermal affections which sometimes follow the exhibition of mercury and assume an erythematous type. The susceptibility of some per- sons to calomel, the slightest dose causing profuse salivation and painful oral symptoms, is so common that few physicians administer mercury to their patients without some knowledge of their susceptibility to this drug. Blun- del ^ relates a curious case occurring in the times when mercury was given in great quantities, in which to relieve obstinate constipation a half ounce of crude mercury was administered and repeated in twelve hours. Scores of globules of mercury soon appeared over a vesicated surface, the result of a previous blister applied to the epigastric region. Blundel, not satisfied with the actuality of the phenomena, submitted his case to Dr. Lister, who, after careful examination, pronounced the globules metallic. Oils. — Mauvezin s tells of the ingestion of three drams of croton oil by a child of six, followed by vomiting and rapid recovery. There was no diar- rhea in this case. Wood quotes Cowan in mentioning the case of a child of four, who in two days recovered from a teaspoonful of croton oil taken on a full stomach. Adams saw recovery in an adult after ingestion of the same amount. There is recorded^ an instance of a woman who took about an ounce, and, emesis being produced three-quarters of an hour afterward by mustard, she finally recovered. There is a record in which so small a dose as three minims is supposed to have killed a child of thirteen months.' According to Wood, Giacomini mentions a case in which 24 grains of the drug proved fatal in as many hours. Castor oil is usually considered a harmless drug, but the castor bean, from which it is derived, contains a poisonous acrid principle, three such beans having sufficed to produce death in a man. Doubtless some of the in- a 491, 1887, 120. b 224, 1888, ii., 720. c 124, 1863, 340. d 476, .Sept. 16, 1871. e 261, 1887, No. 47. f 476, 1830, 767. g 363, 1869, 290. h 218, 1868. i., 294. i 548, 1870, i. OPIUM. 505 stances in which castor oil has produced symptoms similar to cholera are the results of the administration of contaminated oil. The untoward effects of opium and its derivatives are quite numerous. Gaubius treated an old woman in whom, after three days, a single grain of opium produced a general desquamation of the epidermis ; this peculiarity was not accidental, as it was verified on several other occasions. Hargens*'^ speaks of a woman in whom the slightest bit of opium in any form produced considerable salivation. Gastric disturbances are quite common, severe vomiting being produced by minimum doses ; not infrequently, intense mental confusion, vertigo, and headache, lasting hours and even days, some- times referable to the frontal region and sometimes to the occipital, are seen in certain nervous individuals after a dose of from |- to |- gr. of opium. These symptoms were familiar to the ancient physicians, and, according to Lewin, Tralles reports an observation with reference to this in a man, and says regarding it in rather unclassioal Latin : " . . . per multos dies pon- derosissimum caput circumgestasse." Convulsions are said to be observed after medicinal doses of opium. Albers " states that twitching in the tendons, tremors of the hands, and even paralysis, have been noticed after the inges- tion of opium in even ordinary doses. The " pruritus opii," so familiar to physicians, is spoken of in the older writings. Dioscorides, Paulus Aegineta., and nearly all the writers of the last century describe this symptom as an annoying and unbearable affection. In some instances the ingestion of opium provokes an eruption in the form of small, isolated red spots, which, in their general character, resemble roseola. Rieken ^ remarks that when these spots spread over all the body they present a scarlatiniform appearance, and he adds that even the mucous membranes of the mouth and throat may be attacked with erethematous inflammation. Behrend <^ observed an opium exanthem, which was attended by intolerable itching, after the exhibition of a quarter of a grain. It was seen on the chest, on the inner surfaces of the arms, on the flexor surfaces of the forearms and wrists, on the thighs, and posterior and inner surfaces of the legs, terminating at the ankles in a stripe- like discoloration about the breadth of three fingers. It consisted of closely disposed papules of the size of a pin-head, and several days after the dis- appearance of the eruption a fine, bran-like desquamation of the epidermis ensued. Brand ^ has also seen an eruption on the trunk and flexor surfaces, accompanied with fever, from the ingestion of opium. Billroth " mentions the case of a lady in whom appeared a feeling of anxiety, nausea, and vomit- ing after ingestion of a small fraction of a grain of opium ; she would rather endure her intense pain than suffer the untoward action of the drug. According to Lewin, Brochin ^ reported a case in which the idiosyn- crasy to morphin was so great that -Jj- of a grain of the drug administered a 161, xxvi., 225. b 720, cvii., 22. <= 199, 1879, 626. d 199, 1879, 718. e 611, 1868, 763. f 363, 1877, 226. 506 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. hypodermically caused irregularity of the respiration, suspension of the heart-beat, and profound narcosis. According to the same authority, "Wemich has called attention to paresthesia of the sense of taste after the employment of morphin, which, according to his observation, is particularly prone to supervene in patients who are much reduced and in persons otherwise healthy who have suffered from prolonged inanition. These effects are prob- ably due to a central excitation of a similar nature to that produced by san- tonin. Persons thus attacked complain, shortly after the injection, of an intensely sour or bitter taste, which for the most part ceases after elimination of the morphin. Von Graefe and Sommerfrodt speak of a spasm of accom- modation occurring after ingestion of medicinal doses of morphin. There are several cases on record " in which death has been produced in an adult by the use of J to -^ grain of morphin. According to Wood, the maximum doses from which recovery has occurred without emesis are 55 grains of solid opium, and six ounces of laudanum. According to the same authority, in 1854 there was a case in which a babe one day old was killed by one minim of laudanum, and in another case a few drops of paregoric proved fatal to a child of nine months. Doubtful instances of death from opium are given, one in an adult female ^ after 30 grains of Dover's powder given in divided doses, and another " after a dose of J grain of morphin. Yavorski^* cites a rather remarkable instance of morphin-poisoning with recovery : a female took 30 grains of acetate of morphin, and as it did not act qviickly enough she took an additional dose of J ounce of laudanum. After this she slept a few hours, and awoke complaining of being ill. Yavorski saw her about an hour later, and by producing emesis, and giving coffee, atropin, and tincture of musk, he saved her life. Pyle *= describes a pugilist of twenty-two who, in a fit of despondency after a debauch (in which he had taken repeated doses of morphin sulphate), took with suicidal intent three teaspoonfuls of morphin j after rigorous treatment he revived and was discharged on the next day per- fectly well. Potassium permanganate was used in this case. Chaffee ^ speaks of recovery after the ingestion of 18 grains of morphin without vomiting. In chronic opium eating the amount of this drug which can be ingested with safety assumes astounding proportions. In his " Confessions " De Quincey remarks : " Strange as it may sound, I had a little before this time descended suddenly and without considerable effort from 320 grains of opium (8000 drops of laudanum) per day to 40 grains, or \ part. Instantaneously, and as if by magic, the cloud of profoundest melancholy which rested on my brain, like some black vapors that I have seen roll away from the summits of the mountains, drew off in one day, — passed off with its murky banners as simul- taneously as a ship that has been stranded and is floated off by a spring-tide — ' That moveth altogether, if it move at all. ' a 829, 168. b 269, July, 1882. <= 218, Jan. 3, 1885. a 812, 1885. e 533, May 12, 1894. f 545, 1882, xlvli., 697. CHRONIC OPIUM EATING. 507 Now, then, I was again happy ; I took only a thousand drops of laudanum per day, and what was that ? A latter spring had come to close up the sea- son of youth ; my brain performed its functions as healthily as ever before ; I read Kant again, and again I understood him, or fancied that I did." There have been many authors who, in condemning De Quincey for unjustly throwing about the opium habit a halo of literary beauty which has tempted many to destruction, absolutely deny the truth of his statements. No one has any stable reason on which to found denial of De Quincey's statements as to the magnitude of the doses he was able to take ; and his frankness and truth- fulness is equal to that of any of his detractors. "WiUiam Kosse Cobbe, in a volume entitled " Dr. Judas, or Portrayal of the Opium Habit," gives with great frankness of confession and considerable purity of diction a record of his own experiences with the drug. One entire chapter of Mr. Cobbe' s book and several portions of other chapters are devoted to showing that De Quincey was wrong in some of his statements, but notwithstanding his criticism of De Quincey, Mr. Cobbe seems to have experienced the same adventures in his dreams, showing, after all, that De Quincey knew the effects of opium, even if he seemed to idealize it. According to Mr. Cobbe, there are in the United States upward of two millions of victims of enslaving drugs entirely exclusive of alcohol. Cobbe mentions several instances in which De Quincey's dose of 320 grains of opium daily has been surpassed. One man, a resident of Southern Illinois, consumed 1072 grains a day ; another in the same State contented himself with 1685 grains daily; and still another is given whose daily consumption amounted to 2345 grains per day. In all cases of laudanum-takers it is probable that analysis of the commercial laudanum taken would show the amount of opium to be greatly below that of the offici- nal proportion, and little faith can be put in the records of large amounts of opium taken when the deduction has been made from the laudanum used. Dealers soon begin to know opium victims, and find them ready dupes for adulteration. According to Lewin, Samter mentions a case of morphin-habit which was continued for three years, during which, in a period of about three hundred and twenty-three days, upward of 2 J ounces of morphin was taken daily. According to the same authority, Eder reports still larger doses. In the case observed by him the patient took laudanum for six years in increasing doses up to one ounce per day ; for eighteen months, pure opium, commencing with 15 grains and increasing to 2 J drams daily; and for eighteen months morphin, in commencing quantities of six grains, which were later increased to 40 grains a day. When deprived of their accustomed dose of morphin the sufferings which these patients experience are terrific, and they pursue all sorts of deceptions to enable them to get their enslaving drug. Patients have been known to conceal tubes in their mouths, and even swallow them, and the authors know of a fatal instance in which a tube of hypodermic tablets of the drug was found concealed in the rectum. 508 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. The administration of such an inert substance as the infusion of orange- peel has been sufficient to invariably produce nervous excitement in a patient afflicted with carcinoma. Sonnenschein refers to a case of an infant of five weeks who died from the effects of one phosphorous match head containing only j^g- grain of phosphorus. There are certain people who by reason of a special suscepti- bility cannot tolerate phosphorus, and the exhibition of it causes in them nausea, oppression, and a feeling of pain in the epigastric region, tormina and tenesmus, accompanied with diarrhea, and in rare cases jaundice, sometimes lasting several months. In such persons -^ grain is capable of causing the foregoing symptoms. In 1882 a man was admitted to Guy's Hospital, Lon- don, after he had taken half of a sixpenny pot of phosphorous paste in whis- key, and was subsequently discharged completely recovered. A peculiar feature of phosphorus-poisoning is necrosis of the jaw. This affection was first noticed in 1838, soon after the introduction of the manu- facture of phosphorous matches. In late years, owing to the introduction of precautions in their manufacture, the disease has become much less common. The tipping of the match sticks is accomplished by dipping their ends in a warm solution of a composition of phosphorus, chlorate of potassium, with particles of ground flint to assist friction, some coloring agent, and Irish glue. From the contents of the dipping-pans fumes constantly arise into the faces of the workmen and dippers, and in cutting the sticks and packing the matches the hands are constantly in contact with phosphorus. The region chiefly affected in this poisoning is the jaw-bone, but the inflammation may spread to the adjoining bones and involve the vomer, the zygoma, the body of the sphenoid bone, and the basilar process of the occipital bone. It is supposed that conditions in which the periosteum is exposed are favorable to the progress of the disease, and, according to Hirt, workmen with diseased teeth are affected three times as readily as those M-ith healthy teeth, and are therefore carefully excluded from some of the factories in America. Prentiss of "Washington, D. C, in 1881* reported a remarkable case of pilocarpin idiosyncrasy in a blonde of twenty-five. He was consulted by the patient for constipation. Later on symptoms of cystitis developed, and an ultimate diagnosis of pyelitis of the right kidney was made. Uremic symptoms Avere avoided by the constant use of pilocarpin. Between Decem- ber 16, 1880, and February 22, 1881, the patient had 22 sweats from pilo- carpin. The action usually lasted from two to six hours, and quite a large dose was at length necessary. The idiosyncrasy noted was found in the hair, which at first was quite light, afterward chestnut-brown, and May 1, 1881, almost pure black. The growth of the hair became more vigorous and thicker than formerly, and as its color darkened it became coarser in propor- tion. In March, 1889, Prentiss saw his patient, and at that time her hair was a 547, July 2, 1881. QUININ. 509 dark brown, having returned to that color from black. Prentiss also reported the following case » as adding another to the evidence that jaborandi will produce the effect mentioned under favorable circumstances : Mrs. L., aged seventy-two years, was suffering from Bright's disease (contracted kidney). Her hair and eyebrows had been snow-white for twenty years. She suf- fered greatly from itching of the skin, due to the uremia of the kidney- disease ; the skin was harsh and dry. For this symptom fluid extract of jaborandi was prescribed with the effect of relieving the itching. It was taken in doses of 20 or 30 drops several times a day, from October, 1886, to February, 1888. During the fall of 1887 it was noticed by the nurse that the eyebrows were growing darker, and that the hair of the head was darker in patches. These patches and the eyebrows continued to become darker, until at the time of her death they were quite black, the black tufts on the head presenting a very curious appearance among the silver-white hairs sur- rounding them. Quiniu being such a universally used drug, numerous instances of idio- syncrasy and intolerance have been recorded. Chevalier '' mentions that through contact of the drug workmen in the manufacture of quinin are liable to an affection of the skin which manifests itself in a vesicular, papular, or pustular eruption on different parts of the body. V6pan " mentions a lady who took 1 J grains and afterward 2 J grains of quinin for neuralgia, and two days afterward her body was covered with purpuric spots, which disappeared in the course of nine days but reappeared after the administration of the drug was resumed. Lewin says that in this case the severity of the eruption was in accordance with the size of the dose, and during its existence there was bleeding at the gums ; he adds that Gouchet also noticed an eruption of this kind in a lady who after taking quinin expectorated blood. The pe- techise were profusely spread over the entire body, and they disappeared after the suspension of the drug. Dauboeuf, Garraway,'* Hemming,*' Skinner,^ and Cobner s mention roseola and scarlatiniform erythema after minute doses of quinin. In nearly all these cases the accompanying symptoms were differ- ent. Heusinger'' speaks of a lady who, after taking J grain of quinin, ex- perienced headache, nausea, intense burning, and edema, together with nodular erythema on the eyelids, cheeks, and portion of the forehead. At another time IJ grains of the drug gave rise to herpetic vesicles on the cheeks, fol- lowed by branny desquamation on elimination of the drug. In other patients intense itching is experienced after the ingestion of quinin. Peters^ cites an instance of a woman of sixty-five who, after taking one grain of quinin, invariably exhibited after an hour a temperature of from 104° to 105° F., accelerated pulse, rigors, slight delirium, thirst, and all the appearances of a 727, Oct. 3, 1890. b 141, 1851, T. Ixviii., 5. <= 369, 1865. 200, x., 242. 476, 1870, i., 446. ^ 381, 1880, ii., 387. 520 PHYSIOLOQIO AND FUNCTIONAL ANOMALIES. are true of persons buried alive and returning to life, only to find themselves hopelessly lost in a narrow coffin many feet below the surface of the earth. Among the lower classes the dread of being buried before life is extinct is quite generally felt, and for generations the medical profession have been de- nomiced for their inability to discover an infallible sign of death. Most of the instances on record, and particularly those from lay journals, are vivid exaggerations, drawn from possibly such a trivial sign as a corpse found with the fist tightly clenched or the face distorted, which are the mspiration of the horrible details of the dying struggles of the person in the coffin. In the works of Fontenelle there are 46 cases recorded of the premature interment of the living, in which apparent has been mistaken for real death. None of these cases, however, are sufficiently authentic to be reliable. Moreover, in all modern methods of burial, even if life were not extinct, there could be no possibility of consciousness or of struggling. Absolute asphyxiation would soon follow the closing of the coffin lid. We must admit, however, that the mistake has been made, particularly in instances of catalepsy or trance, and during epidemics of malignant fevers or plagues, in which there is an absolute necessity of hasty burial for the pre- vention of contagion. In a few instances on the battle-field sudden s3Ticope, or apparent death, has possibly led to premature interment ; but in the present day this is surely a very rare occurrence. There is also a danger of mistake from cases of asphyxiation, drowning, and similar sudden suspensions of the vital functions. It is said that in the eighty-fourth Olympiad, Empedocles restored to life a woman who was about to be buried, and that this circumstance induced the Greeks, for the future protection of the supposed dead, to establish laws which enacted that no person should be interred until the sixth or seventh day. But even this extension of time did not give satisfaction, and we read that when Hephestion, at whose funeral obsequies Alexander the Great was present, was to be buried his funeral was delayed until the tenth day. There is also a legend that when Acilius Aviola fell a victim to disease he was burned alive, and although he cried out, it was too late to save him, as the fire had become so widespread before life returned. While returning to his country house Asclepiades, a physician denommated the " God of Physic," and said to have been a descendant of ^sculapius, saw during the time of Pompey the Great a crowd of mourners about to start a fire on a funeral pile. It is said that by his superior knowledge he per- ceived indications of life in the corpse and ordered the pile destroyed, subse- quently restormg the supposed deceased to life. These examples and several others of a similar nature induced the Eomans to delay their funeral rites, and laws were enacted to prevent haste in burning, as well as in interment. It was not until the eighth day that the final rites were performed, the days im- mediately subsequent to death having their own special ceremonies. The PREMATURE BURIAL. 521 Turks were also fearful of premature interment and subjected the defunct to every test ; among others, one was to examine the contractility of the sphincter ani, which shows their keen observation of a well-known modern medical fact. According to the Memoirs of Amelot de la Houssaye, Cardinal Espinola, Prime Minister to Philip II., put his hand to the embalmer's knife with which he was about to be opened. It is said that Vesalius, sometimes called the " Father of Anatomy," having been sent for to perform an autopsy on a woman subject to hysteric convulsions, and who was supposed to be dead, on making the first incision perceived by her motion and cries that she was still alive. This circumstance, becoming known, rendered him so odious that he had to leave the community in which he practised, and it is believed that he never entirely recovered from the shock it gave him. The Abb6 Provost, so well known by his works and the singularities of his life, was seized by apoplexy in the Forest of Chantilly on October 23, 1763. His body was carried to the nearest village, and the officers of justice proceeded to open it, when a cry he sent forth frightened all the assistants and convinced the sur- geon in charge that the Abb6 was not dead ; but it was too late to save him, as he had already received a mortal wound. Massien speaks of a woman living in Cologne in 1571 who was interred living, but was not awakened from her lethargy until a grave-digger opened her grave to steal a valuable ring which she wore. This instance has been cited in nearly every language. There is another more recent instance, com- ing from Poitiers, of the wife of a goldsmith named Mernache who was buried with all her jewels. During the night a beggar attempted to steal her jewelry, and made such exertion in extracting one ring that the woman re- covered and was saved. After this resurrection she is said to have had sev- eral children. This case is also often quoted. Zacchias '^^ mentions an in- stance which, from all appearances, is authentic. It was that of a young man, pest-stricken and thought to be dead, who was placed with the other dead for burial. He exhibited signs of life, and was taken back to the pest- hospital. Two days later he entered a lethargic condition simulating death, and was again on his way to the sepulcher, when he once more recovered. It is said that when the body of William, Earl of Pembroke," who died April 10, 1630, was opened to be embalmed, the hand raised when the first incision was made. There is a story of an occurrence which happened on a return voyage from India.^ The wife of one of the passengers, an officer in the army, to all appearances died. They were about to resort to sea-burial, when, through the interposition of the husband, who was anxious to take her home, the ship-carpenters started to construct a coffin suitable for a long voy- age, a process which took several days, during which time she lay in her berth, swathed in robes and ready for interment. When the coffin was at last ready the husband went to take his last farewell, and removed the wed- a 536, 1887, i., 586. I' 548, 1866, i., 287. 522 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. ding-ring, which was quite tightly on her finger. In the effort to do this she was aroused, recovered, and arrived in England perfectly well. It is said that when a daughter of Henry Laurens, the first President of the American Congress, died of small-pox, she was laid out as dead, and the windows of the room were opened for ventilation. While left alone in this manner she recovered. This circumstance so impressed her illustrious father that he left explicit directions that in case of his death he should be burned. * The same journal also contains the case of a maid-servant who recovered thrice on her way to the grave, and who, when really dead, was kept a pre- posterous length of time before burial. The literature on this subject is very exhaustive, volumes having been written on the uncertainty of the signs of death, with hundreds of examples cited illustrative of the danger of premature interment. The foregoing in- stances have been given as indicative of the general style of narration ; for further information the reader is referred to the plethora of material on this subject. Postmortem Anomalies. — Among the older writers startling move- ments of a corpse have given rise to much discussion, and possibly often led to suspicion of premature burial. Bartholinus ^^^ describes motion in a cadaver. Barlow '' says that movements were noticed after death in the vic- tims of Asiatic cholera. The bodies were cold and expressions were death- like, but there were movements simulating natural life. The most common was flexion of the right leg, which would also be drawn up toward the body and resting on the left leg. In some cases the hand was moved, and in one or two instances a substance was grasped as if by reflex action. Some observers have stated that reflex movements of the face were quite noticeable. These movements continued sometimes for upward of aji hour, occurring mostly in muscular subjects who died very suddenly, and in whom the mus- cular irritability or nervous stimulus or both had not become exhausted at the moment of dissolution. Richardson "^ doubts the existence of postmortem movertients of respiration. Snow is accredited ° with having seen a girl in Soho who, dying of scarlet fever, turned dark at the moment of death, but in a few hours presented such a life-like appearance and color as to almost denote the return of life. The center of the cheeks became colored in a ntitural fashion, and the rest of the body resumed the natural flesh color. The parents refused to believe that death had ensued. Eichardson remarks that he had seen two similar cases, and states that he believes the change is due to oxidation of the blood sur- charged with carbon dioxid. The moist tissues suffuse carbonized blood, and there occurs an osmotic interchange between the carbon dioxid and the oxygen of the air resulting in an oxygenation of the blood, and modification of the color from dark venous to arterial red. a 548, 1866, i., 287. b 173, 1889, 5. c Richardson, 173, 1889. POSTMORTEM ANOMALIES. 623 A peculiar postmortem anomaly is erection of the penis. The Ephem- erides and Morgagni^^^ discuss postmortem erection, and Guyon mentions that on one occasion he saw 14 negroes hanged, and states that at the moment of suspension erection of the penis occurred in each ; in nine of these blacks traces of this erectile state were perceived an hour after death. Cadaveric perspiration has been observed and described by several authors, and PauUini ^^^ has stated that he has seen tears flow from the eyes of a corpse. The retardation of putrefaction of the body after death sometunes presents interesting changes. Petrifaction or mummification of the body are quite well known, and not being in the province of this work, will be referred to collateral books on this subject ; but sometimes an unaccountable preservation takes place. In a tomb recently opened at Canterbury Cathedral, " for the purpose of discovering what Archbishop's body it contained, the corpse was of an extremely offensive and sickening odor, unmistakably that of putre- faction. The body was that of Hubert "Walter, who died in 1204 A. D., and the decomposition had been retarded, and was actually still in progress, several hundred years after burial. Retardation of the putrefactive process has been noticed in bodies some years under water. Konig of Hermannstadt mentions a man who, forty years previous to the time of report, had fallen under the waters of Echo- schacht, and who was found in a complete state of preservation. Postmortem Growth of Hair and Nails. — The hair and beard may grow after death, and even change color. Bartholinus recalls a case of a man who had short, black hair and beard at the time of interment, but who, some time after death, was found to possess long and yellowish hair. Aristotle discusses postmortem growth of the hair, and Garmanus cites an instance in which the beard and hair were cut several times from the cadaver. We occasionally see evidences of this in the dissecting-rooms. Caldwell ^ men- tions a body buried four years, the hair from which protruded at the points where the joints of the coffin had given away. The hair of the head measured 18 inches, that of the beard eight inches, and that on the breast from four to six inches, lilosse of Washington mentions an instance in which after burial the hair turned from dark brown to red, and also cites a case in a Washington cemetery of a girl, twelve or thirteen years old, who when exhumed was found to have a new growth of hair all over her body. The Ephemerides contains an account of hair suddenly turning gray after death. Nails sometimes grow several inches after death, and there is on record the account of an idiot who had an idiosyncrasy for long nails, and after death the nails were found to have grown to such an extent that they curled up under the palms and soles. The untoward effects of the emotions on the vital functions are " 476, 1890, i., 1105. b538, 1877. 524 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. quite well exemplified in medical literature. There is an abundance of cases reported in which joy, fear, pride, and grief have produced a fatal issue. In history we have the old story of the Lacedemonian woman who for some time had believed her son was dead, and who from the sudden joy occasioned by see- ing him alive, herself fell lifeless. There is a similar instance in Roman history. Aristotle, Pliny, Livy, Cicero, and others cite instances of death from sudden or excessive joy. Fouquet died of excessive joy on being released from prison. A niece of the celebrated Leibnitz immediately fell dead on seeing a casket of gold left to her by her deceased uncle. Galen mentions death from joy, and in comment upon it he says that the emotion of joy is much more dangerous than that of anger. In discussing this subject, Haller says that the blood is probably sent with such violence to the bram as to cause apoplexy. There is one case on record in which after a death from sudden joy the pericardium was found full of blood.* The Ephemerides, Marcellus Donatus,'"^ Martini, and Struthius all mention death from joy. Death from violent laughter has been recorded, but in this instance it is very probable that death was not due to the emotion itself, but to the ex- treme convulsion and exertion used in the laughter. The Ephemerides men- tions a death from laughter, and also describes the death of a pregnant woman from violent mirth. Eoy,'^ Swinger," and Camerarius^*^ have recorded in- stances of death from laughter. Strange as it may seem, Saint-Foix"^ says that the Moravian brothers, a sect of Anabaptists having great horror of bloodshed, executed their condemned brethren by tickling them to death. Powerfully depressing emotions, which are called by Kant " asthenic," such as great and sudden sorrow, grief, or fright, have a pronounced effect on the vital functions, at times even causing death. Throughout literature and history we have examples of this anomaly. In Shakespeare's " Pericles," Thaisa, the daughter to Simonides and wife of Pericles, frightened when pregnant by a threatened shipwreck, dies m premature childbirth. In Scott's " Guy Mannering," Mrs. Bertram, on suddenly learning of the death of her little boy, is thrown into premature labor, followed by death. Various theories are advanced in explanation of this anomaly. A very plausible one is, that the cardiac palsy is caused by energetic and persistent excitement of the inhibitory cardiac nerves. Strand** is accredited with saying that agony of the mind produces rupture of the heart. It is quite common to hear the expression, " Died of a broken heart ; " and, strange to say, in some cases postmortem examination has proved the actual truth of the saying. Bartholinus, Fabricius Hildanus, Pliny, Rhodius, Schenck, Marcellus Dona- tus, Eiedlin, and Garengeot speak of death from fright and fear, and the a "Anecdotes de M6decine," 117. b 462, 1812, Oct., 199. « "Theatre vitse human," 2656. d " Essais historiques sur Paris," T. v., 54. e "Treatise on the Physical Cause of the Death of Christ." DEA TH FR OM FEAR. 525 Ephemerides describes a death the direct cause of which was intense shame. Deleau, ^ a celebrated doctor of Paris, while embracing his favorite daughter, who was in the last throes of consumption, was so overcome by intense grief that he fell over her corpse and died, and both were buried together. The fear of child-birth has been frequently cited as a cause of death. McClintock quotes a case from Travers of a young lady, happily married, who entertained a fear of death in child-birth ; although she had been safely delivered, she suddenly and without apparent cause died in six hours. Every region of the body was examined with minutest care by an eminent physician, but no signs indicative of the cause of death were found. Mor- dret cites a similar instance of death from fear of labor. Morgagni^^^ men- tions a woman who died from the disappointment of bearing a girl baby when she was extremely desirous of a boy. The following case, quoted from Lauder Brunton,*" shows the extent of shock which may be produced by fear : Many years ago a janitor of a college had rendered himself obnoxious to the students, and they determined to punish him. Accordingly they prepared a block and an axe, which they conveyed to a lonely place, and having appropriately dressed themselves, some of them prepared to act as judges, and sent others of their company to bring him be- fore them. He first affected to treat the whole affair as a joke, but was solemnly assured by the students that they meant it in real earnest. He was told to prepare for immediate death. The trembling janitor looked all aroimd in the vain hope of seeing some indication that nothing was really meant, but stern looks met him everywhere. He was blindfolded, and made to kneel before the block. The executioner's axe was raised, but, instead of the sharp edge, a wet towel was brought sharply down on the back of the neck. The bandage was now removed from the culprit's eyes, but to the horror and astonishment of the students they found that he was dead. Such a case may be due to heart-failure from fear or excitement. It is not uncommon that death ensues from the shock alone following blows that cause no visible injury, but administered to vital parts. This is particularly true of blows about the external genital region, or epigastrium, where the solar plexus is an active factor in inhibition. Ivanhoff of Bulgaria in 1886 speaks of a man of forty-five who was dealt a blow on the testicle in a violent street fight, and staggering, he fell insensible. Despite vigorous medical efforts he never regained consciousness and died m forty- five minutes. Postmortem examination revealed everything normal, and death must have been caused by syncope following violent pain. Watkins " cites an mstance occurring in South Africa. A native shearing sheep for a farmer provoked his master's ire by calling him by some nickname. While the man was in a squatting posture the farmer struck him in the epigastrium. He followed this up by a kick in the side and a blow on the head, neither of a 224, 1878, ii., 381. "^ 846, 282. c 476, 1884, i., 916. 526 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. which, however, was as severe as the first blow. The man fell unconscious and died. At the autopsy there were no signs indicative of death, which must have been due to the shock following the blow on the epigastrium. As illustrative of the sensitiveness of the epigastric region, Vincent relates the following case : " A man received a blow by a stick upon the epigastrium. He had an anxious expression and suffered from oppression. Irregular heart- action and shivering were symptoms that gradually disappeared during the day. In the evening his appetite returned and he felt well ; during the night he died without a struggle, and at the autopsy there was absolutely nothing abnormal to be found." Blows upon the neck often produce sudden collapse. Prize-fighters are well aware of the effects of a blow on the jugular vein. Maschka, quoted by Warren,**^ reports the case of a boy of twelve, who was struck on the anterior portion of the larynx by a stone. He fell lifeless to the ground, and at autopsy no local lesion was found nor any lesion elsewhere. The sudden death may be attributed in this case partly to shock and partly to cerebral anemia. Soldiers have been seen to drop lifeless on the battle-field without apparent injury or organic derangement ; in the olden times this death was attributed to fear and fright, and later was supposed to be caused by what is called " the wind of a cannon-ball." Tolifree * has written an article on this cause of sudden death and others have discussed it. By some it is maintained that the momentum acquired by a cannon-ball generates enough force in the neigh- boring air to prostrate a person in the immediate vicmity of its path of flight " 187, 1834, ii., 151. CHAPTER X. SUEGICAL AI^OMALIES OF THE HEAD AND NECK. Injuries of such a delicate organ as the eye, in which the slightest acci- dent can produce such disastrous consequences, naturally elicit the interest of all. Examples of exophthalmos, or protrusion of the eye from the orbit from bizarre causes, are of particular interest. Among the older writers we find Picker* and the Ephemerides giving instances of exophthalmos from vomiting. Fabricius Hildanus'' mentions a similar instance. Salmuth,™^ Verduc,'^^ and others mention extrusion of the eyeball from the socket, due to excessive coughing. Ab Heers*"' and Sennert'^^ mention instances in which after replacement the sight was uninjured. Tyler relates the case of a man who, after arising in the morning, blew his nose violently, and to his horror his left eye extruded from -the orbit. With the assistance of his wife it was immediately replaced and a bandage placed over it. When Tyler saw him the upper lid was slightly swollen and discolored, but there was no hemorrhage. .^ Hutchinson " describes extrusion of the eyeball from the orbit caused by a thrust with a stick. There was paraphymotic strangulation of the globe, entirely preventiag replacement and necessitating excision. Reyssie '^ speaks of a patient who, during a fire, was struck in the right eye by a stream of water from a hose, violently thrusting the eye backward. Contractiag under the double influence of shock and cold, the surrounding tissues forced the eyeball from the orbit, and an hour later Reyssie saw the patient with the eye hanging by the optic nerve and muscles. Its reduction was easy, and after some minor treatment vision was perfectly restored in the injured orgE^n. Thirty months after the accident the patient had perfect vision, and the eye had never in the slightest way discommoded him. Bodkin " mentions the case of a woman of sixty who fell on the key in a door and completely avulsed her eye. In von Graefe's Archiv there is a record of a man of seventy-five who suffered complete avulsion of the eye by a cart- wheel passing over his head. Verhaeghe records^ complete avulsion of the eye caused by a man falhng against the ring of a sharp-worn key. Hamill ^ ■•^ 452, 1809, xi., 63. b 334, cent, i., obs. i. <= 693, 1866. d 363, 1859, No. 65. e 312, 1854. f 145, xxvi., 99. e 224, 1878, i., 894. 527 528 SURGICAL ANOMALIES OF THE HEAD AND NECK. describes the case of a young girl whose conjunctiva was pierced by one of the rests of an ordinary gas-bracket. Being hooked at one of its extremities the iron became entangled in either the inferior oblique or external rectus muscles, and completely avulsed the eyeball upon the cheek. The real dam- age could not be estimated, as the patient never returned after the muscle was clipped off close to its conjunctival insertion. Calhoun " mentions an instance of a little Esquimaux dog whose head was seized between the jaws of a large Newfoundland with such force as to press the left eyeball from the socket. The ball rested on the cheek, held by the taut optic nerve ; the cornea was opaque. The ball was carefully and gently replaced, and sight soon returned to the eye. In former days there was an old-fashioned manner of fighting called "gouging." In this brutal contest the combatant was successful who could, with his thumb, press his opponent's eyeball out. Strange to say, little serious or permanently bad results followed such inhuman treatment of the eye. Von Langenbeck of Berlin mentions an instance of fracture of the superior maxilla, in which the eyeball was so much displaced as to lodge in the antrum of Highmore. Von Becker of Heidelberg reports the history of a case in which a blow from the horn of a cow dislocated the eye so far back in the orbit as to present the appearance of enucleation. The conjunctiva hid the organ from view, but when it was pulled aside the eyeball was exposed, and in its remote position still possessed the power of vision. In some cases in which exophthalmos has been seemingly spontaneous, extreme laxity of the lids may serve as an explanation. There is an instance on record in which a Polish Jew appeared in a Continental hospital, saying that while turning in bed, without any apparent cause, his eyeball was completely extruded. There have been people who prided themselves on their ability to produce partial exophthalmos. Rupture of the Eyeball. — Jessop mentions the case of a child of eight who suffered a blow on the eye from a fall against a bedpost, followed by compound rupture of the organ. The wound in the sclerotic was three or four lines in length, and the rent in the conjunctiva was so large that it required three sutures. The chief interest in this case was the rapid and complete recovery of vision. Adler "^ reports a case of fracture of the superior maxillary in which the dislocated bone-fragment of the lower orbital border, through pressure on the inferior maxillary and counter pressure on the skull, caused rupture of the conjunctiva of the left eye. Serious Sequelae of Orbital Injuries. — In some instances injuries pri- marily to the orbit either by extension or implication of the cerebral contents provoke the most serious issues. Pointed instruments thrust into the orbital cavity may by this route reach the brain. There is a record" of death a 176, 1876. b wien. Med. Woch., No. 6, 1895. o 476, 1831. GUNSHOT INJURIES OF THE ORBIT. 529 caused by a wound of a cavernous sinus through the orbit by the stem of a tobacco-pipe. Bower * saw a woman at the Gloucester Infirmary who had been stabbed in the eye by the end of an umbrella. There was profuse hemorrhage from the nostrils and left eye, but no signs indicative of its origin. Death shortly ensued, and at the necropsy a fracture through the roof of the orbit was revealed, the umbrella point having completely severed the optic nerve and divided the ophthalmic artery. The internal carotid artery was wounded in one-half of its circumference at its bend, just before it passes up between the anterior clinoid process and the optic nerve. The cavernous sinus was also opened. In this rare injury, although there was a considerable quantity of clotted blood at the base of the brain, there was no wound to the eyeball nor to the brain itself. Pepper records a case in which a knife was thrust through the sphenoidal 'fissure, wounding a large meningeal vein, causing death from intracranial hemorrhage. N61aton describes an instance in which the point of an umbrella wounded the cavernous sinus and internal carotid artery of the opposite side, causing the formation of an arteriovenous aneurysm which ultimately burst, and death ensued. Polaillon *" saw a boy of eighteen who was found in a state of coma. It was stated that an umbrella stick had been thrust up through the roof of the orbit and had been withdrawn with much diificulty. The anterior lobe of the brain was evidently much wounded ; an incision was made in the forehead and a portion of the frontal bone chiseled away ; en- trance being thus effected, the dura was incised, and some blood and cerebro- spinal fluid escaped. Five splinters were removed and a portion of the damaged brain-substance, and a small artery was tied with catgut. The debris of the eyeball was enucleated and a drain was placed in the frontal wound, coming out through the orbit. The patient soon regained conscious- ness and experienced no bad symptoms afterward. The drains were gradu- ally withdrawn, the process of healing advanced rapidly, and recovery soon ensued. Annandale " mentions an instance in which a knitting-needle penetrated the brain through the orbit. Hewett ^ speaks of perforation of the roof of the orbit and injury to the brain by a lead-pencil. Gunshot Injuries of the Orbit. — Barkan ^ recites the case in which a leaden ball -^-^ inch in diameter was thrown from a sling into the left orbital cavity, penetrating between the eyeball and osseous wall of the orbit without rupturing the tunics of the eye or breaking the bony wall of the cavity. It remained lodged two weeks without causing any pain or symptoms, and sub- sequently worked itself forward, contained in a perfect conjunctival sac, in which it was freely movable. Buchanan ' recites the case of a private in the army who was shot at a a 476, 1879, i., 547. b 233, Aug., 1891. c 318, 1877, xii. '1779, 1848-50, i., 188. 6 616,1874-5,444. f 545, 1862-3, ix., 274. 34 530 SURGICAL ANOMALIES OF THE HEAD AND NECK. distance of three feet away, the ball entering the inner canthus of the right eye and lodging under the skin of the opposite side. The eye was not lost, and opacity of the lower part of the cornea alone resulted. Cold water and purging constituted the treatment. It is said " that an old soldier of one of Napoleon's armies had a muskets ball removed from his left orbit after twenty-four years' lodgment. He was struck in the orbit by a musket-ball, but as at the same time a companion fell dead at his side he inferred that the bullet rebounded from his orbit and killed his comrade. For twenty-four years he had suffered from cephalalgia and pains and partial exophthalmos of the left eye. After removal of the ball the eye partially atrophied. Warren reports a case of a man of thirty-five whose eyeball was destroyed by the explosion of a gun, the breech-pin flying off and penetrating the head. The orbit was crushed ; fourteen months afterward the man complained of soreness on the hard palate, and the whole breech-pin, with screw attached, was extracted. The removal of the pin was followed by fissure of the hard palate, which, however, was relieved by operation. The following is an ex- tract ^ of a report by Wenyon of Fatshan, South China : — " Tang Shan, Chinese farmer, thirty-one years of age, was injured in the face by the bursting of a shot-gun. After being for upward of two months under the treatment of native practitioners, he came to me on December 4, 1891. I observed a cicatrix on the right side of his nose, and above this a sinus, still unhealed, the orifice of which involved the inner canthus of the right eye, and extended downward and inward for about a centimeter. The sight of the right eye was entirely lost, and the anterior surface of the globe was so uniformly red that the cornea could hardly be distinguished from the surrounding conjunctiva. There was no perceptible enlargement or protrusion of the eyeball, and it did not appear to have sustained any mechanical injury or loss of tissue. The ophthalmia and keratitis were possibly caused by the irritating substances applied to the wound by the Chinese doctors. The sinus on the side of the nose gave exit to a continuous discharge of slightly putrid pus, and the patient complained of continuous headache and occasional dizziness, which interfered with his M'ork. The pain ^\&s referred to the right frontal and temporal regions, and the skin on this part of the head had a slight blush, but there was no superficial tenderness. The patient had been told by his native doctors, and he believed it himself, that there was no foreign body in the wound ; but on probing it I easily recognized the lower edge of a hard metallic substance at a depth of about one inch posteriorly from the orifice of the sinus. Being unable to obtain any reliable informa- tion as to the probable size or shape of the object, I cautiously made several attempts to remove it through a slightly enlarged opening, but without success. I therefore continued the incision along the side of the nose to the nostril, a 222, 1846. b 224, Oct. 12, 1895. FOREIGN BODIES IN THE ORBIT. 531 thus laying open the right nasal cavity ; then, seizing the foreign body with a pair of strong forceps, I with difficulty removed the complete breech-pin of a Chinese gun. Its size and shape are accurately represented by the accompanying drawing (Fig. 190). The breech-pin measures a little over three inches in length, and weighs 2f ounces, or 75.6 grams. It had evidently lain at the back of the orbit, inclined upward and slightly backward from its point of entrance, at an angle of about 45 degrees. On its removal the headache was at once relieved and did not return. In ten days the wound was perfectly healed and the patient went back to his work. A somewhat similar case, but which terminated fatally, is recorded in the American Journal of the Medical Sciences of July, 1882." The extent of permanent injury done by foreign bodies in the orbit is variable. In some instances the most extensive wound is followed by the happiest result, while in others vision is entirely destroyed by a minor injury. Carter* reports a case in which a hat-peg 3^ inches long and about \ inch in diameter (upon one end of which was a knob nearly J inch in diame- ter) was impacted in the orbit for from ten to twenty days, and during this Fig. 190. — Breech-pin removed from tlie orbit. (Actual size.) time the patient was not aware of the fact. Recovery followed its extraction, the vision and movements of the eye being unimpaired. According to the Philosophical Transactions '' a laborer thrust a long lath with great violence into the inner canthus of the left eye of his fellow work- man, Edward Roberts. The lath broke off short, leaving a piece two inches long, J inch wide, and \ inch thick, in situ. Roberts rode about a mile to the surgery of Mr. Justinian Morse, who extracted it with much difficulty ; recovery followed, together with restoration of the sight and muscular action. The lath was supposed to have passed behind the eyeball. CoUette" speaks of an instance in which 186 pieces of glass were extracted from the left orbit, the whole mass weighing 186 Belgian grains. They were blown in by a gust of wind that broke a pane of glass ; after extraction no affection of the brain or eye occurred. Watson * speaks of a case in which a chip of steel f inch long was imbedded in cellular tissue of the orbit for four days, and was re- moved without injury to the eye. Wordsworth" reports a case in which a foreign body was deeply imbedded in the orbit for six weeks, and was re- a Ophth. Eev., No. 4, p. 337. b 629, 1743, 945. <= 145, 1850, 217. d224, 1876, i., 506. " 548, 1861, ii., 452. 532 SURGICAL ANOMALIES OF THE HEAD AND NECK. moved with subsequent recovery. Chisholm* has seen a case in which for five weeks a fly was imbedded in the culdesac between the lower lid and the eyeball. Foreign bodies are sometimes contained in the eyeball for many years. There is an instance on record ^ in which a wooden splinter, five mm. long and two mm. broad, remained in the eye forty-seven years. It was extracted, with the lens in which it was lodged, to relieve pain and other distressing symptoms. Snell " reports a case in which a piece of steel was imbedded and encapsulated in the ciliary process twenty-nine years without producing sym- pa^thetic irritation of its fellow, but causing such pain as to warrant enuclea- tion of this eye. Gunning"^ speaks of a piece of thorn f inch long, im- bedded in the left eyeball of an old man for six years, causing total loss of vision ; he adds that, after its removal, some improvement was noticed. Williams mentions a stone-cutter whose left eye was put out by a piece of stone. Shortly after this his right eye was wounded by a knife, causing traumatic cataract, which was extracted by Sir William Wilde, giving the man good sight for twelve years, after which iritis attacked the right eye and produced a false membrane over the pupil so that the man could not work. It was in this condition that he consulted Williams, fourteen years after the loss of the left eye. The eye was atrophied, and on examination a piece of stone was seen projecting from it directly between the lids. The visible portion was J inch long, and the end in the shrunken eye was evi- dently longer than the end protruding. The sclera was incised, and, after fourteen years' duration in the eye, the stone was removed. Taylor ^ reports the removal of a piece of bone which had remained qui- escent in the eye for fourteen years ; after the removal of the eye the bone was found adherent to the inner tunics. It resembled the lens in size and shape. Williams ^ mentions continual tolerance of foreign bodies in the eye- ball for fifteen and twenty-two years; and Chisholme reports the lodgment of a fragment of metal in the iris for twenty-three years. Liebreich ^ ex- tracted a piece of steel from the interior of the eye where it had been lodged twenty-two years. Barkar^ speaks of a piece of steel which penetrated through the cornea and lens, and which, five months later, was successfully removed by the extraction of the cataractous lens. CritchettJ gives an in- stance of a foreign body being loose in the anterior chamber for sixteen years. Eider'' speaks of the lodgment of a fragment of a copper percussion cap in the left eye, back of the inner ciliary margin of the iris, for thirty-five years ; and Bartholinus ' mentions a thorn in the canthus for thirty years. Jacob ■" re- ports a case in which a chip of iron remained in the eyeball twenty-eight years a 186, 1870. b 543, 1880, i., 280. 476, I88O, i., 749. a 476, 1880 i 749 e 809, 1878. f 218, 1881, 84. g 476, April 3, 1880. h 224, 1873, ii., 651. 1 Archiv. of Opthal. and Otol., N. Y., 1874, iv., 231. j 693, 1857-8, i., 264. k 773, 1873, 160. 1188, iv., obs. 64. m 476, 1880, i., 667. BARE ACCIDENTS TO THE EYE. 533 without giving indications for removal. It was clearly visible, protruding into the anterior surface of the iris, and although it was rusted by its long lodgment, sight in the eye was fairly good, and there was no sign of irritation. Snell ^ gives an instance in which a piece of steel was imbedded close to the optic disc with retention of sight. It was plainly visible by the opthal- moscope eighteen months after the accident, when as yet no diminution of sight was apparent. Smyly ^ speaks of a portion of a tobacco pipe which was successfully removed from the anterior chamber by an incision through the cornea. Clark " mentions a case in which molten lead in the eye caused no permanent injury ; and there are several cases mentioned in confirmation of the statement that the eye seems to be remarkably free from disastrous effects after this injury. Williamson ^ mentions eyelashes in the anterior chamber of the eye, the result of a stab wound of this organ. Contusion of the eyeball may cause dislocation of the lens into the an- terior chamber, and several instances have been recorded. We regret our in- ability to give the reference or authority for a report that we have seen, stating that by one kick of a horse the lenses of both eyes of a man were synchronously knocked through the eyeballs by the calkins of the horseshoe. Oliver mentions extraction of a lens by a thrust of a cow's horn. Lowe " speaks of rupture of the anterior capsule of the lens from violent sneezing, with subsequent absorption of the lenticular substance and restora- tion of vision. Trioen ^ mentions a curious case of expulsion of the crystalline lens from the eye in ophthalmia, through the formation of a corneal fissure. The authors have personal knowledge of a case of spontaneous extrusion of the lens through a corneal ulcer, in a case of ophthalmia of the new-born. Injury of the Eyeball by Birds. — ^There are several instances in which birds have pierced the eyeball with their bills, completely destroying vision. Not long since a prominent taxidermist winged a crane, picked it up, and started to examine it, when it made one thrust with its bill and totally de- stroyed his eyeball. In another instance a man was going from the railroad station to his hotel in a gale of wind, when, as he turned the corner of the street, an English sparrow was blown into his face. Its bill penetrated his eyeball and completely ruined his sight. There are several instances on record in which game fowls have destroyed the eyes of their owners. In one case a game cock almost completed the enucleation of the eye of his handler, by striking him with his gaff while preparing in a cock-pit. Moorehead e explains a rare accident to an eye as follows : — " Mr. S. B. A., while attending to his bees, was stung by one upon the right upper eyelid near its center. An employee, who was assisting in the work, immediately discovered the sting driven in the lid and cautiously ex- a 693, ix., part iii. ^ 310, 1876, 181. <= 591, 1852, 303. d 476, 1882, ii., 448. e 476, 1861, i., 530. f 784, 98. g 533, May 27, 1893. 534 SURGICAL ANOMALIES OF- THE HEAD AND NECK. tracted it, stating that he made sufficient traction to lift the lid well away from the globe. In a few hours the lid became much swollen, but the pain experienced at first had disappeared. Before retiring for the night he began gentle massage of the lid, stroking it horizontally with his finger. The edematous condition was by this means much reduced in a short time. While thus engaged in stroking the lid he suddenly experienced intense pain in the eye as if- it had been pierced by a sharp instrument. The suffering was very severe, and he passed a wretched night, constantly feeling 'something in his eye.' " The next morning, the trouble continuing, he came to me for relief. Upon examination of the lid, no opening could be made out where the sting had penetrated, and a minute inspection of the conjunctival surface with a good glass failed to reveal any foreign substance. Cleansing the lid thoroughly, and carefully inspecting with a lens under strong light, a minute dark point was made out about the center of the lid. Feeling that this might be the point of the sting, I had recourse to several expedients for its removal, but without success. Finally, with a fine knife, I succeeded in cutting down by the side of the body and tilting it out. Examination with a ^ inch objective -confirmed my opinion that it was the point of the bee-sting. " The barbed formation of the point explains how, under the stroking with the finger, it was forced through the dense tarsal cartilage and against the cornea of the eye." There is a story told i« La M6decine Moderne " of a seamstress of Berlin who was in the habit of allowing her dog to lick her face. She was attacked with a severe inflammation of the right eye, which had to be enucleated, and was found full of tenia echinococcus, evidently derived from the dog's tongue. Gabb *" mentions a case of epistaxis in which the blood welled up through the lacrimal ducts and suffused into the eye so that it was constantly neces- sary to wipe the lower eyelid, and the discharge ceased only when the nose stopped bleeding. A brief editorial note on epistaxis through the eyes, referring to a case in the Medical News of November 30, 1895, provoked further reports from numerous correspondents. Among others, the follow- ing :— " Dr. T. L. Wilson of Bellwood, Pa., relates the case of an old lady of seventy-eight whom he found with the blood gushing from the nostrils. After plugging the nares thoroughly with absorbent cotton dusted with tannic acid he was surprised to see the blood ooze out around the eyelids and trickle down the cheeks. This oozing continued for the greater part of an hour, being controlled by applications of ice to both sides of the nose." " Dr. F. L. Donlon of New York City reports the case of a married woman, about fifty years old, in whom epistaxis set in suddenly at 11 P. M., and had continued for several hours, when the anterior nares were plugged. >» 545, June 6, 1896. b 224, 1883, i., 715. LATE RESTORATION OF SIGHT. 535 In a short time the woman complained that she could scarcely see, owing to the welling up of blood in the eyes and trickling down her face. The bleeding only ceased when the posterior nares also were plugged." " Dr. T. G. Wright of Plainville, Conn., narrates the case of a young man whom he found in the night, bleeding profusely, and having already lost a large amount of blood. Shortly after plugging both anterior and pos- terior nares the blood found its way through the lacrimal ducts to the eyes and trickled down the cheeks." " Dr. Charles W. Crumb cites the case of a man, sixty-five years old, with chronic nephritis, in whom a slight bruise of the nose was followed by epis- taxis lasting twenty-four hours. When the nares were plugged blood escaped freely from the eyes. A cone-shaped bit of sponge, saturated with ferrous sulphate, was passed into each anterior naris, and another piece of sponge, similarly medicated, into either posterior naris. The patient had been taking various preparations of potassium, and it was thought that his blood contained a deficiency of fibrin. Upon removal of the nasal plugs a catarrhal inflam- mation developed which lasted a long time and was attended with considerable purulent discharge." Late Restoration of Sight. — There are some marvelous cases on record in which, after many years of blindness, the surgeon has been able, by opera^ tion, to restore the sight. McKeown " gives the history of a blind fiddler of sixty-three, who, when one and a half years old, had lost the sight of both eyes after an attack of small-pox. Iridectomy was performed, and after over sixty years of total blindness his sight was restored ; color-perception was good. Berncastle ** mentions a case of extraction of double cataract and double iri- dectomy for occluded pupils, which, after thirty years of blindness, resulted in the recovery of good sight. The patient was a blind beggar of Sydney. To those interested in this subject, Jauffret" has a most interesting de- scription of a man by the name of Garin, who was born blind, who talked at eight or nine months, showed great intelligence, and who was educated at a blind asylum. At the age of twenty-four he entered the hospital of For- lenze, to be operated upon by that famous oculist. Garin had never seen, but could distinguish night or darkness by one eye only, and recognized orange and red when placed close to that eye. He could tell at once the sex and age of a person approximately by the voice and tread, and formed his conclusions more rapidly in regard to females than males. Forlenze diagnosed cataract, and, in the presence of a distinguished gathering, operated with the happiest result. The description that follows, which is quoted by Fournier * and is readily accessible to any one, is well worth reading, as it contains an account of the first sensations of light, objects, distance, etc., and minor analogous a 476, 1888, i., 14. " 179, Oct. 15, 1869. "Experience metaphysique ou Developpement de la lumifere et des sensations." d 302, iv. 536 SURGICAL ANOMALIES OF THE HEAD AND NECK. thoughts, of an educated and matured mind experiencing its first sensations of sight. Hansell and Clark ^^ say that the perplexities of learning to see after twenty-six years of blindness from congenital disease, as described by a patient of Franke, remind one of the experience of Shelley's Frankenstein. Franke's patient was successfully operated on for congenital double cataract, at twenty-six years of age. The author describes " the difficulties the patient had of recognizing by means of vision the objects he had hitherto known through his other senses, and his slowness in learning to estimate distances and the comparative size of objects. Sight is popularly supposed to be occasionally restored without the aid of art, after long years of blindness. Benjamin Rush saw a man of forty-five who, twelve years before, became blind without ascertainable cause, and recovered his sight equally without reason. St. Clair mentions Marshal Vivian, who at the age of one hundred regained sight that for nearly forty years had gradually been failing almost to bhndness, and preserved this new sight to the time of his death. There are many superstitions prevalent among uneducated people as to " second sight," recovery of vision, etc., which render their reports of such things untrustworthy. The real explanations of such cases are too varied for discussion here. Nyctalopia etymologically means night-blindness, but the general usage, making the term mean night-vision, is so strongly intrenched that it is useless aiid confusing to attempt any reinstatement of the old significance. The con- dition in which one sees better by night, relatively speaking, than by day is due to some lesion of the macular region, rendering it blind. At night the pupil dilates more than in the day-time, and hence vision with the extramac- ular or peripheral portions of the retina is correspondingly better. It is, therefore, a symptom of serious retinal disease. All night-prowling animals have widely dilatable pupils, and in addition to this they have in the retina a special organ called the tapetum luddum, the function of which is to reflect to a focus in front of them the relatively few rays of hght that enter the widely-dilated pupil and thus enable them the better to see their way. Hence the luminous appearance of the eyes of such animals in the dark. Hemeralopia (etymologically day-bUndness, but by common usage mean- ing day-vision or night-bhndness) is a symptom of a peculiar degenerative disease of the retina, called retinitis pigmentosa. It also occurs in some cases of extreme denutrition, numerous cases having been reported among those who make the prolonged fasts customary in the Russian church. In retinitis pig- mentosa the peripheral or extramacular portions of the retina are subject to a pigmentary degeneration that renders them insensitive to light, and patients so afflicted are consequently uicapable of seeing at night as well as others. They stumble and run against objects easily seen by the normal eye. a Beit, zur Augenh., Heft xvi., 1894. INJURIES TO THE EAR. 537 Snow-blindness occurs from prolonged exposure of the eyes to snow upon which the sun is shining. Some years ago, some seventy laborers, who were clearing away snow-drifts in the Caucasus, were seized, and thirty of them could not find their way home, so great was the photophobia, conjunctivitis, and lacrimation. Graddy '^ reports six cases, and many others are constantly occurring. Other forms of retinal injury from too great or too prolonged exposure to light are " moon-bUndness," due to sleeping with the eyes exposed to bright moonlight, and that due to lightning — a case, e.g., being reported by Knies.^ Silex " also reports such a case and reviews the reported cases, 25 in number, in ten of which cataract ensued. In the Annual of the Universal Medical Sciences, 1888, there is a report of seven cases of retinal injury with central scotoma, amblyopia, etc., in Japanese medical students, caused by observation of the sun in eclipse. In discussing the question of electric- light injuries of the eyes Gould ^ reviews the literature of the subject and epitomizes the cases reported up to that time. They numbered 23. No patient was seriously or permanently injured, and none was in a person who used the electric light in a proper manner as an illuminant. All were in scientific investigators or workmen about the light, who approached it too closely or gazed at it too long and without the colored protecting spectacles now found necessary by such workers. Injuries to the Ear. — The folly of the practice of boxing children's ears, and the possible disastrous results subsequent to this punishment, are well exemplified throughout medical literature. Stewart "^ quotes four cases of rupture of the tympanum from boxing the ears, and there is an instance ^ of a boy of eight, who was boxed on the ear at school, in whom subsequent brain-disease developed early, and death followed. Eoosa of New York mentions the loss of hearing following a kiss on the ear.s Dalby,*" in a paper citing many different causes of rupture of the tympanic membrane, mentions the following : A blow in sparring ; violent sneezing ; blowing the nose ; forcible dilatation of the Eustachian canal ; a thorn or twig of a tree accidentally thrust into the head ; picking the ear with a toothpick. In time of battle soldiers sometimes have their tympanums ruptured by the concussion caused by the firing of cannon. Dalby mentions an instance of an officer who was discharged for deafness acquired in this manner during the Crimean War. He was standing beside a mortar which, unexpectedly to him, was fired, causing rupture of the tympanic membrane, followed by hemorrhage from the ear. Similar cases were reported in the recent naval engagements between the Chinese and Japanese. Wilson' reports two a 124, 1887. ^ Graefe's Archiv, 1887. <= Arch. f. Augenheilk., 1887. d 533, Dec. 8, 1888. ■= 476, 1889, i., 574. f 476, 1879, i., 23. g Archives of Otology, 1880, ix., 16. 1 476, 1875, i., 752. i 533, xli., 173. 638 SURGICAL ANOMALIES OF THE HEAD AND NECK. cases of rupture of the membrana tympani caused by diving. Roosa^ divides the causes into traumatic, hemorrhagic, and inflammatory, and primary lesions of the labyrinth, exemplifying each by numerous instances. Under traumatic causes he mentions severe falls, blows about the head or face, con- stant listening to a telegraphic instrument, cannonading, and finally eight cases of boiler-makers' deafness. Roosa cites a curious case of sudden and pro- found deafness in a young man in perfect health, while calling upon the parents of his lady-love to ask her hand in marriage. Strange to say that after he had had a favorable reply he gradually recovered his hearing ! In the s^me paper there is an instance of a case of deafness due to the sudden cessation of perspiration, and an instance of tinnitus due to the excessive use of tobacco ; Eoosa also mentions a case of deafness due to excessive mental employment. Perforation of the Tympanum. — Kealy ^ relates an instance in which a pin was introduced into the left ear to relieve an intolerable itching. It perforated the tympanum, and before the expiration of twenty-four hours was coughed up from the throat with a small quantity of blood. The pin was bent at an angle of about 1 20 degrees. Another similar case " was that of a girl of twenty-two who, while pricking her ear with a hair-pin, was jerked or struck on the arm by a child, and the pin forced into the ear ; great pain and deafness followed, together with the loss of taste on the same side of the tongue ; after treatment both of the disturbed senses were restored. A man of twenty"^ was pricked in the ear by a needle entering the meatus. He uttered a cry, fell senseless, and so continued until the fourth day when he died. The whole auditory meatus was destroyed by suppuration. Gamgee " tells of a constable who was stabbed in the left ear, severing the middle meningeal artery, death ensuing. In this instance, after digital compression, ligature of the common carotid was practised as a last resort. There is an account ' of a provision-dealer's agent who fell asleep at a public house at Tottenham. In sport an attendant tickled his ear with a wooden article used as a pipe light. A quick, unconscious movement forced the wooden point through the tympanum, causing cerebral inflammation and subsequent death. There is a record s of death, in a child of niiie, caused by the passage of a knitting-needle into the auditory meatus. Kauifmann ^ reports a case of what he calls objective tinnitus aurium, in which the noise originating in the patient's ears was distinctly audible by others. The patient was a boy of fourteen, who had fallen on the back of his head and had remained unconscious for nearly two weeks. The noises were bilateral, but more distinct on the left than on the right side. The sounds were described as crackling, and seemed to depend on movements of » 124, Oct., 1874, 376. b 543, 1859, 602. c 476, 1889, i., 574. a 566, Jan. 20, 1829. e 476, 1875, i., 535. f 476, 1895, ii., 222. g 224, 1869, ii., 470. h Deutsche Med. Zeitung, Jan. 6, 1896. FOREIGN BODIES IN THE EAR. 539 the arch of the palate. Kauffmann expresses the opinion that the noises were due to clonic spasm of the tensor velum palati, and states that under appro- priate treatment the tinnitus gradually subsided. The introduction of foreign bodies in the ear is usually accidental, although in children we often find it as a result of sport or curiosity. There is an instance on record of a man who was accustomed to catch flies and put them in his ear, deriving from them a pleasurable sensation from the tickling which ensued. There have been cases in which children, and even adults, have held grasshoppers, crickets, or lady-birds to their ears in order to more atten- tively listen to the noise, and while in this position the insects have escaped and penetrated the auditory canal. Insects often enter the ears of persons re- posing in the fields with the ear to the ground. Fabricius Hildanus speaks of a cricket penetrating the ear during sleep. Calhoun " mentions an instance of disease of the ear which he found was due to the presence of several living maggots in the interior of the ear. The patient had been sleeping in a horse stall in which were found maggots similar to those extracted from his ear. An analogous instance was seen in a negro in the Emergency Hospital, Wash- ington, D. C, in the summer of 1894 ; and many others are recorded. The insects are frequently removed only after a prolonged lodgment. D'Aguanno ^ gives an account of two instances of living larvse of the musca sarcophaga in the ears of children. In one of the cases the larvse entered the drum-cavity through a rupture in the tympanic membrane. In both cases the maggots were removed by forceps. Haug " has observed a tic (Ixodes ricinus) in the ear of a lad of seventeen. The creature was killed by a mercuric-chlorid solution, and removed with a probe. There is a common superstition that centipedes have the faculty of entering the ear and penetrating the brain, causing death. The authors have knowl- edge of an instance in which three small centipedes were taken from the ear of a policeman after remaining there three days ; during this time they caused excruciating pain, but there was no permanent injury. The Ephemerides con- tains instances in which, while yet living, worms, crickets, ants, and beetles have all been taken from the ear. In one case the entrance of a cricket in the auditory canal was the cause of death. Martin '^ gives an instance in which larvse were deposited in the ear. Stalpart van der Wiel ^^^ relates an instance of the lodgment of a living spider in the ear. Far more common than insects are inanimate objects as foreign bodies in the ear, and numerous examples are to be found in literature. Fabricius Hildanus ^'^ tells of a glass ball introduced into the auditory canal of a girl of ten, followed by headache, numbness on the left side, and after four or five years epileptic seizures, and atrophy of the arm. He extracted it and the symptoms immediately ceased. Sabatier speaks of an abscess of the brain caused by a ball of paper in the ear ; and it is quite common for persons in a 176, 1873, X., 665. b 843, 836. c Ibid. d 462, T. xxxi., 179. 540 SURGICAL ANOMALIES OF THE HEAD AND NECK. the habit of using a tampon of cotton in the meatus to mistake the deep entrance of this substance for functional derangement, and many cases of temporary deafness are simply due to forgetfulness of the cause. A strange case is reported in a girl of fourteen, who lost her tympanum from a profuse otorrhea, and who substituted an artificial tympanum which was, in its turn, lost by deep penetration, causing augmentation of the symptoms, of the cause of which the patient herself seemed unaware.* Sometimes artificial otoliths are produced by the insufflation of various powders which become agglutinated, and are veritable foreign bodies. Holman'' tells of a negro, aged thirty-five, whose wife poured molten pewter in his ear while asleep. It was removed, but total deafness was the result. Alley " mentions a New Orleans wharf laborer, in whose ear was poured some molten lead ; seventeen months afterward the lead was still occupying the external auditory meatus. It is quite remarkable that the lead should have remained such a length of time without causing meningeal inflammation. There was deafness and palsy of that side of the face. A fungous growth occupied the external portion of the ear ; the man suffered pain and discharge from the ear, and had also great difficulty in closing his right eyelid. Mor- rison •* mentions an alcoholic patient of forty who, on June 6, 1833, had nitric acid poured in her right ear. There were no headache, febrile symptoms, stupor, or vertigo. Debility alone was present. Two weeks after the injury paralysis began on the right side, and six weeks from the injury the patient died. This case is interesting from the novel mode of death, the perfect par- alysis of the arm, paralysis agitans of the body (occurring as hemorrhage from the ear came on, and subsiding with it), and extensive caries of the petrous bone, without sensation of pain or any indicative symptoms. There is an instance in a young girl in which a piece of pencil remained in the right ear for seven years. ^ Haug speaks of two beads lying in the auditory canal for twenty-eight years without causing any harm. A boy of six introduced a carob-nut kernel into each ear. On the next day incompetent persons attempted to extract the kernel from the left side, but only caused pain and hemorrhage. The nut issued spontaneously from the right side. In the afternoon the auditory canal was found excoriated and red, and deep in the meatus the kernel was found, covered with blood. The patient had been so excited and pained by the bungling attempts at extraction that the employment of instruments was impossible ; prolonged employment of injections was substituted. Discharge from the ear commenced, intense fever and delirium ensued, and the patient had to be chloroformed to facili- tate the operation of extraction. The nut, when taken out, was found to have a consistency much larger than originally, caused by the agglutination of wax and blood. Unfortunately the symptoms of meningitis increased ; three days a 720, 1877, 210. b 744, I888. c 124, April, 1852, 377. d 310, 1836, ix., 99. e 554, 1842, No. 32. FOREIGN BODIES IN THE EAR. 541 after the operation coma followed, and on the next day death ensued.* In 75 cases collected by Mayer, and cited by Poulet^*i (whose work on " Foreign Bodies " is the most extensive in existence), death as a consequence of menin- gitis was found in three. Fleury de Clermont * mentions a woman of twenty-five who consulted him for removal of a pia which was in her right ear. Vain attempts by some of her lay-friends to extract the pin had only made matters worse. The pin was directed transversely, and its middle part touched the membrana tym- panum. The mere touching of the pin caused the woman intense pain ; even after etherization it was necessary to construct a special instrument to extract it. She suffered intense cephalalgia and other signs of meningitis ; despite vigorous treatment she lost consciousness and died shortly after the operation. Winterbotham " reports an instance in which a cherry-stone was removed from the meatus auditorius after lodgment of upward of sixty years. Mar- chal de Calvi mentions intermittent deafness for forty years, caused by the lodgment of a small foreign body in the auditory canal. There is an instance in which a carious molar tooth has been tolerated in the same location for forty years.^ Albucasius, Fabricius Hildanus, Par6, and others, have mentioned the fact that seeds and beans have been frequently seen to increase in volume while lodged in the auditory canal. Tulpius **^ speaks of an infant, playing with his comrades, who put a cherry-seed in his ear which he was not able to extract. The seed increased in volume to such an extent that it was only by surgical interference that it could be extracted, and then such serious consequences followed that death resulted. Albers^ reports an instance in which a pin introduced into the ear issued from the pharynx. Confusion of diagnosis is occasionally noticed in terrified or hysteric per- sons. Lowenberg was called to see a child of five who had introduced a button into his left ear. When he saw the child it complained of all the pain in the right ear, and he naturally examined this ear first but found nothing to indicate the presence of a foreign body. He examined the ear supposed to be healthy and there found the button lying against the tympanum. This was explained by the fact that the child was so pained and terrified by the previous explorations of the affected ear that rather than undergo them again he presented the well ear for examination. In the British Medical Journal for 1877 is an account of an unjustified exploration of an ear for a foreign body by an incompetent physician, who spent a half hour in exploration and manipulation, and whose efforts resulted in the extraction of several pieces of bone. The child died in one and a half hours afterward from extreme hemor- rhage, and the medical bungler was compelled to appear before a coroner's jury in explanation of his ignorance. In the external ear of a child Tansley observed a diamond which he a 720, 1800, 230. ^ 363, 1870, 58. c 548, 1866, ii., 496.