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´╗┐Title: Anomalies and Curiosities of Medicine
Author: Gould, George M. (George Milbrey), 1848-1922, Pyle, Walter L. (Walter Lytle), 1871-1921
Language: English
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ANOMALIES and CURIOSITIES of MEDICINE

Being an encyclopedic collection of rare and extraordinary cases, and
of the most striking instances of abnormality in all branches of
medicine and surgery, derived from an exhaustive research of medical
literature from its origin to the present day, abstracted, classified,
annotated, and indexed.

by GEORGE M. GOULD, A.M., M.D. and WALTER L. PYLE, A.M., M.D.



PREFATORY AND INTRODUCTORY.

----

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 anomalous 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 arousing 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 Nature, 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 chose qui s'offre a l' 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
organization, and reining them to impersonal service and far-off ends.
All ethnologists 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, 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, memorabilia, 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 establishment or
illustration of the common, or of general principles. With all his
sovereign sound sense, Ambrose Pare 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
journal 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 insertion of such a report is generally productive of
correspondence and discussion 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 thaumatographia 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, Obstetrics, 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 extremes 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 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 importance 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 applied to early physicians, we
suggest that the suspicion may easily be too active. When Pare, 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
confreres have seen on the battle-field or in the dissecting room, we
think, within moderate 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 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 facto, a
scientific caricature (or worse!), and if it is so with facts, what
must be the effect 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 medical 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 personal 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
unknown or unique, or that are worthy of particular interest or further
investigation. 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 description has not been thought necessary, mere
citation being sufficient, references are but briefly given or omitted
altogether. For the same reason a bibliographic 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.

Notwithstanding that every effort has been made to conveniently and
satisfactorily 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 consequently 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 indebtedness to the officers and assistants of the
Surgeon-General's Library at Washington, D.C., the Library of the Royal
College of Surgeons of London, the Library of the British Museum, the
Library of the British Medical Association, the Bibliotheque de Faculte
de Medecine de Paris, the Bibliotheque Nationale, and the Library of
the College of Physicians of Philadelphia.

                                  GEORGE M. GOULD.
PHILADELPHIA, October, 1896.      WALTER L. PYLE.



TABLE OF CONTENTS.

CHAPTER                                                   PAGES

I. GENETIC ANOMALIES . . . . . . . . . . . . . . . . .    17-49

II. PRENATAL ANOMALIES . . . . . . . . . . . . . . . .   50-112

III. OBSTETRIC ANOMALIES . . . . . . . . . . . . . . .  113-143

IV. PROLIFICITY  . . . . . . . . . . . . . . . . . . .  144-160

V. MAJOR TERATA  . . . . . . . . . . . . . . . . . . .  161-212

VI. MINOR TERATA . . . . . . . . . . . . . . . . . . .  213-323

VII. ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT . . .  324-364

VIII. LONGEVITY  . . . . . . . . . . . . . . . . . . .  365-382

IX. PHYSIOLOGIC AND FUNCTIONAL ANOMALIES . . . . . . .  383-526

X. SURGICAL ANOMALIES OF THE HEAD AND NECK . . . . . .  527-587

XI. SURGICAL ANOMALIES OF THE EXTREMITIES  . . . . . .  588-605

XII. SURGICAL ANOMALIES OF THE THORAX AND ABDOMEN  . .  606-666

XIII. SURGICAL ANOMALIES OF THE GENITOURINARY SYSTEM .  667-696

XIV. MISCELLANEOUS SURGICAL ANOMALIES  . . . . . . . .  697-758

XV. ANOMALOUS TYPES AND INSTANCES OF DISEASE . . . . .  759-822

XVI. ANOMALOUS SKIN-DISEASES . . . . . . . . . . . . .  823-851

XVII. ANOMALOUS NERVOUS AND MENTAL DISEASES  . . . . .  852-890

XVIII. HISTORIC EPIDEMICS  . . . . . . . . . . . . . .  891-914



ANOMALIES AND CURIOSITIES OF MEDICINE.



CHAPTER I.

GENETIC ANOMALIES.

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 Flemming, 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
menstruating 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 prepare food for anyone save themselves. It was
believed that, were a menstruating 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 effect that the "medicine" will be
effective provided that no woman in this condition is allowed to
approach the tent of the official in charge.

Empiricism had doubtless taught the ancient husbands the dangers of
sexual intercourse during this period, and the after-results of many
such connections 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
valuable 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 suppress 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
menstruation, and were so explained even by the older writers, there
are many that are physiologic curiosities of considerable interest.
Lheritier 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 continued 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
of bloody sweat occurring periodically in a woman of twenty-seven; the
intervals, however, were occasionally but a week or a fortnight, and
the exudation 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'Andrade 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 menstruation 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 forehead. 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 menstruation 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 bleeding 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'Andrade's observation, 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
mammae involved in cases of anomalous menstruation, and the truth of
this supposition is substantiated in the abundance of such cases on
record. Schenck reports instances of menstruation from the nipple; and
Richter, de Fontechia, Laurentius, Marcellus Donatus, Amatus Lusitanus,
and Bierling are some of the older writers who have observed this
anomaly. Pare says the wife of Pierre de Feure, an iron merchant,
living at Chasteaudun, menstruated such quantities from the breasts
each month that several serviettes were necessary to receive the
discharge.  Cazenave details the history of a case in which the mammary
menstruation was associated with a similar exudation from the face, and
Wolff saw an example associated with hemorrhage from the fauces. In the
Lancet (1840-1841) is an instance of monthly discharge from beneath the
left mamma. Finley also writes of an example of mammary hemorrhage
simulating menstruation. Barnes saw a case in St. George's Hospital,
London, 1876, in which the young girl menstruated vicariously from the
nipple and stomach. In a London discussion there was mentioned the case
of a healthy woman of fifty who never was pregnant, and whose
menstruation had ceased two years previously, but who for twelve months
had menstruated regularly from the nipples, the hemorrhage being so
profuse as to require constant change of napkins. The mammae were large
and painful, and the accompanying symptoms were those of ordinary
menstruation. Boulger mentions an instance of periodic menstrual
discharge from beneath the left mamma. Jacobson speaks of habitual
menstruation by both breasts. Rouxeau describes amenorrhea in a girl of
seventeen, who menstruated from the breast; and Teufard reports a case
in which there was reestablishment of menstruation by the mammae at the
age of fifty-six. Baker details in full the description of a case of
vicarious menstruation from an ulcer on the right mamma of a woman of
twenty. At the time he was called to see her she was suffering with
what was called "green-sickness." The girl had never menstruated
regularly or freely. The right mamma was quite well developed, flaccid,
the nipple prominent, and the superficial veins larger and more
tortuous than usual. The patient stated that the right mamma had always
been larger than the left. The areola was large and well marked, and
1/4 inch from its outer edge, immediately under the nipple, there was
an ulcer with slightly elevated edges measuring about 1 1/4 inches
across the base, and having an opening in its center 1/4 inch in
diameter, covered with a thin scab. By removing the scab and making
pressure at the base of the ulcer, drops of thick, mucopurulent matter
were made to exude. This discharge, however, was not offensive to the
smell. On March 17, 1846, the breast became much enlarged and
congested, as portrayed in Plate 1. The ulcer was much inflamed and
painful, the veins corded and deep colored, and there was a free
discharge of sanguineous yellowish matter. When the girl's general
health improved and menstruation became more natural, the vicarious
discharge diminished in proportion, and the ulcer healed shortly
afterward. Every month this breast had enlarged, the ulcer became
inflamed and discharged vicariously, continuing in this manner for a
few days, with all the accompanying menstrual symptoms, and then dried
up gradually. It was stated that the ulcer was the result of the girl's
stooping over some bushes to take an egg from a hen's nest, when the
point of a palmetto stuck in her breast and broke off. The ulcer
subsequently formed, and ultimately discharged a piece of palmetto.
This happened just at the time of the beginning of the menstrual epoch.
The accompanying figures, Plate 1, show the breast in the ordinary
state and at the time of the anomalous discharge.

Hancock relates an instance of menstruation from the left breast in a
large, otherwise healthy, Englishwoman of thirty-one, who one and a
half years after the birth of the youngest child (now ten years old)
commenced to have a discharge of fluid from the left breast three days
before the time of the regular period. As the fluid escaped from the
nipple it became changed in character, passing from a whitish to a
bloody and to a yellowish color respectively, and suddenly terminating
at the beginning of the real flow from the uterus, to reappear again at
the breast at the close of the flow, and then lasting two or three days
longer.  Some pain of a lancinating type occurred in the breast at this
time. The patient first discovered her peculiar condition by a stain of
blood upon the night-gown on awakening in the morning, and this she
traced to the breast. From an examination it appeared that a neglected
lacerated cervix during the birth of the last child had given rise to
endometritis, and for a year the patient had suffered from severe
menorrhagia, for which she was subsequently treated. At this time the
menses became scanty, and then supervened the discharge of bloody fluid
from the left breast, as heretofore mentioned. The right breast
remained always entirely passive. A remarkable feature of the case was
that some escape of fluid occurred from the left breast during coitus.
As a possible means of throwing light on this subject it may be added
that the patient was unusually vigorous, and during the nursing of her
two children she had more than the ordinary amount of milk
(galactorrhea), which poured from the breast constantly. Since this
time the breasts had been quite normal, except for the tendency
manifested in the left one under the conditions given.

Cases of menstruation through the eyes are frequently mentioned by the
older writers. Bellini, Hellwig, and Dodonaeus all speak of
menstruation from the eye. Jonston quotes an example of ocular
menstruation in a young Saxon girl, and Bartholinus an instance
associated with bloody discharge of the foot. Guepin has an example in
a case of a girl of eighteen, who commenced to menstruate when three
years old. The menstruation was tolerably regular, occurring every
thirty-two or thirty-three days, and lasting from one to six days. At
the cessation of the menstrual flow, she generally had a supplementary
epistaxis, and on one occasion, when this was omitted, she suffered a
sudden effusion into the anterior chamber of the eye. The discharge had
only lasted two hours on this occasion. He also relates an example of
hemorrhage into the vitreous humor in a case of amenorrhea.
Conjunctival hemorrhage has been noticed as a manifestation of
vicarious menstruation by several American observers. Liebreich found
examples of retinal hemorrhage in suppressed menstruation, and Sir
James Paget says that he has seen a young girl at Moorfields who had a
small effusion of blood into the anterior chamber of the eye at the
menstrual period, which became absorbed during the intervals of
menstruation. Blair relates the history of a case of vicarious
menstruation attended with conjunctivitis and opacity of the cornea.
Law speaks of a plethoric woman of thirty who bled freely from the
eyes, though menstruating regularly.

Relative to menstruation from the ear, Spindler, Paullini, and Alibert
furnish examples. In Paullini's case the discharge is spoken of as very
foul, which makes it quite possible that this was a case of middle-ear
disease associated with some menstrual disturbance, and not one of true
vicarious menstruation.  Alibert's case was consequent upon suppression
of the menses. Law cites an instance in a woman of twenty-three, in
whom the menstrual discharge was suspended several months. She
experienced fulness of the head and bleeding (largely from the ears),
which subsequently occurred periodically, being preceded by much
throbbing; but the patient finally made a good recovery. Barnes,
Stepanoff, and Field adduce examples of this anomaly. Jouilleton
relates an instance of menstruation from the right ear for five years,
following a miscarriage.

Hemorrhage from the mouth of a vicarious nature has been frequently
observed associated with menstrual disorders. The Ephemerides,
Meibomius, and Rhodius mention instances. The case of Meibomius was
that of an infant, and the case mentioned by Rhodius was associated
with hemorrhages from the lungs, umbilicus, thigh, and tooth-cavity.
Allport reports the history of a case in which there was recession of
the gingival margins and alveolar processes, the consequence of
amenorrhea. Caso has an instance of menstruation from the gums, and
there is on record the description of a woman, aged thirty-two, who had
bleeding from the throat preceding menstruation; later the menstruation
ceased to be regular, and four years previously, after an unfortunate
and violent connection, the menses ceased, and the woman soon developed
hemorrhoids and hemoptysis. Henry speaks of a woman who menstruated
from the mouth; at the necropsy 207 stones were found in the
gall-bladder. Krishaber speaks of a case of lingual menstruation at the
epoch of menstruation.

Descriptions of menstruation from the extremities are quite numerous.
Pechlin offers an example from the foot; Boerhaave from the skin of the
hand; Ephemerides from the knee; Albertus from the foot; Zacutus
Lusitanus from the left thumb; Bartholinus a curious instance from the
hand; and the Ephemerides another during pregnancy from the ankle.

Post speaks of a very peculiar case of edema of the arm alternating
with the menstrual discharge. Sennert writes of menstruation from the
groin associated with hemorrhage from the umbilicus and gums. Moses
offers an example of hemorrhage from the umbilicus, doubtless
vicarious. Verduc details the history of two cases from the top of the
head, and Kerokring cites three similar instances, one of which was
associated with hemorrhage from the hand.

A peculiar mode is vicarious menstrual hemorrhage through old ulcers,
wounds, or cicatrices, and many examples are on record, a few of which
will be described. Calder gives an excellent account of menstruation at
an ankle-ulcer, and Brincken says he has seen periodical bleeding from
the cicatrix of a leprous ulcer. In the Lancet is an account of a case
in the Vienna Hospital of simulated stigmata; the scar opened each
month and a menstrual flow proceeded therefrom; but by placing a
plaster-of-Paris bandage about the wound, sealing it so that tampering
with the wound could be easily detected, healing soon ensued, and the
imposture was thus exposed. Such would likely be the result of the
investigation of most cases of "bleeding wounds" which are exhibited to
the ignorant and superstitious for religious purposes.

Hogg publishes a report describing a young lady who injured her leg
with the broken steel of her crinoline. The wound healed nicely, but
always burst out afresh the day preceding the regular period. Forster
speaks of a menstrual ulcer of the face, and Moses two of the head.
White, quoted by Barnes, cites an instance of vicarious hemorrhage from
five deep fissures of the lips in a girl of fourteen; the hemorrhage
was periodical and could not be checked. At the advent of each
menstrual period the lips became much congested, and the
recently-healed menstrual scars burst open anew.

Knaggs relates an interesting account of a sequel to an operation for
ovarian disease. Following the operation, there was a regular, painless
menstruation every month, at which time the lower part of the wound
re-opened, and blood issued forth during the three days of the
catamenia. McGraw illustrates vicarious menstruation by an example, the
discharge issuing from an ovariotomy-scar, and Hooper cites an instance
in which the vicarious function was performed by a sloughing ulcer.
Buchanan and Simpson describe "amenorrheal ulcers." Dupuytren speaks of
denudation of the skin from a burn, with the subsequent development of
vicarious catamenia from the seat of the injury.

There are cases on record in which the menstruation occurs by the
rectum or the urinary tract. Barbee illustrates this by a case in which
cholera morbus occurred monthly in lieu of the regular menstrual
discharge. Barrett speaks of a case of vicarious menstruation by the
rectum. Astbury says he has seen a case of menstruation by the
hemorrhoidal vessels, and instances of relief from plethora by
vicarious menstruation in this manner are quite common. Rosenbladt
cites an instance of menstruation by the bladder, and Salmuth speaks of
a pregnant woman who had her monthly flow by the urinary tract. Ford
illustrates this anomaly by the case of a woman of thirty-two, who
began normal menstruation at fourteen; for quite a period she had
vicarious menstruation from the urinary tract, which ceased after the
birth of her last child. The coexistence of a floating kidney in this
case may have been responsible for this hemorrhage, and in reading
reports of so-called menstruation due consideration must be given to
the existence of any other than menstrual derangement before we can
accept the cases as true vicarious hemorrhage.  Tarnier cites an
instance of a girl without a uterus, in whom menstruation proceeded
from the vagina. Zacutus Lusitanus relates the history of a case of
uterine occlusion, with the flow from the lips of the cervix. There is
mentioned an instance of menstruation from the labia.

The occurrence of menstruation after removal of the uterus or ovaries
is frequently reported. Storer, Clay, Tait, and the British and Foreign
Medico-Chirurgical Review report cases in which menstruation took place
with neither uterus nor ovary.  Doubtless many authentic instances like
the preceding could be found to-day. Menstruation after hysterectomy
and ovariotomy has been attributed to the incomplete removal of the
organs in question, yet upon postmortem examination of some cases no
vestige of the functional organs in question has been found.

Hematemesis is a means of anomalous menstruation, and several instances
are recorded. Marcellus Donatus and Benivenius exemplify this with
cases. Instances of vicarious and compensatory epistaxis and hemoptysis
are so common that any examples would be superfluous. There is recorded
an inexplicable case of menstruation from the region of the sternum,
and among the curious anomalies of menstruation must be mentioned that
reported by Parvin seen in a woman, who, at the menstrual epoch,
suffered hemoptysis and oozing of blood from the lips and tongue.
Occasionally there was a substitution of a great swelling of the
tongue, rendering mastication and articulation very difficult for four
or five days. Parvin gives portraits showing the venous congestion and
discoloration of the lips.

Instances of migratory menstruation, the flow moving periodically from
the ordinary passage to the breasts and mammae, are found in the older
writers. Salmuth speaks of a woman on whose hands appeared spots
immediately before the establishment of the menses. Cases of
semimonthly menstruation and many similar anomalies of periodicity are
spoken of.

The Ephemerides contains an instance of the simulation of menstruation
after death, and Testa speaks of menstruation lasting through a long
sleep. Instances of black menstruation are to be found, described in
full, in the Ephemerides, by Paullini and by Schurig, and in some of
the later works; it is possible that an excess of iron, administered
for some menstrual disorder, may cause such an alteration in the color
of the menstrual fluid.

Suppression of menstruation is brought about in many peculiar ways, and
sometimes by the slightest of causes, some authentic instances being so
strange as to seem mythical. Through the Ephemerides we constantly read
of such causes as contact with a corpse, the sight of a serpent or
mouse, the sight of monsters, etc. Lightning stroke and curious
neuroses have been reported as causes. Many of the older books on
obstetric subjects are full of such instances, and modern illustrations
are constantly reported.

Menstruation in Man.--Periodic discharges of blood in man, constituting
what is called "male menstruation," have been frequently noticed and
are particularly interesting when the discharge is from the penis or
urethra, furnishing a striking analogy to the female function of
menstruation. The older authors quoted several such instances, and
Mehliss says that in the ancient days certain writers remarked that
catamenial lustration from the penis was inflicted on the Jews as a
divine punishment.  Bartholinus mentions a case in a youth; the
Ephemerides several instances; Zacutus Lusitanus, Salmuth, Hngedorn,
Fabricius Hildanus, Vesalius, 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 menstruation. 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 relates 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
menstruation 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 menstruation 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 evacuation 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, Jouilleton, and Rayman
also record male menstruation.

Cases of menstruation during pregnancy and lactation are not rare. It
is not uncommon to find pregnancy, lactation, and menstruation
coexisting. No careful obstetrician will deny pregnancy solely on the
regular occurrence of the menstrual periods, any more than he would
make the diagnosis 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 menstruation 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
Hannoverisehes Magazin, Drummond, Buxtorf, Arnold, The Lancet, and the
British Medical Journal.

Cecil 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,
began to menstruate soon after birth, and at the first year was regular
in this function. At birth her mamma were well developed and her
axillae were slightly covered 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 thirteen. 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 1 5/8 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 menstruation at the fourth month. A case is
on record of an infant who menstruated 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 is that of a child, nineteen months old,
whose breasts and external genitals were fully developed, 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 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 33 1/2 inches. The pelvis was broad and well shaped, and
measured 10 1/2 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 axillae were
covered with hair. She was lady-like and maidenly in her demeanor,
without unnatural constraint or effrontery. A case somewhat 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 developed, 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 development 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 a 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 1/2 inches tall; her features
were regular, the complexion rosy, the hair chestnut, the eyes
blue-gray, her mamma 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 neuralgia, 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 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.

Instances of protracted menstruation are, as a rule, reliable, the
individuals themselves being cognizant of the nature of true
menstruation, and themselves furnishing the requisite information as to
the nature and periodicity of the discharge in question.  Such cases
range even past the century-mark. Many elaborate statistics on this
subject have been gathered by men of ability.  Dr. Meyer of Berlin
quotes the following:--

  28  at 50 years of age,
   3  at 57 years of age,
  18  "  51   "   "   "
   3  "  58   "   "   "
  18  "  52   "   "   "
   1  "  59   "   "   "
  11  "  53   "   "   "
   4  "  60   "   "   "
  13  "  54   "   "   "
   4  "  62   "   "   "
   5  "  55   "   "   "
   3  "  63   "   "   "
   4  "  56   "   "   "

These statistics were from examination of 6000 cases of menstruating
women. The last seven were found to be in women in the highest class of
society.

Mehliss has made the following collection of statistics of a somewhat
similar nature--

                      Late Dentition.   Late          Late
                      Male.  Female.   Lactation.  Menstruation.
  Between 40 and 50    0         4        0            0
          " 50 " 60    1         4        2            1
          " 60 " 70    3         2        1            0
          " 70 " 80    3         2        0            7
          " 80 " 90    6         2        0            0
         " 90 " 100    1         1        0            1
    Above 100 .....    6         1        0            1
                      --        --       --           --
                      20        16       3           10

These statistics seem to have been made with the idea of illustrating
the marvelous rather than to give the usual prolongation of these
functions. It hardly seems possible that ordinary investigation would
show no cases of menstruation between sixty and seventy, and seven
cases between seventy and eighty; however, in searching literature for
such a collection, we must bear in mind that the more extraordinary the
instance, the more likely it is that it would be spoken of, as the
natural tendency of medical men is to overlook the important ordinary
and report the nonimportant extraordinary. Dewees mentions an example
of menstruation at sixty-five, and others at fifty-four and fifty-five
years. Motte speaks of a case at sixty-one; Ryan and others, at
fifty-five, sixty, and sixty-five; Parry, from sixty-six to seventy
seven; Desormeux, from sixty to seventy-five; Semple, at seventy and
eighty seven; Higgins, at seventy-six; Whitehead, at seventy-seven;
Bernstein, at seventy-eight; Beyrat, at eighty-seven; Haller, at one
hundred; and highest of all is Blancardi's case, in which menstruation
was present at one hundred and six years. In the London Medical and
Surgical Journal, 1831, are reported cases at eighty and ninety-five
years. In Good's System of Nosology there are instances occurring at
seventy-one, eighty, and ninety years.  There was a woman in Italy
whose menstrual function continued from twenty-four to ninety years.
Emmet cites an instance of menstruation at seventy, and Brierre de
Boismont one of a woman who menstruated regularly from her
twenty-fourth year to the time of her death at ninety-two.

Strasberger of Beeskow describes a woman who ceased menstruating at
forty-two, who remained in good health up to eighty, suffering slight
attacks of rheumatism only, and at this late age was seized with
abdominal pains, followed by menstruation, which continued for three
years; the woman died the next year. This late menstruation had all the
sensible characters of the early one. Kennard mentions a negress, aged
ninety-one, who menstruated at fourteen, ceased at forty-nine, and at
eighty-two commenced again, and was regular for four years, but had had
no return since. On the return of her menstruation, believing that her
procreative powers were returning, she married a vigorous negro of
thirty-five and experienced little difficulty in satisfying his
desires. Du Peyrou de Cheyssiole and Bonhoure speak of an aged peasant
woman, past ninety-one years of age, who menstruated regularly.

Petersen describes a woman of seventy-nine, who on March 26th was
seized with uterine pains lasting a few days and terminating with
hemorrhagic discharge. On April 23d she was seized again, and a
discharge commenced on the 25th, continuing four days. Up to the time
of the report, one year after, this menstruation had been regular.
There is an instance on record of a female who menstruated every three
months during the period from her fiftieth to her seventy-fourth year,
the discharge, however, being very slight. Thomas cites an instance of
a woman of sixty-nine who had had no menstruation since her forty-ninth
year, but who commenced again the year he saw her. Her mother and
sister were similarly affected at the age of sixty, in the first case
attributable to grief over the death of a son, in the second ascribed
to fright. It seemed to be a peculiar family idiosyncrasy. Velasquez of
Tarentum says that the Abbess of Monvicaro at the very advanced age of
one hundred had a recurrence of catamenia after a severe illness, and
subsequently a new set of teeth and a new growth of hair.

Late Establishment of Menstruation.--In some cases menstruation never
appears until late in life, presenting the same phenomena as normal
menstruation. Perfect relates the history of a woman who had been
married many years, and whose menstruation did not appear until her
forty-seventh year. She was a widow at the time, and had never been
pregnant. Up to the time of her death, which was occasioned by a
convulsive colic, in her fifty-seventh year, she had the usual
prodromes of menstruation followed by the usual discharge. Rodsewitch
speaks of a widow of a peasant who menstruated for the first time at
the age of thirty-six. Her first coitus took place at the age of
fifteen, before any signs of menstruation had appeared, and from this
time all through her married life she was either pregnant or suckling.
Her husband died when thirty-six years old, and ever since the
catamenial flow had shown itself with great regularity. She had borne
twins in her second, fourth, and eighth confinement, and altogether had
16 children. Holdefrund in 1836 mentions a case in which menstruation
did not commence until the seventieth year, and Hoyer mentions one
delayed to the seventy-sixth year. Marx of Krakau speaks of a woman,
aged forty-eight, who had never menstruated; until forty-two years old
she had felt no symptoms, but at this time pain began, and at
forty-eight regular menstruation ensued. At the time of report, four
years after, she was free from pain and amenorrhea, and her flow was
regular, though scant. She had been married since she was twenty-eight
years of age. A somewhat similar case is mentioned by Gregory of a
mother of 7 children who had never had her menstrual flow.  There are
two instances of delayed menstruation quoted: the first, a woman of
thirty, well formed, healthy, of good social position, and with all the
signs of puberty except menstruation, which had never appeared; the
second, a married woman of forty-two, who throughout a healthy
connubial life had never menstruated. An instance is known to the
authors of a woman of forty who has never menstruated, though she is of
exceptional vigor and development. She has been married many years
without pregnancy.

The medical literature relative to precocious impregnation is full of
marvelous instances. Individually, many of the cases would be beyond
credibility, but when instance after instance is reported by reliable
authorities we must accept the possibility of their occurrence, even if
we doubt the statements of some of the authorities. No less a medical
celebrity than the illustrious Sir Astley Cooper remarks that on one
occasion he saw a girl in Scotland, seven years old, whose pelvis was
so fully developed that he was sure she could easily give birth to a
child; and Warner's case of the Jewish girl three and a half years old,
with a pelvis of normal width, more than substantiates this
supposition. Similar examples of precocious pelvic and sexual
development are on record in abundance, and nearly every medical man of
experience has seen cases of infantile masturbation.

The ordinary period of female maturity is astonishingly late when
compared with the lower animals of the same size, particularly when
viewed with cases of animal precocity on record. Berthold speaks of a
kid fourteen days old which was impregnated by an adult goat, and at
the usual period of gestation bore a kid, which was mature but weak, to
which it gave milk in abundance, and both the mother and kid grew up
strong. Compared with the above, child-bearing by women of eight is not
extraordinary.

The earliest case of conception that has come to the authors' notice is
a quotation in one of the last century books from von Mandelslo of
impregnation at six; but a careful search in the British Museum failed
to confirm this statement, and, for the present, we must accept the
statement as hearsay and without authority available for
reference-purposes.

Molitor gives an instance of precocious pregnancy in a child of eight.
It was probably the same case spoken of by Lefebvre and reported to the
Belgium Academy: A girl, born in Luxemborg, well developed sexually,
having hair on the pubis at birth, who menstruated at four, and at the
age of eight was impregnated by a cousin of thirty-seven, who was
sentenced to five years' imprisonment for seduction. The pregnancy
terminated by the expulsion of a mole containing a well-characterized
human embryo.  Schmidt's case in 1779 was in a child who had
menstruated at two, and bore a dead fetus when she was but eight years
and ten months old. She had all the appearance and development of a
girl of seventeen. Kussmaul gives an example of conception at eight.
Dodd speaks of a child who menstruated early and continued up to the
time of impregnation. She was a hard worker and did all her mother's
washing. Her labor pains did not continue over six hours, from first to
the last. The child was a large one, weighing 7 pounds, and afterward
died in convulsions. The infant's left foot had but 3 toes. The young
mother at the time of delivery was only nine years and eight months
old, and consequently must have been impregnated before the age of
nine.  Meyer gives an astonishing instance of birth in a Swiss girl at
nine. Carn describes a case of a child who menstruated at two, became
pregnant at eight, and lived to an advanced age. Ruttel reports
conception in a girl of nine, and as far north as St.  Petersburg a
girl has become a mother before nine years. The Journal de Scavans,
1684, contains the report of the case of a boy, who survived, being
born to a mother of nine years.

Beck has reported an instance of delivery in a girl a little over ten
years of age. There are instances of fecundity at nine years recorded
by Ephemerides, Wolffius, Savonarola, and others.  Gleaves reports from
Wytheville, Va., the history of what he calls the case of the youngest
mother in Virginia--Annie H.--who was born in Bland County, July 15,
1885, and, on September 10, 1895, was delivered of a well-formed child
weighing 5 pounds. The girl had not the development of a woman,
although she had menstruated regularly since her fifth year. The labor
was short and uneventful, and, two hours afterward, the child-mother
wanted to arise and dress and would have done so had she been
permitted.  There were no developments of the mammae nor secretion of
milk.  The baby was nourished through its short 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
Massachusetts a mother at ten years, eight months, and seventeen days,
and one in Philadelphia 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 very 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
conditions would never be recognized as such.

The instance in the Journal decavans 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. Rowlett, 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 7 3/4 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 years and nine months, and gave 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 consequence
is that girls are married at the age of nine or ten years, but it is
understood or professed 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 20 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.

"Reform 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 prejudices and
customs which insist on marriage before menstruation."

In 1816 some girls were admitted to the Paris Maternite as young as
thirteen, and during the Revolution 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 following authors have reported cases of
pregnancy before the appearance of menstruation: Ballonius, Vogel,
Morgagni, 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. C., 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 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,
one at sixty years; Schoepfer, at seventy years; and, almost beyond
belief, Debes cites an instance as taking 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 recording 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.

Mayham 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 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. Montgomery, 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 some
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 fertilization, as their power
of motility and tenacity of life have been well demonstrated. 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 citation 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 impregnation 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, Duddell, Mauriceau, a Reyes, Riolan, Harvey,
the discoverer of the circulation of the blood, Wolfius, Walther,
Rongier, Ruysch, Forestus, Ephemerides, and Schurig all mention cases
of conception with intact 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 malcondition 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. Tweedie 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
case of conception in an imperforate uterus, and Duncan relates the
history of a case of pregnancy in an unruptured hymen, characterized by
an extraordinary ascent of the uterus. Among many, the following modern
observers have also reported instances of pregnancy with hymen
integrum: Braun, 3 cases; Francis, Horton, Oakman, Brill, 2 cases;
Burgess, Haig, Hay, and Smith.

Instances in which the presence of an unruptured hymen has complicated
or retarded actual labor are quite common, and until the membrane is
ruptured by external means the labor is often effectually obstructed.
Among others reporting cases of this nature are Beale, Carey, Davis,
Emond Fetherston, Leisenring, Mackinlay, Martinelli, Palmer, Rousseau,
Ware, and Yale.

There are many cases of stricture or complete occlusion of the vagina,
congenital or acquired from cicatricial contraction, obstructing
delivery, and in some the impregnation seems more marvelous than cases
in which the obstruction is only a thin membranous hymen. Often the
obstruction is so dense as to require a large bistoury to divide it,
and even that is not always sufficient, and the Cesarean operation only
can terminate the obstructed delivery; we cannot surmise how conception
could have been possible. Staples records a case of pregnancy and
parturition with congenital stricture of the vagina. Maisonneuve
mentions the successful practice of a Cesarean operation in a case of
congenital occlusion of the vagina forming a complete obstruction to
delivery. Verdile records an instance of imperforate vagina in which
rectovaginal wall was divided and the delivery effected through the
rectum and anus. Lombard mentions an observation of complete occlusion
of the vagina in a woman, the mother of 4 living children and pregnant
for the fifth time.  Thus, almost incredible to relate, it is possible
for a woman to become a mother of a living child and yet preserve all
the vaginal evidences of virginity. Cole describes a woman of
twenty-four who was delivered without the rupture of the hymen, and
Meek remarks on a similar case. We can readily see that, in a case like
that of Verdile, in which rectal delivery is effected, the hymen could
be left intact and the product of conception be born alive.

A natural sequence to the subject of impregnation without entrance is
that of artificial impregnation. From being a matter of wonder and
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 fecundation of the eggs of fish.
Roesel, 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
impregnated a bitch, who brought forth in sixty-two days 3 puppies, all
resembling the male. The illustrious John Hunter advised a man
afflicted 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, Gallard, Courty,
Roubaud, 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
impregnating her. Those who are desirous of full information on this
subject, as regards the modus operandi, etc., are referred to Girault;
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 injections 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
impregnated his wife, and had resorted to injections of semen with a
favorable 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
spermatozoid 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 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; introduced to the fundus of the
uterus, and some drops of the fluid slowly expressed into the uterus.
The woman is then kept in bed on 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.

{footnote} The following extraordinary incident of accidental
impregnation, quoted from the American Medical Weekly by the Lancet, is
given in brief, not because it bears any semblance 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 follows: A matron and her two daughters, aged fifteen and
seventeen years, filled with 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 R----, 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 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
strenuously 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.


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 pregnancy as a result, have been reported in the last
century by Valentini, Genselius, 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 previously
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
salis." 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 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
them 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 sometimes
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
Sparkman 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.

Superfetation 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 superfetation. Schenck
relates instances, and Zacchias, Velchius, and Sinibaldus mention
eases. Pare seemed to be well conversant with the possibility as well
as the actuality of superfetation; and Harvey reports that a certain
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 delivered of another child, a product of superfetation,
which proclaimed the crime that she had so cunningly concealed before.

Marcellus Donatus, Goret, Schacher, and Mauriceau mention
superfetation. In the Academie des Sciences, at Paris, in 1702, there
was mentioned 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 possible 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. Ruysch 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
sixteen 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
husband, 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 Arles 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 supposed that she had become impregnated by the
first intercourse after confinement; 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 peculiar instance of superfetation was reported by Langmore in which
there was an abortion of a fetus between the third and fourth months,
apparently 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' formation. 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 twins, and who aborted a fetus of four months'
gestation; serious hemorrhage accompanied the removal of the placenta,
and on placing the hand in the uterine 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. Severe hemorrhage complicated the case,
but was controlled, and convalescence 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 being 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 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 unfaithful 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 Rouen, 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 pregnancy, though living with the white man who first
impregnated her. Two placentae were expelled some time after the twins,
and showed a membranous junction. The children died shortly after birth.

Pregnancy often takes place in a unicorn or bicorn uterus, leading to
similar anomalous conditions. Galle, Hoffman, Massen, and Sanger give
interesting accounts of this occurrence, and Ross 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.



CHAPTER II.

PRENATAL ANOMALIES.

Extrauterine Pregnancy.--In the consideration of prenatal anomalies,
the first 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,
figures 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 offer 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 Pathologique," 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
Fallopian 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 supposed to be only extrauterine have been instances
simply of double uterus, with single or concurrent pregnancy. Ross
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 five months' development. 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 extrauterine 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 at attack of inflammatory fever, followed by tumefaction
of the abdomen, convulsions, 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.

The curious cases mentioned by older writers, and called abortion by
the mouth, etc., are doubtless, in many instances, remnants of
extrauterine pregnancies or dermoid cysts. Maroldus speaks in full of
such cases; Bartholinus, Salmuth, and a Reyes 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 accompanied 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 in
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 spontaneous elimination of a fetal skeleton by the rectum
after five years of retention, with recovery of the patient. Butcher
speaks of delivery through the rectum at the fourth month, with
recovery. Depaul mentions a similar expulsion 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 extrauterine 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 speaks of the expulsion
of extrauterine 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 White 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 extraordinary 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. Campbell quotes the case of
a Polish woman, aged thirty-five, the mother of nine 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 pregnancy 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 illustration 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 extrauterine 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 behind 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 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 suddenly, and
being pregnant was opened. In the right iliac fossa was found a male
child weighing 5 pounds and 5 ounces, 8 1/2 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
extrauterine 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 extrauterine 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 wag
reduced to about one-fourth the former size. In April, 1874, the woman
still suffered pain and tenderness in the tumor. Hodgen believed this
to have been originally a tubal pregnancy, which burst, causing much
hemorrhage 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 menstruated
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
remained. 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 advanced 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 abdomen
on her right side and felt motion in it. In about a month she was 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 recurrence 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 operation 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, soon ceasing altogether, and
the wound closed. By December health was good and the menses had
returned.

Ahlfeld, Ambrosioni, Galabin, Packard, Thiernesse, Maxson, de
Belamizaran, 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
example of extrauterine gestation in a woman of twenty-six, who had
previously 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 51 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 conceptions.  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 operation,
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 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 intrauterine fetus died, and the extrauterine fetus lived.
Wilson a 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 presented every appearance of having
another child within her, although examination by the vagina revealed
none. Wilson called Chatard in consultation, 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 distinctly 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 l'Acad. de Med.,
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 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, produce 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 lineae
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
examination. 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 1/2 cm.; the
cervix was soft as that of a primipara at term. Operation, May 2d:
Uterus found empty, cavity 14 1/2 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 restrained 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 iodoform and salicylic gauze. The operation lasted an hour,
and the child, a boy weighing 5 1/2 pounds, after a brief period of
respiratory difficulties, 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."

Quite recently Werder has investigated the question of the ultimate
fate of ectopic children delivered alive. He has been able to obtain
the record of 40 cases. 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 accounted 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 Dorland. 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 retention of
an extrauterine gestation is sometimes remarkable, and it is no
uncommon occurrence for several pregnancies to successfully ensue
during such retention. The Ephemerides contains examples of
extrauterine pregnancy remaining in the abdomen forty-six years;
Hannaeus mentioned an instance 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, the labor pains intervened without expulsion of the
fetus. Impregnation ensued twice afterward, 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, when 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 hypogastric and umbilical regions. It weighed
eight pounds and consisted of a male 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 ossified 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 surrounding 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 intraligamentally 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
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, forty years; Johnson,
forty-four years; Josephi, 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
intrauterine 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 of a case in which a child was
carried many years in the uterus, being converted into a clay-like
substance, but preserving form and outline. Caldwell 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. Hannaeus, in 1686, issued a paper on such a case
under the title, "Mater, Infantis Mortui Vivum 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 Jahrbucher contain the
report of a woman of forty-nine, who had borne two children. While
threshing corn 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 remnants of a putrid fetus with its numerous
bones.  There is an instance recorded 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
supervened 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 supposed 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
case 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 movements,
and during recent years, in the Southern States, there was quite a
prevalence of this kind of imposters. Many instances of the exhibition
of fetal movements in the bellies of old negro women have been noticed
by the lay journals, but investigation proves them to have been nothing
more than an exceptional control over the abdominal muscles, with the
ability to simulate at will the supposed fetal jerks. One old woman
went so far as to show the fetus dancing to the music of a banjo with
rhythmical movements. Such imposters flourished best in the regions
given to "voodooism." We can readily believe how easy the deception
might be when we recall the exact simulation of the fetal movements in
instances of pseudocyesis.

The extraordinary diversity of reports concerning the duration of
pregnancy has made this a much mooted question. Many opinions relative
to the longest and shortest period of pregnancy, associated with
viability of the issue, have been expressed by authors on medical
jurisprudence. There is perhaps no information more unsatisfactory or
uncertain. Mistakes are so easily made in the date of the occurrence of
pregnancy, or in the date of conception, that in the remarkable cases
we can hardly accept the propositions as worthy evidence unless
associated with other and more convincing facts, such as the appearance
and stage of development of the fetus, or circumstances making
conception impossible before or after the time mentioned, etc. It will
be our endeavor to cite the more seemingly reliable instances of the
anomalies of the time or duration of pregnancy reported in reputable
periodicals or books.

Short Pregnancies.--Hasenet speaks of the possibility of a living birth
at four months; Capuron relates the instance of Fortunio Liceti, who
was said to have been born at the end of four and a half months and
lived to complete his twenty-fourth year. In the case of the Marechal
de Richelieu, the Parliament of Paris decreed that an infant of five
months possessed that capability of living the ordinary period of
existence, i.e., the "viabilite," which the law of France requires for
the establishment of inheritance. In his seventh book Pliny gives
examples of men who were born out of time. Jonston gives instances of
births at five, six, seven, and eight months. Bonnar quotes 5 living
births before the one hundred and fiftieth day; 1 of one hundred and
twenty-five days; 1 of one hundred and twenty days; 1 of one hundred
and thirty-three days, surviving to twenty-one months; and 1 of one
hundred and thirty-five days' pregnancy surviving to eighty years.
Maisonneuve describes a case in which abortion took place at four and a
half months; he found the fetus in its membranes two hours after
delivery, and, on laying the membranes open, saw that it was living. He
applied warmth, and partly succeeded in restoring it; for a few minutes
respiratory movements were performed regularly, but it died in six
hours. Taylor quotes Carter concerning the case of a fetus of five
months which cried directly after it was born, and in the half hour it
lived it tried frequently to breathe. He also quotes Davies, mentioning
an instance of a fetus of five months, which lived twelve hours,
weighing 2 pounds, and measuring 12 inches, and which cried vigorously.
The pupillary membrane was 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 measured 9 3/4 inches; the other 10 ounces 7 drams, with the
same length as the first. Routh speaks of a Mrs. F----, aged
thirty-eight, who had borne 9 children and had had 3 miscarriages, the
last conception terminating as such. 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. During 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 1/2 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' pregnancy, and Kopp speaks of a six months' child
which 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 1/2 inches long, and weighed 1 pound 3 1/2 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, who
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 the fifth month weighing 1 1/2 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 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 ossification. 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. Muller, 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 Societe Obstetricale et Gynecologique 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 1/2 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 1/2
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 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 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 duration 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
incubator 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 appears 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 Decenviri
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 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 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'; 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 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 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 miscarriage, 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 7 1/4 pounds; he relates the
history of another case, in Clifton, W. Va., of a woman expecting
confinement on June 1st going over to September 16th, the fetus being
in the uterus over twelve months, and nine months after quickening was
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 morning 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. Ballard 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
describes a similar case of ten and a half months' duration.
Raux-Tripier has seen protraction to the thirteenth month. Enguin
reports an observation 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 observation 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 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-Bohemian 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 promontory was
exaggerated, and the anteroposterior pelvic diameter of the inlet in
consequence diminished. The fetus was large and occupied the first
position. 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 asylum, but recovered in a few
months. Tanner saw a woman of forty-two who had been suffering with
abdominal pains. She had been married three years and had never been
pregnant. Her catamenia were very scant, but this was 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
pregnancy. She was successfully delivered of a girl, which 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 husband 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, 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 weighing 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 resembling
those of labor and a fetus slipped into the vagina without any
hemorrhage; 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 speaking of pregnancy remaining unrecognized by the mother
until the period of accouchement, Lozes and Rhades record peculiar
cases; and Mouronval 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 Munzenthaler also record
examples of unconscious pregnancy.

Pseudocyesis.--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 pseudocyesis. 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 pseudocyesis. Of course, many of the cases are
not examples of true pseudocyesis, 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 pseudocyesis 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 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 increased; 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 condition. 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 convinced of her error, and at once dropped
weight at the rate of half a pound a day despite every effort 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 become 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 suffered 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 abdomen 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
assured that no child existed within her."

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 pregnancy. A woman who had several children fell sick with a
chest-affection, followed by an edema.  For fifteen months she was
confined to her bed, and had never had connection with her husband
during that time. Her menses ceased; her mammae became engorged and
discharged a serous lactescent fluid; her belly enlarged, and both she
and her physician 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 husband 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 mammae 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
abdomen 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 several 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 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 pregnancy was strongly confirmed.
Her favorite amusement then was to make baby-clothes and count on her
fingers the months of pregnancy. When 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 ambassador 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 whole 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 rolling under the hand. Her abdomen progressively enlarged to
the regular size of matured gestation; but the extrauterine pregnancy,
which was supposed to have existed, was not seen at the autopsy,
nothing more than an enlarged liver being found. The movement was due
to spasmodic movements 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 overflow 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 much 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 reassured her of
the nonexistence of pregnancy; she became very indignant, triumphantly
squeezed lactescent fluid from her breasts, and, insisting that she
could feel fetal movements, left to seek a more sympathetic accoucheur.
Underhill, 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 complaining of great labor-pains, biting a
handkerchief, and pulling on a cloth 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 convicted 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 performed ovariotomy
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 hemorrhage. The child was well developed, the
mons was covered with hair, and all the associate symptoms tended to
increase the deception.

Sympathetic Male Nausea of Pregnancy.--Associated with pregnancy there
are often present morning-nausea and vomiting as prominent and reliable
symptoms. Vomiting is often so excessive as to be provocative 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 very fat, and as the
growth was largely, in fact excessively, abdominal, she became easily
sure of her condition. She was not my patient, but her husband
consulted me as to his own 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 similarly
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
appetites. 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." Pare 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 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
polydipsia and bulimia developed; these can be readily attributed to
the increased 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 monstrosities 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
literature. 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 painting 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 longing 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,
therefore, no absolute proof that Hippocrates was a believer in one of
the most popular and long-persisting beliefs concerning fetal
deformities.

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 ingeniously
used to explain the hereditary nature of certain diseases and
malformations. 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 Pare, Damascene saw a girl with long hair like a bear,
whose mother had constantly before her a picture of the hairy St. John.
Pare also appends an illustration showing the supposed resemblance to a
bear. Jonston quotes a case of Heliodorus; it was an Ethiopian, who by
the effect of the imagination produced a white child. Pare 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 Andromeda excited in Persina throughout the whole of the
pregnancy." Van Helmont cites the case of a tailor's wife 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 of a child with one
eye blue and the other black, whose mother during confinement had seen
a person so marked; of an infant with fins 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 sister. 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 of. 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
terminated by the birth of a well-formed dead female child, apparently
blistered 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 rabbit-shaped. Instead of a nose, it had a fleshy growth 3/4 inch
long by 1/4 inch broad, directed upward at an angle of 45 degrees. 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.

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 cattle 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 deformed extremities, who might be
classed as an ectromelus, 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 cupboard. 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 exhibited the shape and action of a snake, and
involuntarily 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 suffering 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 account 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 the
nephew and the uncle was identical. A most peculiar case is stated by
Clerc as occurring in the experience of Kuss 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 the 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
paternal 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 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
Keimplasma," 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 1816
Lord Morton put a male quagga to a young chestnut mare of 7/8 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 15/16 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 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 Dachshund 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
Shrop 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 which 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 animals
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 continually noticing amongst the colored population of Surinam
'that if a negress had a child or children by a white, and afterward
fruitful intercourse with a negro, the latter offspring 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 parent 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
explanation, 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; nevertheless, we have a fair number of recorded
instances of dark-colored children 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 precise 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 medical 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 questioned.'

"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
interesting case in the American Journal of the Medical Sciences for
1868: 'A black woman, mother of several negro children, none of whom
were deformed 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 supernumerary finger.' Taruffi,
the celebrated Italian teratologist, in speaking of the 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 Vanini 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 (Traite de Physiologie), and Dr. William 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, loc. cit.). He noticed that when an
aboriginal 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 disproved, 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
reproductive 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,
accidents, and operations that affect the pregnant uterus and its
contents; these are rich in anomalies and facts of curious interest,
and have been recognized from the earliest times. In the various works
usually grouped together under the general designation of "Hippocratic"
are to be found 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 followed 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 Littre puts it,
"Les ecrits hippocratiques demeurent isoles au milieu des debris de
l'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 exception
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
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
presenting 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 occurring 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
regular coarse 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 Hamburg 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
collected a number of cases of pneumonia occurring during pregnancy,
showing 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 recovered, 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.

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. Henning 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 extraordinary: 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 unhealthy. Porak has
recently investigated the passage of substances foreign to the organism
through the placenta, and offers an excellent paper on this subject,
which is quoted in brief in a contemporary number of Teratologia.

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 mercury, 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
accumulation 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 passage of
poisons, the placenta offers a varying degree of obstruction: it allows
copper and lead to pass easily, arsenic with greater difficulty. The
accumulation 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 accumulate 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
("mortinatatite") 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 character of
saturnine encephalopathic lesions. The presence of arsenic in the fetal
skin alone gives an explanation of the therapeutic results of the
administration of this substance in skin diseases.

Intrauterine amputations are of interest to the medical man,
particularly those cases in which the accident has happened in early
pregnancy and the child is born with a very satisfactory and clean
stump. Montgomery, in an excellent paper, advances the theory, which is
very plausible, that intrauterine amputations are caused by contraction
of bands or membranes 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 extremities 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 1/2 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 1/4 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 1/4 inch long. The right lower limb was merely a fleshy corpuscle
3/4 inch wide and 1/4 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 corpuscle 1 inch long and 1/4 inch
in circumference, resembling the great toe of an infant. There was no
history of shock or injury to the mother. The child presented by the
breech, and by the absence of limbs caused much difficulty in
diagnosis.  The three stages of labor were one and one-half hours,
forty-five minutes, and five minutes, respectively. The accompanying
illustration 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 amputation of both the upper extremities.  Gillilam a
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 encircling 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
extremities 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 Hippocrates, 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 production is described. It is said that if the
cord he extended along one side of the uterus, and the fetus lie more
to the other side, then when the culbute 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
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 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 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 which 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 published
an article on spontaneous amputation of the forearm and rudimentary
regeneration of the hand in the fetus. Among other contributors to this
subject are Avery, Boncour, Brown, Ware, Wrangell, Young, Nettekoven,
Martin, Macan, Leopold, Hecker, Gunther, and Friedinger.

Wygodzky finds that the greatest number of coils of the umbilical cord
ever found to encircle a fetus are 7 (Baudelocque), 8 (Crede), and 9
(Muller 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 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
results 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 thoroughly, and the reader is referred to any responsible
text-book for the theories 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 humerus of a fetus in utero.
Gaultier reports an instance of fracture of both femora intrauterine.
Stanley, Vanderveer, and Young cite instances of intrauterine 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 fragments
during lactation. Danyau, Proudfoot, and Smith mention intrauterine
fracture of the tibia; in Proudfoot's case there was congenital talipes
talus.

Dolbeau 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 fractures. 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 fractures are multiple and the cause
is not apparent.

The results to the fetus of injuries to the pregnant mother are most
diversified. In some instances the marvelous escape of any serious
consequences 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 Hildanus 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 external 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; Reuther describes a contusion 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 record.

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,
reaching 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 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 hanging out
some clothes to dry. She suffered a wound on the internal surface of
the left nympha 1 1/2 inch long and 1/2 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. Cullingworth 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 stooping 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 omentum was mangled and comminuted,
and bore two lacerations of two inches each. The intestines and stomach
were not injured, but there was considerable extravasation of blood
into the abdominal cavity. The intestines were cleansed and an
unsuccessful attempt was made to replace them. The intestines remained
outside of the body for two hours, and the great omentum 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 intestines were all replaced in the abdominal cavity. The
edges were pared, sutured, and the wound dressed. The woman was placed
in bed, on the 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 intestines 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 gestation. Crowdace speaks of a
female pauper, six months pregnant, who was attacked by a buffalo, and
suffered a wound about 1 1/2 inch long and 1/2 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
successfully 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 alone. Subsequently she was
confined, easily bore a perfectly normal female child, and both did
well. Sibois describes the case of a woman weighing 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 suffered 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 10 1/2 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
protruded. 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.

Bancroft 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 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 jumping from a
window. She ruptured her uterus, and a dead child with a fracture 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 puerperal. She died
in a few hours, and at the autopsy it was found that labor 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 pregnancy 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, limiting
himself to operations on the pelvic organs, where interference is
supposed 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 not dangerous or liable to
be followed by abortion.

(8) Operations for vesicovaginal fistulae 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
special interest, will be given below. Polaillon speaks of a double
ovariotomy 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, 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 recovering, but the child was
lost. Galabin had a case of ovariotomy performed on a woman in the
sixth month of pregnancy without interruption of pregnancy; Potter had
a case of double ovariotomy with safe delivery at term; and Storry 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 1/2
ounces and measuring 2 by 2 1/2 inches, with subsequent recovery and
continuation of pregnancy. Rydygier 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 woman without abortion ensued. The Revue de Chirurgien
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 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 interruption of the ordinary course of labor. Russell cites the
instance of a woman who was successfully tapped at the sixth month of
pregnancy.

McLean 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. Keen 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
pregnancy 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 Munde 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 interruption of pregnancy, which
is far from the general result.  Cazin and Rey both produced abortion
by forcible dilatation of the anus for fissure, but Gayet 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 from a woman
pregnant six and a half months, without interruption, and according to
Mann again, McClintock 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 8 3/4 pounds from a pregnant uterus without interrupting
gestation.

The following extract from the University Medical Magazine of
Philadelphia illustrates the after-effects of abdominal hysteropasy on
subsequent pregnancies:--

"Fraipont (Annales de la Societe Medico-Chirurgicale de Liege, 1894)
reports four cases where pregnancy and labor were practically normal,
though the uterus of each patient had been fixed 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
abdominal wall. Even if the adhesions were not broken down they would
of necessity be so stretched as to be useless for their original
purpose after delivery. 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 necessary."

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 terminating 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. Roberts reports a case of
pregnancy associated with a large fibrocellular polypus of the uterus.
A living child was delivered at the seventh month, ecrasement 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 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
mentioned which deserve a place here, viz., those of the membranes
surrounding the fetus. Brown 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 by labor. There is a case mentioned in which an accident and
an inopportune 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 continued 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 menstruated 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 proved 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 of an
accouchement terminating successfully twenty-three days after the loss
of the amniotic fluid. Campbell mentions delivery of a living child
twelve days after rupture of the membranes. Chesney relates the history
of a double collection of waters. Wood reports a case in which there
was expulsion of a bag of waters before the rupture of the membranes.
Bailly, Chestnut, Bjering, Cowger, Duncan, and others also record
premature rupture of the membranes without 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 apparently effected the separation of the
placenta without alarming hemorrhage, the ease being one of placenta
praevia, terminating favorably by natural processes. 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
instances 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 peculiar 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; Gery, Grieve, Mastin,
Passot, Piogey, Woets, and others report instances of this nature.
Newman 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 artificial anus.

The diverse causes of abortion are too numerous to attempt giving them
all, but some are so curious and anomalous that they deserve mention.
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 white 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 odor of urine as provocative of abortion; Sulzberger, Meyer, and
Albertus all mention odors; and Vesti gives as a plausible cause the
odor of carbonic vapor. The Ephemerides mentions singultus as a cause
of abortion. Mauriceau, Pelargus, and Valentini mention coughing.
Hippocrates mentions the case of a woman who induced abortion by
calling excessively loud to some one. Fabrieius Hildanus speaks of
abortion following a kick in the region of the coccyx.  Gullmannus
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 negligence. Hawley mentions abortion at
the fourth or fifth month due to the absorption 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. Hippocrates
speaks of extreme hunger as a cause of abortion. Treuner 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 tight lacing, excessive
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 reliable explanation.  Information from India an 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 obstructed 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 11 inches long, weighed 12 ounces, with a
placenta attached weighing 6 1/2 ounces. It is quite common for a
blighted fetus to be retained and expelled at term with a living child,
its twin.

Bacon 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, 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
February, 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 impregnation 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 discharged 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 pregnancy 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 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, killed 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 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. Pare 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 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.  Ballantyne says that in the writings of Hippocrates
there is in the work on "Diseases", which is not usually regarded as
genuine, a some 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.



CHAPTER III.

OBSTETRIC ANOMALIES.

General Considerations.--In discussing obstetric anomalies we shall
first consider those strange instances in which stages of parturition
are unconscious 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
of symphysiotomy. In 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
Engelmunn, 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 Muas record instances of
painless births. The Ephemerides records a birth as having occurred
during asphyxia, and also one during an epileptic attack. Storok 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 anticipating the event, who gave birth to children,
apparently unconsciously. In 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 through 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
discussed, and Fanton reports 12 cases of parturition under the
hypnotic influence. 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. Montgomery relates the case of a lady, the mother of several
children, who 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 confinement, 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 speaks of a woman, pregnant at term, who fell into a sleep
about 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 progressed 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 September 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 urination.

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 which
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 syncope which lasted four hours. Epley reports painless labor
in a patient with paraplegia. Fahnestock speaks of the case of a woman
who was delivered 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,
Mattei, 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 in 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 exertions she returned the next day to thank her uncle for the two
hours' accommodation. There is related the history of a case of a woman
who 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 not being noticed by her sleeping sister. She buried the child,
"and afterward confessed her wickedness, and was executed in the
Stafford 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 suspicion 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 examination, she stated that on the night in question she got
up toward morning, thinking to relieve her bowels. For this 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 returned 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, following 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
independent vitality when for the second time exposed to the air. This
curious case was verified to English correspondents by Dr. Wagner, and
is of unquestionable authority; it became the subject of a thorough
criminal investigation in Germany.

During the funeral procession of Marshal MacMahon in Paris an enormous
crowd was assembled to see the cortege pass, and in this crowd was a
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 embarrassment. 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
frequently 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 servant to look below the bed-clothes, and then a female
child was discovered.  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 bearing 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 married 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 child 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 the chamber dropped a child. She never
felt a labor-pain, and twelve days afterward 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 pregnancy 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 rupture 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 child with forceps, and
without perineal rupture. There was little hemorrhage, and the placenta
was removed with slight difficulty. Five months 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 menstruated 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 Sorbonne, 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 rectum 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 experienced 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 offending 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. Cassidy reports a case of
child-birth through the perineum. A successful operation was performed
fifteen days after the accident. Dupuytren speaks of the passage of an
infant through a central opening of the perineum. Capuron, Gravis, and
Lebrun all report accouchement 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, Morere, Pollock, and others record the
birth of children through perineal perforations.

Birth Through the Abdominal Wall.--Hollerius gives a very peculiar
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 Ill 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 appearance 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 Willoughby'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 pregnancy 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
breaking 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-nourished. 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 efforts were made to save the child,
but to no purpose. The mother, after a short convalescence, 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 unruptured 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 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 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 delivery
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 anomalous
cases in which the delivery 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 performed after death and the child successfully delivered.
Bartholinus, Wolff, Schenck, Horstius, Hagendorn, Fabricius Hildanus,
Valerius, Rolfinck, Cornarius, 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 Lariboisiere Maternite, 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 4 1/4 to 6 1/2
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. Devilliers 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 Thevenot
discussed this question at length at the International Medico-Legal
Congress in 1878. Duer presented the question of postmortem delivery in
this 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, manual 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 postmortem deliveries,
collecting 44 cases of spontaneous expulsion of the fetus after death
of the mother.

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 to 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 rumbling 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. Hagendorn 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 instance, 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.  Rolfinkius 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, 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 abdominal 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.  Richter 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,
according 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 woman whom a midwife failed to
deliver. Desiring an inquest, the coroner had the body exhumed, when,
on opening the coffin, 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 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
genitals 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 confirmed 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 was no sanguineous
discharge from the genitals, but at the time of raising 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
ease, 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 Hoffman
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
unbelievable 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 nlaterna clausus in alvo Dicitur insuetos ore dedisse
sonos.  Causa subest; doluit se angusta sede telleri Et cupiit magnae
cernere moliis opus.  Aut quia quaerendi studio vis fessa parentum
Aucupii aptas innuit esse manus."

The Ephemerides gives examples of the child hiccoughing in the uterus.
Cases of crying before delivery, some in the vagina, some just before
the complete expulsion of the head from the os uteri, are very numerous
in the older writers; and it is quite possible that on auscultation of
the pregnant abdomen fetal sounds may have been exaggerated into cries.
Bartholinus, Borellus, Boyle, Buchner, Paullini, Mezger, Riolanus,
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 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 was 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,
Aretxeus, 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 born 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 frequent 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. Aesculapius, according 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 supposed to have been delivered in this way
after the death of his mother, Margery Bruce, who was killed 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 performed by
Jacob Nufer, 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 1/2 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 1
1/4 inches. The hygienic surroundings for the operation were not of the
best, as the woman lived in a cellar. Tait's method of performing 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 1/2 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. Munde 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 1/2 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 successful 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 operation, as is now generally done. Bacque reports two sections
in the same woman, and Bertrandi speaks of a case in which the
operation was successfully executed many times in the same woman.
Rosenberg reports three cases repeated successfully by Leopold of
Dresden. Skutsch reports a case in 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 twice 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
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.  Michaelis 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 successful terminations as regards both
mothers and children. Rosenberg 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
operation 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. The 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. The wound healed in eleven days, and the
mother made a complete recovery. 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.

Barker gives the instance of a woman who, on being abused by her
husband 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 Rensselaer 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.

Madigan cites the case of a woman of thirty-four, in her seventh
confinement, who, while temporarily insane, laid open her abdomen with
a razor, incised the uterus, and brought out a male child.  The
abdominal wound was five inches long, and extended from one inch above
the umbilicus straight downward. 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 awful 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 term, 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 off 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 sister 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, 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 subsequently 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 anterior spine to the other. The woman
was found cold and insensible and 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 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 delivered 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
children, 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-quarters 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 portion. 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, involving the parietes and the uterus. The child was
extruded through 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 investigation, 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 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 "les 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 supposed to have been born in this manner.
Francois de Civile, who on great occasions signed himself "trois fois
enterre et trois fois par le grace de Dieu ressucite," saw the light of
the world by a happy Cesarean operation on his exhumed mother.
Fabricius Hildanus and Boarton 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 Italian 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
Swartzenberg, 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 mentions 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
  "   "   10 and 15   "    "    "   "    "    "      13
  "   "   15 and 30   "    "    "   "    "    "       2
  "   "   1 hour      "    "    "   "    "    "       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 alive; if from six to
ten minutes, they may 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
children gave signs of life, but only 45 survived.

During the Commune of Paris, Tarnier, one night at the Maternite, 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
lived 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
minutes 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 section was performed and a living male child
delivered. This infant was nourished 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 extracted from her by Cesarean section. There was a similar case in
the Hopital 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 was 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 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 cessation 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.
Schreiber 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. Vespre 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
abdomen ruptured from the pressure of the fetus; and quite recently
Geoghegan illustrates the possibilities of uterine pressure in
pregnancy by a postmortem 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 praevia, the patient recovered.

Rupture of the uterus and recovery does not necessarily prevent
subsequent successful pregnancy and delivery by the natural channels.
Whinery relates 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. Analogous 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 transverse and quite extensive, but the woman made a good recovery.
Schauta pictures an exostosis on the promontory of the sacrum.
Blenkinsop 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 section. A peculiarity of this case was
the easy expulsion from the uterus, no instrumental or other manual
interference being attempted and the uterus remaining perfectly intact.

In some cases there is extensive sloughing of the genitals after
parturition with recovery far beyond expectation. Gooch mentions a case
in which the whole vagina sloughed, yet to his surprise the patient
recovered. 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,
nymphae, 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 survived, 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 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
descended several inches and hung loosely on the concave surface of the
rectum. 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 wound
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
extracted. There have been instances in which the whole uterus and its
appendages, not being recognized, have been dragged out. Walters cites
the instance of a woman of twenty-two, who was in her third
confinement. 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 protruding
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"
consisted of the uterus, with the placenta attached to the fundus, the
funis, a portion 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 an hour after the
intestines had been found in the yard (where the brute had thrown
them), still alive and reproaching her murderer.  Hoffman 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 refuge in a
neighboring house, and soon felt the pains of child-birth. The
accoucheur was summoned, pronounced 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 unfortunate 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.

It would too much extend this chapter to include the many accidents
incident 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
3/4 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 10
1/2 pounds and had a large head in a remarkably advanced stage of
ossification, with the fontanelles nearly closed. Delivery was
effected, 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.

Sanders reports a case of the separation of the pubic bones in labor.
Studley mentions a case of fracture of the pelvis during instrumental
delivery. 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.

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
symphysis in order to facilitate delivery in narrow pelves. This
operation has undergone 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 Courvee upon a dead body
in order to save the child, and afterward by Plenk, in 1766, 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
symphysiotormist, and the procedure is very generally known as the
"Sigaultean operation." From Ferrara's time to 1858, when the operation
had practically died out, it had been performed 85 times, with a
recorded mortality of 33 per cent. In 1866 the Italians, under the
leadership of Morisani of Naples, revived the operation, and in twenty
years had performed it 70 times with a mortality of 24 per cent. Owing
to rigid antiseptic technic, the last 38 of these operations (1886 to
1891) showed a mortality of only 50 per cent, while the
infant-mortality was only 10 2/3 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 correspondingly encouraging.

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 perform 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
seventeen days; and there were 2 cases on record in France in the last
century, one of which 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 taken 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, 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 continued until February 4th (seventeen
days after). At this time she was delivered 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 woman with a
bicornate uterus who bore two twins at fifty-four days' interval.



CHAPTER IV.

PROLIFICITY.

General Historic Observations.--Prolificity is a much discussed
subject, 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 increase 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 breeding
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 the
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 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,"
bemoaning 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 Rudbeck 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 wonderful 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. Pare, 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 excess, 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 plural gestation
(monochorionic and dichorionic) were known to the ancients. In this
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 Pare, who has done some good work in statistical
research on this subject, says a that Margaret, of a noble and ancient
family near Cracovia, the wife of Count Virboslaus, 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 exhibition 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 Countess 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
hydatidiform 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
  Prussia,     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


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 supplied 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 reports 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 Ingersoll, Texas:--

"I was called to see Mrs. E. T. Page, January 10, 1890, about 4 o'clock
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 11 A.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 1/2 pounds
without clothing; the first weighed 6 pounds; the second 5 pounds; the
third 4 1/2 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 1/4 ounces and 4 pounds 3 ounces; and of 2 females, weighing 4 pounds
3 ounces and 3 pounds 13 3/4 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 woman residing in Courland gave birth to 4 girls, 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 surviving. 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 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 9 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. Pare 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. 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 1/2 to 16 1/2 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 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 birth at Monticello, Ill., 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 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 a of sextuplets in
Italy in 1844.  In Maine, June 27, 1847, a woman was delivered of 6
children, 2 surviving 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 delivered.  Traction on
the umbilical cord started hemorrhage, to check which the physician
placed his hand in the uterine cavity. In this most arduous position he
remained four hours until assistance from Lugano came. Then, in the
presence of the three visiting physicians, a sixth amniotic sac was
delivered with its fetus.  The woman had a normal convalescence, and in
the following year gave birth to healthy, living twins. The News says
the children 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 generally 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 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 pregnant 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 Mirandulae, quoted by Pare, 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. In the
Annals, History, and Guide to Leeds and York, according to Walford,
there is mention of Ann Birch, who in 1781 was delivered of 10
children. One daughter, the sole survivor of the 10, married a market
gardener named Platt, 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 Le Brun, 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 "gines" 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
numerous, 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 had quintuplets four times.
Pliny's case of quintuplets four times repeated has been mentioned; and
Pare, 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 Mirandulae 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 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
Fuentemajor, in Spain, forty-three years of age, was delivered of
triplets 13 times. Puech read a paper before the French Academy in
which he reports 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 second was uneventful, the 3 children living at the time of
the report. Rockwell 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, 6 1/4 pounds; the third, a male, 5 1/2 pounds. The
third child lived twenty days, the other two died of cholera infantum
at the sixth month, attributable to the bottle-feeding. Banerjee gives
the history of a case of a woman of thirty being delivered 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
quadruplets 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 accouchements,
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
of 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 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 Hookes, 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 November 21, 1768, Mrs. Shury, the wife of a cooper, in Vine Street,
Westminster, was delivered of 2 boys, making 26 by the same husband.
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 total of 53. He was 6 feet tall and lived to his
ninety-sixth year. We have already mentioned the two Russian 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 married 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
announced. About forty years of age and being quite wealthy, this
bizarre philanthropist visited various quarters of the world, securing
women of different 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 1840.
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 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
consenting 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 Nequeiras 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
grandchildren, 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.

The following is a communication to "Notes and Queries," March 21,
1891: "Mrs. Mary Honeywood was daughter and one of the coheiresses of
Robert Waters, Esq., of Lenham, in Kent. She was born in 1527; married
in February, 1543, at sixteen years of age, to her only husband, Robert
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
youngest 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 daughter's daughter hath a daughter.'

"In Markshal Church, in Essex, on Mrs. Honeywood's tomb is the
following inscription: 'Here lieth the body of Mary Waters, the
daughter and coheir of Robert Waters, of Lenham, in Kent, wife of
Robert Honeywood, of Charing, in Kent, her only husband, who had at her
decease, lawfully descended 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,' 1826.)            S. S. R."

Animal prolificity though not finding a place in this work, presents
some wonderful anomalies.

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, 1896, their sire being a magnificent
dog--"Young York." There is quoted an incredible account of a cow, the
property of J. N. Sawyer of Ohio, which gave birth to 56 calves, one of
which was fully 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.



CHAPTER V.

MAJOR TERATA.

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 Democritus, 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 muliebribus, 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 monstrosities) in the treatise De
Superfoetatione, 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 possession 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 concerning teratologic subjects which so
closely resemble those of the Chaldean magi as to be indistinguishable
from them. Indeed, such works as those of Obsequens, Lycosthenes,
Licetus, and Ambroise Pare only repeat, but with less accuracy of
description and with greater freedom of imagination, 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 existence of monsters, and in the
Middle Ages these were as faulty as the descriptions themselves.  They
were interpreted as divinations, and were cited as forebodings and
examples of wrath, or even as glorifications 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 Pare 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. 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 Liege, 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. Pare 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 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
recognized 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 procreation 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 existence 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 outrun 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 Washington devoted exclusively 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 different
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. Rueff 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. Pare describes and pictures a monster, at Rome, on
November 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 gruesome examples of the power of imagination.

Early Teratology.--Besides such cases as the foregoing, we find the
medieval writers report likely instances of terata, as, for instance,
Rhodiginus, 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 Pare 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. Pare 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, which shows a
creature that was born shortly after a battle of 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 Pare believed in the
possibility 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 other female. Pare gives a picture 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 Mery, Duverney, Winslow, Lemery,
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 scientific epoch of teratology. We can
almost with a certainty start this era with 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 Geoffroy-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 investigation 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 teratogenesis, with reference to batrachians, have been
offered by Lombardini; and by Lereboullet and Knoch with reference to
fishes. Foll 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.  Pare
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. Many of the Museums of Natural History
contain evidences of animal terata. At Hallae is a two-headed mouse;
the Conant Museum in Maine contains the skeleton 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
causation 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 grouping of Geoffroy-Saint-Hilaire given by Hirst and Piersol, or
those of Blanc and Guinard. For convenience, we have adopted the
following classification, which will include only those monsters that
have LIVED AFTER BIRTH, and who have attracted general notice or
attained some fame in their time, as attested by accounts in
contemporary literature.

CLASS 1.--Union of several fetuses.  CLASS 2.--Union of two distinct
fetuses by a connecting band.  CLASS 3.--Union of two distinct fetuses
by an osseous junction of the cranial bones.  CLASS 4.--Union of two
distinct fetuses in which one or more parts are eliminated by the
junction.  CLASS 5.--Fusion of two fetuses by a bony union of the
ischii. CLASS 6.--Fusion of two fetuses below the umbilicus into a
common lower extremity.  CLASS 7.--Bicephalic monsters.  CLASS
8.--Parasitic monsters.  CLASS 9.--Monsters with a single body and
double lower extremities.  CLASS 10.--Diphallic terata. CLASS
11.--Fetus in fetu, and dermoid cysts.  CLASS 12.--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. Bartholinus 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 mentioning 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.  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 Pare, 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 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, described by Dr. Andrew Berry, lived
to be seven years old; they stood face to face, with their chests 6 1/2
inches and their pubes 8 1/2 inches apart. Mitchell describes the
full-grown female twins, born at Newport, Ky., called the Newport
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 advisability 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 surprise an investigator. A curious volume
in this library is a book containing 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 will 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 born 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, 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
Chowpahyi to allow them to go away for exhibition. They were first
taken out of the country by a certain Captain Coffin. The first
scientific description 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 1 1/2 inches in height.
They presented all the characteristics of Chinamen and wore long black
queues coiled thrice around their heads, as shown by the accompanying
illustration. After an eight-weeks' tour over the Eastern States they
went to London, arriving 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, adopting the name of Bunker. When
forty-four years of age they married two sisters, 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 separation," 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
affection 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 Physicians, Philadelphia.

The feasibility of the operation of separating them was discussed by
many of the leading men of America, and Thompson, Fergusson, Syme, Sir
J. Y. Simpson, Nelaton, and many others in Europe, 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 intemperate, had marked
spinal curvature, and shortly afterward became hemiplegic. They were
both partially blind in their two anterior eyes, possibly from looking
outward and obliquely. The point of junction was about the
sterno-siphoid 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 4 1/2 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.

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 intercommunication of the livers and independence of
the two peritoneal cavities and the intestines. The band itself was
chiefly a coalescence of the xyphoid cartilages, surrounded by areolar
tissue and skin.

The "Orissa sisters," or Radica-Doddica, shown in Europe in 1893, were
similar to the Siamese twins in conformation. They were born in 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. 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
monstrosity in the form of two female children, one 34 inches and the
other 33 3/4 inches high, connected by the sternum. They were said to
have had small-pox and to have recovered. They seemed to have had
individual nervous 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.

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 1/2
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 separated 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 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 Roman 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 governmental order,
being considered a presage of evil. They returned, however, at 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 performed
without accident, but one of the children, already very feeble, died
three days after; the other survived. The last attempt at an operation
like this was in 1881, when Biaudet and Buginon attempted to separate
conjoined sisters (Marie-Adele) born in Switzerland on June 26th.
Unhappily, they were very feeble and life was despaired of when the
operation was performed, on October 29th. Adele 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 sometimes called craniopagi. A very ancient observation 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. When one walked forward, 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; 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.

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 a of two girls joined at their vertices, who survived
their birth. With the exception 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. 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
individuals 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 Biddenden, 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 $155.00
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. 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 20 acres of land, now yielding L35 per annum. and known as the
'Bread and Cheese Lands.' About the year 1100 there lived Eliza and
Mary Chulkhurst, 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 curiosities. 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
distribution 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
occasionally so reprehensible that sometimes the church-wardens had to
use their wands for other purposes than symbols 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 teratologic 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
occurrence. The year 1100 was, it will be remembered, that in which
William Rufus 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, several 'prodigies' preceded the death of this profligate
and extravagant monarch. 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 declared that they had seen it. And after
this, on the morning after Lammas 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 evident 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", published in 1557, states, upon what
authority I know not, that in the year 1112 joined twins resembling the
Biddenden phenomenon in all points save in sex were born in England.
The passage is as follows: '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 passing 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 forgotten.

"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 according 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. R.
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 (Rosalie
and Josepha Blazek). The interspace between the thoraces may, however,
have simply been the addition 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 improbable 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 l'Acad. Med., 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 forthcoming 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 examined 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 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 Komorn, 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
depressed. 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 suddenly 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
interesting paper, discusses the physical, moral, and religious
questions in reference 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.

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 and the
dominating spirit.  They menstruated regularly from the age of
thirteen. One from long habit yielded instinctively to the other's
movements, thus preserving the necessary harmony. They ate separately,
had distinct thoughts, and carried on distinct conversations at the
same time. They experienced hunger and thirst generally simultaneously,
and defecated and urinated nearly at the same times. One, in tranquil
sleep, would be wakened by a call of nature of the other. Common
sensibility was experienced 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 distinct in each, except where the pelves joined.
They were exhibited in Paris 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 photograph of these "Bohemian twins," as they are
now called.

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 intention 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 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 alongside of each
other. They were females, and had two vaginae, two urethrae four labia
minora, and two labia majora, one anus, but a double rectum divided by
a septum. They micturated independently but defecated simultaneously.
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 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 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 genitourinary organs; it only
lived a short while. Many people in the region flocked to see the
wonderful child, whom Licetus called "Monstrum Anglicum." 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-Saint-Hilaire 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 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
succession 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.

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 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
Commentaries 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 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.

Roger 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 survivor 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 sensations,
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, 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 at a point a little below the mammae.  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 exhibition, 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, 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 digestive 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 rudimentary os
innorminatum. 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.

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 therefore impossible. All their sensations 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
several 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
commenced 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 measured five inches in length and tapered to
a fine point, being furnished 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 sensations 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 respiratory
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. 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.
Pare mentions and gives an illustration of a female apparently single
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; 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. 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 physiologic 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
the head. The ordinary head was nearly perfect and of usual volume, but
fused with its vertex and reversed was a supernumerary head. 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 midwife, 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.

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
deformity 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 committed 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 malignant sort,
however.' It would be seen to smile and sneer while Mordake 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 whispers
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 brown 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,
pseudencephalon, and the janiceps, prosopthoracopagus, disprosopus,
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. Pare, 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." Bustorf 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. Reichel and
Anderson mention a living parasitic monster, the inferior trunk of one
body proceeding from the pectoral region of the other.

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.
Pare appends an illustration, which is, perhaps, one of the most
familiar in all teratology. He also gives a portrait of a man who had a
parasitic head 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 to manhood and both heads were utilized in
alimentation.  Bartholinus details a history of an individual named
Lazarus-Joannes Baptista Colloredo, 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 accredited with being married and the father of several
children who were fully and admirably developed. Moreau quotes a case
of an infant similar in conformation 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 Academie
Royale des Sciences the history of a girl of twelve who died at the
Hotel-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
evacuated at intervals from the parasite, and received into a diaper
constantly worn for this purpose. Sensibility in the two was common, an
impression applied to the parasite being felt by the girl. Winslow
gives an interesting 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 l'Hopital at
Naples, he saw in that city an aged man, well conformed, with 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 like 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
extraordinary freak of nature, was an amalgamation of two children.
From the body of an otherwise perfectly formed child was a
supernumerary head protruding 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. Montare and Reyes were commissioned by the Academy of Medicine of
Havana to examine and report on a monstrous 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 cartilage 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 3/4 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 rudimentary 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 perfect infant's notice. The mouth of the parasite constantly
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 effected 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 mammae, one larger than the other. No
genitalia were seen on the parasite and it exhibited no active
movements, 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 daughters.

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 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 testicles; 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 temperature seemed to occur
simultaneously in both. To pander to the morbid curiosity of the
curious, the "Dime Museum" 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
analogous 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 represents an epignathus, a
peculiar type 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
duplication of the lower extremities. Pare says that on January 9,
1529, there was living in Germany a male infant having four legs and
four arms. In Paris, at the Academie des Sciences, on September 6,
1830, there was presented 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. Aldrovandus 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, 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 a describes Mrs. B., aged twenty, still alive and healthy.  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
menstruation occurs simultaneously. She was married at nineteen, and
became pregnant 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 outside 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 continuation of the processus coceygeus of
the sacrum, and in addition to well developed mammae regularly
situated, there were two rudimentary ones close together above the
pubes. There were two vaginae and two well-developed vulvae, both
having equally developed sensations. The sexual appetite was markedly
developed, and coitus was practised in both vaginae. 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
supernumerary 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.

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
discussion. To many of these cases have been attributed exaggerated
function, notwithstanding the fact that modern observation almost
invariably shows that the virile power diminishes in exact proportion
to the extent of duplication.  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 a was in a soldier of Charles VI,
twenty-two years old, who applied to the surgeon for a bubonic
affection, and who declared that he passed urine from the orifice of
the left glans and also said that he was incapable of true coitus.
Valentini mentions an instance in a boy of four, in which the two
penises were superimposed. Bucchettoni 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
duplication of each scrotum, but only one testicle in each, and several
other minor malformations.

Gore, 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 urethra, urine being discharged
from both simultaneously. In a similar case, spoken of by
Geoffroy-Saint-Hilaire, the two organs were also separate, but urine
and semen escaped sometimes 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
proportioned, and had two distinct penises, each as large as that of a
child of six months.  Urination proceeded 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
connected to the pubis by a short stem 1/2 inch long and as large as
the little finger, consisting of separate 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 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
coceygeus. 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 instance 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
apparently 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 sufficient 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 desires, erections, and emissions.  Both penises became
erect simultaneously, the right more vigorously. The left leg was
shorter than the right and congenitally 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-formed 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 1/4 or 1/2 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 1/2 inch long, and a divided scrotal sac 21
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
provided 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 case, 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 duplication of
the female genital organs (double clitoris, vulva, vagina, and uterus).
Although Schurig, Meckel, Himly, Taruffi, and others give bibliographic
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 individually 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 distance 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 distinctly 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 vesiculae 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 abdominal 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 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. Ruysch 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 laminae 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 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 tibiae 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 affected 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 child 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
abdomen 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 old, when after much enlargement of pregnancy and subsequent
flooding the boy died." The fetus, removed after death, on the whole
not very imperfectly 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 Hopital de la Charite in Paris, Velpeau startled an audience of
500 students and many physicians by saying that he expected to find a
rudimentary fetus in a scrotal tumor placed in his hands for operation.
His diagnosis proved correct, and brought him resounding praise, and
all wondered 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.
Aretaeos 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' pregnancy. One was very rudimentary and only 21 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 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 submits 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. McIntyre speaks of a child of eleven,
playing about and feeling well, but whose abdomen progressively
increased in size 1 1/2 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 was
found in a man's bladder. Bouchacourt reports the successful
extirpation 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
foregoing instances could be paralleled from other sources.  Rodriguez
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, accompanied 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 sacrococcygeal 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 containing
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 sebaceous 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 containing 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
previously mentioned structures, cartilage and glands, mucous and
serous membrane, 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, taken 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
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.
According to Senn, the swelling never caused any pain or inconvenience
until it inflamed, 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 numerous 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 sternum at the
junction of the manubrium with the gladiolus, and a similar cyst in 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 containing 11
ounces of atheromatous material. In the Museum of St. Bartholomew'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 contained 40 ounces of atheromatous material. 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 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 instrument. 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 abdomen
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 1/2 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 evidently 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 Rayer 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.

Hermaphroditism.--Some writers claim that Adam was the first
hermaphrodite 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 foregoing 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 prevalent in the olden times. The ancients
considered the birth of hermaphrodites 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 Tertullian noticed this anomaly among the Romans.
Aetius and Paulus Aegineta speak of females in Egypt with prolonged
clitorides which made them appear like hermaphrodites. Throughout the
Middle Ages we frequently find accounts, naturally exaggerated, 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 epispadias, rotundity of the mammae, 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. Pare 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 Albucasiusus describes a necessary operation
for the removal of the clitoris.

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 Charles Hoffman, 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 afterward. Fitch speaks of a house-servant with masculine
features and movements, 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 5 1/4
inches long and 3 5/8 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 menstruation, which lasted but two days.

Beclard showed Marie-Madeline Lefort, nineteen years of age, 1 1/2
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. She menstruated slightly and had an
opening at the root of the clitoris. The parotid region showed signs of
a beard and she had hair on her upper lip. On August 20, 1864, a person
came into the Hotel-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.  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 made. 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 twenty-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 discussion, in which the court took part, that it was
definitely settled that this person was a male.

Adelaide Preville, 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-Dieu to be a man. A man was spoken of in both France and Germany
a who passed for many years as a female. He had a cleft scrotum and
hypospadias, 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 impregnating 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 examination
proved to be a male pseudohermaphrodite.

Fournier speaks of an individual in Lisbon in 1807 who was in the
highest degree graceful, the voice feminine, the mammae well developed,
The female genitalia were normal 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
testicles, which were well formed, there existed a small vulva
furnished with labia and nymphae, 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, and adds that perfect
hermaphroditism is a physical impossibility without great alterations
of the natural connections of the bones and other parts of the pelvis.
Cooper describes a woman with an enormous development 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
accompanying 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.

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 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 internal 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 radical cure of a right
inguinal hernia. The external organs were those of a male with
undescended 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 children 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
hermaphroditism due to elongation of the clitoris. In Litten's case a
the clitoris was 3 1/2 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 mammae 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 congenital, 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 approximation 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 declared, and sometimes dissection does not definitely
indicate the predominating sex. Such cases are classed under the head
of neuter hermaphrodites, possibly an analogy of the "genus epicoenum"
of Quintilian. Marie Dorothee, 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 inferior face near the root an opening
for the passage of urine. No traces of nymphae, 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
classification. 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,
voluminous 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 exclusive 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.  "Hermaphroditus an ad testamentum adhiberi
possit qualitas sesus 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.



CHAPTER VI.

MINOR TERATA.

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 addition 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. Ballantyne 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 'genethliaque,' 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 monstrosities
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 teratologic auguries which
occupy so much space in the fragments of the great treatise on
terrestrial presages which have up to the present time been published."

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) that 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 estroyed;

(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 will be in affliction, 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 effaced;

(20) that has no nose, affliction will 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 kuri 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
lukunu;

(30) that has six toes on each foot, the people of the world will be
injured (calamity to the troops);

(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 the 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 bir;

(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 (?);

(61) that has on the head two long and thick ears, there will be
tranquility and the pacification 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 lion' (No. 1) may have been it is difficult to
determine; but doubtless 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), Gradenigo (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 Psychiatrie 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 (Toynbee, 'Diseases of the Ear,' 1860). The instance of an
infant born with two ears on the right side (No. 10) 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 probably 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 (syndactyly), 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 statement 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, hali riksi, and kali on the head of the
new-born infant it is impossible to tell. The guess may be hazarded
that cephalhematoma, hydrocephalus, 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 necessary
before any certain identification is possible. The 'pieces of skin
hanging from the 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
elasticity 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 subcutaneous 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 exhibitionist 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, 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 transformation 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
appearance like that of the true "elastic-skin man."

Occasionally abnormal development of the scalp is noticed.  McDowall of
twenty-two. On each side of the median line of the head there were five
deep furrows, 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 hypertrophy 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 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 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
individuals 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 big enough to
admit his body and is closely set with sharp knife-points, daggers,
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,
considered it worth while to lecture about the man's skin, pronouncing
it an inexplicable 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.

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 Trelat 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 complete
form. Heredity plays no part in the number of cases investigated by the
authors. D'Aube, by his observations on white rabbits, believes that
the influence of consanguinity is a marked factor in the production of
albinism; there are, however, many instances of heredity in this
anomaly on record, and this idea is possibly in harmony with the
majority of observers.  Geoffroy-Saint-Hilaire has noted that albinism
can also be a consequence of a pathologic condition having its origin
in adverse 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, two consecutive white girls, one
black girl, one white boy. Sym of Edinburgh 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
particularly 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. Rene Claille, in his "Voyage a Tombouctou," says that he saw a
white infant, the offspring 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 necessarily 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. Ordinarily 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 hair. Partial albinism, necessarily
congenital, presenting a piebald appearance, 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
celebrated in the religious history of Oriental nations, and is an
object of veneration and worship in Siam. White monkeys and white
roosters are also worshiped. In the Natural History Museum in London
there are stuffed 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 molluscum
simplex, 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
examples. Aldrovandus, Amatus Lusitanus, Boerhaave, Dupre, Schenck,
Riverius, 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. Rhodius 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 11 inches
long and 2 1/2 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
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 collection 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 sustenance 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. 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
disturbance 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 diameter and six inches in height.
It was hard at the summit and had a fetid 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 forehead. Sands speaks
of a woman who had a horn 6 3/4 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 1/2 cm. at the apex, and was quite
mobile. It began to grow at the age of eleven and had constantly
increased. Vidal presented before the Academie de Medecine in 1886 a
twisted horn from the head of a woman. This excrescence was ten inches
long, and at the time of presentation 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 representing the growth during twelve months. Lall
mentions a horn from the cheek; Gregory reports one that measured 7 1/2
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 auricle; Saxton of New York has excised several horns from the
tympanic membrane of the ear; Noyes speaks of one from the eyelid;
Bigelow 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 appeared a small wart, followed by
a horn about the size of a marble. Jewett speaks of a penile horn 3 1/2
inches long and 3 3/4 inches in diameter; Pick mentions one 2 1/2
inches long. There is an account of a Russian peasant boy who had a
horn on his penis from his earliest childhood. Johnson mentions a case
of a horn from the scrotum, which was of sebaceous origin and was
subsequently supplanted by an epithelioma.

Ash reported the case of a girl named Annie Jackson, living in
Waterford, Ireland, who had horny excrescences from her joints, arms,
axillae, nipples, ears, and forehead. Locke speaks of a boy at the
Hopital de la Charite in Paris, who had horny excrescences four inches
long and 11 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 carcinomatous 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 its origin from beneath the preputium clitoridis.

Horns are generally solitary 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 Manzuroff had 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 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 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 perspiration 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 Philadelphia 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. Hill 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 hairless. Hill mentions 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
congenital 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 reports 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 peculiarity in his cousin-german.  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.

Rayer quotes the case of Beauvais, who was a patient in the Hopital de
la Charite 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, occasioned by the stumps of several hairs
which the patient had shaved off. 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 indicated 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 syphilis 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 destitute 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 section on precocious development (Chapter VII);
however, Moreau de la Sarthe showed a child to the Medical Faculty of
Paris in whom precocious development 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
Paullini 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
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 excessive 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 Rosine-Marguerite
Muller, 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 mustache. 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.
Ecker examined in 1876 a woman who died at Fribourg, whose face
contained a full beard and a luxuriant mustache.

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 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 sentiments. 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 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 woman 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 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 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
development 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
like animals; but this is sometimes found among civilized people. This
abnormal presence of hair on the human body has been known for many
years; the description of Esau in the 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 "l'homme-chien" Adrien Jeftichew,
a Russian 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
Crawford 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 the euphonious name of "Jo-Jo, the dog-face boy." His
face was truly that of a skye-terrier.

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.

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 unfortunate 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., undoubtedly 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 prominent
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 naevus.

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 molluscum. In addition to hairy
nevi on the other parts of the body there was localized ichthyosis.

Ziemssen figures an interesting case of naevus pilosus resembling
"bathing tights". There were also present several benign tumors
(fibroma molluscum) 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 naevus spreading 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 naevus, 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 naevus pilosus and fibroma molluscum 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
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 London 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 Sutherland Sisters," whose hair touched the ground,
and with whom nearly every one is familiar through a hair tonic which
they extensively advertised. In Nature, January 9, 1892, is an account
of a Percheron horse whose mane measured 13 feet and whose tail
measured almost ten feet, probably 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 Ephemerides contains the account of a woman who had hair from the
mons veneris which hung to the knees; it was affected with plica
polonica, as was also the other hair of the body.

Rayer saw a Piedmontese of twenty-eight, with an athletic build, who
had 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 circumference.

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. Rayer 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
illness occasioned by an affection analogous to marasmus became
covered, especially on the back, breast, and abdomen, with a multitude
of small elevations similar to those which appear on exposure to cold.
These little 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 according 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 having 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 1 1/2 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
consequence of some distressing news that reached him. Cassan records a
similar case. According to Rayer, a woman by the name of Perat,
summoned 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 opening 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 contents 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-Sequard observed on several occasions in his own
dark beard hairs which had turned white in a night and which he
epileptoid. 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 five 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 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 flexion 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 before the Faculte de Montpelier, and though
cured of his nervous symptoms his hair was still white, and no
suggestion of relief was offered him.

Louis of Bavaria, who died in 1294, on learning of the innocence of his
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 terrible 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 Hirshberg, 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-white in a short time. Ludwig has known the eyelashes to
become white after small-pox.  Communications are also on record of
local decolorization 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 they 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
temple, 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 while 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 mottling of hair in a girl sick with chlorosis.
The whitening extended from the roots to a distance of two inches. The
probable cause was a temporary alteration of the pigment-forming
function. When the chlorosis was cured the natural color returned.
Paullini 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 appearance shown in Figure 89.  The complexion
was delicate throughout, the eyelashes and eyelids dark brown, the
moustache and whiskers blond, and in the latter were a few groups of
white hair. The white patches were chiefly on the left side of the
head. The hairs 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, 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 contrary, 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. Villerme 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 literature Blanchard and Marcellus Donatus speak of green
hair; Rosse 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 Africanus, in his description of Barbary,
describes endemic baldness. Neyronis makes the following observation: 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, hypertrophy,
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 time
in the care of these nails.  Some savage tribes have long and thick
nails resembling the claws of beasts, and use them in the same way as
the lower animals.  There is a description of a person with
finger-nails that resembled the horns of a goat.

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.
Bartholinus 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.

Rouhuot sent a description and drawing of some monstrous nails to the
Academie des Sciences de Paris. The largest of these was the left great
toe-nail, which, from its extremity to its root, measured 4 3/4 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. Rayer
mentions two nails sent to him by Bricheteau, physician of the Hopital
Necker, belonging to an old woman who had lived in the Salpetriere.
They were very thick and spirally twisted, like the horns of a ram.
Saviard informs us that he saw a patient at the Hotel 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 exterior, 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, presented these horny
productions. One of them was four inches in length. This horny growth
appeared after small-pox. Ash, in the Philosophical Transactions,
records a somewhat similar case in a girl of twelve.

Anomalies of the Teeth.--Pliny, Colombus, van Swieten, Haller,
Marcellus 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 sixteenth century; Boyd, the poet;
Valerian, Richard 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 Academie de Medecine 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,
Mattei, Dumas, Belluzi, and others report the eruption of teeth in the
newborn. In Dumas' case the teeth had to be extracted on account of
ulceration of the tongue. Instances of triple dentition late in life
are quite numerous, many occurring 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
afterward 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 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 Petrequin have observed similar
cases. Carter describes an example of third dentition. Lison 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 "l'homme-chien," was the subject of defective dentition. Borellus
found atrophy of all the dental follicles in a woman of sixty who never
had possessed 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 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. Giraldes 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 incisors of the first dentition in the superior
maxilla. Rayer 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 Soemmering 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
continuous mass. In the "Musee de l'ecole 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
speaks 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 Laegevidenskaben, 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 accidentally during the routine examination.  It was
easily removed, having 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 deviation of position. Fanton-Touvet, however,
gives an example of a supernumerary tooth implanted in the palatine
arch. Branch a 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
extrafollicular 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
anencephalous 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 cerebrum. Heysham records the birth of a child without a
cerebrum and remarks 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 century. In the Philosophical
Transactions there is mentioned a child virtually born without a head
who lived four days; and Le Duc 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 Elsner
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. Malacarne saw life in one for
twelve hours, and Mery has given a description of a child born without
brain that lived almost a full day and took nourishment. In the
Hotel-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 cerebellum. 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
intelligence, 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.

{footnote} The argument that the brain is not the sole organ of the
mind is in a measure substantiated by a wonderful case of a decapitated
rooster, reported from Michigan. A stroke of the knife bad 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.


Ward mentions an instance of congenital absence of the corpora
callosum. Paget and Henry mention cases in which the corpora callosum,
the fornix, and septum lucidum were imperfectly formed.  Maunoir
reports congenital 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
individual was called "l'homme-oiseau," or the human bird, and his
cranial capacity was only 390 c.c. Lombroso speaks of another
individual called "l'homme-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". 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 degrees, 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 fourteen 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 microcephalic woman of thirty who
weighed 70 pounds.

Hippocrates and Strabonius both speak of head-binding as a custom
inducing 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
seven. At twenty-seven it measured over 37 inches in circumference and
the man's face was 15 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 1/4 inches; from the chin over the
cranial summit to the suboccipital protuberance, 37 1/2 inches; the
distance from the chin to the pubes was 20 inches; and from the pubes
to the soles of the feet, 16; 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 1/2 inches in head-circumference.

The largest healthy brains on record, that is, of men of prominence,
are those of Cuvier, weighing 64 1/3 ounces; of Daniel Webster,
weighing 63 3/4 ounces (the circumference of whose head was 23 3/4
inches); of Abercrombie, weighing 63 ounces, and of Spurzheim, weighing
55 1/16 ounces. Byron and Cromwell had abnormally heavy brains, showing
marked evidence of disease.

A curious instance in this connection is that quoted by Pigne, 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.
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 hydrocephalic infant whose head measured 27
1/2 inches in circumference; Bright describes one whose head measured
32 inches; and Klein, one 43 inches. Figure 93 represents a child of
six whose head circumference was 36 inches. Figure 94 shows a
hydrocephalic adult who was exhibited 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
material of the bones of the head. There was considerable arrest of
development of the parietal, temporal, and superior maxillary bones, in
consequence of which a very small amount of the cerebral substance
could be protected by 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 nostrils were
imperforate and there was no roof to the mouth nor floor to the nares.
The eyes were curiously free from eyelashes, eyelids, or brows. The
cornea threatened to slough. There was double harelip 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 exhibited no sense of light. It
died shortly after the accompanying sketch was made.

Occasionally a deficiency in the osseous material of the cranium or an
abnormal dilatation of the fontanelles 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. 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, agnathes 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
immobility of the jaws. Boullard reports a deformity of the visage,
resulting in a deficiency of the condyles of the lower jaw. Maurice
made an observation on a vice of conformation of the lower jaw which
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
appendix, there was a plane surface perforated by two small openings a
little less than one mm. in diameter 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
celebrities, we find that Numa, to whom was given the surname
Pompilius, had a nose which measured six inches.  Plutarch, Lyourgus,
and Solon had a similar enlargement, as had all the kings of Italy
except Tarquin the Superb.

Early in the last century a man, Thomas Wedders (or Wadhouse), with a
nose 7 1/2 inches long, was exhibited throughout Yorkshire. This man
expired as he had lived, in a condition of mind best described as the
most abject idiocy. The accompanying illustration 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
alimentation; but these will be spoken of in another chapter.

There have been some celebrities whose noses were undersized. The Duc
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. Rikere
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 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 congenital 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 6
1/2 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
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. In
other cases this malformation is unilateral and the fissure ascends, in
which instance the fissure may be accompanied by a fistula of the duct
of Stensen. Sometimes there is associated with these anomalies curious
terminations 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.  Molliere
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,
Smith, Sourrouille, and Stankiewiez 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 Philadelphia. 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
malformation of the lower lip occurring in one family.

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. In other cases the minimum degree of this deformity is
seen.

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. Aurran, Bartholinus, Louis, Parsons, Tulpius, and others
mention speech without the presence of a tongue.

Philib reports a case in which mutism, almost simulating that of one
congenitally 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. Rev. Henry Wharton, Chaplain to Archbishop Sancroft, in his
journal, written in the seventeenth century, says that he was born with
two tongues and passed through life so, one, however, gradually
atrophying. In the polyclinic 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 histologic 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 fissured tongues. Dolaeus
records an instance of double tongue in a paper entitled "De puella
bilingui," and Beaudry and Brothers speak of cleft 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
complained 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,
bilateral, 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 Salmuth describe uvulae so defective as to
be hardly noticeable. Bolster, Delius, Hodges, Mackenzie of Baltimore,
Orr, Riedel, Schufeldt, and Tidyman are among observers reporting
bifurcated and double uvula, and they are quite common. Ogle records
instances of congenital absence of the uvula.

Anomalies of the Epiglottis.--Morgagni mentions a man without an
epiglottis who ate and spoke without 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 without interference with deglutition.  Manifold speaks of a
case of bifurcated epiglottis. Debloisi records an instance of
congenital web of the vocal bands.  Mackenzie removed a congenital
papillomatous web which had united the vocal cords until the age of
twenty-three, thus establishing 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 singing 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 adjustment 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.

{footnote} The following 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 sometimes 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."


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. Holmes reports a
case of congenital absence of both eyes, the child otherwise being
strong and perfect. The child died of 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 deficiency 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
exophthalmos, 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.
Vallentini in 1884 reports a case of a male cyclopic infant which lived
for seventy-three hours. There were median fissures of the upper lip,
preauricular appendages, oral deformity, and absence of the olfactory
proboscis The fetus was therefore a cyclops arrhynchus, or
cyclocephalus. Blok describes 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 monstrosity
of whom little reliable information is obtainable. He was 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 was 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, looking backward with one and forward with
another, upward with one and downward with another simultaneously.' He
was of a savage, malignant disposition, delighting in ugly tricks,
teasing children, torturing helpless animals, 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, Oregon, which had a median rudimentary eye between two normal
eyes. Fournier 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
congenital 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, Reuling, 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 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 resembling 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 staphyloma 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 a 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
chambers. 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
without mention. Kuhn presents an exhaustive analysis of 73 cases of
congenital defects of the movements of the eyes, considered clinically
and didactically. 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
performed two operations for the cure of cataract in two brothers. The
operations 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 supernumerary tooth. He believes the
defects were inherited, as the patient's mother also had a
supernumerary tooth.

Nunnely 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 cornea, 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 congenital 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
"Yungti," 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 deafness 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 partial
loss of hearing. Mussey reports several cases of congenitally deficient
or absent aural appendages. One case was that in which there was
congenital 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 hearing. 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 aegipan in the British Museum showing a
supernumerary 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 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 defective
audition--harelip, ocular disturbance, 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 appendages. Figure 104 represents a
girl with a supernumerary auricle in the neck, described in the Lancet,
1888. A little girl under Birkett's care in Guy's Hospital more than
answered to Macbeth's requisition, "Had I three ears I'd hear thee!"
since she possessed two superfluous 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 on the left side of whose
neck, over the middle anterior border of the sternocleidomastoid
muscle, was a nipple-like projection 1/2 inch in length; a rod of
cartilage was prolonged into it from a thin plate, which was freely
movable in the subcutaneous tissue, forming a striking analogue to an
auricle.  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 Abbe de Marolles,
says Vigneul-Marville, bears witness in his "Memoires" that the Regent
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
explains 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.
Probably the most celebrated of this class was Marc Cazotte, otherwise
known as "Pepin," 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 Musee Dupuytren. 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. Garlick 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 ordinary stumps after 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 amputation. The flaps
were healed at the deltoid insertion and just below the groin. Pare
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 dexterity that finally his companions refused to play
with him. He was proved to be a thief and a murderer and was finally
hanged at Gueldres. Pare also relates having seen a woman in Paris who
sewed, embroidered, and did other things with her feet. Jansen speaks
of a man 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,
as he could pick up a coin thrown to him. A monster of the same
conformation was the celebrated painter, Ducornet, 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 (representing 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
exhibited 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 Societe 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 "l'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. Caldani
speaks of a monster without arms, Davis mentions one, and Smith
describes a boy of four with his upper limbs entirely absent. Breschet
has seen a child of nine with only portions of the upper arms and
deformity of lower extremities and pelvis. Pare says that 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. Pare attributes this anomaly to a
default 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 notwithstanding 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. 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 22 1/2
inches high, had no spinal curvature, but was absolutely devoid of
lower extremities. The right arm was two inches long and the left 2
1/4. Each contained the head and a small adjoining portion 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. His rolling was accomplished
by a peculiar twisting of the thorax and bending of the pelvis. There
was no history of maternal impression during pregnancy, no injury, and
no hereditary disposition to anomalous members. Figure 112 represents a
boy with congenital deficiency of the lower extremities who was
exhibited a few years ago in Philadelphia. In Figure 113, which
represents a similar case in a girl whose photograph is deposited in
the Mutter 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 signifies
abortive or imperfect formation of the members. The hands and feet were
normally developed, but the arms, forearms, and legs are much shortened.

The "turtle-woman" of Demerara 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 ligamentum 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, from whose right hip there depended a foot. 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 opening 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.  Geoffroy-Saint-Hilaire presented to
the Academie 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 supernumerary limb had six toes, while the other, which was
merely an outgrowth, had two toes on it.

According to Jules Guerin, the child named Gustav Evrard was born with
a thigh ending in two legs and two imperfect feet depending from the
left nates.

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 limb contained three fingers only, one of which did
not have a bony skeleton.

Pare 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.

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 posterior part. The anterior
foot presented a great toe and four smaller ones, but deformed like an
example of talipes equinovarus.  Continuous with the outer edge of the
anterior part and curving beneath it was a posterior part, looking not
unlike a second foot, containing six well-formed toes situated directly
beneath the other five. The eleven toes were all perfect and none of
them were webbed.

There is a class of monsters called "Sirens" on account of their
resemblance 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, which
are thought to resemble the enchantresses celebrated by Homer.

Anomalies of the Hand.--Blumenbach speaks of an officer who, having
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
abnormal, the flexion of the elbow imperfect, and the forearm
terminated 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 was 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
webbed 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. 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.

Absence of Digits.--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.

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.

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
overgrown that they could be opposed. In this family for four
generations 15 individuals 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-claw 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
articulating 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
which was dissected by Ruysch, the celebrated Amsterdam anatomist,
writes as follows.--

"This quaint figure is copied from Theodore Kerckring's 'Spicilegium
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 development 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 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 modification 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 possible that it is still in existence in
Amsterdam, and if so it is very desirable that it should be more
exactly described."

In Figure 126, A represents division of thumb after Guyot-Daubes, 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 fingers 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.

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 illustration 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.
Reaumur 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 inhabitants 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. Maupertuis 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 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 individuals 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, Ephemerides,
Munconys, as well as in numerous journals since.  This anomaly is not
confined to man alone; apes, dogs, and other lower animals possess it.
Bucephalus, the celebrated horse of Alexander, and the horse of Caesar
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 Surgeons in London.

Curling quotes a most peculiar instance of hypertrophy of the fingers
in a sickly girl. The middle and ring fingers of the right hand were of
unusual size, the middle finger measuring 5 1/2 inches in length four
inches in circumference. On the left hand the thumb and middle fingers
were hypertrophied and the index finger was as long as the middle one
of the right hand. The middle finger had a lateral curvature outward,
due to a displacement of the extensor tendon. This affection resembled
acromegaly. Curling cites similar cases, one in a Spanish gentleman,
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 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
extremities 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. Tyrtee, Parini, Byron, and Scott are among the
poets who were club-footed; some writers say that Shakespeare suffered
in a slight degree from this deformity.  Agesilas, Genserie, Robert 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. Mlle.  Valliere, 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 vertebrae are sometimes seen. In
man the lumbar vertebrae have sometimes assumed the character of the
sacral vertebrae, the sacral vertebrae presenting the aspect of lumbar
vertebrae, 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 vertebrae. In the
lower animals the vertebrae 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 missionary, 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 people
afflicted with hereditary malformation analogous to sexdigitism. A
tailed race of princes have ruled Rajoopootana, and are fond of their
ancestral 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 Indians. The workmen pursued the Indians but only succeeded
in capturing a boy of eight. He was taken to the house of Senor
Francisco Galeochoa at Posedas, and was there discovered to have a tail
ten inches long. On interrogation 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. 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 described 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 Guinea; their coccygeal bones projected 1 1/2 inches. Oliver
Wendell Holmes in the Atlantic Monthly, June, 1890, says that he saw in
London a photograph 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 distress, 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
persons 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 article on human tails.

Science contains a description of a negro child born near Louisville,
eight weeks old, with a pedunculated tail 2 1/2 inches long, with a
base 1 1/4 inches in circumference. The tail resembled in shape a pig's
tail and had grown 1/4 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. It was a
well-developed female between 5 1/2 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 3/16 inch on the inner surface and 3/8
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,
Dickinson 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 supracondyloid foremen 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 distinct projection of the great toe at an angle from
the side of the foot.

(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 concretions, 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 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
segment 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.
Nicoll 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, lordosis, 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 spine
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 spondylolisthesis.
Scoliosis may be a cervicodorsal, dorsolumbar, or lumbosacral curve,
and the inclination of the vertebral column may be to the right or
left. The pathologists divide scoliosis into a myopathic variety, in
which the trouble is a physiologic antagonism of the muscles; or
osteopathic, ordinarily associated 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 1/2 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 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 ectopies 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, corresponding to the absence of sternum,
was a longitudinal groove bounded on either side by a continuous hard
ridge which articulated with the costal cartilages. 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 occupied 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
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 approximating 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
absence of osseous structure in the middle line of the sternum, leaving
a fissure 5 3/8 X 1 3/16 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 1/2 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.

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, nipples, 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 Fevrier the exploration of a lateral pharyngeal fistula
produced by the introduction 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 Fevrier, Le Dentu, Marchand, Peyrot, and Routier.

The median congenital fissures of the neck are probably caused by
defective 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 malformation of the esophagus is imperforation
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
congenital 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 communication. 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
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 having
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. Tichomiroff 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 analogous pulmonary malformation. Eckley reports
an instance of supernumerary lobe of the right lung in close connection
with the vena azygos major.  Collins mentions a similar case. Bonnet
and Edwards speak of instances of four lobes in the right lung. Testut
and Marcondes report a 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.  Bouchand reports an instance of
absence of the right half of the diaphragm in an infant born at term.
Lawrence mentions congenital deficiency of the muscular fibers of the
left half of the diaphragm with displacement of the stomach. The
patient died of double pneumonia. Carruthers, McClintock, Polaillon,
and van Geison also record instances of congenital 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 congenital hernia of the stomach in a man of thirty-seven,
who died from collapse following lymphangitis, persistent vomiting, 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 Sandifort 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 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 example 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 Poelman, 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 Osler 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 infancy. Postmortem the
colon was found as large as that of an ox, the circumference ranging
from 15 to 30 inches. The weight of the contents was 47 pounds. Cases
are not uncommon in children. Osler reports three well-marked cases
under his care. Chapman mentions a case in which the liver was
displaced by dilatation of the sigmoid flexure. Mya reports two cases
of congenital dilatation and hypertrophy of the colon (megacolon
congenito). Hirsohsprung, Genersich, Faralli, Walker, and Griffiths all
record similar instances, 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 inaccessible 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.
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, otherwise 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 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
trying 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 practiced by a cannula introduced through
the opening, and a great number of cherry stones agglutinated with
feces followed the water, and labor was 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 hydronephrosis of a confluent kidney. There was a minute
opening into the bladder, which allowed the passage of meconium through
the urethra. Burge mentions the case of what he calls "sexless child,"
in which there was an imperforate 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.

The Liver.--The Ephemerides, Frankenau, von Home, Molinetti, Schenok,
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 mentions such a case.  Kirmisson reports a singular anomaly of
the liver which he calls double displacement by interversion and
rotation 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
communis 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 Gall-Bladder.--Harle mentions the case of a man of fifty, in whom
he could find no gall-bladder; Patterson has seen a similar instance in
a men 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;
Hollerius, 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 mesogastrium,
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 histologic appearance of splenic tissue. According to
the review of this article, Toldt explains the case by assuming that
other parts of the celomic epithelium, besides that of the
mesogastrium, are capable of forming splenic tissue.  Jameson 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
mentions an instance of second spleen. Beclard 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
Mery described the instance later which was the subject of the
following quatrain:--

"La nature, peu sage et sans douse en debauche Placa le foie au cote
gauche, Et de meme, vice versa Le coeur a le droite placa."

Young cites an example in a woman of eighty-five who died at
Hammersmith, London. She was found dead in bed, and in a postmortem
examination, 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 instance in a
man.

Herrick 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, Beclard, 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.

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 Stoll 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.
Excluding 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 vesiculae seminales in the
male, rather than the ovaries or testicles. Finally, he points out the
practical bearing of the subject--for example, the probability 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 cystoscope, and also the
likelihood of its occurring where any abnormality 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
structures in their place. Guiteras 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
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 supernumerary kidney are not uncommon, generally being
segmentation of one of the normal kidneys. Rayer has seen three kidneys
united and formed like a horseshoe. We are quite familiar with the
ordinary "horseshoe kidney," in which two normal kidneys are connected.

There are several forms of displacement of the kidneys, the most common
being the "floating kidney," which is sometimes successfully removed or
fixed; 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 supplying the left suprarenal capsule, which was in
its ordinary place.  Displacements 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 describes an elongated kidney with two ureters.
Coeyne mentions duplication 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
normally in a number of animals and causes the incessant flow of urine,
resulting in a serious inconvenience. Flajani speaks of the termination
of the ureters in the pelvis; Nebel has seen them appear just beneath
the umbilicus; 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 of
a man who evidently suffered from a patent urachus, as the urine passed
in jets 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 occasionally seen in the new-born. Shattuck describes
a male fetus showing reptilian characters in the sexual ducts. There
was ectopia vesicae and prolapse 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
Mullerian ducts which opened externally inferiorly, 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 Mullerian
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 bladders, each
receiving a ureter. Bussiere describes a triple bladder, and Scibelli
of Naples mentions an instance in a subject who died at fifty-seven
with symptoms of retention of urine. In the illustration, 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 bladders.

The Ephemerides speaks of a case of coalition of the bladder with the
os pubis and another case of coalition with the omentum.  Prochaska
mentions 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
hypospadias, 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, Rhodins, 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 foremen 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 foremen ovale remained open until the age of thirty-seven; there
were but two pulmonary valves; there was another heart showing a large
patent foramen 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 foremen ovale was still open
and would admit the fore-finger. This woman had shown no symptoms of
the malformation. There were also hearts in which 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. Ramel 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
described 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 difficulty always returned. At last deglutition became
impossible and the patient died of malnutrition. A necropsy revealed
the presence of the subclavicular artery passing between the tracheal
artery and the esophagus, compressing 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
describes 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,
Paull, and others. Scanzoni has observed absence of the left mamma with
absence of the left ovary.

Micromazia is not so rare, and is generally seen in females with
associate genital troubles. Excessive development of the mammae,
generally being a pathologic phenomenon, will be mentioned in another
chapter. However, among some of the indigenous negroes the female
breasts are naturally very large and pendulous. This is well shown in
Figure 144, which represents a woman of the Bushman tribe nursing an
infant. The breasts are sufficiently pendulous and loose to be easily
thrown over the shoulder.

Polymazia is of much more frequent occurrence than is supposed.  Julia,
the mother of Alexander Severus, was surnamed "Mammea" because she had
supernumerary breasts. Anne Boleyn, the unfortunate wife of Henry VIII
of England, was reputed to have had six toes, six fingers, and three
breasts. Lynceus says that in his time there existed a Roman woman with
four mammae, very beautiful in contour, arranged in two lines,
regularly, one above the other, and all giving milk in abundance.
Rubens has pictured a woman with four breasts; the painting may be seen
in the Louvre in Paris.

There was a young and wealthy heiress who addressed herself to the
ancient faculty at Tubingen, asking, as she displayed four mammary,
whether, should she marry, she would have three or four children at a
birth. This was a belief with which some of her elder matron friends
had inspired her, and which she held as a hindrance to marriage.

Leichtenstern, who has collected 70 cases of polymazia in females and
22 in males, thinks that accessory breasts or nipples are due to
atavism, and that our most remote inferiorly organized ancestors had
many breasts, but that by constantly bearing but one child, from being
polymastic, females have gradually become bimastic. Some of the older
philosophers contended that by the presence of two breasts woman was
originally intended to bear two children.

Hirst says: "Supernumerary breasts and nipples are more common than is
generally supposed. Bruce found 60 instances in 3956 persons examined
(1.56 per cent). Leichtenstern places the frequency at one in 500. Both
observers declare that men present the anomaly about twice as
frequently as women. It is impossible to account for the accessory
glands on the theory of reversion, as they occur with no regularity in
situation, but may develop at odd places on the body. The most frequent
position is on the pectoral surface below the true mammae and somewhat
nearer the middle line, but an accessory gland has been observed on the
left shoulder over the prominence of the deltoid, on the abdominal
surface below the costal cartilages, above the umbilicus, in the
axilla, in the groin, on the dorsal surface, on the labium majus, and
on the outer aspect of the left thigh. Ahlfeld explains the presence of
mammae on odd parts of the body by the theory that portions of the
embryonal material entering into the composition of the mammary gland
are carried to and implanted upon any portion of the exterior of the
body by means of the amnion."

Possibly the greatest number of accessory mammae reported is that of
Neugebauer in 1886, who found ten in one person. Peuch in 1876
collected 77 cases, and since then Hamy, Quinqusud, Whiteford,
Engstrom, and Mitchell Bruce have collected cases. Polymazia must have
been known in the olden times, and we still have before us the old
images of Diana, in which this goddess is portrayed with numerous
breasts, indicating her ability to look after the growing child. Figure
145 shows an ancient Oriental statue of Artemisia or Diana now at
Naples.

Bartholinus has observed a Danish woman with three mammae, two
ordinarily formed and a third forming a triangle with the others and
resembling the breasts of a fat man. In the village of Phullendorf in
Germany early in this century there was an old woman who sought alms
from place to place, exhibiting to the curious four symmetrical
breasts, arranged parallel. She was extremely ugly, and when on all
fours, with her breasts pendulous, she resembled a beast. The authors
have seen a man with six distinct nipples, arranged as regularly as
those of a bitch or sow. The two lower were quite small. This man's
body was covered with heavy, long hair, making him a very conspicuous
object when seen naked during bathing. The hair was absent for a space
of nearly an inch about the nipples. Borellus speaks of a woman with
three mammae, two as ordinarily, the third to the left side, which gave
milk, but not the same quantity as the others.  Gardiner describes a
mulatto woman who had four mammae, two of which were near the axillae,
about four inches in circumference, with proportionate sized nipples.
She became a mother at fourteen, and gave milk from all her breasts. In
his "Dictionnaire Philosophique" Voltaire gives the history of a woman
with four well-formed and symmetrically arranged breasts; she also
exhibited an excrescence, covered with a nap-like hair, looking like a
cow-tail. Percy thought the excrescence a prolongation of the coccyx,
and said that similar instances were seen in savage men of Borneo.

Percy says that among some prisoners taken in Austria was found a woman
of Valachia, near Roumania, exceedingly fatigued, and suffering
intensely from the cold. It was January, and the ground was covered
with three feet of snow. She had been exposed with her two infants, who
had been born twenty days, to this freezing temperature, and died on
the next day. An examination of her body revealed five mammae, of which
four projected as ordinarily, while the fifth was about the size of
that of a girl at puberty.

They all had an intense dark ring about them; the fifth was situated
about five inches above the umbilicus. Percy injected the subject and
dissected and described the mammary blood-supply.  Hirst mentions a
negress of nineteen who had nine mammae, all told, and as many nipples.
The two normal glands were very large.  Two accessory glands and
nipples below them were small and did not excrete milk. All the other
glands and nipples gave milk in large quantities. There were five
nipples on the left and four on the right side. The patient's mother
had an accessory mamma on the abdomen that secreted milk during the
period of lactation.

Charpentier has observed in his clinic a woman with two supplementary
axillary mammae with nipples. They gave milk as the ordinary mammae.
Robert saw a woman who nourished an infant by a mamma on the thigh.
Until the time of pregnancy this mamma was taken for an ordinary nevus,
but with pregnancy it began to develop and acquired the size of a
citron. Figure 147 is from an old wood-cut showing a child suckling at
a supernumerary mamma on its mother's thigh while its brother is at the
natural breast.  Jenner speaks of a breast on the outer side of the
thigh four inches below the great trochanter. Hare describes a woman of
thirty-seven who secreted normal milk from her axillae. Lee mentions a
woman of thirty-five with four mammae and four nipples; she suckled
with the pectoral and not the axillary breasts. McGillicudy describes a
pair of rudimentary abdominal mammae, and there is another similar case
recorded. Hartung mentions a woman of thirty who while suckling had a
mamma on the left labium majus. It was excised, and microscopic
examination showed its structure to be that of a rudimentary nipple and
mammary gland. Leichtenstern cites a case of a mamma on the left
shoulder nearly under the insertion of the deltoid, and Klob speaks of
an acromial accessory mamma situated on the shoulder over the greatest
prominence of the deltoid. Hall reports the case of a functionally
active supernumerary mamma over the costal cartilage of the 8th rib.
Jussieu speaks of a woman who had three breasts, one of which was
situated on the groin and with which she occasionally suckled; her
mother had three breasts, but they were all situated on the chest.
Saunois details an account of a female who had two supernumerary
breasts on the back. Bartholinus (quoted by Meckel) and Manget also
mention mammae on the back, but Geoffroy-Saint-Hilaire questions their
existence. Martin gives a very clear illustration of a woman with a
supernumerary breast below the natural organ. Sneddon, who has
collected quite a number of cases of polymazia, quotes the case of a
woman who had two swellings in each axilla in which gland-structure was
made out, but with no external openings, and which had no anatomic
connection with the mammary glands proper. Shortly after birth they
varied in size and proportion, as the breasts were full or empty, and
in five weeks all traces of them were lost.  Her only married sister
had similar enlargements at her third confinement.

Polymazia sometimes seems to be hereditary. Robert saw a daughter whose
mother was polymastic, and Woodman saw a mother and eldest daughter who
each had three nipples. Lousier mentions a woman wanting a mamma who
transmitted this vice of conformation to her daughter. Handyside says
he knew two brothers in both of whom breasts were wanting.

Supernumerary nipples alone are also seen, as many as five having been
found on the same breast. Neugebauer reports eight supernumerary
nipples in one case. Hollerus has seen a woman who had two nipples on
the same breast which gave milk with the same regularity and the same
abundance as the single nipple. The Ephemerides contains a description
of a triple nipple. Barth describes "mamma erratica" on the face in
front of the right ear which enlarged during menstruation.

Cases of deficiency of the nipples have been reported by the
Ephemerides, Lentilius, Severinus, and Werckardus.

Cases of functional male mammae will be discussed in Chapter IX.

Complete absence of the hymen is very rare, if we may accept the
statements of Devilliers, Tardieu, and Brouardel, as they have never
seen an example in the numerous young girls they have examined from a
medico-legal point of view.

Duplication or biperforation of the hymen is also a very rare anomaly
of this membrane. In this instance the hymen generally presents two
lateral orifices, more or less irregular and separated by a membranous
band, which gives the appearance of duplicity. Roze reported from
Strasburg in 1866 a case of this kind, and Delens has observed two
examples of biperforate hymen, which show very well that this
disposition of the membrane is due to a vice of conformation. The first
was in a girl of eleven, in which the membrane was of the usual size
and thickness, but was duplicated on either side. In her sister of nine
the hymen was normally conformed. The second case was in a girl under
treatment by Cornil in 1876 for vaginitis. Her brother had accused a
young man of eighteen of having violated her, and on examination the
hymen showed a biperforate conformation; there were two oval orifices,
their greatest diameter being in the vertical plane; the openings were
situated on each side of the median line, about five mm. apart; the
dividing band did not appear to be cicatricial, but presented the same
roseate coloration as the rest of the hymen. Since this report quite a
number of cases have been recorded.

The different varieties of the hymen will be left to the works on
obstetrics. As has already been observed, labor is frequently seriously
complicated by a persistent and tough hymen.

Deficient vulva may be caused by the persistence of a thick hymen, by
congenital occlusion, or by absolute absence in vulvar structure.
Bartholinus, Borellus, Ephemerides, Julius, Vallisneri, and Baux are
among the older writers who mention this anomaly, but as it is
generally associated with congenital occlusion, or complete absence of
the vagina, the two will be considered together.

Complete absence of the vagina is quite rare. Baux a reports a case of
a girl of fourteen in whom "there was no trace of fundament or of
genital organs." Oberteuffer speaks of a case of absent vagina. Vicq
d'Azir is accredited with having seen two females who, not having a
vagina, copulated all through life by the urethra, and Fournier sagely
remarks that the extra large urethra may have been a special
dispensation of nature. Bosquet describes a young girl of twenty with a
triple vice of conformation--an obliterated vulva, closure of the
vagina, and absence of the uterus. Menstrual hemorrhage took place from
the gums. Clarke has studied a similar case which was authenticated by
an autopsy.

O'Ferral of Dublin, Gooch, Davies, Boyd, Tyler Smith, Hancock, Coste,
Klayskens, Debrou, Braid, Watson, and others are quoted by Churchill as
having mentioned the absence of the vagina. Amussat observed a German
girl who did not have a trace of a vagina and who menstruated
regularly. Griffith describes a specimen in the Museum of St.
Bartholomew's Hospital, London, in which the ovaries lay on the surface
of the pelvic peritoneum and there was neither uterus nor vagina; the
pelvis had some of the characteristics of the male type. Matthews
Duncan has observed a somewhat similar case, the vagina not measuring
more than an inch in length. Ferguson describes a prostitute of
eighteen who had never menstruated. The labia were found well
developed, but there was no vagina, uterus, or ovaries. Coitus had been
through the urethra, which was considerably distended, though not
causing incontinence of urine. Hulke reports a case of congenital
atresia of the vagina in a brunette of twenty, menstruation occurring
through the urethra. He also mentions the instance of congenital
atresia of the vagina with hernia of both ovaries into the left groin
in a servant of twenty, and the case of an imperforate vagina in a girl
of nineteen with an undeveloped uterus.

Brodhurst reports an instance of absence of the vagina and uterus in a
girl of sixteen who at four years of age showed signs of approaching
puberty. At this early age the mons was covered with hair, and at ten
the clitoris was three inches long and two inches in circumference. The
mammae were well developed. The labia descended laterally and expanded
into folds, resembling the scrotum.

Azema reports an instance of complete absence of the vagina and
impermeability and probable absence of the col uterinus. The
deficiencies were remedied by operation. Berard mentions a similar
deformity and operation in a girl of eighteen. Gooding cites an
instance of absent vagina in a married woman, the uterus discharging
the functions. Gosselin reports a case in which a voluminous tumor was
formed by the retained menstrual fluid in a woman without a vagina. An
artificial vagina was created, but the patient died from extravasation
of blood into the peritoneal cavity. Carter, Polaillon, Martin, Curtis,
Worthington, Hall, Hicks, Moliere, Patry, Dolbeau, Desormeaux, and
Gratigny also record instances of absence of the vagina.

There are some cases reported in extramedical literature which might be
cited. Bussy Rabutin in his Memoires in 1639 speaks of an instance. The
celebrated Madame Recamier was called by the younger Dumas an
involuntary virgin; and in this connection could be cited the malicious
and piquant sonnet--

Chateaubriand et Madame Recamier.

  "Juliette et Rene s'aimaient d'amour si tendre
  Que Dien, sans les punir, a pu leur pardonner:
  Il n'avait pas voulu que l'une put donner
  Ce que l'autre ne pouvait prendre."

Duplex vagina has been observed by Bartholinus, Malacarne, Asch,
Meckel, Osiander, Purcell, and other older writers. In more modern
times reports of this anomaly are quite frequent. Hunter reports a case
of labor at the seventh month in a woman with a double vagina, and
delivery through the rectum. Atthill and Watts speak of double vagina
with single uterus.

Robb of Johns Hopkins Hospital reports a case of double vagina in a
patient of twenty suffering from dyspareunia. The vaginal orifice was
contracted; the urethra was dilated and had evidently been used for
coitus. A membrane divided the vagina into two canals, the cervix lying
in the right half; the septum was also divided. Both the thumbs of the
patient were so short that their tips could scarcely meet those of the
little fingers. Double vagina is also reported by Anway, Moulton,
Freeman, Frazer, Haynes, Lemaistre, Boardman, Dickson, Dunoyer, and
Rossignol.  This anomaly is usually associated with bipartite or double
uterus. Wilcox mentions a primipara, three months pregnant, with a
double vagina and a bicornate uterus, who was safely delivered of
several children. Haller and Borellus have seen double vagina, double
uterus, and double ovarian supply; in the latter case there was also a
double vulva. Sanger speaks of a supernumerary vagina connecting with
the other vagina by a fistulous opening, and remarks that this was not
a case of patent Gartner's duct.

Cullingworth cites two cases in which there were transverse septa of
the vagina. Stone reports five cases of transverse septa of the vagina.
Three of the patients were young women who had never borne children or
suffered injury. Pregnancy existed in each case. In the first the
septum was about two inches from the introitus, and contained an
opening about 1/2 inch in diameter which admitted the tip of the
finger. The membrane was elastic and thin and showed no signs of
inflammation. Menstruation had always been regular up to the time of
pregnancy. The second was a duplicate of the first, excepting that a
few bands extended from the cervix to the membranous septum. In the
third the lumen of the vagina, about two inches from the introitus, was
distinctly narrowed by a ridge of tissue. There was uterine
displacement and some endocervicitis, but no history of injury or
operation and no tendency to contraction. The two remaining cases
occurred in patients seen by Dr. J. F. Scott. In one the septum was
about 1 3/4 inches from the entrance to the vagina and contained an
orifice large enough to admit a uterine probe. During labor the septum
resisted the advance of the head for several hours, until it was slit
in several directions. In the other, menstruation had always been
irregular, intermissions being followed by a profuse flow of black and
tarry blood, which lasted sometimes for fifteen days and was
accompanied by severe pain. The septum was 1 1/2 inches from the
vaginal orifice and contained an opening which admitted a uterine
sound. It was very dense and tight and fully 1/8 inch in thickness.

Mordie reported a case of congenital deficiency of the rectovaginal
septum which was successfully remedied by operation.

Anomalous Openings of the Vagina.--The vagina occasionally opens
abnormally into the rectum, into the bladder, the urethra, or upon the
abdominal parietes. Rossi reports from a hospital in Turin the case of
a Piedmontese girl in whom there was an enormous tumor corresponding to
the opening of the vaginal orifice; no traces of a vagina could be
found. The tumor was incised and proved to be a living infant. The
husband of the woman said that he had coitus without difficulty by the
rectum, and examination showed that the vagina opened into the rectum,
by which means impregnation had been accomplished. Bonnain and Payne
have observed analogous cases of this abnormality of the vaginal
opening and subsequent accouchement by the anus. Payne's case was of a
woman of thirty-five, well formed, who had been in labor thirty-six
hours, when the physician examined and looked in vain for a vaginal
opening; the finger, gliding along the perineum, came in contact with
the distended anus, in which was recognized the head of the fetus. The
woman from prolongation of labor was in a complete state of
prostration, which caused uterine inertia.  Payne anesthetized the
patient, applied the forceps, and extracted the fetus without further
accident. The vulva of this woman five months afterward displayed all
the characteristics of virginity, the vagina opened into the rectum,
and menstruation had always been regular. This woman, as well as her
husband, averred that they had no suspicion of the anomaly and that
coitus (by the anus) had always been satisfactory.

Opening of the vagina upon the parietes, of which Le Fort has collected
a number of cases, has never been observed in connection with a viable
fetus.

Absence of the labia majora has been observed, especially by Pozzi, to
the exclusion of all other anomalies. It is the rule in exstrophy of
the bladder.

Absence of the nymphae has also been observed, particularly by Auvard
and by Perchaux, and is generally associated with imperfect development
of the clitoris. Constantinedes reports absence of the external organs
of generation, probably also of the uterus and its appendages, in a
young lady. Van Haartman, LeFort, Magee, and Ogle cite cases of absence
of the external female organs. Riolan in the early part of the
seventeenth century reported a case of defective nymphae; Neubauer in
1774 offers a contrast to this case in an instance of triple nymphae.

The nymphae are sometimes enormously enlarged by hypertrophy, by
varicocele, or by elephantiasis, of which latter type Rigal de Gaillac
has observed a most curious case. There is also a variety of
enlargement of the clitoris which seems to be constant in some races;
it may be a natural hypertrophy, or perhaps produced by artificial
manipulation.

The peculiar conditions under which the Chinese women are obliged to
live, particularly their mode of sitting, is said to have the effect of
causing unusual development of the mons veneris and the labia majora.
On the other hand, some of the lower African races have been
distinguished by 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 nymphae. According to John
Knott, the French traveler, Le Vaillant, said that the more coquettish
among the Hottentot girls are excited by extreme vanity to practice
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 attraction for the
male members of the race. Merensky says that in Basutoland the elder
women begin to practice 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 accredited
with seeing a case which exhibited neither nymphae, clitoris, nor
urinary meatus. Mauriceau performed nymphotomy on a woman whose nymphae
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 enlarged clitoris gave the external 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.

Among the older authorities quoting instances of enlarged clitorides
are Bartholinus, Schenck, Hellwig, Rhodius, Riolanus, and Zacchias.
Albucasis 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 Aegean 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
references 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 practiced 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 practiced
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 1/2 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 nymphae; Gallieni found a similar operation
customary on the upper banks of the Niger.

Otto at Breslau in 1824 reports seeing a negress with a clitoris 4 1/2
inches long and 1 1/2 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 titillation of the clitoris
without some visible movement.

Columbus cites an example of a clitoris as long as a little finger;
Haller mentions one which measured seven inches, and there is a record
of an enlarged clitoris which resembled the neck of a goose and which
was 12 inches long. Bainbridge reports a case of enlarged clitoris in a
woman of thirty-two who was confined with her first child. This organ
was five inches in length and of about the diameter of a quiescent
penis. Figure 149 shows a well-marked case of hypertrophy of the
clitoris. Rogers describes a woman of twenty-five in a reduced state of
health with an enormous clitoris and warts about the anus; there were
also manifestations of tuberculosis. On questioning her, it was found
that she had formerly masturbated; later she had sexual intercourse
several times with a young man, but after his death she commenced
self-abuse again, which brought on the present enlargement. The
clitoris was ligated and came away without leaving disfigurement.
Cassano and Pedretti of Naples reported an instance of monstrous
clitoris in 1860 before the Academy of Medicine.

In some cases ossification of the clitoris is observed Fournier speaks
of a public woman in Venice who had an osseous clitoris; it was said
that men having connection with her invariably suffered great pain,
followed by inflammation of the penis.

There are a few instances recorded of bifid clitoris, and Arnaud cites
the history of a woman who had a double clitoris. Secretain speaks of a
clitoris which was in a permanent state of erection.

Complete absence of the ovaries is seldom seen, but there are instances
in which one of the ovaries is missing. Hunter, Vidal, and Chaussier
report in full cases of the absence of the ovaries, and Thudicum has
collected 21 cases of this nature. Morgagni, Pears, and Cripps have
published observations in which both ovaries were said to have been
absent. Cripps speaks of a young girl of eighteen who had an infantile
uterus and no ovaries; she neither menstruated nor had any signs of
puberty. Lauth cites the case of a woman whose ovaries and uterus were
rudimentary, and who exhibited none of the principal physiologic
characteristics of her sex; on the other hand, Ruband describes a woman
with only rudimentary ovaries who was very passionate and quite
feminine in her aspect.

At one time the existence of genuine supernumerary ovaries was
vigorously disputed, and the older records contain no instances, but
since the researches of Beigel, Puech, Thudicum, Winckler, de Sinety,
and Paladino the presence of multiple ovaries is an incontestable fact.
It was originally thought that supernumerary ovaries as well as
supernumerary kidneys were simply segmentations of the normal organs
and connected to them by portions of the proper substance; now,
however, by the recent reports we are warranted in admitting these
anomalous structures as distinct organs. It has even been suggested
that it is the persistence of these ovaries that causes the
menstruation of which we sometimes hear as taking place after
ovariotomy. Sippel records an instance of third ovary; Mangiagalli has
found a supernumerary ovary in the body of a still-born child, situated
to the inner side of the normal organ. Winckel discovered a large
supernumerary ovary connected to the uterus by its own ovarian
ligament. Klebs found two ovaries on one side, both consisting of true
ovarian tissue, and connected by a band 3/5 inch long.

Doran divides supernumerary ovaries into three classes:--

(1) The ovarium succentauriatum of Beigel.

(2) Those cases in which two masses of ovarian tissue are separated by
ligamentous bands.

(3) Entirely separate organs, as in Winckel's case.

Prolapsus or displacement of the ovaries into the culdesac of Douglas,
the vaginal wall, or into the rectum can be readily ascertained by the
resulting sense of nausea, particularly in defecation or in coitus.
Munde, Barnes, Lentz, Madden, and Heywood Smith report instances, and
Cloquet describes an instance of inguinal hernia of the ovary in which
the uterus as well as the Fallopian tube were found in the inguinal
canal. Debierre mentions that Puech has gathered 88 instances of
inguinal hernia of the ovary and 14 of the crural type, and also adds
that Otte cites the only instance in which crural ovarian hernia has
been found on both sides. Such a condition with other associate
malformations of the genitalia might easily be mistaken for an instance
of hermaphroditic testicles.

The Fallopian tubes are rarely absent on either side, although Blasius
reports an instance of deficient oviducts. Blot reports a case of
atrophy, or rather rudimentary state of one of the ovaries, with
absence of the tube on that side, in a woman of forty.

Doran has an instance of multiple Fallopian tubes, and Richard, in
1861, says several varieties are noticed. These tubes are often found
fused or adherent to the ovary or to the uterus; but Fabricius
describes the symphysis of the Fallopian tube with the rectum.

Absence of the uterus is frequently reported. Lieutaud and Richerand
are each said to have dissected female subjects in whom neither the
uterus nor its annexed organs were found. Many authors are accredited
with mentioning instances of defective or deficient uteri, among them
Bosquet, Boyer, Walther, Le Fort, Calori, Pozzi, Munde, and Strauch.
Balade has reported a curious absence of the uterus and vagina in a
girl of eighteen. Azem, Bastien, Bibb, Bovel, Warren, Ward, and many
others report similar instances, and in several cases all the adnexa as
well as the uterus and vagina were absent, and even the kidney and
bladder malformed.

Phillips speaks of two sisters, both married, with congenital absence
of the uterus. In his masterly article on "Heredity," Sedgwick quotes
an instance of total absence of the uterus in three out of five
daughters of the same family; two of the three were twice married.

Double uterus is so frequently reported that an enumeration of the
cases would occupy several pages. Bicorn, bipartite, duplex, and double
uteruses are so called according to the extent of the duplication. The
varieties range all the way from slight increase to two distinct
uteruses, with separate appendages and two vaginae. Meckel, Boehmer,
and Callisen are among the older writers who have observed double
uterus with associate double vagina. Figure 150 represents a transverse
section of a bipartite uterus with a double vagina. The so-called
uterus didelphus is really a duplex uterus, or a veritable double
uterus, each segment having the appearance of a complete unicorn uterus
more or less joined to its neighbor. Vallisneri relates the history of
a woman who was poisoned by cantharides who had two uteruses, one
opening into the vagina, the other into the rectum. Morand,
Bartholinus, Tiedemann, Ollivier, Blundell, and many others relate
instances of double uterus in which impregnation had occurred, the
fetus being retained until the full term.

Purcell of Dublin says that in the summer of 1773 he opened the body of
a woman who died in the ninth month of pregnancy. He found a uterus of
ordinary size and form as is usual at this period of gestation, which
contained a full-grown fetus, but only one ovary attached to a single
Fallopian tube. On the left side he found a second uterus,
unimpregnated and of usual size, to which another ovary and tube were
attached. Both of these uteruses were distinct and almost entirely
separate.

Pregnancy with Double Uterus.--Hollander describes the following
anomaly of the uterus which he encountered during the performance of a
celiotomy:--

"There were found two uteruses, the posterior one being a normal organ
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 Mullerian 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 superfetation 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 protracted
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. 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
observed in the inguinal region, five on the right and seven on the
left side. In the case of Roux 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,
Ledesma, Rektorzick, and Scazoni have found the uterus in the sac of an
inguinal hernia; Leotaud, Murray, and Hagner in an umbilical hernia.
The accompanying illustration represents a hernia of the gravid womb
through the linea alba.

Absence of the penis is an extremely rare anomaly, although it has been
noted by Schenck, Borellus, Bouteiller, Nelaton, and others. Fortunatus
Fidelis and Revolat describe a newly born child with absence of
external genitals, with spina bifida and umbilical hernia. Nelaton
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 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
demanded 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
Bartholinus, Bauhinus, Cattierus, the Ephemerides, Frank, Panaroli, van
der Wiel, and others. Renauldin describes a man with a small penis and
enormous mammae. Goschler, quoted by Jacobson, speaks of a
well-developed man of twenty-two, with abundant hair on his chin and
suprapubic region and the scrotum apparently perfect, with median
rapine; 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 1 1/2 inches long and 3/4 inch high
continuous with the rapine, which seemed to be formed of erectile
tissue and which swelled under excitement, the enlargement 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
bladder through a urethra 1 1/2 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 3/4 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 specimens
of the male organ divested of skin. From the meatus to the pubis they
measure 6 1/2 and 5 1/2 inches; from the extremity to the termination
of either crus 9 3/4 and 8 3/4 inches, and the circumferences are 4 3/4
and 4 1/4 inches. Between these two we can strike an average of the
size of the normal penis.

In some instances the penis is so large as to forbid coitus and even
inconvenience 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, Peyer, Plater, Schurig, Sinibaldus, and
Zacchias. Several cases of enormous penises in the new-born have been
observed by Wolff 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 projection not over 1/4 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 Guerlin also record cases, both
complicated with associate maldevelopment. Caddy 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, and
Zacchias.

Zacutus Lusitans speaks of torsion of the penis from freezing.
Paullini mentions a case the result of masturbation, and Hunter speaks
of torsion of the penis associated with arthritis.

Ossification of the Penis.--MacClellann 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
discovered in the septum between the corpora cavernosa; this was
dissected out with much hemorrhage and the upward curvature was
removed, but there resulted a slight inclination in the opposite
direction. The formation of bone and cartilage in the penis is quite
rare. Velpeau, Kauffmann, 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 Paullini 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
development is more frequent, but most common is excessive development
of the prepuce, 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, Marcellus 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
fortunately there is generally in such cases some anomalous opening of
the urethra 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 constant flow of semen from an abnormal opening in the abdomen.
La Peyroma 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 published an article clearly exposing a number of cases,
showing that it is possible 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
urethrae. 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.

Hypospadias and epispadias are names given to malformations 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 mentions 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 resolved to imitate nature, and being of a very ingenious
turn of mind, he busied himself with the construction of an artificial
penis. While so engaged 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-band by means of straps, a central and an upper
one being so arranged that the penis could be thrown into an erect
position and so maintained. He had constructed a flesh-colored covering
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 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 effeminate. 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 with 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, 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 malformation. 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 allowance 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, whose 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 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 mentioning a
soldier of twenty-one who had a supernumerary testicle erroneously
diagnosed as inguinal hernia.  Quoted by the same reference, Bulatoff
mentions 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.

Venette gives an instance of four testicles, and Scharff, in the
Ephemerides, mentions five; Blasius 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;
all 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 abdominal and in the latter scrotal. Kerckring has a
description of an individual 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
results of postmortem examinations of 89 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, hypochondriac, the voluptuous, and
the imbecile all found a place in Johnson's statistics; 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. Spermatozoa have been found days and weeks after castration,
and the individuals during this period were capable of impregnation,
but in these cases the reservoirs were not empty, although the spring
had ceased to flow. Beigel, in Virchow's Archives, mentions a
cryptorchid of twenty-two who had nocturnal emissions containing
spermatozoa and who indulged in sexual congress. Partridge describes a
man of twenty-four who, notwithstanding his condition, 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 strangulated hernia. There were two well-developed
testicles in the scrotum, and the hernia proved to be a third. McElmail
describes a soldier of twenty-nine, who two or three months before
examination felt a pricking and slight burning 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 getting 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.
Hutcheson, quoted by Russell, has given a curious case in an English
seaman who, as was the custom at that time, was 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 rejected 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 was 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
distinguished.

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
relaxation; 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, Boyer, Maisonneuve, Royet,
and other writers.

The anomalies of the vas deferens and seminal vesicles are of little
interest 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.



CHAPTER VII.

ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT.

Giants.--The fables of mythology contain accounts of horrible monsters,
terrible in ferocity, whose mission was the destruction of the life of
the individuals 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 superstitions 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, "gigas", or the Latin, "gigas." The Hebrew
parallel is "nophel," or plural, "nephilim."

Ancient Giants.--We are told in the Bible a that the bedstead of Og,
King of Basham, was 9 cubits long, which in English measure is 16 1/2
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 1/2 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 against
the Gigantes.

Pliny describes Gabbaras, who was brought to Rome by Claudius Caesar
from Arabia and was between 9 and 10 feet in height, and adds that the
remains of Posio and Secundilla, found in the reign of Augustus Caesar
in the Sallustian Gardens, of which they were supposed to be the
guardians, measured 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
modern stature is about the same as 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 1/2 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 11 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 1/2 feet high.

There are fabulous stories told of the Emperor Maximilian. Some
accounts say that he was between 8 1/2 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, Thevenot
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 "Giants' Bones."--Riolan, the celebrated anatomist, says
that there was to be seen at one time in the suburbs of Saint Germain
the tomb of the giant Isoret, who was reputed to be 20 feet tall; and
that in 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 Ricon 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 Dauphine boasted of possessing the bones of the giant
Bucart, the tyrant 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 22 1/2 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 skeletons 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 pretended 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, preferring these to
pictures or images. From their enormous size we must believe they were
mastodon bones, as no contemporary animals show such measurements.
Bartholinus describes a large tooth for many years exhibited 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, 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 "Scottish
Giant" of Frederick the Great's regiment of giants. This person was not
quite 8 feet 3 inches tall. Buffon, ordinarily a reliable authority,
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 cannot
accept this deduction from the references offered.

From the original estimation of the height of Adam (Henrion once
calculated 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 1/2 feet or weigh over 350
pounds. Dana 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
accurately and scientifically measured the list is surprisingly small.
Topinard measured the tallest man in the Austrian army and found that
he was 8 feet 4 1/2 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 4
1/4 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
noticed, and in these instances there seems to be an acquired uniform
enlargement 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 "telescoping 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,
bronchitis, night-sweats, headache, and great thirst.  Mentally he was
dull; the bones of the face and extremities showed the hypertrophies
characteristic of acromegaly, the soft parts not being involved. The
circumference of the trunk at the nipples was 62 inches, and over the
most prominent portion of the kyphosis and pigeon-breast, 74 inches.
The authors agree with Dana and others that there is an intimate
relation between acromegaly and gigantism, but they go further and
compare both to the growth of the body. They call attention to the
striking 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 interest.

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
Nicholas 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 1/2 feet high,
who died in 1676 in his forty-fifth year. The giant porter of the Duke
of Wurtemberg was 7 1/2 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 1/2 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 seeing 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 1/2 feet high. The Daily Advertiser for
February 23, 1745, says that there was a young colossus exhibited
opposite the Mansion 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 who was 8 feet
tall.

Nicephorus 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 Gerrit 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
Santiago de los Santos, from the Island of Manilla, thirty-live 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 Netherlands 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 the age of twenty-two.
The story of his connection with the illustrious John Hunter is quite
interesting. Hunter had vowed that he would have the skeleton of
O'Brien, and O'Brien 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 circumstances, are preserved in the Museum
of the Royal College of Surgeons in London, 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 features of the Museum,
is reported to measure 92 3/4 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.

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
Imperial 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."

Buffon refers to a Swedish giantess who he affirms was 8 feet 6 inches
tall. Chang, the "Chinese Giant," whose smiling face is familiar to
nearly 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
himself 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 Whitesburg, Letcher County, Ky., on November 9, 1845. He
enlisted in the Southern 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 2 1/2
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, Switzerland, 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 5 1/2 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.

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. (16
1/2 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 (96 1/2
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, Kleber; 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, Bellart, 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
Spithamiens. In the "Iliad" Homer writes of the pygmies and Juvenal
also describes them; but the fantasies of these poets have given these
creatures such diminutive stature that they have deprived the
traditions of credence. Herodotus relates that in the deserts of Lybia
there were 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 Pygmaeus, son of Dorus. In the
seventeenth century van Helmont supposed that there were pygmies in the
Canary Islands, and Abyssinia, Brazil, and Japan in the older times
were repeatedly said to contain pygmy races. Relics 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
statements 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 compensate 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 Reebas, 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 mythologic 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
anthropologists 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 descriptions. 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
Livingstone, 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.

The "Aztec Children" in 1851, at the ages of seven and six years,
another pair of alleged indigenous pygmies, measured 33 3/4 and 29 1/2
inches in height and weighed 20 3/4 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
by giving them an insufficient alimentation when very young. They soon
became rachitic from their deprivation of lime-salts and a great number
perished, but those who survived were very highly prized by the Roman
Emperors for their grotesque appearance. There were various recipes for
dwarfing children. One of the most efficient in the olden times was
said to 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 aesop, 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 Medicis 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 marriage 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 number 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 Garnier. In the pictures of Raphael, Paul Veronese, and
Dominiquin, and in the "Triumph of Caesar" 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,
possibly augmented by comparison. In a postmortem discussed at a
meeting of the Natural History Society at Bonn in 1868 it was
demonstrated by Schaufhausen that in a dwarf subject the brain weighed
1/19 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 6 inches higher and the
other his size.

Several personages famous in history have been dwarfs. Attila, the
historian Procopius, Gregory of Tours, Pepin le Bref, Charles III, King
of Naples, and Albert the Grand were dwarfs. About the middle of the
seventeenth 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
average 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. Therese Souvray, the dwarf fiancee of Bebe,
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 size, but had another
child who was also a dwarf.

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 distinguished 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. Robert 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 presented 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 capacities 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 challenged 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 Richard
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). Mistress 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 afterward 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,
measuring but 25 1/2 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 Bebe. He
was born at Plaine in the Vosges in 1741; he was but 22 cm. (8 1/2
inches) long, weighed 14 ounces at birth, and was carried on a plate to
the church for baptism. At five Bebe 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
Bebe became engaged to a female dwarf named Therese Souvray, who at one
time was exhibited in Paris at the Theatre Conti, together with an
older sister. Therese 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 Duc de Crequi 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 examples of great age in dwarfs and are
therefore of much interest. Borwilaski'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.

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 an 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 conditions. 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 accomplishments.

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
children. 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.

Buffon 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.

At the "Cosmorama" in Regent 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, however, 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; cheerful and
affectionate; his manners were polite and engaging; he was expert in
many kinds of handicraft; he possessed an ardent desire for knowledge
and aptitude for education.

Rawdon described a boy of five and a half, at the Liverpool Infirmary
for Children, who weighed 10 1/2 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
contractions 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 1/2 pounds, including 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.  Sometimes 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
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 circumference 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
Barnum'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, engaged 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, in 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 Warren" and "Commodore Nutt."
He married one of the Warrens, and by her had one child, Minnie, who
died some months after birth of cerebral congestion. 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
Blaenavon, 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 apparently intelligent. They advertise that they were examined
and still remain 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
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 German 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 1/2 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, at the age of twenty weighed 36
pounds and was only 22 inches tall.

Precocious development is characterized 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 development.  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 (4 1/2 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 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, Portman
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 4 1/2 inches tall and weighed 51 1/4
pounds. The length of his penis when erect was 4 1/2 inches and the
circumference 4 inches; his thigh-measure was 13 1/2 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 possessed 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
extraordinary 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 in Paris a child 3
1/2 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 3/4 inches high, weighed 50 pounds, and had
seminal discharges. One of the cases was a child who at birth resembled
an ordinary 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 4 1/2 inches tall and weighed 51 1/4 pounds. Smith, in Brewster's
Journal, 1829, records the 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 miniature model of an athlete. His height was 4 feet 1/4 inch and
weight 70 pounds; the penis when semiflaccid was 4 1/4 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 6 3/4
inches tall; his penis when flaccid measured 4 inches and when erect 5
1/4 inches, but the testicles were not developed in proportion.  Lopez
describes a mulatto boy of three years ten and a half months whose
height was 4 feet 1/2 inch and weight 82 pounds; he measured about the
chest 27 1/2 inches and about the waist 27 inches; his penis at rest
was 4 inches long and had a circumference of 3 1/2 inches, although the
testes were not descended. He had evidences of a beard and his axillae
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
infantile 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 occurred 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 height was 4 feet 3 1/2 inches and his weight was 82 1/2
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 1/2 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 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
extraordinary fashion. At the age of six years he was 1.28 meters high
(4 feet 2 1/3 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 larger end 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.

The accompanying illustration represents a boy of five years and three
months of age whose height at this time was 4 feet and his physical
development far beyond that usual at this age, his external genitals
resembling those of a man of twenty. His upper lip was covered by a
mustache, and the hirsute growth elsewhere was similarly precocious.

The inscription on the tombstone of James Weir in the Parish of
Carluke, Scotland, says that when only thirteen months old he measured
3 feet 4 inches in height and weighed 5 stone. He was pronounced by the
faculty of Edinburgh and Glasgow to be the most extraordinary child of
his age. Linnaeus saw a boy at the Amsterdam Fair who at the age of
three weighed 98 pounds. In Paris, about 1822, there was shown an
infant Hercules of seven who was more remarkable for obesity than
general development. He was 3 feet 4 inches high, 4 feet 5 inches in
circumference, and weighed 220 pounds. He had prominent eyebrows, black
eyes, and his complexion resembled that of a fat cook in the heat.
Borellus details a description of a giant child. There is quoted from
Boston a the report of a boy of fifteen months weighing 92 pounds who
died at Coney Island. He was said to have been of phenomenal size from
infancy and was exhibited in several museums during his life.

Desbois of Paris mentions an extraordinary instance of rapid growth in
a boy of eleven who grew 6 inches in fifteen days.

Large and Small New-born Infants.--There are many accounts of new-born
infants who were characterized by their diminutive size.  On page 66 we
have mentioned Usher's instance of twins born at the one hundred and
thirty-ninth day weighing each less than 11 ounces; Barker's case of a
female child at the one hundred and fifty-eighth day weighing 1 pound;
Newinton's case of twins at the fifth month, one weighing 1 pound and
the other 1 pound 3 1/2 ounces; and on page 67 is an account of Eikam's
five-months' child, weighing 8 ounces. Of full-term children Sir
Everard Home, in his Croonian Oration in 1824, speaks of one borne by a
woman who was traveling with the baggage of the Duke of Wellington's
army. At her fourth month of pregnancy this woman was attacked and
bitten by a monkey, but she went to term, and a living child was
delivered which weighed but a pound and was between 7 and 8 inches
long. It was brought to England and died at the age of nine, when 22
inches high. Baker mentions a child fifty days' old that weighed 1
pound 13 ounces and was 14 inches long. Mursick describes a living
child who at birth weighed but 1 3/4 pounds.  In June, 1896, a baby
weighing 1 3/4 pounds was born at the Samaritan Hospital, Philadelphia.

Scott has recorded the birth of a child weighing 2 1/2 pounds, and
another 3 1/4 pounds. In the Chicago Inter-Ocean there is a letter
dated June 20, 1874, which says that Mrs. J. B. McCrum of Kalamazoo,
Michigan, gave birth to a boy and girl that could be held in the palm
of the hand of the nurse. Their aggregate weight was 3 pounds 4 ounces,
one weighing 1 pound 8 ounces, the other 1 pound 12 ounces. They were
less than 8 inches long and perfectly formed; they were not only alive
but extremely vivacious.

There is an account of female twins born in 1858 before term. One
weighed 22 1/2 ounces, and over its arm, forearm, and hand one could
easily pass a wedding-ring. The other weighed 24 ounces.  They both
lived to adult life; the larger married and was the mother of two
children, which she bore easily. The other did not marry, and although
not a dwarf, was under-sized; she had her catamenia every third week.
Post describes a 2-pound child.

On the other hand, there have been infants characterized by their
enormous size at birth. Among the older writers, Cranz describes an
infant which at birth weighed 23 pounds; Fern mentions a fetus of 18
pounds; and Mittehauser speaks of a new-born child weighing 24 pounds.
Von Siebold in his "Lucina" has recorded a fetus which weighed 22 1/2
pounds. It is worthy of comment that so great is the rarity of these
instances that in 3600 cases, in the Rotunda Hospital, Dublin, only one
child reached 11 pounds.

There was a child born in Sussex in 1869 which weighed 13 1/2 pounds
and measured 26 1/2 inches. Warren delivered a woman in Derbyshire of
male twins, one weighing 17 pounds 8 ounces and the other 18 pounds.
The placenta weighed 4 pounds, and there was an ordinary pailful of
liquor amnii. Both the twins were muscular and well formed; the parents
were of ordinary stature, and at last reports the mother was rapidly
convalescing. Burgess mentions an 18-pound new-born child; end Meadows
has seen 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 1/2 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
tertipara, 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 19 3/4 pounds and which
was 25 3/4 inches long. The circumference of the head was 16 3/4
inches, of the neck 9 3/4, and of the thigh 10 3/4 inches.

Rice speaks of a child weighing 20 1/4 pounds at birth. Johnston
describes 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 23 3/4 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 23 3/4 pounds and 30 inches long.
The secundines 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 22 1/2 pounds.
Bumm speaks of the birth of a premature male infant weighing 4320 gm.
(9 1/2 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.

Congenital asymmetry and hemihypertrophy of the body are most peculiar
anomalies and must not be confounded with acromegaly or myxedema, 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
mentions 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 Trelat 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 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 increased growth affected the entire right half of the
body, including the face, but was most noticeable in the leg, thigh,
and buttock. Numerous telangiectatic 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 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.
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
members 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 Medico-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 abnormality of the adipose system, causing in consequence
an augmentation of the natural volume of the subject, should be
described with other anomalies of size and stature.  Obesity may be
partial, as seen in the mammae or in the abdomen of both women and men,
or it 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 describes a
female infant not a year old which 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 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 Pomerania 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 sometimes 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 development of fatty tissue. The parents were not excessively
large, and the mother stated that she had had children before of the
same proportions.  Grisolles 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
pounds 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 18
inches and she weighed nearly 200 pounds. In February, 1814, Mr. S.
Pauton was married to the only daughter of Thomas Allanty 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 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 subsequently 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 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
exhibitionist, 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 Holland
that the most remarkable instances of obesity have been seen,
especially in the former country colossal weights have been recorded.
In some countries 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 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
representatives. In other people slenderness is equally persistent, and
efforts to overcome 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
slenderness; 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 alimentation. 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
constitution 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.

Athenaeus 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 constant 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 incurring the danger of suffocation. In the
same work Athenaeus speaks of several sovereigns noted for their
obesity; among others he says that Ptolemy 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 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; Alphonse II, King of Portugal; the Italian poet Bruni, who died
in 1635; Vivonne, a general under Louis XIV; the celebrated German
botanist Dillenius; Haller; Frederick I, King of Wurtemberg, 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 3/4 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
Bright's weight is an account of a man exhibited 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.
Stafford, in all this churchyard."

Wadd has gathered some instances, a few of which will be cited.  At
Staunton, January 2, 1816, there died Samuel Sugars, Gent., who weighed
with a single wood coffin 50 stone (700 pounds).  Jacob Powell died in
1764, weighing 660 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
Teddington, 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 Englishman living in Lincoln who 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 astonishment. 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.
Fabricius 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 gives the history of Marie Francoise-Clay, who attained such
celebrity for her obesity. She was born in poverty, reached puberty at
thirteen, 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 hung as low as the umbilicus. Her
arms were elevated and kept from her body by the fat in her axillae.
Her belly was enormous and was augmented by six pregnancies. Her thighs
and haunches were in proportion to her general contour. At forty she
ceased to menstruate and soon became afflicted with organic heart
diseases.

Fournier quotes an instance of a woman in Paris who at twenty-four, the
time of her death, weighed 486 pounds. Not being able to mount any
conveyance or carriage in the city, she walked from place to place,
finding difficulty not in progression, but in keeping her equilibrium.
Roger Byrne, who lived in Rosenalis, Queen's County, Ireland, died of
excessive fatness at the age of fifty-four, weighing 52 stone. Percy
and Laurent speak of a young German of twenty who weighed 450 pounds.
At birth he weighed 13 pounds, at six months 42, and at four years 150
pounds. He was 5 feet 5 inches tall and the same in circumference.
William Campbell, the landlord of the Duke of Wellington in
Newcastle-on-Tyne, was 6 feet 4 inches tall and weighed 728 pounds. He
measured 96 inches around the shoulders, 85 inches around the waist,
and 35 inches around the calf. He was born at Glasgow in 1856, and was
not quite twenty-two when last measured.  To illustrate the rate of
augmentation, he weighed 4 stone at nine months and at ten years 18
stone. He was one of a family of seven children. His appetite was not
more than the average, and he was moderate as regards the use of
liquors, but a great smoker Notwithstanding his corpulency, he was
intelligent and affable.

Miss Conley, a member of an American traveling circus, who weighed 479
pounds, was smothered in bed by rolling over on her face; she was
unable to turn on her back without assistance.

There was a girl who died at Plaisance near Paris in 1890 who weighed
470 pounds or more. In 1889 an impresario undertook to exhibit her; but
eight men could not move her from her room, and as she could not pass
through the door the idea was abandoned.

There was a colored woman who died near Baltimore who weighed 850
pounds, exceeding the great Daniel Lambert by 120 pounds. The journal
reporting this case quotes the Medical Record as saying that there was
a man in North Carolina, who was born in 1798, who was 7 feet 8 inches
tall and weighed over 1000 pounds, probably the largest man that ever
lived. Hutchison says that he Saw in the Infirmary at Kensington, under
Porter's care, a remarkable example of obesity. The woman was only just
able to walk about and presented a close resemblance to Daniel Lambert.
Obesity forced her to leave her occupation. The accumulation of fat on
the abdomen, back, and thighs was enormous.

According to a recent number of La Liberte, a young woman of
Pennsylvania, although only sixteen years old, weighs 450 pounds.  Her
waist measures 61 inches in circumference and her neck 22 inches. The
same paper says that on one of the quays of Paris may be seen a
wine-shop keeper with whom this Pennsylvania girl could not compare. It
is said that this curiosity of the Notre-Dame quarter uses three large
chairs while sitting behind her specially constructed bar. There is
another Paris report of a man living in Switzerland who weighs more
than 40 stone (560 pounds) and eats five times as much as an ordinary
person. When traveling he finds the greatest difficulty in entering an
ordinary railway carriage, and as a rule contents himself in the
luggage van.  Figure 171 represents an extremely fat woman with a
well-developed beard. To end this list of obese individuals, we mention
an old gentleman living in San Francisco who, having previously been
thin, gained 14 pounds in his seventieth year and 14 pounds each of
seven succeeding years.

Simulation of Obesity.--General dropsy, elephantiasis, lipomata,
myxedema, and various other affections in which there is a hypertrophic
change of the connective tissues may be mistaken for general obesity;
on the other hand, a fatty, pendulous abdomen may simulate the
appearances of pregnancy or even of ovarian cyst.

Dercum of Philadelphia has described a variety of obesity which he has
called "adiposis dolorosa," in which there is an enormous growth of
fat, sometimes limited, sometimes spread all over the body, this
condition differing from that of general lipomatosis in its rarity, in
the mental symptoms, in the headache, and the generally painful
condition complained of. In some of the cases examined by Dercum he
found that the thyroid was indurated and infiltrated by calcareous
deposits. The disease is not myxedema because there is no peculiar
physiognomy, no spade-like hands nor infiltrated skin, no alteration of
the speech, etc. Dercum considers it a connective-tissue dystrophy--a
fatty metamorphosis of various stages, possibly a neuritis. The first
of Dercum's cases was a widow of Irish birth, who died both alcoholic
and syphilitic. When forty-eight or forty-nine her arms began to
enlarge. In June, 1887, the enlargement affected the shoulders, arms,
back, and sides of the chest. The parts affected were elastic, and
there was no pitting. In some places the fat was lobulated, in others
it appeared as though filled with bundles of worms. The skin was not
thickened and the muscles were not involved. In the right arm there was
unendurable pain to the touch, and this was present in a lesser degree
in the left arm.  Cutaneous sensibility was lessened. On June 13th a
chill was followed by herpes over the left arm and chest, and later on
the back and on the front of the chest. The temperature was normal.
The second case was a married Englishwoman of sixty-four. The enlarged
tissue was very unevenly distributed, and sensibility was the same as
in the previous case. At the woman's death she weighed 300 pounds, and
the fat over the abdomen was three inches thick. The third case was a
German woman in whom were seen soft, fat-like masses in various
situations over either biceps, over the outer and posterior aspect of
either arm, and two large masses over the belly; there was excessive
prominence of the mons veneris. At the autopsy the heart weighed 8 1/2
ounces, and the fat below the umbilicus was seven inches thick.

Abnormal Leanness.--In contrast to the fat men are the so-called
"living skeletons," or men who have attained notice by reason of
absence of the normal adipose tissue. The semimythical poet Philotus
was so thin that it was said that he fastened lead on his shoes to
prevent his being blown away,--a condition the opposite of that of
Dionysius of Heraclea, who, after choking to death from his fat, could
hardly be moved to his grave.

In March, 1754, there died in Glamorganshire of mere old age and
gradual decay a little Welshman, Hopkin Hopkins, aged seventeen years.
He had been recently exhibited in London as a natural curiosity; he had
never weighed over 17 pounds, and for the last three years of his life
never more than 12 pounds. His parents still had six children left, all
of whom were normal and healthy except a girl of twelve, who only
weighed 18 pounds and bore marks of old age.

There was a "living skeleton" brought to England in 1825 by the name of
Claude Seurat. He was born in 1798 and was in his twenty-seventh year.
He usually ate in the course of a day a penny roll and drank a small
quantity of wine. His skeleton was plainly visible, over which the skin
was stretched tightly. The distance from the chest to the spine was
less than 3 inches, and internally this distance was less. The
pulsations of the heart were plainly visible. He was in good health and
slept well. His voice was very weak and shrill. The circumference of
this man's biceps was only 4 inches. The artist Cruikshank has made
several drawings of Seurat.

Calvin Edson was another living skeleton. In 1813 he was in the army at
the battle of Plattsburg, and had lain down in the cold and become
benumbed. At this time he weighed 125 pounds and was twenty-five years
old. In 1830 he weighed but 60 pounds, though 5 feet 4 inches tall. He
was in perfect health and could chop a cord of wood without fatigue; he
was the father of four children.

Salter speaks of a man in 1873 who was thirty-two years of age and only
weighed 49 pounds. He was 4 feet 6 inches tall: his forehead measured
in circumference 20 1/2 inches and his chest 27 inches. His genitals,
both internal and external, were defectively developed. Figure 175
represents the well-known Ohio "living skeleton," J. W. Coffey, who has
been exhibited all over the Continent. His good health and appetite
were proverbial among his acquaintances.

In some instances the so-called "living skeletons" are merely cases of
extreme muscular atrophy. As a prominent example of this class the
exhibitionist, Rosa Lee Plemons at the age of eighteen weighed only 27
pounds. Figure 177 shows another case of extraordinary atrophic
condition of all the tissues of the body associated with
nondevelopment. These persons are always sickly and exhibit all the
symptoms of progressive muscular atrophy, and cannot therefore be
classed with the true examples of thinness, in which the health is but
slightly affected or possibly perfect health is enjoyed.



CHAPTER VIII.

LONGEVITY.

Scope of the Present Article.--The limits of space in this work render
impossible a scientific discussion upon the most interesting subject of
longevity, and the reader is referred to some of the modern works
devoted exclusively to this subject. In reviewing the examples of
extreme age found in the human race it will be our object to lay before
the reader the most remarkable instances of longevity that have been
authentically recorded, to cite the source of the information, when
possible to give explanatory details, and to report any relative points
of value and interest. Throughout the article occasional facts will be
given to show in what degree character, habit, and temperament
influence longevity, and in what state of mind and body and under what
circumstances man has obtained the highest age.

General Opinions.--There have been many learned authorities who
invariably discredit all accounts of extraordinary age, and contend
that there has never been an instance of a man living beyond the
century mark whose age has been substantiated by satisfactory proof.
Such extremists as Sir G. Cornewall Lewis and Thoms contend that since
the Christian era no person of royal or noble line mentioned in history
whose birth was authentically recorded at its occurrence has reached
one hundred years. They have taken the worst station in life in which
to find longevity as their field of observation. Longevity is always
most common in the middle and lower classes, in which we cannot expect
to find the records preserved with historical correctness.

The Testimony of Statistics.--Walford in his wonderful "Encyclopedia of
Insurance" says that in England the "Royal Exchange" for a period of
one hundred and thirty-five years had insured no life which survived
ninety-six. The "London Assurance" for the same period had no clients
who lived over ninety, and the "Equitable" had only one at ninety-six.
In an English Tontine there was in 1693 a person who died at one
hundred; and in Perth there lived a nominee at one hundred and
twenty-two and another at one hundred and seven. On the other hand, a
writer in the Strand Magazine points out that an insurance investigator
some years ago gathered a list of 225 centenarians of almost every
social rank and many nationalities, but the majority of them Britons or
Russians.

In reviewing Walford's statistics we must remember that it has only
been in recent years that the middle and lower classes of people have
taken insurance on their lives. Formerly only the wealthy and those
exposed to early demise were in the habit of insuring.

Dr. Ogle of the English Registrar-General's Department gives tables of
expectancy that show that 82 males and 225 females out of 1,000,000 are
alive at one hundred years. The figures are based on the death-rates of
the years 1871-80.

The researches of Hardy in the thirteenth, fourteenth, fifteenth, and
sixteenth centuries are said to indicate that three-score-and-ten was
considered old age; yet many old tombstones and monuments contain
inscriptions recording age far beyond this, and even the pages of
ordinary biographies disprove the alleged results of Hardy's research.

In all statistical work of an individual type the histories of the
lower classes are almost excluded; in the olden times only the lives
and movements of the most prominent are thought worthy of record. The
reliable parish register is too often monopolized by the gentry,
inferior births not being thought worth recording.

Many eminent scientists say that the natural term of the life of an
animal is five times the period needed for its development.  Taking
twenty-one as the time of maturity in man, the natural term of human
life would be one hundred and five. Sir Richard Owen fixes it at one
hundred and three and a few months.

Censuses of Centenarians.--Dr. Farr, the celebrated English
Registrar-General, is credited with saying that out of every 1,000,000
people in England only 223 live to be one hundred years old, making an
average of one to 4484. French says that during a period of ten years,
from 1881 to 1890, in Massachusetts, there were 203 deaths of persons
past the age of one hundred, making an average, with a population of
394,484, of one in 1928. Of French's centenarians 165 were between one
hundred and one hundred and five; 35 were between one hundred and five
and one hundred and ten; five were between one hundred and ten and one
hundred and fifteen; and one was one hundred and eighteen. Of the 203,
153 were females and 50 males. There are 508 people in Iowa who are
more than ninety years of age. There are 21 who are more than one
hundred years old. One person is one hundred and fifteen years old, two
are one hundred and fourteen, and the remaining 18 are from one hundred
to one hundred and seven.

In the British Medical Journal for 1886 there is an account of a report
of centenarians. Fifty-two cases were analyzed. One who doubts the
possibility of a man reaching one hundred would find this report of
interest.

The Paris correspondent to the London Telegraph is accredited with the
following:--

"A census of centenarians has been taken in France, and the results,
which have been published, show that there are now alive in this
country 213 persons who are over one hundred years old.  Of these 147
are women, the alleged stronger sex being thus only able to show 66
specimens who are managing to still "husband out life's taper" after
the lapse of a century. The preponderance of centenarians of the
supposed weaker sex has led to the revival of some amusing theories
tending to explain this phenomenon. One cause of the longevity of women
is stated to be, for instance, their propensity to talk much and to
gossip, perpetual prattle being highly conducive, it is said, to the
active circulation of the blood, while the body remains unfatigued and
undamaged. More serious theorists or statisticians, while commenting on
the subject of the relative longevity of the sexes, attribute the
supremacy of woman in the matter to the well-known cause, namely, that
in general she leads a more calm and unimpassioned existence than a
man, whose life is so often one of toil, trouble, and excitement.
Setting aside these theories, however, the census of French
centenarians is not devoid of interest in some of its details. At
Rocroi an old soldier who fought under the First Napoleon in Russia
passed the century limit last year. A wearer of the St. Helena medal--a
distinction awarded to survivors of the Napoleonic campaigns, and who
lives at Grand Fayt, also in the Nord--is one hundred and three years
old, and has been for the last sixty-eight years a sort of rural
policeman in his native commune. It is a rather remarkable fact in
connection with the examples of longevity cited that in almost every
instance the centenarian is a person in the humblest rank of life.
According to the compilers of these records, France can claim the honor
of having possessed the oldest woman of modern times. This venerable
dame, having attained one hundred and fifty years, died peacefully in a
hamlet in the Haute Garonne, where she had spent her prolonged
existence, subsisting during the closing decade of her life on goat's
milk and cheese. The woman preserved all her mental faculties to the
last, but her body became attenuated to an extraordinary degree, and
her skin was like parchment."

In the last ten years the St. James' Gazette has kept track of 378
centenarians, of whom 143 were men and 235 were women. A writer to the
Strand Magazine tells of 14 centenarians living in Great Britain within
the last half-dozen years.

It may be interesting to review the statistics of Haller, who has
collected the greatest number of instances of extreme longevity.  He
found:--

 1000 persons who lived from 100 to 110
   15 persons who lived from 130 to 140
   60   "      "    "    "   110 to 120
    6   "      "    "    "   140 to 150
   29   "      "    "    "   120 to 130
    1 person   "    "    "       to 169

Effect of Class-Influences, Occupation, etc.--Unfortunately for the
sake of authenticity, all the instances of extreme age in this country
have been from persons in the lower walks of life or from obscure parts
of the country, where little else than hearsay could be procured to
verify them. It must also be said that it is only among people of this
class that we can expect to find parallels of the instances of extreme
longevity of former times.  The inhabitants of the higher stations of
life, the population of thickly settled communities, are living in an
age and under conditions almost incompatible with longevity. In fact,
the strain of nervous energy made necessary by the changed conditions
of business and mode of living really predisposes to premature decay.

Those who object to the reliability of reports of postcentenarianism
seem to lose sight of these facts, and because absolute proof and
parallel cannot be obtained they deny the possibility without giving
the subject full thought and reason.  As tending to substantiate the
multitude of instances are the opinions of such authorities as
Hufeland, Buffon, Haller, and Flourens. Walter Savage Landor on being
told that a man in Russia was living at one hundred and thirty-two
replied that he was possibly older, as people when they get on in years
are prone to remain silent as to the number of their years--a statement
that can hardly be denied. One of the strongest disbelievers in extreme
age almost disproved in his own life the statement that there were no
centenarians.

It is commonly believed that in the earliest periods of the world's
history the lives of the inhabitants were more youthful and perfect;
that these primitive men had gigantic size, incredible strength, and
most astonishing duration of life. It is to this tendency that we are
indebted for the origin of many romantic tales. Some have not hesitated
to ascribe to our forefather Adam the height of 900 yards and the age
of almost a thousand years; but according to Hufeland acute theologians
have shown that the chronology of the early ages was not the same as
that used in the present day. According to this same authority Hensler
has proved that the year at the time of Abraham consisted of but three
months, that it was afterward extended to eight, and finally in the
time of Joseph to twelve. Certain Eastern nations, it is said, still
reckon but three months to the year; this substantiates the opinion of
Hensler, and, as Hufeland says, it would be inexplicable why the life
of man should be shortened nearly one-half immediately after the flood.

Accepting these conclusions as correct, the highest recorded age, that
of Methuselah, nine hundred years, will be reduced to about two
hundred, an age that can hardly be called impossible in the face of
such an abundance of reports, to which some men of comparatively modern
times have approached, and which such substantial authorities as
Buffon, Hufeland, and Flourens believed possible.

Alchemy and the "Elixir of Life."--The desire for long life and the
acquisition of wealth have indirectly been the stimulus to medical and
physical investigation, eventually evolving science as we have it now.
The fundamental principles of nearly every branch of modern science
were the gradual metamorphoses of the investigations of the old
searchers after the "philosopher's stone" and "elixir of life." The
long hours of study and experiment in the chase for this
will-o'-the-wisp were of vast benefit to the coming generations; and to
these deluded philosophers of the Middle Ages, and even of ancient
times, we are doubtless indebted for much in this age of advancement.

With a credulous people to work upon, many of the claimants of the
discovery of the coveted secret of eternal life must be held as rank
impostors claiming ridiculous ages for themselves. In the twelfth
century Artephius claimed that by the means of his discovery he had
attained one thousand and twenty-five years.  Shortly after him came
Alan de Lisle of Flanders with a reputed fabulous age. In 1244 Albertus
Magnus announced himself as the discoverer. In 1655 the celebrated
Doctor Dee appeared on the scene and had victims by the score. Then
came the Rosicrucians.  Count Saint-Germain claimed the secret of the
"philosopher's stone" and declared to the Court of Louis XV that he was
two thousand years old, and a precursor of the mythical "Wandering
Jew," who has been immortalized in prose and rhyme and in whose
existence a great mass of the people recently believed. The last of the
charlatans who claimed possession of the secret of perpetual life was
Joseph Balsamo, who called himself "Count of Cagliostro." He was born
in Italy in 1743 and acquired a world-wide reputation for his alleged
occult powers and acquisition of the "philosopher's stone." He died in
1795, and since then no one has generally inspired the superstitious
with credence in this well-worn myth. The ill-fated Ponce de Leon when
he discovered Florida, in spite of his superior education, announced
his firm belief in the land of the "Fountain of Perpetual Youth," in
the pursuit of which he had risked his fortune and life.

We wish to emphasize that we by no means assume the responsibility of
the authenticity of the cases to be quoted, but expressing belief in
their possibility, we shall mention some of the extraordinary instances
of longevity derived from an exhaustive research of the literature of
all times. This venerable gallery of Nestors will include those of all
periods and nations, but as the modern references are more available
greater attention will be given to them.

Turning first to the history of the earlier nations, we deduce from
Jewish history that Abraham lived to one hundred and seventy-five;
Isaac, likewise a tranquil, peaceful man, to one hundred and eighty;
Jacob, who was crafty and cunning, to one hundred and forty-seven;
Ishmael, a warrior, to one hundred and thirty-seven; and Joseph, to one
hundred and ten. Moses, a man of extraordinary vigor, which, however,
he exposed to great cares and fatigues, attained the advanced age of
one hundred and twenty; and the warlike and ever-active Joshua lived to
one hundred and ten. Lejoucourt gives the following striking parallels:
John Glower lived to one hundred and seventy-two, and Abraham to one
hundred and seventy-five; Susan, the wife of Gower, lived to one
hundred and sixty-four, and Sarah, the wife of Abraham, to one hundred
and twenty-seven. The eldest son of the Gower couple was one hundred
and fifteen when last seen, and Isaac, the son of Abraham and Sarah,
lived to one hundred and eighty.

However replete with fables may be the history of the Kings of Egypt,
none attained a remarkable age, and the record of the common people is
incomplete or unavailable.

If we judge from the accounts of Lucian we must form a high idea of the
great age of the Seres, or ancient Chinese. Lucian ascribes this
longevity to their habit of drinking excessive quantities of water.

Among the Greeks we find several instances of great age in men of
prominence. Hippocrates divided life into seven periods, living himself
beyond the century mark. Aristotle made three divisions,--the growing
period, the stationary period, and the period of decline. Solon made
ten divisions of life, and Varro made five. Ovid ingeniously compares
life to the four seasons.  Epimenides of Crete is said to have lived
one hundred and fifty-seven years, the last fifty-seven of which he
slept in a cavern at night. Gorgias, a teacher, lived to one hundred
and eight; Democritus, a naturalist, attained one hundred and nine;
Zeno, the founder of the Stoics, lived to one hundred; and Diogenes,
the frugal and slovenly, reached ninety years. Despite his life of
exposure, Hippocrates lived to one hundred and nine; and Galen, the
prince of physicians after him, who was naturally of a feeble
constitution, lived past eighty, and few of the followers of his system
of medicine, which stood for thirteen centuries, surpassed him in point
of age.

Among the Romans, Orbilis, Corvinus, Fabius, and Cato, the enemy of the
physicians, approximated the century mark.

A valuable collection relative to the duration of life in the time of
the Emperor Vespasian has been preserved for us by Pliny from the
records of a census, a perfectly reliable and creditable source. In 76
A. D. there were living in that part of Italy which lies between the
Apennines and the Po 124 persons who had attained the age of one
hundred and upward. There were 54 of one hundred; 57 of one hundred and
ten; 2 of one hundred and twenty-five; 4 of one hundred and thirty; 4
of from one hundred and thirty-five to one hundred and thirty-seven,
and 3 of one hundred and forty. In Placentia there was a man of one
hundred and thirty and at Faventia a woman of one hundred and
thirty-two.  According to Hufeland, the bills of mortality of Ulpian
agree in the most striking manner with those of our great modern cities.

Among hermits and ecclesiastics, as would be the natural inference from
their regular lives, many instances of longevity are recorded. John was
supposed to be ninety-three; Paul the hermit was one hundred and
thirteen; Saint Anthony lived to one hundred and five; James the hermit
to one hundred and four; Saint Epithanius lived to one hundred and
fifteen; Simeon Stylites to one hundred and twelve; Saint Mungo was
accredited with one hundred and eighty-five years (Spottiswood), and
Saint David attained one hundred and forty-six. Saint Polycarpe
suffered martyrdom at over one hundred, and Simon Cleophas was Bishop
of Jerusalem at one hundred and twenty.

Brahmin priests of India are known to attain incredible age, and one of
the secrets of the adepts of the Buddhist faith is doubtless the
knowledge of the best means of attaining very old age. Unless cut off
by violence or accident the priests invariably become venerable
patriarchs.

Influence of Mental Culture.--Men of thought have at all times been
distinguished for their age. Among the venerable sages are Appolonius
of Tyana, a follower of Pythagoras, who lived to over one hundred;
Xenophilus, also a Pythagorean, was one hundred and six; Demonax, a
Stoic, lived past one hundred; Isocrates was ninety-eight, and Solon,
Sophocles, Pindar, Anacreon, and Xenophon were octogenarians.

In more modern times we find men of science and literature who have
attained advanced age. Kant, Buffon, Goethe, Fontenelle, and Newton
were all over eighty. Michael Angelo and Titian lived to eighty-nine
and ninety-nine respectively. Harvey, the discoverer of the
circulation; Hans Sloane, the celebrated president of the Royal Society
in London; Plater, the Swiss physician; Duverney, the anatomist, as
well as his confrere, Tenon, lived to be octogenarians. Many men have
displayed activity when past four score. Brougham at eighty-two and
Lyndhurst at eighty-eight could pour forth words of eloquence and
sagacity for hours at a time.  Landor wrote his "Imaginary
Conversations" when eighty-five, and Somerville his "Molecular Science"
at eighty-eight; Isaac Walton was active with his pen at ninety;
Hahnemann married at eighty and was working at ninety-one.

J. B. Bailey has published a biography of "Modern Methusalehs," which
includes histories of the lives of Cornaro, Titian, Pletho, Herschell,
Montefiore, Routh, and others. Chevreul, the centenarian chemist, has
only lately died. Gladstone, Bismarck, and von Moltke exemplify vigor
in age In the Senate of the United States, Senators Edmunds, Sherman,
Hoar, Morrill, and other elderly statesmen display as much vigor as
their youthful colleagues. Instances of vigor in age could be cited in
every profession and these few examples are only mentioned as typical.
At a recent meeting of the Society of English Naturalists, Lord Kelvin
announced that during the last year 26 members had died at an average
age of seventy-six and a half years; one reached the age of ninety-nine
years, another ninety-seven, a third ninety-five, etc.

In commenting on the perfect compatibility of activity with longevity,
the National Popular Review says:--

"Great men usually carry their full mental vigor and activity into old
age. M. Chevreul, M. De Lesseps, Gladstone, and Bismarck are evidences
of this anthropologic fact. Pius IX, although living in tempestuous
times, reached a great age in full possession of all his faculties, and
the dramatist Crebillon composed his last dramatic piece at
ninety-four, while Michael Angelo was still painting his great canvases
at ninety-eight, and Titian at ninety still worked with all the vigor
of his earlier years. The Austrian General Melas was still in the
saddle and active at eighty-nine, and would have probably won Marengo
but for the inopportune arrival of Desaix. The Venetian Doge Henry
Dandolo, born at the beginning of the eleventh century, who lost his
eyesight when a young man, was nevertheless subsequently raised to the
highest office in the republic, managed successfully to conduct various
wars, and at the advanced age of eighty-three, in alliance with the
French, besieged and captured Constantinople. Fontenelle was as
gay-spirited at ninety-eight as in his fortieth year, and the
philosopher Newton worked away at his tasks at the age of eighty-three
with the same ardor that animated his middle age. Cornaro was as happy
at ninety as at fifty, and in far better health at the age of
ninety-five than he had enjoyed at thirty.

"These cases all tend to show the value and benefits to be derived from
an actively cultivated brain in making a long life one of comfort and
of usefulness to its owner. The brain and spirits need never grow old,
even if our bodies will insist on getting rickety and in falling by the
wayside. But an abstemious life will drag even the old body along to
centenarian limits in a tolerable state of preservation and usefulness.
The foregoing list can be lengthened out with an indefinite number of
names, but it is sufficiently long to show what good spirits and an
active brain will do to lighten up the weight of old age. When we
contemplate the Doge Dandolo at eighty-three animating his troops from
the deck of his galley, and the brave old blind King of Bohemia falling
in the thickest of the fray at Crecy, it would seem as it there was no
excuse for either physical, mental, or moral decrepitude short of the
age of four score and ten."

Emperors and Kings, in short, the great ones of the earth, pay the
penalty of their power by associate worriment and care. In ancient
history we can only find a few rulers who attained four score, and this
is equally the case in modern times. In the whole catalogue of the
Roman and German Emperors, reckoning from Augustus to William I, only
six have attained eighty years.  Gordian, Valerian, Anastasius, and
Justinian were octogenarians, Tiberius was eighty-eight at his death,
and Augustus Caesar was eighty-six. Frederick the Great, in spite of
his turbulent life, attained a rare age for a king, seventy-six.
William I seems to be the only other exception.

Of 300 Popes who may be counted, no more than five attained the age of
eighty. Their mode of life, though conducive to longevity in the minor
offices of the Church, seems to be overbalanced by the cares of the
Pontificate.

Personal Habits.--According to Hufeland and other authorities on
longevity, sobriety, regular habits, labor in the open air, exercise
short of fatigue, calmness of mind, moderate intellectual power, and a
family life are among the chief aids to longevity. For this reason we
find the extraordinary instances of longevity among those people who
amidst bodily labor and in the open air lead a simple life, agreeable
to nature. Such are farmers, gardeners, hunters, soldiers, and sailors.
In these situations man may still maintain the age of one hundred and
fifty or even one hundred and sixty.

Possibly the most celebrated case of longevity on record is that of
Henry Jenkins. This remarkable old man was born in Yorkshire in 1501
and died in 1670, aged one hundred and sixty-nine. He remembered the
battle of Flodden Field in 1513, at which time he was twelve years old.
It was proved from the registers of the Chancery and other courts that
he had appeared in evidence one hundred and forty years before his
death and had had an oath administered to him. In the office of the
King's Remembrancer is a record of a deposition in which he appears as
a witness at one hundred and fifty-seven. When above one hundred he was
able to swim a rapid stream.

Thomas Parr (or Parre), among Englishmen known as "old Parr," was a
poor farmer's servant, born in 1483. He remained single until eighty.
His first wife lived thirty-two years, and eight years after her death,
at the age of one hundred and twenty, he married again. Until his one
hundred and thirtieth year he performed his ordinary duties, and at
this age was even accustomed to thresh.  He was visited by Thomas, Earl
of Arundel and Surrey, and was persuaded to visit the King in London.
His intelligence and venerable demeanor impressed every one, and crowds
thronged to see him and pay him homage. The journey to London, together
with the excitement and change of mode of living, undoubtedly hastened
his death, which occurred in less than a year. He was one hundred and
fifty-two years and nine months old, and had lived under nine Kings of
England. Harvey examined his body and at the necropsy his internal
organs were found in a most perfect state. His cartilages were not even
ossified, as is the case generally with the very aged. The slightest
cause of death could not be discovered, and the general impression was
that he died from being over-fed and too-well treated in London. His
great-grandson was said to have died in this century in Cork at the age
of one hundred and three. Parr is celebrated by a monument reared to
his memory in Westminster Abbey.

The author of the Dutch dictionary entitled "Het algemen historish
Vanderbok" says that there was a peasant in Hungary named Jean Korin
who was one hundred and seventy-two and his wife was one hundred and
sixty-four; they had lived together one hundred and forty-eight years,
and had a son at the time of their death who was one hundred and
sixteen.

Setrasch Czarten, or, as he is called by Baily, Petratsh Zartan, was
also born in Hungary at a village four miles from Teneswaer in 1537. He
lived for one hundred and eighty years in one village and died at the
age of one hundred and eighty-seven, or, as another authority has it,
one hundred and eighty-five. A few days before his death he had walked
a mile to wait at the post-office for the arrival of travelers and to
ask for succor, which, on account of his remarkable age, was rarely
refused him. He had lost nearly all his teeth and his beard and hair
were white. He was accustomed to eat a little cake the Hungarians call
kalatschen, with which he drank milk. After each repast he took a glass
of eau-de-vie. His son was living at ninety-seven and his descendants
to the fifth generation embellished his old age.  Shortly before his
death Count Wallis had his portrait painted.  Comparing his age with
that of others, we find that he was five years older than the Patriarch
Isaac, ten more than Abraham, thirty-seven more than Nahor, sixteen
more than Henry Jenkins, and thirty-three more than "old Parr."

Sundry Instances of Great Age.--In a churchyard near Cardiff,
Glamorganshire, is the following inscription: "Here lieth the body of
William Edwards, of Cacreg, who departed this life 24th February, Anno
Domini 1668, anno aetatis suae one hundred and sixty-eight."

Jonas Warren of Balydole died in 1787 aged one hundred and sixty-seven.
He was called the "father of the fishermen" in his vicinity, as he had
followed the trade for ninety-five years.

The Journal de Madrid, 1775, contains the account of a South American
negress living in Spanish possessions who was one hundred and
seventy-four years of age. The description is written by a witness, who
declares that she told of events which confirmed her age. This is
possibly the oft-quoted case that was described in the London
Chronicle, October 5, 1780, Louisa Truxo, who died in South America at
the age of one hundred and seventy-five.

Huteland speaks of Joseph Surrington, who died near Bergen, Norway, at
the age of one hundred and sixty. Marvelous to relate, he had one
living son of one hundred and three and another of nine. There has been
recently reported from Vera Cruz, Mexico, in the town of Teluca, where
the registers are carefully and efficiently kept, the death of a man
one hundred and ninety-two years old--almost a modern version of
Methuselah. Buffon describes a man who lived to be one hundred and
sixty-five.  Martin mentions a man of one hundred and eighty. There was
a Polish peasant who reached one hundred and fifty-seven and had
constantly labored up to his one hundred and forty-fifth year, always
clad lightly, even in cold weather. Voigt admits the extreme age of one
hundred and sixty.

There was a woman living in Moscow in 1848 who was said to be one
hundred and sixty-eight; she had been married five times and was one
hundred and twenty-one at her last wedding. D'Azara records the age of
one hundred and eighty, and Roequefort speaks of two cases at one
hundred and fifty.

There are stories of an Englishman who lived in the sixteenth century
to be two hundred and seven, and there is a parallel case cited.

Van Owen tabulates 331 cases of deaths between 110 and 120, 91 between
120 and 130, 37 between 130 and 140, 11 at 150, and 17 beyond this age.
While not vouching for the authenticity in each case, he has always
given the sources of information.

Quite celebrated in English history by Raleigh and Bacon was the
venerable Countess Desmond, who appeared at Court in 1614, being one
hundred and forty years old and in full possession of all her powers,
mental and physical. There are several portraits of her at this
advanced age still to be seen. Lord Bacon also mentions a man named
Marcus Appenius, living in Rimini, who was registered by a Vespasian
tax-collector as being one hundred and fifty.

There are records of Russians who have lived to one hundred and
twenty-five, one hundred and thirty, one hundred and thirty-five, one
hundred and forty-five, and one hundred and fifty. Nemnich speaks of
Thomas Newman living in Bridlington at one hundred and fifty-three
years. Nemnich is confirmed in his account of Thomas Newman by his
tombstone in Yorkshire, dated 1542.

In the chancel of the Honington Church, Wiltshire, is a black marble
monument to the memory of G. Stanley, gent., who died in 1719, aged one
hundred and fifty-one.

There was a Dane named Draakenburg, born in 1623, who until his
ninety-first year served as a seaman in the royal navy, and had spent
fifteen years of his life in Turkey as a slave in the greatest misery.
He was married at one hundred and ten to a woman of sixty, but outlived
her a long time, in his one hundred and thirtieth year he again fell in
love with a young country girl, who, as may well be supposed, rejected
him. He died in 1772 in his one hundred and forty-sixth year. Jean
Effingham died in Cornwall in 1757 in his one hundred and forty-fourth
year. He was born in the reign of James I and was a soldier at the
battle of Hochstadt; he never drank strong liquors and rarely ate meat;
eight days before his death he walked three miles.

Bridget Devine, the well-known inhabitant of Olean Street, Manchester
died at the age of one hundred and forty-seven in 1845. On the register
of the Cheshire Parish is a record of the death of Thomas Hough of
Frodsam in 1591 at the age of one hundred and forty-one.

Peter Garden of Auchterless died in 1775 at the age of one hundred and
thirty-one. He had seen and talked with Henry Jenkins about the battle
of Flodden Field, at which the latter was present when a boy of twelve.
It seems almost incredible that a man could say that he had heard the
story of an event which had happened two hundred and sixty-three years
before related by the lips of an eye-witness to that event;
nevertheless, in this case it was true. A remarkable instance of
longevity in one family has recently been published in the St. Thomas's
Hospital Gazette.  Mrs. B., born in 1630 (five years after the
accession of Charles I), died March 13, 1732. She was tended in her
last illness by her great-granddaughter, Miss Jane C., born 1718, died
1807, and Miss Sarah C., born 1725, died 1811. A great-niece of one of
these two ladies, Mrs. W., who remembers one of them, was born in 1803,
and is at the present time alive and well. It will be seen from the
above facts that there are three lives only to bridge over the long
period between 1630 and 1896, and that there is at present living a
lady who personally knew Miss C., who had nursed a relative born in
1630. The last lady of this remarkable trio is hale and hearty, and has
just successfully undergone an operation for cataract. Similar to the
case of the centenarian who had seen Henry Jenkins was that of James
Horrocks, who was born in 1744 and died in 1844. His father was born in
1657, one year before the death of the Protector, and had issue in
early life. He married again at eighty-four to a woman of twenty-six,
of which marriage James was the offspring in 1744. In 1844 this man
could with verity say that he had a brother born during the reign of
Charles II, and that his father was a citizen of the Commonwealth.

Among the Mission Indians of Southern California there are reported
instances of longevity ranging from one hundred and twenty to one
hundred and forty. Lieutenant Gibbons found in a village in Peru one
hundred inhabitants who were past the century mark, and another
credible explorer in the same territory records a case of longevity of
one hundred and forty. This man was very temperate and always ate his
food cold, partaking of meat only in the middle of the day. In the year
of 1840 in the town of Banos, Ecuador, died "Old Morales," a carpenter,
vigorous to his last days. He was an elderly man and steward of the
Jesuits when they were expelled from their property near this location
in 1767. In the year 1838 there was a witness in a judicial trial in
South America who was born on the night of the great earthquake which
destroyed the town of Ambato in 1698. How much longer this man who was
cradled by an earthquake lived is not as yet reported. In the State of
Vera Cruz, Mexico, as late as 1893 a man died at the age of one hundred
and thirty-seven. The census of 1864 for the town of Pilaguin, Ecuador,
lying 11,000 feet above the level of the sea and consisting of about
2000 inhabitants, gives 100 above seventy, 30 above ninety, five above
one hundred, and one at one hundred and fifteen years.

Francis Auge died in Maryland in 1767 at the age of one hundred and
thirty-four. He remembered the execution of Charles I and had a son
born to him after he was one hundred.

There are several other instances in which men have displayed
generative ability in old age. John Gilley, who died in Augusta, Maine,
in 1813, was born in Ireland in 1690. He came to this country at the
age of sixty, and continued in single blessedness until seventy-five,
when he married a girl of eighteen, by whom he had eight children. His
wife survived him and stated that he was virile until his one hundred
and twentieth year. Baron Baravicino de Capelis died at Meran in 1770
at the age of one hundred and four, being the oldest man in Tyrol. His
usual food was eggs, and he rarely tasted meat. He habitually drank tea
and a well-sweetened cordial of his own recipe. He was married four
times during his life, taking his fourth wife when he was eighty-four.
By her he had seven children and at his death she was pregnant with the
eighth child.

Pliny mentions cases of men begetting sons when past the age of eighty
and Plot speaks of John Best of the parish of Horton, who when one
hundred and four married a woman of fifty-six and begat a son. There
are also records of a man in Stockholm of one hundred who had several
children by a wife of thirty.

On August 7, 1776, Mary, the wife of Joseph Yates, at Lizard Common not
far from London, was buried at the age of one hundred and twenty-seven.
She had walked to London in 1666, and was hearty and strong at one
hundred and twenty, and had married a third husband at ninety-two.

A case without parallel, of long survival of a deaf mute, is found in
Mrs. Gray of Northfleet, Kent, who died in 1770, one hundred and
twenty-one years old. She was noted for her cheerful disposition, and
apparently enjoyed life in spite of her infirmity, which lasted one
hundred and twenty-one years.

Macklin the actor was born in 1697 and died in 1797. Several years
before his death he played "Shylock," displaying great vigor in the
first act, but in the second his memory failed him, and with much grace
and solemnity he advanced to the foot-lights and apologized for his
inability to continue. It is worthy of remark that several instances of
longevity in Roman actresses have been recorded. One Luceja, who came
on the stage very young, performed a whole century, and even made her
public appearance in her one hundred and twelfth year. Copiola was said
to have danced before Augustus when past ninety.

Influence of Stimulants, etc.--There have been men who have attributed
their long lives to their excesses in stimulants.  Thomas Wishart of
Annandale, Dumfries, died in 1760 at one hundred and twenty-four. He
had chewed tobacco one hundred and seventeen years, contracting the
habit when a child; his father gave it to him to allay hunger while
shepherding in the mountains. John de la Somet of Virginia died in 1766
aged one hundred and thirty. He was a great smoker, and according to
Eaton the habit agreed with his constitution, and was not improbably
the cause of his long health and longevity. William Riddell, who died
at one hundred and sixteen carefully avoided water all his life and had
a love for brandy.

Possession of Faculties.--Eglebert Hoff was a lad driving a team in
Norway when the news was brought that Charles I was beheaded.  He died
in Fishkill, N.Y., in 1764 at the age of one hundred and twenty-eight.
He never used spectacles, read fluently, and his memory and senses were
retained until his death, which was due to an accident. Nicolas
Petours, curate of the parish of Baleene and afterward canon of the
Cathedral of Constance, died at the age of one hundred and
thirty-seven; he was always a healthy, vigorous man, and celebrated
mass five days before his death. Mr. Evans of Spital Street,
Spitalfields, London, died in 1780 aged one hundred and thirty-nine,
having full possession of his mental faculties. Of interest to
Americans is the case of David Kinnison, who, when one hundred and
eleven, related to Lossing the historian the tale of the Boston Tea
Party, of which he had been a member. He died in good mental condition
at the age of one hundred and fifteen. Anthony Senish, a farmer of the
village of Limoges, died in 1770 in his one hundred and eleventh year.
He labored until two weeks before his death, had still his hair, and
his sight had not failed him. His usual food was chestnuts and Turkish
corn; he had never been bled or used any medicine. Not very long ago
there was alive in Tacony, near Philadelphia, a shoemaker named R. Glen
in his one hundred and fourteenth year.  He had seen King William III,
and all his faculties were perfectly retained; he enjoyed good health,
walking weekly to Philadelphia to church. His third wife was but thirty
years old.

Longevity in Ireland.--Lord Bacon said that at one time there was not a
village in all Ireland in which there was not a man living upward of
eighty. In Dunsford, a small village, there were living at one time 80
persons above the age of four score. Colonel Thomas Winslow was
supposed to have died in Ireland on August 26, 1766, aged one hundred
and forty-six. There was a man by the name of Butler who died at
Kilkenny in 1769 aged one hundred and thirty-three. He rode after the
hounds while yet a centenarian.  Mrs. Eckelston, a widow in
Phillipstown, Kings County, Ireland, died in 1690 at one hundred and
forty-three.

There are a number of instances in which there is extraordinary
renovation of the senses or even of the body in old age,--a new period
of life, as it were, is begun. A remarkable instance is an old
magistrate known to Hufeland, who lived at Rechingen and who died in
1791 aged one hundred and twenty. In 1787, long after he had lost all
his teeth, eight new ones appeared, and at the end of six months they
again dropped out, but their place was supplied by other new ones, and
Nature, unwearied, continued this process until his death. All these
teeth he had acquired and lost without pain, the whole number amounting
to 150. Alice, a slave born in Philadelphia, and living in 1802 at the
age of one hundred and sixteen, remembered William Penn and Thomas
Story.  Her faculties were well preserved, but she partially lost her
eyesight at ninety-six, which, strange to say, returned in part at one
hundred and two. There was a woman by the name of Helen Gray who died
in her one hundred and fifth year, and who but a few years before her
death had acquired a new set of teeth.

In Wilson's "Healthy Skin" are mentioned several instances of very old
persons in whom the natural color of the hair returned after they had
been gray for years. One of them was John Weeks, whose hair became
brown again at one hundred and fourteen. Sir John Sinclair a mentions a
similar case in a Scotchman who lived to one hundred and ten. Susan
Edmonds when in her ninety-fifth year recovered her black hair, but
previously to her death at one hundred and five again became gray.
There was a Dr. Slave who at the age of eighty had a renewal of rich
brown hair, which he maintained until his death at one hundred. There
was a man in Vienna, aged one hundred and five, who had black hair long
after his hair had first become white This man is mentioned as a
parallel to Dr. Slave. Similar examples are mentioned in Chapter VI.

It is a remarkable fact that many persons who have reached an old age
have lived on the smallest diet and the most frugal fare.  Many of the
instances of longevity were in people of Scotch origin who subsisted
all their lives on porridges. Saint Anthony is said to have maintained
life to one hundred and five on twelve ounces of bread daily. In 1792
in the Duchy of Holstein there was an industrious laborer named Stender
who died at one hundred and three, his food for the most part of his
life having been oatmeal and buttermilk. Throughout his life he had
been particularly free from thirst, drinking little water and no
spirits.

Heredity.--There are some very interesting instances of successive
longevity. Lister speaks of a son and a father, from a village called
Dent, who were witnesses before a jury at York in 1664. The son was
above one hundred and the father above one hundred and forty. John
Moore died in 1805 aged one hundred and seven. His father died at one
hundred and five and his grandfather at one hundred and fifteen, making
a total of three hundred and twenty-seven years for the three
generations.  Recently, Wynter mentions four sisters,--of one hundred,
one hundred and three, one hundred and five, and one hundred and seven
years respectively. On the register of Bremhill 1696, is the following
remarkable entry: "Buried, September 29th, Edith Goldie, Grace Young,
and Elizabeth Wiltshire, their united ages making three hundred." As
late as 1886 in the district of Campinos there was a strong active man
named Joseph Joachim de Prado, of good family, who was one hundred and
seven years old.  His mother died by accident at one hundred and
twelve, and his maternal grandmother died at one hundred and twenty-two.

Longevity in Active Military Service.--One of the most remarkable
proofs that under fickle fortune, constant danger, and the most
destructive influences the life of man may be long preserved is
exemplified in the case of an old soldier named Mittelstedt, who died
in Prussia in 1792, aged one hundred and twelve. He was born at Fissalm
in June, 1681. He entered the army, served under three Kings, Frederick
I, Frederick William I, and Frederick II, and did active service in the
Seven Years' War, in which his horse was shot under him and he was
taken prisoner by the Russians. In his sixty-eight years of army
service he participated in 17 general engagements, braved numerous
dangers, and was wounded many times. After his turbulent life he
married, and at last in 1790, in his one hundred and tenth year, he
took a third wife.  Until shortly before his death he walked every
month to the pension office, a distance of two miles from his house.

Longevity in Physicians.--It may be of interest to the members of our
profession to learn of some instances of longevity among confreres. Dr.
R. Baynes of Rockland, Maine, has been mentioned in the list of "grand
old men" in medicine; following in the footsteps of Hippocrates and
Galen, he was practicing at ninety-nine. He lives on Graham's diet,
which is a form of vegetarianism; he does not eat potatoes, but does
eat fruit. His drink is almost entirely water, milk, and chocolate, and
he condemns the use of tea, coffee, liquors, and tobacco. He has almost
a perfect set of natural teeth and his sight is excellent.  Like most
men who live to a great age, Dr. Baynes has a "fad," to which he
attributes a chief part in prolonging his life. This is the avoidance
of beds, and except when away from home he has not slept on a bed or
even on a mattress for over fifty years. He has an iron reclining
chair, over which he spreads a few blankets and rugs.

The British Medical Journal speaks of Dr. Boisy of Havre, who is one
hundred and three. It is said he goes his rounds every day, his
practice being chiefly among the poor. At one time he practiced in
India. He has taken alcoholic beverages and smoked tobacco since his
youth, although in moderation. His father, it is added, died at the age
of one hundred and eight. Mr. William R. Salmon, living near Cowbridge,
Glamorganshire, recently celebrated his one hundred and sixth birthday.
Mr. Salmon was born at Wickham Market in 1790, and became a member of
the Royal College of Surgeons in 1809, the year in which Gladstone was
born. He died April 11, 1896. In reference to this wonderful old
physician the Journal of the American Medical Association, 1896, page
995, says--

"William Reynold Salmon, M.R.C.S., of Penllyn Court, Cowbridge,
Glamorganshire, South Wales, completed his one hundred and sixth year
on March 16th, and died on the 11th of the present month--at the time
of his death the oldest known individual of indisputably authenticated
age, the oldest physician, the oldest member of the Royal College of
Surgeons, England, and the oldest Freemason in the world. His age does
not rest upon tradition or repute. He was the son of a successful and
esteemed practicing physician of Market Wickham, Suffolk, England, and
there is in the possession of his two surviving relatives, who cared
for his household for many years, his mother's diary, in which is
inscribed in the handwriting of a lady of the eighteenth century, under
the date, Tuesday, March 16, 1790, a prayer of thankfulness to God that
she had passed her 'tryall,' and that a son was born, who she hoped
'would prosper, be a support to his parents, and make virtue his chief
pursuit.' The Royal College of Surgeons verified this record many years
ago, and it was subsequently again authenticated by the authorities of
the Freemasons, who thereupon enshrined his portrait in their gallery
as the oldest living Freemason. The Salmon family moved to Cowbridge in
1796, so that the doctor had lived exactly a century in the lovely and
poetic Vale of Glamorgan, in the very heart of which Penllyn Court is
situated. Here on his one hundred and sixth birthday--a man of over
middle height, with still long, flowing hair, Druidical beard and
mustache, and bushy eyebrows--Dr. Salmon was visited by one who
writes:--

"'Seen a few days ago, the Patriarch of Penllyn Court was hale and
hearty. He eats well and sleeps well and was feeling better than he had
felt for the last five years. On that day he rose at noon, dined at
six, and retired at nine. Drank two glasses of port with his dinner,
but did not smoke. He abandoned his favorite weed at the age of ninety,
and had to discontinue his drives over his beautiful estate in his one
hundredth year. One day is much the same as another, for he gives his
two relatives little trouble in attending upon his wants. Dr. Salmon
has not discovered the elixir of life, for the shadows of life's
evening are stealing slowly over him. He cannot move about, his hearing
is dulled, and the light is almost shut out from the "windows of his
soul." Let us think of this remarkable man waiting for death
uncomplainingly in his old-fashioned mansion, surrounded by the
beautiful foliage and the broad expanse of green fields that he loved
so much to roam when a younger man, in that sylvan Sleepy Hollow in the
Vale of Glamorgan.'

"Eight weeks later he, who in youth had been 'the youngest surgeon in
the army, died, the oldest physician in the world."

Dr. William Hotchkiss, said to have reached the age of one hundred and
forty years, died in St. Louis April 1, 1895. He went to St. Louis
forty years ago, and has always been known as the "color doctor." In
his peculiar practice of medicine he termed his patients members of his
"circles," and claimed to treat them by a magnetic process. Dr. A. J.
Buck says that his Masonic record has been traced back one hundred
years, showing conclusively that he was one hundred and twenty-one
years old. A letter received from his old home in Virginia, over a year
ago, says that he was born there in 1755.

It is comforting to the members of our profession, in which the average
of life is usually so low, to be able to point out exceptions. It has
been aptly said of physicians in general: "Aliis inserviendo
consumuntur; aliis medendo moriuntur," or "In serving others they are
consumed; in healing others they are destroyed."

Recent Instances of Longevity.--There was a man who died in Spain at
the advanced age of one hundred and fifty-one, which is the most
extraordinary instance from that country. It is reported that quite
recently a Chinese centenarian passed the examination for the highest
place in the Academy of Mandarins. Chevreul, born in 1786, at Angers,
has only recently died after an active life in chemical investigation.
Sir Moses Montefiore is a recent example of an active centenarian.

In the New York Herald of April 21, 1895, is a description and a
portrait of Noah Raby of the Piscataway Poor Farm of New Jersey, to
whom was ascribed one hundred and twenty-three years. He was discharged
from active duty on the "Brandywine," U.S.N., eighty-three years ago.
He relates having heard George Washington speak at Washington and at
Portsmouth while his ship was in those places. The same journal also
says that at Wichita, Kansas, there appeared at a municipal election an
old negress named Mrs. Harriet McMurray, who gave her age as one
hundred and fifteen.  She had been a slave, and asserted that once on a
visit to Alexandria with her master she had seen General Washington.
From the Indian Medical Record we learn that Lieutenant Nicholas Lavin
of the Grand Armee died several years ago at the age of one hundred and
twenty-five, leaving a daughter of seventy-eight. He was born in Paris
in 1768, served as a hussar in several campaigns, and was taken a
prisoner during the retreat from Moscow. After his liberation he
married and made his residence in Saratoff.



CHAPTER IX.

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

In considering the anomalies of the secretions, it must be remembered
that the ingestion of certain kinds of food and the administration of
peculiar drugs in medicine have a marked influence in coloring
secretions. Probably the most interesting of all these anomalies is the
class in which, by a compensatory process, metastasis of the secretions
is noticed.

Colored Saliva.--Among the older writers the Ephemerides contains an
account of blue saliva; Huxham speaks of green saliva; Marcellus
Donatus of yellow, and Peterman relates the history of a case of yellow
saliva. Dickinson describes a woman of sixty whose saliva was blue;
besides this nothing was definitely the matter with her. It seemed
however, that the color was due to some chemic-pencil poisoning rather
than to a pathologic process.  A piece of this aniline pencil was
caught in the false teeth.  Paget cites an instance of blue saliva due
to staining the tongue in the same manner. Most cases of anomalous
coloring of this kind can be subsequently traced to artificial
substances unconsciously introduced. Crocker mentions a woman who on
washing her hands constantly found that the water was stained blue, but
this was subsequently traced to the accidental introduction of an
orchid leaf. In another instance there was a woman whose linen was at
every change stained brown; this, however, was found to be due to a
hair-wash that she was in the habit of using.

Among the older writers who have mentioned abnormal modes of exit of
the urine is Baux, who mentions urine from the nipples; Paullini and
the Ephemerides describe instances of urination from the eyes.
Blancard, the Ephemerides, Sorbalt, and Vallisneri speak of urination
by the mouth. Arnold relates the history of a case of dysuria in which
urine was discharged from the nose, breasts, ears, and umbilicus; the
woman was twenty-seven years old, and the dysuria was caused by a
prolapsed uterus. There was an instance of anomalous discharge of urine
from the body reported in Philadelphia many years ago which led to
animated discussion. A case of dysuria in which the patient discharged
urine from the stomach was reported early in this century from Germany.
The patient could feel the accumulation of urine by burning pain in the
epigastrium. Suddenly the pain would move to the soles of the feet, she
would become nauseated, and large quantities of urine would soon be
vomited. There was reported the case of an hysterical female who had
convulsions and mania, alternating with anuria of a peculiar nature and
lasting seven days. There was not a drop of urine passed during this
time, but there were discharges through the mouth of alkaline waters
with a strong ammoniacal odor.

Senter reports in a young woman a singular case of ischuria which
continued for more than three years; during this time if her urine was
not drawn off with the catheter she frequently voided it by vomiting;
for the last twenty months she passed much gravel by the catheter; when
the use of the instrument was omitted or unsuccessfully applied the
vomitus contained gravel. Carlisle mentions a case in which there was
vomiting of a fluid containing urea and having the sensible properties
of urine. Curious to relate, a cure was effected after ligature of the
superior thyroid arteries and sloughing of the thyroid gland. Vomiting
of urine is also mentioned by Coley, Domine, Liron, Malago, Zeviani,
and Yeats. Marsden reports a case in which, following secondary papular
syphilis and profuse spontaneous ptyalism, there was vicarious
secretion of the urinary constituents from the skin.

Instances of the anomalous exit of urine caused by congenital
malformation or fistulous connections are mentioned in another chapter.
Black urine is generally caused by the ingestion of pigmented food or
drugs, such as carbolic acid and the anilines.  Amatus Lusitanus,
Bartholinus, and the Ephemerides speak of black urine after eating
grapes or damson plums. The Ephemerides speaks of black urine being a
precursor of death, but Piso, Rhodius, and Schenck say it is anomalous
and seldom a sign of death. White urine, commonly known as chyluria, is
frequently seen, and sometimes results from purulent cystitis. Though
containing sediment, the urine looks as if full of milk. A case of this
kind was seen in 1895 at the Jefferson Medical College Hospital,
Philadelphia, in which the chyluria was due to a communication between
the bladder and the thoracic duct.

Ackerman has spoken of metastasis of the tears, and Dixon gives an
instance in which crying was not attended by the visible shedding of
tears. Salomon reports a case of congenital deficiency of tears.
Blood-stained tears were frequently mentioned by the older writers.
Recently Cross has written an article on this subject, and its analogy
is seen in the next chapter under hemorrhages from the eyes through the
lacrimal duct.

The Semen.--The older writers spoke of metastasis of the seminal flow,
the issue being by the skin (perspiration) and other routes. This was
especially supposed to be the case in satyriasis, in which the
preternatural exit was due to superabundance of semen, which could be
recognized by its odor.  There is no doubt that some people have a
distinct seminal odor, a fact that will be considered in the section on
"Human Odors."

The Ephemerides, Schurig, and Hoffman report instances of what they
call fetid semen (possibly a complication of urethral disease). Paaw
speaks of black semen in a negro, and the Ephemerides and Schurig
mention instances of dark semen. Blancard records an instance of
preternatural exit of semen by the bowel.  Heers mentions a similar
case caused by urethral fistula. Ingham mentions the escape of semen
through the testicle by means of a fistula. Demarquay is the authority
on bloody semen.

Andouard mentions an instance of blue bile in a woman, blue flakes
being found in her vomit. There was no trace of copper to be found in
this case. Andouard says that the older physicians frequently spoke of
this occurrence.

Rhodius speaks of the sweat being sweet after eating honey; the
Ephemerides and Paullini also mention it. Chromidrosis, or colored
sweat, is an interesting anomaly exemplified in numerous reports. Black
sweat has been mentioned by Bartholinus, who remarked that the
secretion resembled ink; in other cases Galeazzi and Zacutus Lusitanus
said the perspiration resembled sooty water. Phosphorescent sweat has
been recorded. Paullini and the Ephemerides mention perspiration which
was of a leek-green color, and Borellus has observed deep green
perspiration. Marcard mentions green perspiration of the feet, possibly
due to stains from colored foot-gear. The Ephemerides and Paullini
speak of violet perspiration, and Bartholinus has described
perspiration which in taste resembled wine.

Sir Benjamin Brodie has communicated the history of a case of a young
girl of fifteen on whose face was a black secretion. On attempting to
remove it by washing, much pain was caused. The quantity removed by
soap and water at one time was sufficient to make four basins of water
as black as if with India ink. It seemed to be physiologically
analogous to melanosis. The cessation of the secretion on the forehead
was followed by the ejection of a similar substance from the bowel,
stomach, and kidney. The secretion was more abundant during the night,
and at one time in its course an erysipelas-eruption made its
appearance. A complete cure ultimately followed.

Purdon describes an Irish married woman of forty, the subject of
rheumatic fever, who occasionally had a blue serous discharge or
perspiration that literally flowed from her legs and body, and
accompanied by a miliary eruption. It was on the posterior portions,
and twelve hours previous was usually preceded by a moldy smell and a
prickly sensation. On the abdomen and the back of the neck there was a
yellowish secretion. In place of catamenia there was a discharge
reddish-green in color. The patient denied having taken any coloring
matter or chemicals to influence the color of her perspiration, and no
remedy relieved her cardiac or rheumatic symptoms.

The first English case of chromidrosis, or colored sweat, was published
by Yonge of Plymouth in 1709. In this affection the colored sweating
appears symmetrically in various parts of the body, the parts commonly
affected being the cheeks, forehead, side of the nose, whole face,
chest, abdomen, backs of the hands, finger-tips, and the flexors,
flexures at the axillae, groins, and popliteal spaces. Although the
color is generally black, nearly every color has been recorded. Colcott
Fox reported a genuine case, and Crocker speaks of a case at Shadwell
in a woman of forty-seven of naturally dark complexion. The bowels were
habitually sluggish, going three or four days at least without action,
and latterly the woman had suffered from articular pains.  The
discolored sweat came out gradually, beginning at the sides of the
face, then spreading to the cheeks and forehead. When seen, the upper
half of the forehead, the temporal regions, and the skin between the
ear and malar eminence were of a blackish-brown color, with slight
hyperemia of the adjacent parts; the woman said the color had been
almost black, but she had cleaned her face some. There was evidently
much fat in the secretion; there was also seborrhea of the scalp.
Washing with soap and water had very little effect upon it; but it was
removed with ether, the skin still looking darker and redder than
normal.  After a week's treatment with saline purgatives the
discoloration was much less, but the patient still had articular pains,
for which alkalies were prescribed; she did not again attend. Crocker
also quotes the case of a girl of twenty, originally under Mackay of
Brighton. Her affection had lasted a year and was limited to the left
cheek and eyebrow. Six months before the patch appeared she had a
superficial burn which did not leave a distinct scar, but the surface
was slightly granular. The deposit was distinctly fatty, evidently
seborrheic and of a sepia-tint. The girl suffered from obstinate
constipation, the bowels acting only once a week. The left side flushed
more than the right In connection with this case may be mentioned one
by White of Harvard, a case of unilateral yellow chromidrosis in a man.
Demons gives the history of a case of yellow sweat in a patient with
three intestinal calculi.

Wilson says that cases of green, yellow, and blue perspiration have
been seen, and Hebra, Rayer, and Fuchs mention instances.  Conradi
records a case of blue perspiration on one-half the scrotum. Chojnowski
records a case in which the perspiration resembled milk.

Hyperidrosis occurs as a symptom in many nervous diseases, organic and
functional, and its presence is often difficult of explanation. The
following are recent examples: Kustermann reports a case of acute
myelitis in which there was profuse perspiration above the level of the
girdle-sensation and none at all below. Sharkey reports a case of tumor
of the pons varolii and left crus cerebri, in which for months there
was excessive generalized perspiration; it finally disappeared without
treatment. Hutchinson describes the case of a woman of sixty-four who
for four years had been troubled by excessive sweating on the right
side of the face and scalp. At times she was also troubled by an
excessive flow of saliva, but she could not say if it was unilateral.
There was great irritation of the right side of the tongue, and for two
years taste was totally abolished. It was normal at the time of
examination. The author offered no explanation of this case, but the
patient gave a decidedly neurotic history, and the symptoms seem to
point with some degree of probability to hysteria. Pope reports a
peculiar case in which there were daily attacks of neuralgia preceded
by sweating confined to a bald spot on the head. Rockwell reports a
case of unilateral hyperidrosis in a feeble old man which he thought
due to organic affection of the cervical sympathetic.

Dupont has published an account of a curious case of chronic general
hyperidrosis or profuse sweating which lasted upward of six years. The
woman thus affected became pregnant during this time and was happily
delivered of an infant, which she nursed herself. According to Dupont,
this hyperidrosis was independent of any other affection, and after
having been combated fruitlessly by various remedies, yielded at last
to fluid extract of aconitin.

Myrtle relates the case of a man of seventy-seven, who, after some
flying pains and fever, began to sweat profusely and continued to do so
until he died from exhaustion at the end of three months from the onset
of the sweating. Richardson records another case of the same kind.
Crocker quotes the case of a tailor of sixty-five in whom hyperidrosis
had existed for thirty-five years. It was usually confined to the hands
and feet, but when worst affected the whole body. It was absent as long
as he preserved the horizontal posture, but came on directly when he
rose; it was always increased in the summer months. At the height of
the attack the man lost appetite and spirit, had a pricking sensation,
and sometimes minute red papules appeared all over the hand. He had
tried almost every variety of treatment, but sulphur did the most good,
as it had kept the disease under for twelve months. Latterly, even that
failed.

Bachman reports the history of a case of hyperidrosis cured by
hypnotism.

Unilateral and localized sweating accompanies some forms of nervous
disturbance. Mickle has discussed unilateral sweating in the general
paralysis of the insane. Ramskill reports a case of sweating on one
side of the face in a patient who was subject to epileptic convulsions.
Takacs describes a case of unilateral sweating with proportionate
nervous prostration. Bartholow and Bryan report unilateral sweating of
the head. Cason speaks of unilateral sweating of the head, face, and
neck. Elliotson mentions sweat from the left half of the body and the
left extremities only. Lewis reports a case of unilateral perspiration
with an excess of temperature of 3.5 degrees F. in the axilla of the
perspiring side. Mills, White, Dow, and Duncan also cite instances of
unilateral perspiration. Boquis describes a case of unilateral
perspiration of the skin of the head and face, and instances of
complete unilateral perspiration have been frequently recorded by the
older writers,--Tebure, Marcellus Donatus, Paullini, and Hartmann
discussing it. Hyperidrosis confined to the hands and feet is quite
common.

Instances of bloody sweat and "stigmata" have been known through the
ages and are most interesting anomalies. In the olden times there were
people who represented that in their own persons they realized at
certain periods the agonies of Gethsemane, as portrayed in medieval
art, e.g., by pictures of Christ wearing the crown of thorns in
Pilate's judgment hall. Some of these instances were, perhaps, of the
nature of compensatory hemorrhage, substituting the menses or periodic
hemorrhoids, hemoptysis, epistaxis, etc., or possibly purpura. Extreme
religious frenzy or deep emotions might have been the indirect cause of
a number of these bleeding zealots. There are instances on record in
which fear and other similar emotions have caused a sweating of blood,
the expression "sweating blood" being not uncommon.

Among the older writers, Ballonius, Marcolini, and Riedlin mention
bloody sweat. The Ephemerides speaks of it in front of the
hypochondrium. Paullini observed a sailor of thirty, who, falling
speechless and faint during a storm on the deck of his ship, sweated a
red perspiration from his entire body and which stained his clothes. He
also mentions bloody sweat following coitus. Aristotle speaks of bloody
sweat, and Pellison describes a scar which periodically opened and
sweated blood. There were many cases like this, the scars being usually
in the location of Christ's wounds.

De Thou mentions an Italian officer who in 1552, during the war between
Henry II of France and Emperor Charles V, was threatened with public
execution; he became so agitated that he sweated blood from every
portion of the body. A young Florentine about to be put to death by an
order of Pope Sixtus V was so overcome with grief that he shed bloody
tears and sweated blood. The Ephemerides contains many instances of
bloody tears and sweat occasioned by extreme fear, more especially fear
of death.  Mezeray mentions that the detestable Charles IX of France,
being under constant agitation and emotion, sank under a disorder which
was accompanied by an exudation of blood from every pore of his body.
This was taken as an attempt of nature to cure by bleeding according to
the theory of the venesectionists. Fabricius Hildanus mentions a child
who, as a rule, never drank anything but water, but once, contrary to
her habit, drank freely of white wine, and this was soon followed by
hemorrhage from the gums, nose, and skin.

There is a case also related of a woman of forty-five who had lost her
only son. One day she fancied she beheld him beseeching her to release
his soul from purgatory by prayers and fasting every Friday. The
following Friday, which was in the month of August, and for five
succeeding Fridays she had a profuse bloody perspiration, the disorder
disappearing on Friday, March 8th, of the following year. Pooley says
that Maldonato, in his "Commentaries of Four Gospels," mentions a
healthy and robust man who on hearing of his sentence of death sweated
blood, and Zacchias noted a similar phenomenon in a young man condemned
to the flames. Allusion may also be made to St. Luke, who said of
Christ that in agony He prayed more earnestly, "and His sweat was, as
it were, great drops of blood falling down to the ground."

Pooley quotes the case of a young woman of indolent habit who in a
religious fanatical trance sweated blood. The stigmatists were often
imposters who artificially opened their scars, and set the example for
the really peculiar cases of bloody sweat, which among ignorant people
was considered evidence of sympathy with the agony of the Cross.

Probably the best studied case on record is that of Louise Lateau of
Bois d'Haine, which, according to Gray, occurred in 1869 in a village
of Belgium when the girl was at the age of twenty-three; her previous
life had offered nothing remarkable. The account is as follows: "One
Friday Louise Lateau noticed that blood was flowing from one side of
her chest, and this recurred every Friday. On each Thursday morning an
oval surface about one inch in length on the back of each hand became
pink in color and smooth, whilst a similar oval surface on the palm of
each hand became of the same hue, and on the upper surface of each foot
a pinkish-white square appeared. Examined under a magnifying glass, the
epidermis appeared at first without solution of continuity and
delicate. About noon on Thursday a vesicle formed on the pink surfaces
containing clear serum. In the night between Thursday and Friday,
usually between midnight and one o'clock, the flow of blood began, the
vesicle first rupturing. The amount of blood lost during the so called
stigmata varied, and some observers estimated it at about one and
three-quarter pints. The blood itself was of a reddish color, inclining
to violet, about the hue therefore, of capillary blood, coagulating in
the usual way, and the white and red corpuscles being normal in
character and relative proportion. The flow ceased on Saturdays. During
the flow of the blood the patient was in a rapt, ecstatic condition.
The facial expression was one of absorption and far-off contemplation,
changing often to melancholy, terror, to an attitude of prayer or
contrition. The patient herself stated that at the beginning of the
ecstasy she imagined herself surrounded by a brilliant light; figures
then passed before her, and the successive scenes of the crucifixion
were panoramically progressive. She saw Christ in person--His clothing,
His wounds, His crown of thorns, His cross--as well as the Apostles,
the holy women, and the assembled Jews. During the ecstasy the
circulation of the skin and heart was regular, although at times a
sudden flash or pallor overspread the face, according with the play of
the expression. From midday of Thursdays, when she took a frugal meal,
until eight o'clock on Saturday mornings the girl took no nourishment,
not even water, because it was said that she did not feel the want of
it and could not retain anything upon her stomach. During this time the
ordinary secretions were suspended."

Fournier mentions a statesman of forty-five who, following great
Cabinet labors during several years and after some worriment, found
that the day after indulging in sexual indiscretions he would be in a
febrile condition, with pains in the thighs, groins, legs, and penis.
The veins of these parts became engorged, and subsequently blood oozed
from them, the flow lasting several days. The penis was the part most
affected. He was under observation for twenty months and presented the
same phenomena periodically, except that during the last few months
they were diminished in every respect. Fournier also mentions a curious
case of diapedesis in a woman injured by a cow. The animal struck her
in the epigastric region, she fell unconscious, and soon after vomited
great quantities of blood, and continued with convulsive efforts of
expulsion to eject blood periodically from every eight to fifteen days,
losing possibly a pound at each paroxysm. There was no alteration of
her menses. A physician gave her astringents, which partly suppressed
the vomiting, but the hemorrhage changed to the skin, and every day she
sweated blood from the chest, back of the thighs, feet, and the
extremities of the fingers. When the blood ceased to flow from her skin
she lost her appetite, became oppressed, and was confined to her bed
for some days. Itching always preceded the appearance of a new flow.
There was no dermal change that could be noticed.

Fullerton mentions a girl of thirteen who had occasional oozing of
blood from her brow, face, and the skin under the eyes.  Sometimes a
pound of clots was found about her face and pillow.  The blood first
appeared in a single clot, and, strange to say, lumps of fleshy
substance and minute pieces of bone were discharged all day. This
latter discharge became more infrequent, the bone being replaced by
cartilaginous substance. There was no pain, discoloration, swelling, or
soreness, and after this strange anomaly disappeared menstruation
regularly commenced. Van Swieten mentions a young lady who from her
twelfth year at her menstrual periods had hemorrhages from pustules in
the skin, the pustules disappearing in the interval.

Schmidt's Jahrbucher for 1836 gives an account of a woman who had
diseased ovaries and a rectovesicovaginal fistula, and though sometimes
catamenia appeared at the proper place it was generally arrested and
hemorrhage appeared on the face. Chambers mentions a woman of
twenty-seven who suffered from bloody sweat after the manner of the
stigmatists, and Petrone mentions a young man of healthy antecedents,
the sweat from whose axillae and pubes was red and very pungent.
Petrone believes it was due to a chromogenic micrococcus, and relieved
the patient by the use of a five per cent solution of caustic potash.
Chloroform, ether, and phenol had been tried without success. Hebra
mentions a young man in whom the blood spurted from the hand in a
spiral jet corresponding to the direction of the duct of the
sweat-gland.  Wilson refers to five cases of bloody sweat.

There is a record of a patient who once or twice a day was attacked
with swelling of the scrotum, which at length acquired a deep red color
and a stony hardness, at which time the blood would spring from a
hundred points and flow in the finest streams until the scrotum was
again empty.

Hill describes a boy of four who during the sweating stage of malaria
sweated blood from the head and neck. Two months later the
skin-hemorrhages ceased and the boy died, vomiting blood and with
bloody stools.

Postmortem sweating is described in the Ephemerides and reported by
Hasenest and Schneider. Bartholinus speaks of bloody sweat in a cadaver.

In considering the anomalies of lactation we shall first discuss those
of color and then the extraordinary places of secretion.  Black milk is
spoken of by the Ephemerides and Paullini. Red milk has been observed
by Cramer and Viger. Green milk has been observed by Lanzonius,
Riverius, and Paullini. The Ephemerides also contains an account of
green milk. Yellow milk has been mentioned in the Ephemerides and its
cause ascribed to eating rhubarb.

It is a well-known fact that some cathartics administered to nursing
mothers are taken from the breast by their infants, who,
notwithstanding its indirect mode of administration, exhibit the
effects of the original drug. The same is the case with some poisons,
and instances of lead-poisoning and arsenic-poisoning have been seen in
children who have obtained the toxic substance in the mother's milk.
There is one singular case on record in which a child has been poisoned
from the milk of its mother after she had been bitten by a serpent.

Paullini and the Ephemerides give instances of milk appearing in the
perspiration, and there are numerous varieties of milk-metastasis
recorded Dolaeus and Nuck mention the appearance of milk in the saliva.
Autenreith mentions metastasis of milk through an abdominal abscess to
the thigh, 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 umbilicus, Haen to the back, and Schurig to a
wound in the foot. Knackstedt 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 vicariously.

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
sensation 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 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 lactation in an infant.
Variot 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-shaped, with a rosy areola, in the center of which was
a nipple. These precocious 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 lactation 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 pregnant, 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
Sinnety have cited instances.

Lactation in the aged has been frequently noticed. Amatus Lusitanus 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 which 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 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
instance 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 indefinitely prolonged; she married at
sixteen, two years after the establishment of menstruation. She became
pregnant shortly after marriage, and after delivery had continued
lactation for a year without any sign of returning menstruation. 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
herself 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 drawing it
from the breast to relieve painful tension.

Kennedy 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 1/2 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 seen
men with mammae a which were as well developed as those of a woman, and
Paulus aegineta recognized the fact in the ancient Greeks. Subsequently
Albucasis discusses it in his writings. Bartholinus, Behr, Benedictus,
Borellus, 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 conscripts.

To Bedor, a marine surgeon, we owe the first scientific exposition of
this subject, and a little later Villeneuve published his article in
the French dictionary. 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 children. 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. Petrequin 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 circumference at
the base, and hung like those of a nursing woman.

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. Petrequin describes a man with three mammae, 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 circumference
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, accompanied 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
mammae "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
proportion to the size of the breast and the manners became effeminate.
Cameron, quoted by Snedden, speaks of a fellow-student who had a
supernumerary 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 Liege, saw a conscript of thirteen whose left mamma
was well developed like that of a woman, and whose nipple was
surrounded by a large areola. 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 Royal Naval 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. The man stated that he first observed the breast to
enlarge at sixteen and a half years; since that time it had steadily
increased, but there was no milk at any time from the nipple; the
external genital organs were well 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 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.

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 began 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
infants. 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 sixteenth 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.
Paullini and Schenck cite cases of men suckling infants, and Blumenbach
has described a male-goat which, on account of the engorgement of the
mammae, it was necessary 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 faculty 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.

Fournier also mentions a French woman, an inhabitant of Naples, who had
an extreme supersensitiveness of smell. The slightest odor was to her
intolerable; 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 apartments. Cadet de Gassieourt witnessed this
peculiar instance, and in consultation 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
particularly 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 saddler, 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
Bergamons 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., artificially applied. In
more modern times Malherbe and Haller were said to diffuse from their
bodies the agreeable odor of musk. These "human flowers," to use
Goethe's expression, are more highly perfumed in Southern latitudes.

Modifying Causes.--According to Brieude, sex, age, climate, habits,
ailments, the passions, the emotions, and the occupations modify the
difference in the humors exhaled, resulting in necessarily different
odors. Nursing infants have a peculiar 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 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.  Negroes
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 medicolegal 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 Hopital de la Charite
affected with chronic peritonitis, who some time before her death
exhaled a very 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 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.--Pare states that persons of red hair and freckled
complexion 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. Fevre 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. Burrows 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
handkerchief, 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 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
Medicis, 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 following 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
"fetichism," in which the subject displays a perverted taste for the
odors of handkerchiefs, 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 in the Middle Ages were not
only tokens of remembrance and appreciation, but sexual excitants as
well. In his remarkable "Osphresiologie," Cloquet calls attention to
the sexual pleasure excited by the odors of flowers, and tells how
Richelieu 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 Conde, Henry
immediately conceived 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."

Krafft-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 necessary 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 toilet. 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 Krafft Ebing, Althaus shows that
animals of opposite sexes are drawn to each other by means of olfactory
perceptions, 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 extirpated 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 materials having a
very strong odor. Musk, a substance possessing the most penetrating
odor and used in therapeutics, is obtained from the preputial follicles
of the musk-deer of Thibet; and castor, a substance less penetrating,
is obtained 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 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 was 105 pounds,
but when last seen he weighed 284 pounds and was increasing 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 snow 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 Tennessee, 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 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 a 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
incredible. McElroy has made observations in the glass-factories in his
neighborhood, 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 water.  Occasionally a man becomes what is
termed "blown-up with water;" that is, the perspiration 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 symptoms. McElroy, among other cases, speaks of one in a
patient who was continually 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 earliest accounts of the
Indians of Florida and Texas show that "for food, they dug roots, and
that they ate spiders, ants' eggs, worms, lizards, salamanders, snakes,
earth, wood, the dung of deer, and many other things." Gomara, in his
"Historia de les Indias," says this loathsome diet was particular to
one tribe, the Yagusces 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.

Bourke recalls that the drinking of human urine has often been a
religious rite, and describes the urine-dance of the Zunis 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 disappear 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 diseases.  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 Domenech, 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 thousands of
maggots, and says that they ravenously devoured dogs' guts raw.
Spencer, in his "Descriptive Sociology," describes a "Snake savage" of
Australia who 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 Reverend 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. Numerous authorities are quoted by
Bourke 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-honored custom among some of the tribes of Africa. This custom is
often practised 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 necessity. In a famine in Egypt, as
pictured by the Arab Abdullatif, the putrefying debris of animals, as
well as their excrement, was used as food, and finally the human dead
were used; then infants were killed and devoured, so great was the
distress. In many sieges, shipwrecks, etc., cannibalism has been
practiced 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 comrades. In the famous Wiertz Museum in Brussels is a
painting by this eccentric 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 conclusion 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
Lumholtz, a Norwegian scientist, spent many months in studying them in
the wilds of the interior. He was alone among these savages, who are
extremely treacherous. 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 prevented 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 complacency, 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 grave. In the grave is a man not related to the
deceased, who proceeds to cut off 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 person 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 redoubtable 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. Surrounded 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, 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
friendship 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 northwest 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
ceremonies, Boas, quoted by Bourke, says that members of the tribes
practicing Hamatsa ceremonies show remarkable scars produced by biting,
and at certain festivals ritualistic cannibalism is practiced, it being
the duty of the Hamatsa 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 civilized 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 choleric 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 by an
irresistible desire to eat human flesh, assassinated many persons; and
his daughter, though educated away from him, yielded to the same
graving.

At Bicetre there was an individual who had a horribly depraved appetite
for decaying human flesh. He would haunt the graveyards and eat the
putrefying remains of the recently buried, preferring the intestines.
Having regaled 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 1600,
there is the record of a boy named Jean Granier, who had repeatedly
killed and devoured several young children before he was discovered.
Rodericus a Castro 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 adhesions
between the brain and the cerebral membranes. Mascha relates a similar
instance in a man of fifty-five who violated and killed a young girl,
eating of her genitals and mammae. 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 Menesclou,
who was examined by Brouardel, Motet, and others, and declared to be
mentally sound; he was convicted. This miscreant was arrested with the
forearm 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. Krafft-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 mentioned 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 porter or
garcon 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 appetite. 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 collection. 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
aggregate 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 hospital 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 purulent diarrhea, all
his intestines and peritoneum being in a suppurating condition.

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
disposition 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
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 scorpions. 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
Woensel 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 a 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 Wurtemberg 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 ha said
invariably relieved his gastric irritation. In the twenty-five years of
the habit he had used over 1/2 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 instinctive 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 suffered from
small-pox; on waking up in the night with a fever, he always cried for
a piece of mortar. The quantity consumed in twenty-four hours was about
1/2 teacupful. 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 quantities taken habitually are quite sufficient to produce
immediate death ordinarily. 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
exhibitionists and jugglers, and not individuals with perverted
appetites, will be considered in Chapter XII.

Fasting.--The length of time which a person can live with 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 penance and to gain
the approbation of Heaven.

In many religions fasting has become a part of worship or religions
ceremony, 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 Egyptians, 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 prolonged.

At the present day religious fervor accounts for but few of our
remarkable 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 nourished 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 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
diseases, particularly of the febrile type; but in all of these the
patient is maintained 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
disturbance of hysteria which Sir William Gull has called anorexia
nervosa. In this 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 degree of muscular
restlessness, so that the patients wander about until exhausted.
According to Osler, 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 esophagus, 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
repugnance 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 degrees 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
exhibitionists 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 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. Muller 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
Ephemerides, thirteen months; Gerard, sixty-nine days (resulting in
death); and in 1722 there was recorded an instance of abstinence
lasting twenty-five months.

Desbarreaux-Bernard says that Guillaume Granie 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
extraordinary was that of a girl of Confolens, described by Citois of
Poitiers, who published a history of the case in the beginning of the
seventeenth century. This girl is said to have passed three entire
years, from eleven to fourteen, 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 Confolens," 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 subsisted nearly four years on
water. In 1684 four miners were buried in a coal-pit in Horstel, a half
mile from Liege, 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
overcome 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 where they had been buried by an avalanche of snow,
March 19, 1765. 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 snow
liquefied by the heat of their hands. Their sufferings were greatly
increased 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 Woodcock
dismounted from her horse, which ran away, leaving her in a violent
snowstorm. 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 Creaser 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
returned 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 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 well as motionless. There were
several livid spots on his legs and one toe was gangrenous. 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
Abyssinians who became destitute of provisions while en route to Cairo,
and who lived two months on gum arabic 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. Glower 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 lived 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, end 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 relates of Apollonia Schreiera that she lived three
years without meat or drink. He also tells of Eva Flegen, who began to
fast in 1596, 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 abstinence 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.  Benjamin Rush
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
Saint-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 earthquake, 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 recovery. 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 fifty-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 supposed
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 "fasting girls," Margaret Weiss, although only ten
years old, had such powers of deception that after being watched by the
priest of the parish, Dr. Bucoldianus, she was considered free from
juggling, and, to everybody's astonishment, she grew, walked, and
talked like other children 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 fasting 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 Racconis, in Piedmont, who died on May 19, 1828, after
having endured a supposed fast of two years, eight months, and eleven
days, revealed remarkable intestinal changes. The serous membranes were
all callous and thickened, and the canal of the sigmoid flexure was
totally obliterated. The mucous membranes were all soft and friable,
and presented the appearance of incipient gangrene.

Modern Cases.--Turning now to modern literature, we have cases of
marvelous abstinence well substantiated by authoritative evidence.
Dickson describes a man of sixty-two, suffering from monomania, who
refused food for four months, but made a successful recovery.
Richardson 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 li