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 lived on water until the day of his death.
Richardson gives an interesting account of the changes noticed at the
necropsy. There is an account of a religious mendicant of the Jain
caste who as a means of penance fasted for ninety-one days.  The
previous year he had fasted eighty-six days. He had spent his life in
strict asceticism, and during his fasting he was always engrossed in
prayer.

Collins describes a maiden lady of eighty, always a moderate eater, who
was attacked by bronchitis, during which she took food as usual. Two
days after her recovery, without any known cause, she refused all food
and continued to do so for thirty-three days, when she died. She was
delirious throughout this fast and slept daily seven or eight hours. As
a rule, she drank about a wineglassful of water each day and her urine
was scanty and almost of the consistency of her feces. There is a
remarkable case of a girl of seventeen who, suffering with typhoid
fever associated with engorgement of the abdomen and suppression of the
functions of assimilation, fasted for four months without visible
diminution in weight. Pierce reports the history of a woman of
twenty-six who fasted for three months and made an excellent recovery.

Grant describes the "Market Harborough fasting-girl," a maiden of
nineteen, who abstained from food from April, 1874, until December,
1877, although continually using morphia. Throughout her fast she had
periodic convulsions, and voided no urine or feces for twelve months
before her death. There was a middle-aged woman in England in 1860 who
for two years lived on opium, gin, and water. Her chief symptoms were
almost daily sickness and epileptic fits three times a week. She was
absolutely constipated, and at her death her abdomen was so distended
as to present the appearance of ascites. After death, the distention of
the abdomen was found to be due to a coating of fat, four inches thick,
in the parietes. There was no obstruction to the intestinal canal and
no fecal or other accumulation within it.  Christina Marshall, a girl
of fourteen, went fifteen and one-half months without taking solid
nourishment. She slept very little, seldom spoke, but occasionally
asked the time of day. She took sweets and water, with beef tea at
intervals, and occasionally a small piece of orange. She died April 18,
1882, after having been confined to her bed for a long while.

King, a surgeon, U.S.A., gives an account of the deprivation of a squad
of cavalry numbering 40. While scouting for Indians on the plains they
went for eighty-six hours without water; when relieved their mouths and
throats were so dry that even brown sugar would not dissolve on their
tongues. Many were delirious, and all had drawn fresh blood from their
horses. Despite repeated vomiting, some drank their own urine. They
were nearly all suffering from overpowering dyspnea, two were dead, and
two were missing. The suffering was increased by the acrid atmosphere
of the dry plains; the slightest exercise in this climate provoked a
thirst. MacLoughlin, the surgeon in charge of the S.S. City of Chester,
speaks of a young stowaway found by the stevedores in an insensible
condition after a voyage of eleven days. The man was brought on deck
and revived sufficiently to be sent to St.  Vincent's Hospital, N.Y.,
about one and one-half hours after discovery, in an extremely
emaciated, cold, and nearly pulseless condition. He gave his name as
John Donnelly, aged twenty, of Dumbarton, Scotland. On the whole voyage
he had nothing to eat or drink. He had found some salt, of which he ate
two handfuls, and he had in his pocket a small flask, empty. Into this
flask he voided his urine, and afterward drank it. Until the second day
he was intensely hungry, but after that time was consumed by a burning
thirst; he shouted four or five hours every day, hoping that he might
be heard. After this he became insensible and remembered nothing until
he awakened in the hospital where, under careful treatment, he finally
recovered.

Fodere mentions some workmen who were buried alive fourteen days in a
cold, damp cavern under a ruin, and yet all lived. There is a modern
instance of a person being buried thirty-two days beneath snow, without
food. The Lancet notes that a pig fell off Dover Cliff and was picked
up alive one hundred and sixty days after, having been partially
imbedded in debris. It was so surrounded by the chalk of the cliff that
little motion was possible, and warmth was secured by the enclosing
material. This animal had therefore lived on its own fat during the
entire period.

Among the modern exhibitionists may be mentioned Merlatti, the fasting
Italian, and Succi, both of whom fasted in Paris; Alexander Jacques,
who fasted fifty days; and the American, Dr. Tanner, who achieved great
notoriety by a fast of forty days, during which time he exhibited
progressive emaciation. Merlatti, who fasted in Paris in 1886, lost 22
pounds in a month; during his fast of fifty days he drank only pure
filtered water. Prior to the fast his farewell meal consisted of a
whole fat goose, including the bones, two pounds of roast beef,
vegetables for two, and a plate of walnuts, the latter eaten whole.
Alexander Jacques fasted fifty days and Succi fasted forty days.
Jacques lost 28 pounds and 4 ounces (from 142 pounds, 8 ounces to 114
pounds, 4 ounces), while Succi's loss was 34 pounds and 3 ounces.
Succi diminished in height from 65 3/4 to 64 1/2 inches, while Jacques
increased from 64 1/2 to 65 1/2 inches. Jacques smoked cigarettes
incessantly, using 700 in the fifty days, although, by professional
advice, he stopped the habit on the forty-second day. Three or four
times a day he took a powder made of herbs to which he naturally
attributed his power of prolonging life without food. Succi remained in
a room in which he kept the temperature at a very high point. In
speaking of Succi's latest feat a recent report says: "It has come to
light in his latest attempt to go for fifty days without food that he
privately regaled himself on soup, beefsteak, chocolate, and eggs. It
was also discovered that one of the 'committee,' who were supposed to
watch and see that the experiment was conducted in a bona fide manner,
'stood in' with the faster and helped him deceive the others. The
result of the Vienna experiment is bound to cast suspicion on all
previous fasting accomplishments of Signor Succi, if not upon those of
his predecessors."

Although all these modern fasters have been accused of being jugglers
and deceivers, throughout their fasts they showed constant decrease in
weight, and inspection by visitors was welcomed at all times. They
invariably invited medical attention, and some were under the closest
surveillance; although we may not implicitly believe that the fasts
were in every respect bona fide, yet we must acknowledge that these men
displayed great endurance in their apparent indifference for food, the
deprivation of which in a normal individual for one day only causes
intense suffering.

Anomalies of Temperature.--In reviewing the reports of the highest
recorded temperatures of the human body, it must be remembered that no
matter how good the evidence or how authentic the reference there is
always chance for malingering. It is possible to send the index of an
ordinary thermometer up to the top in ten or fifteen seconds by rubbing
it between the slightly moistened thumb and the finger, exerting
considerable pressure at the time. There are several other means of
artificially producing enormous temperatures with little risk of
detection, and as the sensitiveness of the thermometer becomes greater
the easier is the deception.

Mackenzie reports the temperature-range of a woman of forty-two who
suffered with erysipelatous inflammation of a stump of the leg.
Throughout a somewhat protracted illness, lasting from February 20 to
April 22, 1879, the temperature many times registered between 108
degrees and 111 degrees F. About a year later she was again troubled
with the stump, and this time the temperature reached as high as 114
degrees. Although under the circumstances, as any rational physician
would, Mackenzie suspected fraud, he could not detect any method of
deception.  Finally the woman confessed that she had produced the
temperature artificially by means of hot-water bottles, poultices, etc.

MacNab records a case of rheumatic fever in which the temperature was
111.4 degrees F. as indicated by two thermometers, one in the axilla
and the other in the groin. This high degree of temperature was
maintained after death. Before the Clinical Society of London, Teale
reported a case in which, at different times, there were recorded
temperatures from 110 degrees to 120 degrees F. in the mouth, rectum,
and axilla. According to a comment in the Lancet, there was no way that
the patient could have artificially produced this temperature, and
during convalescence the thermometer used registered normal as well as
subnormal temperatures. Caesar speaks of a girl of fifteen with enteric
fever, whose temperature, on two occasions 110 degrees F., reached the
limit of the mercury in the thermometer.

There have been instances mentioned in which, in order to escape
duties, prisoners have artificially produced high temperatures, and the
same has occasionally been observed among conscripts in the army or
navy. There is an account of a habit of prisoners of introducing
tobacco into the rectum, thereby reducing the pulse to an alarming
degree and insuring their exemption from labor. In the Adelaide
Hospital in Dublin there was a case in which the temperature in the
vagina and groin registered from 120 degrees to 130 degrees, and one
day it reached 130.8 degrees F.; the patient recovered. Ormerod
mentions a nervous and hysteric woman of thirty-two, a sufferer with
acute rheumatism, whose temperature rose to 115.8 degrees F. She
insisted on leaving the hospital when her temperature was still 104
degrees.

Wunderlich mentions a case of tetanus in which the temperature rose to
46.40 degrees C. (115.5 degrees F.), and before death it was as high as
44.75 degrees C. Obernier mentions 108 degrees F.  in typhoid fever.
Kartulus speaks of a child of five, with typhoid fever, who at
different times had temperatures of 107 degrees, 108 degrees, and 108.2
degrees F.; it finally recovered.  He also quotes a case of pyemia in a
boy of seven, whose temperature rose to 107.6 degrees F. He also speaks
of Wunderlich's case of remittent fever, in which the temperature
reached 107.8 degrees F. Wilson Fox, in mentioning a case of rheumatic
fever, says the temperature reached 110 degrees F.

Philipson gives an account of a female servant of twenty-three who
suffered from a neurosis which influenced the vasomotor nervous system,
and caused hysteria associated with abnormal temperatures. On the
evening of July 9th her temperature was 112 degrees F.; on the 16th, it
was 111 degrees; on the 18th, 112 degrees; on the 24th, 117 degrees
(axilla); on the 28th, in the left axilla it was 117 degrees, in the
right axilla, 114 degrees, and in the mouth, 112 degrees; on the 29th,
it was 115 degrees in the right axilla, 110 degrees in the left axilla,
and 116 degrees in the mouth The patient was discharged the following
September.  Steel of Manchester speaks of a hysteric female of twenty,
whose temperature was 116.4 degrees. Mahomed mentions a hysteric woman
of twenty-two at Guy's Hospital, London, with phthisis of the left
lung, associated with marked hectic fevers. Having registered the limit
of the ordinary thermometers, the physicians procured one with a scale
reaching to 130 degrees F. She objected to using the large
thermometers, saying they were "horse thermometers." On October 15,
1879, however, they succeeded in obtaining a temperature of 128 degrees
F. with the large thermometer. In March of the following year she died,
and the necropsy revealed nothing indicative of a cause for these
enormous temperatures. She was suspected of fraud, and was closely
watched in Guy's Hospital, but never, in the slightest way, was she
detected in using artificial means to elevate the temperature record.

In cases of insolation it is not at all unusual to see a patient whose
temperature cannot be registered by an ordinary thermometer. Any one
who has been resident at a hospital in which heat-cases are received in
the summer will substantiate this. At the Emergency Hospital in
Washington, during recent years, several cases have been brought in
which the temperatures were above the ordinary registering point of the
hospital thermometers, and one of the most extraordinary cases
recovered.

At a meeting of the Association of American Physicians in 1895, Jacobi
of New York reported a case of hyperthermy reaching 148 degrees F. This
instance occurred in a profoundly hysteric fireman, who suffered a
rather severe injury as the result of a fall between the revolving rods
of some machinery, and was rendered unconscious for four days.
Thereafter he complained of various pains, bloody expectoration, and
had convulsions at varying intervals, with loss of consciousness, rapid
respiration, unaccelerated pulse, and excessively high temperature, the
last on one occasion reaching the height of 148 degrees F. The
temperature was taken carefully in the presence of a number of persons,
and all possible precautions were observed to prevent deception. The
thermometer was variously placed in the mouth, anus, axilla, popliteal
space, groin, urethra, and different instruments were from time to time
employed. The behavior of the patient was much influenced by attention
and by suggestion. For a period of five days the temperature averaged
continuously between 120 degrees and 125 degrees F.

In the discussion of the foregoing case, Welch of Baltimore referred to
a case that had been reported in which it was said that the temperature
reached as high as 171 degrees F. These extraordinary elevations of
temperature, he said, appear physically impossible when they are long
continued, as they are fatal to the life of the animal cell.

In the same connection Shattuck of Boston added that he had observed a
temperature of 117 degrees F.; every precaution had been taken to
prevent fraud or deception. The patient was a hysteric young woman.

Jacobi closed the discussion by insisting that his observations had
been made with the greatest care and precautions and under many
different circumstances. He had at first viewed the case with
skepticism, but he could not doubt the results of his observation. He
added, that although we cannot explain anomalies of this kind, this
constitutes no reason why we should deny their occurrence.

Duffy records one of the lowest temperatures on record in a negress of
thirty-five who, after an abortion, showed only 84 degrees F. in the
mouth and axillae. She died the next day.

The amount of external heat that a human being can endure is sometimes
remarkable, and the range of temperature compatible with life is none
the less extraordinary. The Esquimaux and the inhabitants of the
extreme north at times endure a temperature of--60 degrees F., while
some of the people living in equatorial regions are apparently healthy
at a temperature as high as 130 degrees F., and work in the sun, where
the temperature is far higher. In the engine-rooms of some steamers
plying in tropical waters temperatures as high as 150 degrees F. have
been registered, yet the engineers and the stokers become habituated to
this heat and labor in it without apparent suffering. In Turkish baths,
by progressively exposing themselves to graduated temperatures, persons
have been able to endure a heat considerably above the boiling point,
though having to protect their persons from the furniture and floors
and walls of the rooms. The hot air in these rooms is intensely dry,
provoking profuse perspiration. Sir Joseph Banks remained some time in
a room the temperature of which was 211 degrees F., and his own
temperature never mounted above normal.

There have been exhibitionists who claimed particular ability to endure
intense heats without any visible disadvantage. These men are generally
styled "human salamanders," and must not be confounded with the
"fire-eaters," who, as a rule, are simply jugglers. Martinez, the
so-called "French Salamander," was born in Havana. As a baker he had
exposed himself from boyhood to very high temperatures, and he
subsequently gave public exhibitions of his extraordinary ability to
endure heat. He remained in an oven erected in the middle of the
Gardens of Tivoli for fourteen minutes when the temperature in the oven
was 338 degrees F. His pulse on entering was 76 and on coming out 130.
He often duplicated this feat before vast assemblages, though hardly
ever attaining the same degree of temperature, the thermometer
generally varying from 250 degrees F. upward. Chamouni was the
celebrated "Russian Salamander," assuming the title of "The
Incombustible." His great feat was to enter an oven with a raw leg of
mutton, not retiring until the meat was well baked. This person
eventually lost his life in the performance of this feat; his ashes
were conveyed to his native town, where a monument was erected over
them. Since the time of these two contemporaneous salamanders there
have been many others, but probably none have attained the same
notoriety.

In this connection Tillet speaks of some servant girls to a baker who
for fifteen minutes supported a temperature of 270 degrees F.; for ten
minutes, 279 degrees F.; and for several minutes, 364 degrees F., thus
surpassing Martinez. In the Glasgow Medical Journal, 1859, there is an
account of a baker's daughter who remained twelve minutes in an oven at
274 degrees F. Chantrey, the sculptor, and his workman are said to have
entered with impunity a furnace of over 320 degrees F.

In some of the savage ceremonies of fire worship the degree of heat
endured by the participants is really remarkable, and even if the rites
are performed by skilful juggling, nevertheless, the ability to endure
intense heat is worthy of comment. A recent report says:--

"The most remarkable ceremonial of fire worship that survives in this
country is practiced by the Navajos. They believe in purification by
fire, and to this end they literally wash themselves in it. The feats
they perform with it far exceed the most wonderful acts of fire-eating
and fire-handling accomplished by civilized jugglers. In preparation
for the festival a gigantic heap of dry wood is gathered from the
desert. At the appointed moment the great pile of inflammable brush is
lighted and in a few moments the whole of it is ablaze. Storms of
sparks fly 100 feet or more into the air, and ashes fall about like a
shower of snow. The ceremony always takes place at night and the effect
of it is both weird and impressive.

"Just when the fire is raging at its hottest a whistle is heard from
the outer darkness and a dozen warriors, lithe and lean, dressed simply
in narrow white breech-cloths and moccasins and daubed with white earth
so as to look like so many living statues, come bounding through the
entrance to the corral that incloses the flaming heap. Yelping like
wolves, they move slowly toward the fire, bearing aloft slender wands
tipped with balls of eagle-down. Rushing around the fire, always to the
left, they begin thrusting their wands toward the fire, trying to burn
off the down from the tips. Owing to the intensity of the heat this is
difficult to accomplish. One warrior dashes wildly toward the fire and
retreats; another lies as close to the ground as a frightened lizard,
endeavoring to wriggle himself up to the fire; others seek to catch on
their wands the sparks that fly in the air. At last one by one they all
succeed in burning the downy balls from the wands. The test of
endurance is very severe, the heat of the fire being so great.

"The remarkable feats, however, are performed in connection with
another dance that follows. This is heralded by a tremendous blowing of
horns. The noise grows louder and louder until suddenly ten or more men
run into the corral, each of them carrying two thick bundles of
shredded cedar bark.

"Four times they run around the fire waving the bundles, which are then
lighted. Now begins a wild race around the fire, the rapid running
causing the brands to throw out long streamers of flames over the hands
and arms of the dancers. The latter apply the brands to their own nude
bodies and to the bodies of their comrades in front. A warrior will
seize the flaming mass as if it were a sponge, and, keeping close to
the man he is pursuing, will rub his back with it as if bathing him.
The sufferer in turn catches up with the man in front of him and bathes
him in flame.  From time to time the dancers sponge their own backs
with the flaming brands. When a brand is so far consumed that it can no
longer be held it is dropped and the dancers disappear from the corral.
The spectators pick up the flaming bunches thus dropped and bathe their
own hands in the fire.

"No satisfactory explanation seems to be obtainable as to the means by
which the dancers in this extraordinary performance are able to escape
injury. Apparently they do not suffer from any burns. Doubtless some
protection is afforded by the earth that is applied to their bodies."

Spontaneous combustion of the human body, although doubted by the
medical men of this day, has for many years been the subject of much
discussion; only a few years ago, among the writers on this subject,
there were as many credulous as there were skeptics.  There is,
however, no reliable evidence to support the belief in the spontaneous
combustion of the body. A few apochryphal cases only have been
recorded. The opinion that the tissues of drunkards might be so
saturated with alcohol as to render the body combustible is disproved
by the simple experiment of placing flesh in spirits for a long time
and then trying to burn it.  Liebig and others found that flesh soaked
in alcohol would burn only until the alcohol was consumed. That various
substances ignite spontaneously is explained by chemic phenomena, the
conditions of which do not exist in the human frame. Watkins in
speaking of the inflammability of the human body remarks that on one
occasion he tried to consume the body of a pirate given to him by a U.
S. Marshal. He built a rousing fire and piled wood on all night, and
had not got the body consumed by the forenoon of the following day.
Quite a feasible reason for supposed spontaneous human combustion is to
be found in several cases quoted by Taylor, in which persons falling
asleep, possibly near a fire, have been accidentally ignited, and
becoming first stupefied by the smoke, and then suffocated, have been
burned to charcoal without awaking. Drunkenness or great exhaustion may
also explain certain cases. In substantiation of the possibility of
Taylor's instances several prominent physiologists have remarked that
persons have endured severe burns during sleep and have never wakened.
There is an account of a man who lay down on the top of a lime kiln,
which was fired during his sleep, and one leg was burned entirely off
without awaking the man, a fact explained by the very slow and gradual
increase of temperature.

The theories advanced by the advocates of spontaneous human combustion
are very ingenious and deserve mention here. An old authority has said:
"Our blood is of such a nature, as also our lymph and bile: all of
which, when dried by art, flame like spirit of wine at the approach of
the least fire and burn away to ashes." Lord Bacon mentions spontaneous
combustion, and Marcellus Donatus says that in the time of Godefroy of
Bouillon there were people of a certain locality who supposed
themselves to have been burning of an invisible fire in their entrails,
and he adds that some cut off a hand or a foot when the burning began,
that it should go no further. What may have been the malady with which
these people suffered must be a matter of conjecture.

Overton, in a paper on this subject, remarks that in the "Memoirs of
the Royal Society of Paris," 1751, there is related an account of a
butcher who, opening a diseased beef, was burned by a flame which
issued from the maw of the animal; there was first an explosion which
rose to a height of five feet and continued to blaze several minutes
with a highly offensive odor. Morton saw a flame emanate from beneath
the skin of a hog at the instant of making an incision through it.
Ruysch, the famous Dutch physician, remarks that he introduced a hollow
bougie into a woman's stomach he had just opened, and he observed a
vapor issuing from the mouth of the tube, and this lit on contact with
the atmosphere. This is probably an exaggeration of the properties of
the hydrogen sulphid found in the stomach. There is an account of a man
of forty-three, a gross feeder, who was particularly fond of fats and a
victim of psoriasis palmaria, who on going to bed one night, after
extinguishing the light in the room, was surprised to find himself
enveloped in a phosphorescent halo; this continued for several days and
recurred after further indiscretions in diet. It is well known that
there are insects and other creatures of the lower animal kingdom which
possess the peculiar quality of phosphorescence.

There are numerous cases of spontaneous combustion of the human body
reported by the older writers. Bartholinus mentions an instance after
the person had drunk too much wine. Fouquet mentions a person ignited
by lightning. Schrader speaks of a person from whose mouth and fauces
after a debauch issued fire.  Schurig tells of flames issuing from the
vulva, and Moscati records the same occurrence in parturition,
Sinibaldust, Borellus, and Bierling have also written on this subject,
and the Ephemerides contains a number of instances.

In 1763 Bianchini, Prebendary of Verona, published an account of the
death of Countess Cornelia Bandi of Cesena, who in her sixty-second
year was consumed by a fire kindled in her own body.  In explanation
Bianchini said that the fire was caused in the entrails by the inflamed
effluvia of the blood, by the juices and fermentation in the stomach,
and, lastly, by fiery evaporations which exhaled from the spirits of
wine, brandy, etc. In the Gentleman's Magazine, 1763, there is recorded
an account of three noblemen who, in emulation, drank great quantities
of strong liquor, and two of them died scorched and suffocated by a
flame forcing itself from the stomach. There is an account of a poor
woman in Paris in the last century who drank plentifully of spirits,
for three years taking virtually nothing else. Her body became so
combustible that one night while lying on a straw couch she was
spontaneously burned to ashes and smoke. The evident cause of this
combustion is too plain to be commented on. In the Lancet, 1845, there
are two cases reported in which shortly before death luminous breath
has been seen to issue from the mouth.

There is an instance reported of a professor of mathematics of
thirty-five years of age and temperate, who, feeling a pain in his left
leg, discovered a pale flame about the size of a ten-cent piece issuing
therefrom. As recent as March, 1850, in a Court of Assizes in Darmstadt
during the trial of John Stauff, accused of the murder of the Countess
Goerlitz, the counsel for the defense advanced the theory of
spontaneous human combustion, and such eminent doctors as von Siebold,
Graff, von Liebig, and other prominent members of the Hessian medical
fraternity were called to comment on its possibility; principally on
their testimony a conviction and life-imprisonment was secured. In 1870
there was a woman of thirty-seven, addicted to alcoholic liquors, who
was found in her room with her viscera and part of her limbs consumed
by fire, but the hair and clothes intact. According to Walford, in the
Scientific American for 1870, there was a case reported by Flowers of
Louisiana of a man a hard drinker, who was sitting by a fire surrounded
by his Christmas guests, when suddenly flames of a bluish tint burst
from his mouth and nostrils and he was soon a corpse. Flowers states
that the body remained extremely warm for a much longer period than
usual.

Statistics.--From an examination of 28 cases of spontaneous combustion,
Jacobs makes the following summary:--

(1) It has always occurred in the human living body.

(2) The subjects were generally old persons.

(3) It was noticed more frequently in women than in men.

(4) All the persons were alone at the time of occurrence.

(5) They all led an idle life.

(6) They were all corpulent or intemperate.

(7) Most frequently at the time of occurrence there was a light and
some ignitible substance in the room.

(8) The combustion was rapid and was finished in from one to seven
hours.

(9) The room where the combustion took place was generally filled with
a thick vapor and the walls covered with a thick, carbonaceous
substance.

(10) The trunk was usually the part most frequently destroyed; some
part of the head and extremities remained.

(11) With but two exceptions, the combustion occurred in winter and in
the northern regions.

Magnetic, Phosphorescent, and Electric Anomalies.--There have been
certain persons who have appeared before the public under such names as
the "human magnet," the "electric lady," etc. There is no doubt that
some persons are supercharged with magnetism and electricity. For
instance, it is quite possible for many persons by drawing a rubber
comb through the hair to produce a crackling noise, and even produce
sparks in the dark. Some exhibitionists have been genuine curiosities
of this sort, while others by skilfully arranged electric apparatus are
enabled to perform their feats. A curious case was reported in this
country many years ago, which apparently emanates from an authoritative
source. On the 25th of January, 1837, a certain lady became suddenly
and unconsciously charged with electricity. Her newly acquired power
was first exhibited when passing her hand over the face of her brother;
to the astonishment of both, vivid electric sparks passed from the ends
of each finger. This power continued with augmented force from the 25th
of January to the last of February, but finally became extinct about
the middle of May of the same year.

Schneider mentions a strong, healthy, dark-haired Capuchin monk, the
removal of whose head-dress always induced a number of shining,
crackling sparks from his hair or scalp. Bartholinus observed a similar
peculiarity in Gonzaga, Duke of Mantua. In another case luminous sparks
were given out whenever the patient passed urine. Marsh relates two
cases of phthisis in which the heads of the patients were surrounded by
phosphorescent lights.  Kaster mentions an instance in which light was
seen in the perspiration and on the body linen after violent exertion.
After exertion Jurine, Guyton, and Driessen observed luminous urine
passed by healthy persons, and Nasse mentions the same phenomenon in a
phthisical patient. Percy and Stokes have observed phosphorescence in a
carcinomatous ulcer.

There is a description of a Zulu boy exhibited in Edinburgh in 1882
whose body was so charged with electricity that he could impart a shock
to any of his patrons. He was about six-and-a-half years of age,
bright, happy, and spoke English thoroughly well.  From infancy he had
been distinguished for this faculty, variable with the state of the
atmosphere. As a rule, the act of shaking hands was generally attended
by a quivering sensation like that produced by an electric current, and
contact with his tongue gave a still sharper shock.

Sir Charles Bell has made extensive investigation of the subject of
human magnetism and is probably the best authority on the subject, but
many celebrated scientists have studied it thoroughly. In the Pittsburg
Medical Review there is a description of a girl of three and a half, a
blonde, and extremely womanly for her age, who possessed a wonderful
magnetic power. Metal spoons would adhere to her finger-tips, nose, or
chin. The child, however, could not pick up a steel needle, an article
generally very sensitive to the magnet; nor would a penny stick to any
portion of her body.

Only recently there was exhibited through this country a woman named
Annie May Abbott, who styled herself the "Georgia Electric Lady." This
person gave exhibitions of wonderful magnetic power, and invited the
inspection and discussion of medical men. Besides her chief
accomplishment she possessed wonderful strength and was a skilled
equilibrist. By placing her hands on the sides of a chair upon which a
heavy man was seated, she would raise it without apparent effort. She
defied the strongest person in the audience to take from her hand a
stick which she had once grasped. Recent reports say that Miss Abbott
is amusing herself now with the strong men of China and Japan. The
Japanese wrestlers, whose physical strength is celebrated the world
over, were unable to raise Miss Abbott from the floor, while with the
tips of her fingers she neutralized their most strenuous efforts to
lift even light objects, such as a cane, from a table. The
possibilities, in this advanced era of electric mechanism, make fraud
and deception so easy that it is extremely difficult to pronounce on
the genuineness of any of the modern exhibitions of human electricity.

The Effects of Cold.--Gmelin, the famous scientist and investigator of
this subject, says that man has lived where the temperature falls as
low as -157 degrees F. Habit is a marked factor in this endurance. In
Russia men and women work with their breasts and arms uncovered in a
temperature many degrees below zero and without attention to the fact.
In the most rigorous winter the inhabitants of the Alps work with bare
breasts and the children sport about in the snow. Wrapping himself in
his pelisse the Russian sleeps in the snow. This influence of habit is
seen in the inability of intruders in northern lands to endure the
cold, which has no effect on the indigenous people. On their way to
besiege a Norwegian stronghold in 1719, 7000 Swedes perished in the
snows and cold of their neighboring country. On the retreat from Prague
in 1742, the French army, under the rigorous sky of Bohemia, lost 4000
men in ten days. It is needless to speak of the thousands lost in
Napoleon's campaign in Russia in 1812.

Pinel has remarked that the insane are less liable to the effects of
cold than their normal fellows, and mentions the escape of a naked
maniac, who, without any visible after-effect, in January, even, when
the temperature was -4 degrees F., ran into the snow and gleefully
rubbed his body with ice. In the French journals in 1814 there is the
record of the rescue of a naked crazy woman who was found in the
Pyrenees, and who had apparently suffered none of the ordinary effects
of cold.

Psychologic Effects of Cold.--Lambert says that the mind acts more
quickly in cold weather, and that there has been a notion advanced that
the emotion of hatred is much stronger in cold weather, a theory
exemplified by the assassination of Paul of Russia, the execution of
Charles of England, and that of Louis of France. Emotions, such as
love, bravery, patriotism, etc., together with diverse forms of
excitement, seem to augment the ability of the human body to endure
cold.

Cold seems to have little effect on the generative function. In both
Sweden, Norway, and other Northern countries the families are as large,
if not larger, than in other countries. Cold undoubtedly imparts vigor,
and, according to DeThou, Henry III lost his effeminacy and love of
pleasure in winter and reacquired a spirit of progress and reformation.
Zimmerman has remarked that in a rigorous winter the lubberly Hollander
is like the gayest Frenchman. Cold increases appetite, and Plutarch
says Brutus experienced intense bulimia while in the mountains, barely
escaping perishing. With full rations the Greek soldiers under Xenophon
suffered intense hunger as they traversed the snow-clad mountains of
Armenia.

Beaupre remarks that those who have the misfortune to be buried under
the snow perish less quickly than those who are exposed to the open
air, his observations having been made during the retreat of the French
army from Moscow. In Russia it is curious to see fish frozen stiff,
which, after transportation for great distances, return to life when
plunged into cold water.

Sudden death from cold baths and cold drinks has been known for many
centuries. Mauriceau mentions death from cold baptism on the head, and
Graseccus, Scaliger, Rush, Schenck, and Velschius mention deaths from
cold drinks. Aventii, Fabricius Hildanus, the Ephemerides, and Curry
relate instances of a fatal issue following the ingestion of cold water
by an individual in a superheated condition. Cridland describes a case
of sudden insensibility following the drinking of a cold fluid. It is
said that Alexander the Great narrowly escaped death from a
constrictive spasm, due to the fact that while in a copious sweat he
plunged into the river Cydnus. Tissot gives an instance of a man dying
at a fountain after a long draught on a hot day.  Hippocrates mentions
a similar fact, and there are many modern instances.

The ordinary effects of cold on the skin locally and the system
generally will not be mentioned here, except to add the remark of
Captain Wood that in Greenland, among his party, could be seen
ulcerations, blisters, and other painful lesions of the skin. In
Siberia the Russian soldiers cover their noses and ears with greased
paper to protect them against the cold. The Laplanders and Samoiedes,
to avoid the dermal lesions caused by cold (possibly augmented by the
friction of the wind and beating of snow), anoint their skins with
rancid fish oil, and are able to endure temperatures as low as -40
degrees F. In the retreat of the 10,000 Xenophon ordered all his
soldiers to grease the parts exposed to the air.

Effects of Working in Compressed Air.--According to a writer in
Cassier's Magazine, the highest working pressures recorded have been
close to 50 pounds per square inch, but with extreme care in the
selection of men, and corresponding care on the part of the men, it is
very probable that this limit may be considerably exceeded. Under
average conditions the top limit may be placed at about 45 pounds, the
time of working, according to conditions, varying from four to six
hours per shift. In the cases in which higher pressures might be used,
the shifts for the men should be restricted to two of two hours each,
separated by a considerable interval. As an example of heavy pressure
work under favorable conditions as to ventilation, without very bad
effects on the men, Messrs. Sooysmith & Company had an experience with
a work on which men were engaged in six-hour shifts, separated into two
parts by half-hour intervals for lunch. This work was excavation in
open, seamy rock, carried on for several weeks under about 45 pounds
pressure. The character of the material through which the caisson is
being sunk or upon which it may be resting at any time bears quite
largely upon the ability of the men to stand the pressure necessary to
hold back the water at that point. If the material be so porous as to
permit a considerable leakage of air through it, there will naturally
result a continuous change of air in the working chamber, and a
corresponding relief of the men from the deleterious effects which are
nearly always produced by over-used air.

From Strasburg in 1861 Bucuoy reports that during the building of a
bridge at Kehl laborers had to work in compressed air, and it was found
that the respirations lost their regularity; there were sometimes
intense pains in the ears, which after a while ceased.  It required a
great effort to speak at 2 1/2 atmospheres, and it was impossible to
whistle. Perspiration was very profuse. Those who had to work a long
time lost their appetites, became emaciated, and congestion of the lung
and brain was observed. The movements of the limbs were easier than in
normal air, though afterward muscular and rheumatic pains were often
observed.

The peculiar and extraordinary development of the remaining special
senses when one of the number is lost has always been a matter of great
interest. Deaf people have always been remarkable for their acuteness
of vision, touch, and smell. Blind persons, again, almost invariably
have the sense of hearing, touch, and what might be called the senses
of location and temperature exquisitely developed. This substitution of
the senses is but; an example of the great law of compensation which we
find throughout nature.

Jonston quotes a case in the seventeenth century of a blind man who, it
is said, could tell black from white by touch alone; several other
instances are mentioned in a chapter entitled "De compensatione naturae
monstris facta." It must, however, be held impossible that blind people
can thus distinguish colors in any proper sense of the words. Different
colored yarns, for example, may have other differences of texture,
etc., that would be manifest to the sense of touch. We know of one case
in which the different colors were accurately distinguished by a blind
girl, but only when located in customary and definite positions. Le Cat
speaks of a blind organist, a native of Holland, who still played the
organ as well as ever. He could distinguish money by touch, and it is
also said that he made himself familiar with colors. He was fond of
playing cards, but became such a dangerous opponent, because in
shuffling he could tell what cards and hands had been dealt, that he
was never allowed to handle any but his own cards.

It is not only in those who are congenitally deficient in any of the
senses that the remarkable examples of compensation are seen, but
sometimes late in life these are developed. The celebrated sculptor,
Daniel de Volterre, became blind after he had obtained fame, and
notwithstanding the deprivation of his chief sense he could, by touch
alone, make a statue in clay after a model. Le Cat also mentions a
woman, perfectly deaf, who without any instruction had learned to
comprehend anything said to her by the movements of the lips alone. It
was not necessary to articulate any sound, but only to give the labial
movements. When tried in a foreign language she was at a loss to
understand a single word.

Since the establishment of the modern high standard of blind asylums
and deaf-and-dumb institutions, where so many ingenious methods have
been developed and are practiced in the education of their inmates,
feats which were formerly considered marvelous are within the reach of
all those under tuition To-day, those born deaf-mutes are taught to
speak and to understand by the movements of the lips alone, and the
blind read, become expert workmen, musicians, and even draughtsmen. D.
D. Wood of Philadelphia, although one of the finest organists in the
country, has been totally blind for years. It is said that he acquires
new compositions with almost as great facility as one not afflicted
with his infirmity. "Blind Tom," a semi-idiot and blind negro achieved
world-wide notoriety by his skill upon the piano.

In some extraordinary cases in which both sight and hearing, and
sometimes even taste and smell, are wanting, the individuals in a most
wonderful way have developed the sense of touch to such a degree that
it almost replaces the absent senses. The extent of this compensation
is most beautifully illustrated in the cases of Laura Bridgman and
Helen Keller. No better examples could be found of the compensatory
ability of differentiated organs to replace absent or disabled ones.

Laura Dewey Bridgman was born December 21, 1829, at Hanover, N.H.  Her
parents were farmers and healthy people. They were of average height,
regular habits, slender build, and of rather nervous dispositions.
Laura inherited the physical characteristics of her mother. In her
infancy she was subject to convulsions, but at twenty months had
improved, and at this time had learned to speak several words. At the
age of two years, in common with two of the other children of the
family, she had an attack of severe scarlet fever. Her sisters died,
and she only recovered after both eyes and ears had suppurated; taste
and smell were also markedly impaired. Sight in the left eye was
entirely abolished, but she had some sensation for large, bright
objects in the right eye up to her eighth year; after that time she
became totally blind.  After her recovery it was two years before she
could sit up all day, and not until she was five years old had she
entirely regained her strength. Hearing being lost, she naturally never
developed any speech; however, she was taught to sew, knit, braid, and
perform several other minor household duties. In 1837 Dr. S. W. Howe,
the Director of the Massachusetts Asylum for the Blind, took Laura in
charge, and with her commenced the ordinary deaf-mute education. At
this time she was seven years and ten months old. Two years later she
had made such wonderful progress and shown such ability to learn that,
notwithstanding her infirmities, she surpassed any of the pupils of her
class. Her advancement was particularly noticed immediately after her
realization that an idea could be expressed by a succession of raised
letters. In fact, so rapid was her progress, that it was deemed
advisable by the authorities to hold her back. By her peculiar
sensibility to vibration she could distinguish the difference between a
whole and a half note in music, and she struck the notes on the piano
quite correctly. During the first years of her education she could not
smell at all, but later she could locate the kitchen by this sense.
Taste had developed to such an extent that at this time she could
distinguish the different degrees of acidity. The sense of touch,
however, was exceedingly delicate and acute. As to her moral habits,
cleanliness was the most marked. The slightest dirt or rent in her
clothes caused her much embarrassment and shame, and her sense of
order, neatness, and propriety was remarkable. She seemed quite at home
and enjoyed the society of her own sex, but was uncomfortable and
distant in the society of males. She quickly comprehended the
intellectual capacity of those with whom she was associated, and soon
showed an affiliation for the more intelligent of her friends. She was
quite jealous of any extra attention shown to her fellow scholars,
possibly arising from the fact that she had always been a favorite. She
cried only from grief, and partially ameliorated bodily pain by jumping
and by other excessive muscular movements. Like most mutes, she
articulated a number of noises,--50 or more, all monosyllabic; she
laughed heartily, and was quite noisy in her play. At this time it was
thought that she had been heard to utter the words doctor, pin, ship,
and others. She attached great importance to orientation, and seemed
quite ill at ease in finding her way about when not absolutely sure of
directions. She was always timid in the presence of animals, and by no
persuasion could she be induced to caress a domestic animal. In common
with most maidens, at sixteen she became more sedate, reserved and
thoughtful; at twenty she had finished her education. In 1878 she was
seen by G. Stanley Hall, who found that she located the approach and
departure of people through sensation in her feet, and seemed to have
substituted the cutaneous sense of vibration for that of hearing. At
this time she could distinguish the odors of various fragrant flowers
and had greater susceptibility to taste, particularly to sweet and
salty substances. She had written a journal for ten years, and had also
composed three autobiographic sketches, was the authoress of several
poems, and some remarkably clever letters. She died at the Perkins
Institute, May 24, 1889, after a life of sixty years, burdened with
infirmities such as few ever endure, and which, by her superior
development of the remnants of the original senses left her, she had
overcome in a degree nothing less than marvelous.  According to a
well-known observer, in speaking of her mental development, although
she was eccentric she was not defective.  She necessarily lacked
certain data of thought, but even this feet was not very marked, and
was almost counterbalanced by her exceptional power of using what
remained.

In the present day there is a girl as remarkable as Laura Bridgman, and
who bids fair to attain even greater fame by her superior development.
This girl, Helen Keller, is both deaf and blind; she has been seen in
all the principal cities of the United States, has been examined by
thousands of persons, and is famous for her victories over infirmities.
On account of her wonderful power of comprehension special efforts have
been made to educate Helen Keller, and for this reason her mind is far
more finely developed than in most girls of her age. It is true that
she has the advantage over Laura Bridgman in having the senses of taste
and smell, both of which she has developed to a most marvelous degree
of acuteness. It is said that by odor alone she is always conscious of
the presence of another person, no matter how noiseless his entrance
into the room in which she may be. She cannot be persuaded to take food
which she dislikes, and is never deceived in the taste. It is, however,
by the means of what might be called "touch-sight" that the most
miraculous of her feats are performed. By placing her hands on the face
of a visitor she is able to detect shades of emotion which the normal
human eye fails to distinguish, or, in the words of one of her lay
observers, "her sense of touch is developed to such an exquisite extent
as to form a better eye for her than are yours or mine for us; and what
is more, she forms judgments of character by this sight." According to
a recent report of a conversation with one of the principals of the
school in which her education is being completed, it is said that since
the girl has been under his care he has been teaching her to sing with
great success. Placing the fingers of her hands on the throat of a
singer, she is able to follow notes covering two octaves with her own
voice, and sings synchronously with her instructor. The only difference
between her voice and that of a normal person is in its resonant
qualities. So acute has this sense become, that by placing her hand
upon the frame of a piano she can distinguish two notes not more than
half a tone apart. Helen is expected to enter the preparatory school
for Radcliffe College in the fall of 1896.

At a meeting of the American Association to Promote the Teaching of
Speech to the Deaf, in Philadelphia, July, 1896, this child appeared,
and in a well-chosen and distinct speech told the interesting story of
her own progress. Miss Sarah Fuller, principal of the Horace Mann
School for the Deaf, Boston, is credited with the history of Helen
Keller, as follows:--

"Helen Keller's home is in Tuscumbia, Ala. At the age of nineteen
months she became deaf, dumb, and blind after convulsions lasting three
days. Up to the age of seven years she had received no instruction. Her
parents engaged Miss Sullivan of the Perkins Institute for the Blind,
South Boston, to go to Alabama as her teacher. She was familiar with
methods of teaching the blind, but knew nothing about instructing deaf
children. Miss Sullivan called upon Miss Fuller for some instruction on
the subject. Miss Fuller was at that time experimenting with two little
deaf girls to make them speak as hearing children do, and called Miss
Sullivan's attention to it. Miss Sullivan left for her charge, and from
time to time made reports to Dr. Anagnos the principal of the Perkins
School, which mentioned the remarkable mind which she found this little
Alabama child possessed. The following year Miss Sullivan brought the
child, then eight years old, to Boston, and Mrs. Keller came with her.
They visited Miss Fuller's school.  Miss Sullivan had taught the child
the manual alphabet, and she had obtained much information by means of
it. Miss Fuller noticed how quickly she appreciated the ideas given to
her in that way.

"It is interesting to note that before any attempt had been made to
teach the child to speak or there had been any thought of it, her own
quickness of thought had suggested it to her as she talked by hand
alphabet to Miss Fuller. Her mother, however, did not approve Miss
Fuller's suggestion that an attempt should be made to teach her speech.
She remained at the Perkins School, under Miss Sullivan's charge,
another year, when the matter was brought up again, this time by little
Helen herself, who said she must speak. Miss Sullivan brought her to
Miss Fuller's school one day and she received her first lesson, of
about two hours' length.

"The child's hand was first passed over Miss Fuller's face, mouth, and
neck, then into her mouth, touching the tongue, teeth, lips, and hard
palate, to give her an idea of the organs of speech. Miss Fuller then
arranged her mouth, tongue, and teeth for the sound of i as in it. She
took the child's finger and placed it upon the windpipe so that she
might feel the vibration there, put her finger between her teeth to
show her how wide apart they were, and one finger in the mouth to feel
the tongue, and then sounded the vowel. The child grasped the idea at
once.  Her fingers flew to her own mouth and throat, and she produced
the sound so nearly accurate that it sounded like an echo. Next the
sound of ah was made by dropping the jaw a little and letting the child
feel that the tongue was soft and lying in the bed of the jaw with the
teeth more widely separated. She in the same way arranged her own, but
was not so successful as at first, but soon produced the sound
perfectly."

"Eleven such lessons were given, at intervals of three or four days,
until she had acquired all the elements of speech, Miss Sullivan in the
meantime practicing with the child on the lessons received. The first
word spoken was arm, which was at once associated with her arm; this
gave her great delight. She soon learned to pronounce words by herself,
combining the elements she had learned, and used them to communicate
her simple wants. The first connected language she used was a
description she gave Miss Fuller of a visit she had made to Dr. Oliver
Wendell Holmes, in all over 200 words. They were, all but two or three,
pronounced correctly. She now, six years afterward, converses quite
fluently with people who know nothing of the manual alphabet by placing
a couple of fingers on the speaker's lips, her countenance showing
great intentness and brightening as she catches the meaning.  Anybody
can understand her answers."

In a beautiful eulogy of Helen Keller in a recent number of Harper's
Magazine, Charles Dudley Warner expresses the opinion that she is the
purest-minded girl of her age in the world.

Edith Thomas, a little inmate of the Perkins Institute for the Blind,
at South Boston, is not only deaf and dumb but also blind.  She was a
fellow-pupil with Helen Keller, and in a measure duplicated the rapid
progress of her former playmate. In commenting on progress in learning
to talk the Boston Herald says: "And as the teacher said the word
'Kitty' once or twice she placed the finger-tips of one hand upon the
teacher's lips and with the other hand clasped tightly the teacher's
throat; then, guided by the muscular action of the throat and the
position of the teeth, tongue, and lips, as interpreted by that
marvelous and delicate touch of hers, she said the word 'Kitty' over
and over again distinctly in a very pretty way. She can be called dumb
no longer, and before the summer vacation comes she will have mastered
quite a number of words, and such is her intelligence and patience, in
spite of the loss of three senses, she may yet speak quite readily.

"Her history is very interesting. She was born in Maplewood, and up to
the time of contracting diphtheria and scarlet fever, which occurred
when she was four years old, had been a very healthy child of more than
ordinary quickness and ability. She had attained a greater command of
language than most children of her age. What a contrast between these
'other days,' as she calls them, and the days which followed, when
hearing and sight were completely gone, and gradually the senses of
speech and smell went, too! After the varied instruction of the blind
school the little girl had advanced so far as to make the rest of her
study comparatively easy. The extent of her vocabulary is not
definitely known, but it numbers at least 700 words. Reading, which was
once an irksome task, has become a pleasure to her. Her ideas of
locality and the independence of movement are remarkable, and her
industry and patience are more noticeable from day to day. She has
great ability, and is in every respect a very wonderful child."

According to recent reports, in the vicinity of Rothesay, on the Clyde,
there resides a lady totally deaf and dumb, who, in point of
intelligence, scholarship, and skill in various ways, far excels many
who have all their faculties. Having been educated partly in Paris, she
is a good French scholar, and her general composition is really
wonderful. She has a shorthand system of her own, and when writing
letters, etc., she uses a peculiar machine, somewhat of the nature of a
typewriter.

Among the deaf persons who have acquired fame in literature and the
arts have been Dibil Alkoffay, an Arabian poet of the eighth century;
the tactician, Folard; the German poet, Engelshall; Le Sage; La
Condamine, who composed an epigram on his own infirmity; and Beethoven,
the famous musician. Fernandez, a Spanish painter of the sixteenth
century, was a deaf-mute.

All the world pities the blind, but despite their infirmities many have
achieved the highest glory in every profession. Since Homer there have
been numerous blind poets. Milton lost none of his poetic power after
he had become blind. The Argovienne, Louise Egloff, and Daniel Leopold,
who died in 1753, were blind from infancy. Blacklock, Avisse, Koslov,
and La Mott-Houdart are among other blind poets. Asconius Pedianus, a
grammarian of the first century; Didyme, the celebrated doctor of
Alexandria; the Florentine, Bandolini, so well versed in Latin poetry;
the celebrated Italian grammarian, Pontanus; the German, Griesinger,
who spoke seven languages; the philologist, Grassi, who died in 1831,
and many others have become blind at an age more or less advanced in
their working lives.

Probably the most remarkable of the blind scientists was the
Englishman, Saunderson, who in 1683, in his first year, was deprived of
sight after an attack of small-pox. In spite of his complete blindness
he assiduously studied the sciences, and graduated with honor at the
University of Cambridge in mathematics and optics. His sense of touch
was remarkable. He had a collection of old Roman medals, all of which,
without mistake, he could distinguish by their impressions. He also
seemed to have the ability to judge distance, and was said to have
known how far he had walked, and by the velocity he could even tell the
distance traversed in a vehicle. Among other blind mathematicians was
the Dutchman, Borghes (died in 1652); the French astronomer, the Count
de Pagan, who died in 1655; Galileo; the astronomer, Cassini, and
Berard, who became blind at twenty-three years, and was for a long time
Professor of Mathematics at the College of Briancon.

In the seventeenth century the sculptor, Jean Gonnelli, born in
Tuscany, became blind at twenty years; but in spite of his infirmity he
afterward executed what were regarded as his masterpieces. It is said
that he modeled a portrait of Pope Urban VIII, using as a guide his
hand, passed from time to time over the features. Lomazzo, the Italian
painter of the eighteenth century, is said to have continued his work
after becoming blind.

Several men distinguished for their bravery and ability in the art of
war have been blind. Jean de Troczow, most commonly known by the name
of Ziska, in 1420 lost his one remaining eye, and was afterward known
as the "old blind dog," but, nevertheless, led his troops to many
victories. Froissart beautifully describes the glorious death of the
blind King of Bohemia at the battle of Crecy in 1346. Louis III, King
of Provence; Boleslas III, Duke of Bohemia; Magnus IV, King of Norway,
and Bela II, King of Hungary, were blind. Nathaniel Price, a librarian
of Norwich in the last century, lost his sight in a voyage to America,
which, however, did not interfere in any degree with his duties, for
his books were in as good condition and their location as directly
under his knowledge, during his blindness as they were in his earlier
days. At the present day in New York there is a blind billiard expert
who occasionally gives exhibitions of his prowess.

Feats of Memory.--From time to time there have been individuals,
principally children, who gave wonderful exhibitions of memory, some
for dates, others for names, and some for rapid mental calculation.
Before the Anthropological Society in 1880 Broca exhibited a lad of
eleven, a Piedmontese, named Jacques Inaudi.  This boy, with a trick
monkey, had been found earning his livelihood by begging and by solving
mentally in a few minutes the most difficult problems in arithmetic. A
gentleman residing in Marseilles had seen him while soliciting alms
perform most astonishing feats of memory, and brought him to Paris. In
the presence of the Society Broca gave him verbally a task in
multiplication, composed of some trillions to be multiplied by
billions. In the presence of all the members he accomplished his task
in less than ten minutes, and without the aid of pencil and paper,
solving the whole problem mentally. Although not looking intelligent,
and not being able to read or write, he perhaps could surpass any one
in the world in his particular feat. It was stated that he proceeded
from left to right in his calculations, instead of from right to left
in the usual manner. In his personal appearance the only thing
indicative of his wonderful abilities was his high forehead.

An infant prodigy named Oscar Moore was exhibited to the physicians of
Chicago at the Central Music Hall in 1888, and excited considerable
comment at the time. The child was born of mulatto parents at Waco,
Texas, on August 19, 1885, and when only thirteen months old manifested
remarkable mental ability and precocity. S. V. Clevenger, a physician
of Chicago, has described the child as follows:--

"Oscar was born blind and, as frequently occurs in such cases, the
touch-sense compensatingly developed extraordinarily. It was observed
that after touching a person once or twice with his stubby baby
fingers, he could thereafter unfailingly recognize and call by name the
one whose hand he again felt. The optic sense is the only one
defective, for tests reveal that his hearing, taste, and smell are
acute, and the tactile development surpasses in refinement. But his
memory is the most remarkable peculiarity, for when his sister conned
her lessons at home, baby Oscar, less than two years old, would recite
all he heard her read. Unlike some idiot savants, in which category he
is not to be included, who repeat parrot-like what they have once
heard, baby Oscar seems to digest what he hears, and requires at least
more than one repetition of what he is trying to remember, after which
he possesses the information imparted and is able to yield it at once
when questioned. It is not necessary for him to commence at the
beginning, as the possessors of some notable memories were compelled to
do, but he skips about to any required part of his repertoire.

"He sings a number of songs and counts in different languages, but it
is not supposable that he understands every word he utters. If,
however, his understanding develops as it promises to do, he will
become a decided polyglot. He has mastered an appalling array of
statistics, such as the areas in square miles of hundreds of countries,
the population of the world's principal cities, the birthdays of all
the Presidents, the names of all the cities of the United States of
over 10,000 inhabitants, and a lot of mathematical data. He is greatly
attracted by music, and this leads to the expectation that when more
mature he may rival Blind Tom.

"In disposition he is very amiable, but rather grave beyond his years.
He shows great affection for his father, and is as playful and as happy
as the ordinary child. He sleeps soundly, has a good childish appetite,
and appears to be in perfect health. His motions are quick but not
nervous, and are as well coordinated as in a child of ten. In fact, he
impresses one as having the intelligence of a much older child than
three years (now five years), but his height, dentition, and general
appearance indicate the truthfulness of the age assigned. An evidence
of his symmetrical mental development appears in his extreme
inquisitiveness. He wants to understand the meaning of what he is
taught, and some kind of an explanation must be given him for what he
learns. Were his memory alone abnormally great and other faculties
defective, this would hardly be the case; but if so, it cannot at
present be determined.

"His complexion is yellow, with African features, flat nose, thick lips
but not prognathous, superciliary ridges undeveloped, causing the
forehead to protrude a little. His head measures 19 inches in
circumference, on a line with the upper ear-tips, the forehead being
much narrower than the occipitoparietal portion, which is noticeably
very wide. The occiput protrudes backward, causing a forward sweep of
the back of the neck. From the nose-root to the nucha over the head he
measures 13 1/2 inches, and between upper ear-tips across and over the
head 11 inches, which is so close to the eight-and ten-inch standard
that he may be called mesocephalic. The bulging in the vicinity of the
parietal region accords remarkably with speculations upon the location
of the auditory memory in that region, such as those in the American
Naturalist, July, 1888, and the fact that injury of that part of the
brain may cause loss of memory of the meaning of words. It may be that
the premature death of the mother's children has some significance in
connection with Oscar's phenomenal development. There is certainly a
hypernutrition of the parietal brain with atrophy of the optic tract,
both of which conditions could arise from abnormal vascular causes, or
the extra growth of the auditory memory region may have deprived of
nutrition, by pressure, the adjacent optic centers in the occipital
brain. The otherwise normal motion of the eyes indicates the nystagmus
to be functional.

"Sudden exaltation of the memory is often the consequence of grave
brain disease, and in children this symptom is most frequent.
Pritchard, Rush, and other writers upon mental disorders record
interesting instances of remarkable memory-increase before death,
mainly in adults, and during fever and insanity. In simple mania the
memory is often very acute.  Romberg tells of a young girl who lost her
sight after an attack of small-pox, but acquired an extraordinary
memory. He calls attention to the fact that the scrofulous and rachitic
diatheses in childhood are sometimes accompanied by this disorder.
Winslow notes that in the incipient state of the brain disease of early
life connected with fevers, disturbed conditions of the cerebral
circulation and vessels, and in affections of advanced life, there is
often witnessed a remarkable exaltation of the memory, which may herald
death by apoplexy.

"Not only has the institution of intelligence in idiots dated from
falls upon the head, but extra mentality has been conferred by such an
event Pritchard tells of three idiot brothers, one of whom, after a
severe head injury, brightened up and became a barrister, while his
brothers remained idiotic. 'Father Mabillon,' says Winslow, 'is said to
have been an idiot until twenty-six years of age, when he fractured his
skull against a stone staircase. He was trepanned. After recovering,
his intellect fully developed itself in a mind endowed with a lively
imagination, an amazing memory, and a zeal for study rarely equaled.'
Such instances can be accounted for by the brain having previously been
poorly nourished by a defective blood supply, which defect was remedied
by the increased circulation afforded by the head-injury.

"It is a commonly known fact that activity of the brain is attended
with a greater head-circulation than when the mind is dull, within
certain limits. Anomalous development of the brain through
blood-vessels, affording an extra nutritive supply to the mental
apparatus, can readily be conceived as occurring before birth, just as
aberrant nutrition elsewhere produces giants from parents of ordinary
size.

"There is but one sense-defect in the child Oscar, his
eyesight-absence, and that is atoned for by his hearing and
touch-acuteness, as it generally is in the blind. Spitzka and others
demonstrate that in such cases other parts of the brain enlarge to
compensate for the atrophic portion which is connected with the
functionless nerves. This, considered with his apparently perfect,
mental and physical health, leaves no reason to suppose that Oscar's
extravagant memory depends upon disease any more than we can suspect
all giants of being sickly, though the anomaly is doubtless due to
pathologic conditions. Of course, there is no predicting what may
develop later in his life, but in any event science will be benefited.

"It is a popular idea that great vigor of memory is often associated
with low-grade intelligence, and cases such as Blind Tom and other
'idiot savants,' who could repeat the contents of a newspaper after a
single reading, justify the supposition.  Fearon, on 'Mental Vigor,'
tells of a man who could remember the day that every person had been
buried in the parish for thirty-five years, and could repeat with
unvarying accuracy the name and age of the deceased and the mourners at
the funeral. But he was a complete fool. Out of the line of burials he
had not one idea, could not give an intelligible reply to a single
question, nor be trusted even to feed himself. While memory-development
is thus apparent in some otherwise defective intellects, it has
probably as often or oftener been observed to occur in connection with
full or great intelligence. Edmund Burke, Clarendon, John Locke,
Archbishop Tillotson, and Dr. Johnson were all distinguished for having
great strength of memory. Sir W.  Hamilton observed that Grotius,
Pascal, Leibnitz, and Euler were not less celebrated for their
intelligence than for their memory.  Ben Jonson could repeat all that
he had written and whole books he had read. Themistocles could call by
name the 20,000 citizens of Athens. Cyrus is said to have known the
name of every soldier in his army. Hortensius, a great Roman orator,
and Seneca had also great memories. Niebuhr, the Danish historian, was
remarkable for his acuteness of memory. Sir James Mackintosh, Dugald
Stewart, and Dr. Gregory had similar reputations.

"Nor does great mental endowment entail physical enfeeblement; for,
with temperance, literary men have reached extreme old age, as in the
cases of Klopstock, Goethe, Chaucer, and the average age attained by
all the signers of the American Declaration of Independence was
sixty-four years, many of them being highly gifted men intellectually.
Thus, in the case of the phenomenal Oscar it cannot be predicted that
he will not develop, as he now promises to do, equal and extraordinary
powers of mind, even though it would be rare in one of his racial
descent, and in the face of the fact that precocity gives no assurance
of adult brightness, for it can be urged that John Stuart Mill read
Greek when four years of age.

"The child is strumous, however, and may die young. His exhibitors, who
are coining him into money, should seek the best medical care for him
and avoid surcharging his memory with rubbish. Proper cultivation of
his special senses, especially the tactile, by competent teachers, will
give Oscar the best chance of developing intellectually and acquiring
an education in the proper sense of the word."

By long custom many men of letters have developed wonderful feats of
memory; and among illiterate persons, by means of points of
association, the power of memory has been little short of marvelous. At
a large hotel in Saratoga there was at one time a negro whose duty was
to take charge of the hats and coats of the guests as they entered the
dining-room and return to each his hat after the meal. It was said
that, without checks or the assistance of the owners, he invariably
returned the right articles to the right persons on request, and no
matter how large the crowd, his limit of memory never seemed to be
reached. Many persons have seen expert players at draughts and chess
who, blindfolded, could carry on numerous games with many competitors
and win most of the matches. To realize what a wonderful feat of memory
this performance is, one need only see the absolute exhaustion of one
of these men after a match. In whist, some experts have been able to
detail the succession of the play of the cards so many hands back that
their competitors had long since forgotten it.

There is reported to be in Johnson County, Missouri, a mathematical
wonder by the name of Rube Fields. At the present day he is between
forty and fifty years of age, and his external appearance indicates
poverty as well as indifference. His temperament is most sluggish; he
rarely speaks unless spoken to, and his replies are erratic.

The boyhood of this strange character was that of an overgrown country
lout with boorish manners and silly mind. He did not and would not go
to school, and he asserts now that if he had done so he "would have
become as big a fool as other people." A shiftless fellow, left to his
own devices, he performed some wonderful feats, and among the many
stories connected with this period of his life is one which describes
how he actually ate up a good-sized patch of sugar cane, simply because
he found it good to his taste.

Yet from this clouded, illiterate mind a wonderful mathematical gift
shines. Just when he began to assert his powers is not known; but his
feats have been remembered for twenty years by his neighbors. A report
says:--

"Give Rube Fields the distance by rail between any two points, and the
dimensions of a car-wheel, and almost as soon as the statement has left
your lips he will tell you the number of revolutions the wheel will
make in traveling over the track. Call four or five or any number of
columns of figures down a page, and when you have reached the bottom he
will announce the sum. Given the number of yards or pounds of articles
and the price, and at once he will return the total cost--and this he
will do all day long, without apparent effort or fatigue.

"A gentleman relates an instance of Fields' knowledge of figures.
After having called several columns of figures for addition, he went
back to the first column, saying that it was wrong, and repeating it,
purposely miscalling the next to the last figure.  At once Fields threw
up his hand, exclaiming: 'You didn't call it that way before.'

"Fields' answers come quick and sharp, seemingly by intuition.
Calculations which would require hours to perform are made in less time
than it takes to state the question. The size of the computations seems
to offer no bar to their rapid solution, and answers in which long
lines of figures are reeled off come with perfect ease. In watching the
effort put forth in reaching an answer, there would seem to be some
process going on in the mind, and an incoherent mumbling is often
indulged in, but it is highly probable that Fields does not himself
know how he derives his answers. Certain it is that he is unable to
explain the process, nor has any one ever been able to draw from him
anything concerning it. Almost the only thing he knows about the power
is that he possesses it, and, while he is not altogether averse to
receiving money for his work, he has steadily refused to allow himself
to be exhibited." In reviewing the peculiar endowment of Fields, the
Chicago Record says:--

"How this feat is performed is as much a mystery as the process by
which he solves a problem in arithmetic. He answers no questions. Rapid
mathematicians, men of study, who by intense application and short
methods have become expert, have sought to probe these two mysteries,
but without results. Indeed, the man's intelligence is of so low an
order as to prevent him from aiding those who seek to know. With age,
too, he grows more surly. Of what vast value this 'gift' might be to
the world of science, if coupled with average intelligence, is readily
imagined. That it will ever be understood is unlikely. As it is, the
power staggers belief and makes modern psychology, with its study of
brain-cells, stand aghast. As to poor Fields himself, he excites only
sympathy. Homeless, unkempt, and uncouth, traveling aimlessly on a
journey which he does not understand, he hugs to his heart a marvelous
power, which he declares to be a gift from God. To his weak mind it
lifts him above his fellow-men, and yet it is as useless to the world
as a diamond in a dead man's hand."

Wolf-Children.--It is interesting to know to what degree a human being
will resemble a beast when deprived of the association with man. We
seem to get some insight to this question in the investigation of so
called cases of "wolf-children."

Saxo Grammaticus speaks of a bear that kidnapped a child and kept it a
long time in his den. The tale of the Roman she-wolf is well known, and
may have been something more than a myth, as there have been several
apparently authentic cases reported in which a child has been rescued
from its associations with a wolf who had stolen it some time
previously. Most of the stories of wolf-children come from India.
According to Oswald in Ball's "Jungle Life in India," there is the
following curious account of two children in the Orphanage of Sekandra,
near Agra, who had been discovered among wolves: "A trooper sent by a
native Governor of Chandaur to demand payment of some revenue was
passing along the bank of the river about noon when he saw a large
female wolf leave her den, followed by three whelps and a little boy.
The boy went on all-fours, and when the trooper tried to catch him he
ran as fast as the whelps, and kept up with the old one. They all
entered the den, but were dug out by the people and the boy was
secured. He struggled hard to rush into every hole or gully they came
near. When he saw a grown-up person he became alarmed, but tried to fly
at children and bite them. He rejected cooked meat with disgust, but
delighted in raw flesh and bones, putting them under his paws like a
dog." The other case occurred at Chupra, in the Presidency of Bengal.
In March, 1843, a Hindoo mother went out to help her husband in the
field, and while she was cutting rice her little boy was carried off by
a wolf. About a year afterward a wolf, followed by several cubs and a
strange, ape-like creature, was seen about ten miles from Chupra. After
a lively chase the nondescript was caught and recognized (by the mark
of a burn on his knee) as the Hindoo boy that had disappeared in the
rice-field. This boy would not eat anything but raw flesh, and could
never be taught to speak, but expressed his emotions in an inarticulate
mutter. His elbows and the pans of his knees had become horny from
going on all-fours with his foster mother. In the winter of 1850 this
boy made several attempts to regain his freedom, and in the following
spring he escaped for good and disappeared in the jungle-forest of
Bhangapore.

The Zoologist for March, 1888, reproduced a remarkable pamphlet printed
at Plymouth in 1852, which had been epitomized in the Lancet. This
interesting paper gives an account of wolves nurturing small children
in their dens. Six cases are given of boys who have been rescued from
the maternal care of wolves. In one instance the lad was traced from
the moment of his being carried off by a lurking wolf while his parents
were working in the field, to the time when, after having been
recovered by his mother six years later, he escaped from her into the
jungle. In all these cases certain marked features reappear. In the
first, the boy was very inoffensive, except when teased, and then he
growled surlily. He would eat anything thrown to him, but preferred
meat, which he devoured with canine voracity. He drank a pitcher of
buttermilk at one gulp, and could not be induced to wear clothing even
in the coldest weather. He showed the greatest fondness for bones, and
gnawed them contentedly, after the manner of his adopted parents. This
child had coarse features, a repulsive countenance, was filthy in his
habits, and could not articulate a word.

In another case the child was kidnapped at three and recovered at nine.
He muttered, but could not articulate. As in the other case, he could
not be enticed to wear clothes. From constantly being on all-fours the
front of this child's knees and his elbows had become hardened. In the
third case the father identified a son who had been carried away at the
age of six, and was found four years afterward. The intellectual
deterioration was not so marked. The boy understood signs, and his
hearing was exceedingly acute; when directed by movements of the hands
to assist the cultivators in turning out cattle, he readily
comprehended what was asked of him; yet this lad, whose vulpine career
was so short, could neither talk nor utter any decidedly articulate
sound.

The author of the pamphlet expressed some surprise that there was no
case on record in which a grown man had been found in such association.
This curious collection of cases of wolf-children is attributed to
Colonel Sleeman, a well-known officer, who is known to have been
greatly interested in the subject, and who for a long time resided in
the forests of India. A copy, now a rarity, is in the South Kensington
Museum.

An interesting case of a wolf-child was reported many years ago in
Chambers' Journal. In the Etwah district, near the banks of the river
Jumna, a boy was captured from the wolves. After a time this child was
restored to his parents, who, however, "found him very difficult to
manage, for he was most fractious and troublesome--in fact, just a
caged wild beast. Often during the night for hours together he would
give vent to most unearthly yells and moans, destroying the rest and
irritating the tempers of his neighbors and generally making night
hideous. On one occasion his people chained him by the waist to a tree
on the outskirts of the village. Then a rather curious incident
occurred. It was a bright moonlight night, and two wolf cubs
(undoubtedly those in whose companionship he had been captured),
attracted by his cries while on the prowl, came to him, and were
distinctly seen to gambol around him with as much familiarity and
affection as if they considered him quite one of themselves. They only
left him on the approach of morning, when movement and stir again arose
in the village. This boy did not survive long. He never spoke, nor did
a single ray of human intelligence ever shed its refining light over
his debased features."

Recently a writer in the Badmington Magazine, in speaking of the
authenticity of wolf-children, says:--

"A jemidar told me that when he was a lad he remembered going, with
others, to see a wolf-child which had been netted. Some time after
this, while staying at an up-country place called Shaporeooundie, in
East Bengal, it was my fortune to meet an Anglo-Indian gentleman who
had been in the Indian civil service for upward of thirty years, and
had traveled about during most of that time; from him I learned all I
wanted to know of wolf-children, for he not only knew of several cases,
but had actually seen and examined, near Agra, a child which had been
recovered from the wolves. The story of Romulus and Remus, which all
schoolboys and the vast majority of grown people regard as a myth,
appears in a different light when one studies the question of
wolf-children, and ascertains how it comes to pass that boys are found
living on the very best terms with such treacherous and rapacious
animals as wolves, sleeping with them in their dens, sharing the raw
flesh of deer and kids which the she-wolf provides, and, in fact,
leading in all essentials the actual life of a wolf.

"A young she-wolf has a litter of cubs, and after a time her instinct
tells her that they will require fresh food. She steals out at night in
quest of prey. Soon she espies a weak place in the fence (generally
constructed of thatching grass and bamboos) which encloses the
compound, or 'unguah,' of a poor villager. She enters, doubtless, in
the hope of securing a kid; and while prowling about inside looks into
a hut where a woman and infant are soundly sleeping. In a moment she
has pounced on the child, and is out of reach before its cries can
attract the villagers.  Arriving safely at her den under the rocks, she
drops the little one among her cubs. At this critical time the fate of
the child hangs in the balance. Either it will be immediately torn to
pieces and devoured, or in a most wonderful way remain in the cave
unharmed. In the event of escape, the fact may be accounted for in
several ways. Perhaps the cubs are already gorged when the child is
thrown before them, or are being supplied with solid food before their
carnivorous instinct is awakened, so they amuse themselves by simply
licking the sleek, oily body (Hindoo mothers daily rub their boy babies
with some native vegetable oil) of the infant, and thus it lies in the
nest, by degrees getting the odor of the wolf cubs, after which the
mother wolf will not molest it.  In a little time the infant begins to
feel the pangs of hunger, and hearing the cubs sucking, soon follows
their example. Now the adoption is complete, all fear of harm to the
child from wolves has gone, and the foster-mother will guard and
protect it as though it were of her own flesh and blood.

"The mode of progression of these children is on all fours--not, as a
rule, on the hands and feet, but on the knees and elbows.  The reason
the knees are used is to be accounted for by the fact that, owing to
the great length of the human leg and thigh in proportion to the length
of the arm, the knee would naturally be brought to the ground, and the
instep and top of the toes would be used instead of the sole and heel
of the almost inflexible foot. Why the elbow should be employed instead
of the hand is less easy to understand, but probably it is better
suited to give support to the head and fore-part of the body.

"Some of these poor waifs have been recovered after spending ten or
more years in the fellowship of wolves, and, though wild and savage at
first, have in time become tractable in some degree.  They are rarely
seen to stand upright, unless to look around, and they gnaw bones in
the manner of a dog, holding one end between the forearms and hands,
while snarling and snapping at everybody who approaches too near. The
wolf-child has little except his outward form to show that it is a
human being with a soul. It is a fearful and terrible thing, and hard
to understand, that the mere fact of a child's complete isolation from
its own kind should bring it to such a state of absolute degradation.
Of course, they speak no language, though some, in time, have learned
to make known their wants by signs. When first taken they fear the
approach of adults, and, if possible, will slink out of sight; but
should a child of their own size, or smaller, come near, they will
growl, and even snap and bite at it. On the other hand, the close
proximity of "pariah" dogs or jackals is unresented, in some cases
welcomed; for I have heard of them sharing their food with these
animals, and even petting and fondling them. They have in time been
brought to a cooked-meat diet, but would always prefer raw flesh. Some
have been kept alive after being reclaimed for as long as two years,
but for some reason or other they all sicken and die, generally long
before that time. One would think, however, that, having undoubtedly
robust constitutions, they might be saved if treated in a scientific
manner and properly managed."

Rudyard Kipling, possibly inspired by accounts of these wolf-children
in India, has ingeniously constructed an interesting series of fabulous
stories of a child who was brought up by the beasts of the jungles and
taught their habits and their mode of communication. The ingenious way
in which the author has woven the facts together and interspersed them
with his intimate knowledge of animal-life commends his "Jungle-Book"
as a legitimate source of recreation to the scientific observer.

Among observers mentioned in the "Index Catalogue" who have studied
this subject are Giglioli, Mitra, and Ornstein.

The artificial manufacture of "wild men" or "wild boys" in the Chinese
Empire is shown by recent reports. Macgowan says the traders kidnap a
boy and skin him alive bit by bit, transplanting on the denuded
surfaces the hide of a bear or dog. This process is most tedious and is
by no means complete when the hide is completely transplanted, as the
subject must be rendered mute by destruction of the vocal cords, made
to use all fours in walking, and submitted to such degradation as to
completely blight all reason. It is said that the process is so severe
that only one in five survive. A "wild boy" exhibited in Kiangse had
the entire skin of a dog substituted and walked on all fours. It was
found that he had been kidnapped. His proprietor was decapitated on the
spot. Macgowan says that parasitic monsters are manufactured in China
by a similar process of transplantation. He adds that the deprivation
of light for several years renders the child a great curiosity, if in
conjunction its growth is dwarfed by means of food and drugs, and its
vocal apparatus destroyed. A certain priest subjected a kidnapped boy
to this treatment and exhibited him as a sacred deity. Macgowan
mentions that the child looked like wax, as though continually fed on
lardaceous substances. He squatted with his palms together and was a
driveling idiot. The monk was discovered and escaped, but his temple
was razed.

Equilibrists.--Many individuals have cultivated their senses so acutely
that by the eye and particularly by touch they are able to perform
almost incredible feats of maintaining equilibrium under the most
difficult circumstances Professional rope-walkers have been known in
all times. The Greeks had a particular passion for equilibrists, and
called them "neurobates," "oribates," and "staenobates." Blondin would
have been one of the latter. Antique medals showing equilibrists making
the ascent of an inclined cord have been found. The Romans had walkers
both of the slack-rope and tight-rope Many of the Fathers of the Church
have pronounced against the dangers of these exercises. Among others,
St. John Chrysostom speaks of men who execute movements on inclined
ropes at unheard-of heights. In the ruins of Herculaneum there is still
visible a picture representing an equilibrist executing several
different exercises, especially one in which he dances on a rope to the
tune of a double flute, played by himself. The Romans particularly
liked to witness ascensions on inclined ropes, and sometimes these were
attached to the summits of high hills, and while mounting them the
acrobats performed different pantomimes.  It is said that under Charles
VI a Genoese acrobat, on the occasion of the arrival of the Queen of
France, carried in each hand an illuminated torch while descending a
rope stretched from the summit of the towers of Notre Dame to a house
on the Pont au Change. According to Guyot-Daubes, a similar performance
was seen in London in 1547. In this instance the rope was attached to
the highest pinnacle of St. Paul's Cathedral. Under Louis XII an
acrobat named Georges Menustre, during a passage of the King through
Macon, executed several performances on a rope stretched from the grand
tower of the Chateau and the clock of the Jacobins, at a height of 156
feet. A similar performance was given at Milan before the French
Ambassadors, and at Venice under the Doges and the Senate on each St.
Mark's Day, rope-walkers performed at high altitudes. In 1649 a man
attempted to traverse the Seine on a rope placed between the Tour de
Nesles and the Tour du Grand-Prevost. The performance, however, was
interrupted by the fall of the mountebank into the Seine. At subsequent
fairs in France other acrobats have appeared. At the commencement of
this century there was a person named Madame Saqui who astonished the
public with her nimbleness and extraordinary skill in rope walking. Her
specialty was military maneuvers. On a cord 20 meters from the ground
she executed all sorts of military pantomimes without assistance,
shooting off pistols, rockets, and various colored fires. Napoleon
awarded her the title of the first acrobat of France. She gave a
performance as late as 1861 at the Hippodrome of Paris.

In 1814 there was a woman called "La Malaga," who, in the presence of
the allied sovereigns at Versailles, made an ascension on a rope 200
feet above the Swiss Lake.

In the present generation probably the most famous of all the
equilibrists was Blondin. This person, whose real name was Emile
Gravelet, acquired a universal reputation; about 1860 he traversed the
Niagara Falls on a cable at an elevation of nearly 200 feet. Blondin
introduced many novelties in his performances.  Sometimes he would
carry a man over on his shoulders; again he would eat a meal while on
his wire; cook and eat an omelet, using a table and ordinary cooking
utensils, all of which he kept balanced. In France Blondin was almost
the patron saint of the rope-walkers; and at the present day the
performers imitate his feats, but never with the same grace and
perfection.

In 1882 an acrobat bearing the natural name of Arsens Blondin traversed
one river after another in France on a wire stretched at high
altitudes. With the aid of a balancing-rod he walked the rope
blindfolded; with baskets on his feet; sometimes he wheeled persons
over in a wheelbarrow. He was a man of about thirty, short, but
wonderfully muscled and extremely supple.

It is said that a negro equilibrist named Malcom several times
traversed the Meuse at Sedan on a wire at about a height of 100 feet.
Once while attempting this feat, with his hands and feet shackled with
iron chains, allowing little movement, the support on one side fell,
after the cable had parted, and landed on the spectators, killing a
young girl and wounding many others. Malcom was precipitated into the
river, but with wonderful presence of mind and remarkable strength he
broke his bands and swam to the shore, none the worse for his high
fall; he immediately helped in attention to his wounded spectators. A
close inspection of all the exhibitionists of this class will show that
they are of superior physique and calm courage. They only acquire their
ability after long gymnastic exercise, as well as actual practice on
the rope. Most of these persons used means of balancing themselves,
generally a long and heavy pole; but some used nothing but their
outstretched arms. In 1895, at the Royal Aquarium in London, there was
an individual who slowly mounted a long wire reaching to the top of
this huge structure, and, after having made the ascent, without the aid
of any means of balancing but his arms, slid the whole length of the
wire, landing with enormous velocity into an outstretched net.

The equilibrists mentioned thus far have invariably used a tightly
stretched rope or wire; but there are a number of persons who perform
feats, of course not of such magnitude, on a slack wire, in which they
have to defy not only the force of gravity, but the to-and-fro motion
of the cable as well. It is particularly with the Oriental performers
that we see this exhibition. Some use open parasols, which, with their
Chinese or Japanese costumes, render the performance more picturesque;
while others seem to do equally well without such adjuncts. There have
been performers of this class who play with sharp daggers while
maintaining themselves on thin and swinging wires.

Another class of equilibrists are those who maintain the upright
position resting on their heads with their feet in the air. At the
Hippodrome in Paris some years since there was a man who remained in
this position seven minutes and ate a meal during the interval. There
were two clowns at the Cirque Franconi who duplicated this feat, and
the program called their dinner "Un dejouner en tete-a-tete." Some
other persons perform wonderful feats of a similar nature on an
oscillating trapeze, and many similar performances have been witnessed
by the spectators of our large circuses.

The "human pyramids" are interesting, combining, as they do, wonderful
power of maintaining equilibrium with agility and strength. The
rapidity with which they are formed and are tumbled to pieces is
marvelous they sometimes include as many as 16 persons men, women, and
children.

The exhibitions given by the class of persons commonly designated as
"jugglers" exemplify the perfect control that by continual practice one
may obtain over his various senses and muscles. The most wonderful
feats of dexterity are thus reduced into mere automatic movements.
Either standing, sitting, mounted on a horse, or even on a wire, they
are able to keep three four, five, and even six balls in continual
motion in the air. They use articles of the greatest difference in
specific gravity in the same manner. A juggler called "Kara," appearing
in London and Paris in the summer of 1895, juggled with an open
umbrella, an eye-glass, and a traveling satchel, and received each
after its course in the air with unerring precision. Another man called
"Paul Cinquevalli," well known in this country, does not hesitate to
juggle with lighted lamps or pointed knives. The tricks of the clowns
with their traditional pointed felt hats are well known.  Recently
there appeared in Philadelphia a man who received six such hats on his
head, one on top of the other, thrown by his partner from the rear of
the first balcony of the theater. Others will place a number of rings
on their fingers, and with a swift and dexterous movement toss them all
in the air, catching them again all on one finger. Without resorting to
the fabulous method of Columbus, they balance eggs on a table, and in
extraordinary ways defy all the powers of gravity.

In India and China we see the most marvelous of the knife-jugglers.

With unerring skill they keep in motion many pointed knives, always
receiving them at their fall by the handles. They throw their
implements with such precision that one often sees men, who, placing
their partner against a soft board, will stand at some distance and so
pen him in with daggers that he cannot move until some are withdrawn,
marking a silhouette of his form on the board,--yet never once does one
as much as graze the skin. With these same people the foot-jugglers are
most common. These persons, both made and female, will with their feet
juggle substances and articles that it requires several assistants to
raise.

A curious trick is given by Rousselet in his magnificent work entitled
"L'Inde des Rajahs," and quoted by Guyot-Daubes. It is called in India
the "dance of the eggs." The dancer, dressed in a rather short skirt,
places on her head a large wheel made of light wood, and at regular
intervals having hanging from it pieces of thread, at the ends of which
are running knots kept open by beads of glass. She then brings forth a
basket of eggs, and passes them around for inspection to assure her
spectators of their genuineness. The monotonous music commences and the
dancer sets the wheel on her head in rapid motion; then, taking an egg,
with a quick movement she puts it on one of the running knots and
increases the velocity of the revolution of the wheel by gyrations
until the centrifugal force makes each cord stand out in an almost
horizontal line with the circumference of the wheel.  Then one after
another she places the eggs on the knots of the cord, until all are
flying about her head in an almost horizontal position. At this moment
the dance begins, and it is almost impossible to distinguish the
features of the dancer. She continues her dance, apparently indifferent
to the revolving eggs. At the velocity with which they revolve the
slightest false movement would cause them to knock against one another
and surely break. Finally, with the same lightning-like movements, she
removes them one by one, certainly the most delicate part of the trick,
until they are all safely laid away in the basket from which they came,
and then she suddenly brings the wheel to a stop; after this wonderful
performance, lasting possibly thirty minutes, she bows herself out.

A unique Japanese feat is to tear pieces of paper into the form of
butterflies and launch them into the air about a vase full of flowers;
then with a fan to keep them in motion, making them light on the
flowers, fly away, and return, after the manner of several living
butterflies, without allowing one to fall to the ground.

Marksmen.--It would be an incomplete paper on the acute development of
the senses that did not pay tribute to the men who exhibit marvelous
skill with firearms. In the old frontier days in the Territories, the
woodsmen far eclipsed Tell with his bow or Robin Hood's famed band by
their unerring aim with their rifles. It is only lately that there
disappeared in this country the last of many woodsmen, who, though
standing many paces away and without the aid of the improved sights of
modern guns, could by means of a rifle-ball, with marvelous precision,
drive a nail "home" that had been placed partly in a board. The experts
who shoot at glass balls rarely miss, and when we consider the number
used each year, the proportion of inaccurate shots is surprisingly
small. Ira Paine, Doctor Carver, and others have been seen in their
marvelous performances by many people of the present generation. The
records made by many of the competitors of the modern army-shooting
matches are none the less wonderful, exemplifying as they do the degree
of precision that the eye may attain and the control which may be
developed over the nerves and muscles. The authors know of a countryman
who successfully hunted squirrels and small game by means of pebbles
thrown with his hand.

Physiologic wonders are to be found in all our modern sports and games.
In billiards, base-ball, cricket, tennis, etc., there are experts who
are really physiologic curiosities. In the trades and arts we see
development of the special senses that is little less than marvelous.
It is said that there are workmen in Krupp's gun factory in Germany who
have such control over the enormous trip hammers that they can place a
watch under one and let the hammer fall, stopping it with unerring
precision just on the crystal. An expert tool juggler in one of the
great English needle factories, in a recent test of skill, performed
one of the most delicate mechanical feats imaginable. He took a common
sewing needle of medium size (length 1 5/8 inches) and drilled a hole
through its entire length from eye to point--the opening being just
large enough to admit the passage of a very fine hair. Another workman
in a watch-factory of the United States drilled a hole through a hair
of his beard and ran a fiber of silk through it.

Ventriloquists, or "two-voiced men," are interesting anomalies of the
present day; it is common to see a person who possesses the power of
speaking with a voice apparently from the epigastrium.  Some acquire
this faculty, while with others it is due to a natural resonance,
formed, according to Dupont, in the space between the third and fourth
ribs and their cartilaginous union and the middle of the first portion
of the sternum. Examination of many of these cases proves that the
vibration is greatest here. It is certain that ventriloquists have
existed for many centuries. It is quite possible that some of the old
Pagan oracles were simply the deceptions of priests by means of
ventriloquism.

Dupont, Surgeon-in-chief of the French Army about a century since,
examined minutely an individual professing to be a ventriloquist. With
a stuffed fox on his lap near his epigastrium, he imitated a
conversation with the fox. By lying on his belly, and calling to some
one supposed to be below the surface of the ground, he would imitate an
answer seeming to come from the depths of the earth. With his belly on
the ground he not only made the illusion more complete, but in this way
he smothered "the epigastric voice."

He was always noticed to place the inanimate objects with which he held
conversations near his umbilicus.

Ventriloquists must not be confounded with persons who by means of
skilful mechanisms, creatures with movable fauces, etc., imitate
ventriloquism. The latter class are in no sense of the word true
ventriloquists, but simulate the anomaly by quickly changing the tones
of their voice in rapid succession, and thus seem to make their puppets
talk in many different voices. After having acquired the ability to
suddenly change the tone of their voice, they practice imitations of
the voices of the aged, of children, dialects, and feminine tones, and,
with a set of mechanical puppets, are ready to appear as
ventriloquists. By contraction of the pharyngeal and laryngeal muscles
they also imitate tones from a distance. Some give their performance
with little labial movement, but close inspection of the ordinary
performer of this class shows visible movements of his lips. The true
ventriloquist pretends only to speak from the belly and needs no
mechanical assistance.

The wonderful powers of mimicry displayed by expert ventriloquists are
marvelous; they not only imitate individuals and animals, but do not
hesitate to imitate a conglomeration of familiar sounds and noises in
such a manner as to deceive their listeners into believing that they
hear the discussions of an assemblage of people. The following
description of an imitation of a domestic riot by a Chinese
ventriloquist is given by the author of "The Chinaman at Home" and well
illustrates the extent of their abilities: "The ventriloquist was
seated behind a screen, where there were only a chair, a table, a fan,
and a ruler. With this ruler he rapped on the table to enforce silence,
and when everybody had ceased speaking there was suddenly heard the
barking of a dog. Then we heard the movements of a woman. She had been
waked by the dog and was shaking her husband. We were just expecting to
hear the man and wife talking together when a child began to cry. To
pacify it the mother gave it food; we could hear it drinking and crying
at the same time. The mother spoke to it soothingly and then rose to
change its clothes.  Meanwhile another child had wakened and was
beginning to make a noise. The father scolded it, while the baby
continued crying.  By-and-by the whole family went back to bed and fell
asleep. The patter of a mouse was heard. It climbed up some vase and
upset it. We heard the clatter of the vase as it fell. The woman
coughed in her sleep. Then cries of "Fire! fire!" were heard. The mouse
had upset the lamp; the bed curtains were on fire. The husband and wife
waked up, shouted, and screamed, the children cried, people came
running and shouting. Children cried, dogs barked, squibs and crackers
exploded. The fire brigade came racing up. Water was pumped up in
torrents and hissed in the flames. The representation was so true to
life that every one rose to his feet and was starting away when a
second blow of the ruler on the table commanded silence. We rushed
behind the screen, but there was nothing there except the
ventriloquist, his table, his chair, and his ruler."

Athletic Feats.--The ancients called athletes those who were noted for
their extraordinary agility, force, and endurance. The history of
athletics is not foreign to that of medicine, but, on the contrary, the
two are in many ways intimately blended. The instances of feats of
agility and endurance are in every sense of the word examples of
physiologic and functional anomalies, and have in all times excited the
interest and investigation of capable physicians.

The Greeks were famous for their love of athletic pastimes; and
classical study serves powerfully to strengthen the belief that no
institution exercised greater influence than the public contests of
Greece in molding national character and producing that admirable type
of personal and intellectual beauty that we see reflected in her art
and literature. These contests were held at four national festivals,
the Olympian, the Pythian, the Nemean, and the Isthmean games. On these
occasions every one stopped labor, truce was declared between the
States, and the whole country paid tribute to the contestants for the
highly-prized laurels of these games. Perhaps the enthusiasm shown in
athletics and interest in physical development among the Greeks has
never been equaled by any other people. Herodotus and all the Greek
writers to Plutarch have elaborated on the glories of the Greek
athlete, and tell us of the honors rendered to the victors by the
spectators and the vanquished, dwelling with complacency on the fact
that in accepting the laurel they cared for nothing but honor. The
Romans in "ludi publici," as they called their games, were from first
to last only spectators; but in Greece every eligible person was an
active participant. In the regimen of diet and training the physicians
from the time of Hippocrates, and even before, have been the
originators and professional advisers of the athlete. The change in the
manner of living of athletes, if we can judge from the writings of
Hippocrates, was anterior to his time; for in Book V of the "Epidemics"
we read of Bias, who, "suapte nature vorax, in choleram-morbum incidit
ex carnium esu, praecipueque suillarum crudarum, etc."

From the time of the well-known fable of the hero who, by practicing
daily from his birth, was able to lift a full-grown bull, thus
gradually accustoming himself to the increased weight, physiologists
and scientists have collaborated with the athlete in evolving the
present ideas and system of training. In his aphorisms Hippocrates
bears witness to the dangers of over-exercise and superabundant
training, and Galen is particularly averse to an art which so
preternaturally develops the constitution and nature of man; many
subsequent medical authorities believed that excessive development of
the human frame was necessarily followed by a compensatory shortening
of life.

The foot-race was the oldest of the Greek institutions, and in the
first of the Olympiads the "dromos," a course of about 200 yards, was
the only contest; but gradually the "dialos," in which the course was
double that of the dromos, was introduced, and, finally, tests of
endurance as well as speed were instituted in the long-distance races
and the contests of racing in heavy armor, which were so highly
commended by Plato as preparation for the arduous duties of a soldier.
Among the Greeks we read of Lasthenes the Theban, who vanquished a
horse in the course; of Polymnestor, who chased and caught a hare; and
Philonides, the courier of Alexander the Great, who in nine hours
traversed the distance between the Greek cities Sicyone and Elis, a
distance of over 150 miles. We read of the famous soldier of Marathon,
who ran to announce the victory to the Magistrates of Athens and fell
dead at their feet. In the Olympian games at Athens in 1896 this
distance (about 26 miles) was traversed in less than three hours.

It is said of Euchidas, who carried the fire necessary for the
sacrifices which were to replace those which the Persians had spoiled,
that he ran a thousand stadia (about 125 miles) and fell dead at the
end of his mission. The Roman historians have also recited the
extraordinary feats of the couriers of their times.  Pliny speaks of an
athlete who ran 235 kilometers (almost 150 miles) without once
stopping. He also mentions a child who ran almost half this distance.

In the Middle Ages the Turks had couriers of almost supernatural
agility and endurance. It is said that the distance some of them would
traverse in twenty-four hours was 120 miles, and that it was common for
them to make the round trip from Constantinople to Adrianople, a
distance of 80 leagues, in two days. They were dressed very lightly,
and by constant usage the soles of their feet were transformed into a
leathery consistency. In the last century in the houses of the rich
there were couriers who preceded the carriages and were known as
"Basques," who could run for a very long time without apparent fatigue.
In France there is a common proverb, "Courir comme un Basque." Rabelais
says: "Grand-Gousier depeche le Basque son laquais pour querir
Gargantua en toute hate."

In the olden times the English nobility maintained running footmen who,
living under special regimen and training, were enabled to traverse
unusual distances without apparent fatigue.  There is an anecdote of a
nobleman living in a castle not far from Edinburgh, who one evening
charged his courier to carry a letter to that city. The next morning
when he arose he found this valet sleeping in his antechamber. The
nobleman waxed wroth, but the courier gave him a response to the
letter. He had traveled 70 miles during the night. It is said that one
of the noblemen under Charles II in preparing for a great dinner
perceived that one of the indispensable pieces of his service was
missing. His courier was dispatched in great haste to another house in
his domain, 15 miles distant, and returned in two hours with the
necessary article, having traversed a distance of over 30 miles. It is
also said that a courier carrying a letter to a London physician
returned with the potion prescribed within twenty-four hours, having
traversed 148 miles. There is little doubt of the ability of these
couriers to tire out any horse. The couriers who accompany the
diligences in Spain often fatigue the animals who draw the vehicles.

At the present time in this country the Indians furnish examples of
marvelous feats of running. The Tauri-Mauri Indians, who live in the
heart of the Sierra Madre Mountains, are probably the most wonderful
long-distance runners in the world. Their name in the language of the
mountain Mexicans means foot-runners; and there is little doubt that
they perform athletic feats which equal the best in the days of the
Olympian games. They are possibly the remnants of the wonderful runners
among the Indian tribes in the beginning of this century. There is an
account of one of the Tauri-Mauri who was mail carrier between
Guarichic and San Jose de los Cruces, a distance of 50 miles of as
rough, mountainous road as ever tried a mountaineer's lungs and limbs.
Bareheaded and barelegged, with almost no clothing, this man made this
trip each day, and, carrying on his back a mail-pouch weighing 40
pounds, moved gracefully and easily over his path, from time to time
increasing his speed as though practicing, and then again more slowly
to smoke a cigarette. The Tauri-Mauri are long-limbed and slender,
giving the impression of being above the average height. There is
scarcely any flesh on their puny arms, but their legs are as muscular
as those of a greyhound. In short running they have the genuine
professional stride, something rarely seen in other Indian racers. In
traversing long distances they leap and bound like deer.

"Deerfoot," the famous Indian long-distance runner, died on the
Cattaraugus Reservation in January, 1896. His proper name was Louis
Bennett, the name "Deerfoot" having been given to him for his prowess
in running. He was born on the reservation in 1828.  In 1861 he went to
England, where he defeated the English champion runners. In April,
1863, he ran 11 miles in London in fifty-six minutes fifty-two seconds,
and 12 miles in one hour two minutes and two and one-half seconds, both
of which have stood as world's records ever since.

In Japan, at the present day, the popular method of conveyance, both in
cities and in rural districts, is the two-wheeled vehicle, looking like
a baby-carriage, known to foreigners as the jinrickisha, and to the
natives as the kuruma. In the city of Tokio there is estimated to be
38,000 of these little carriages in use. They are drawn by coolies, of
whose endurance remarkable stories are told. These men wear light
cotton breeches and a blue cotton jacket bearing the license number,
and the indispensable umbrella hat. In the course of a journey in hot
weather the jinrickisha man will gradually remove most of his raiment
and stuff it into the carriage. In the rural sections he is covered
with only two strips of cloth, one wrapped about his head and the other
about his loins. It is said that when the roadway is good, these "human
horses" prefer to travel bare-footed; when working in the mud they wrap
a piece of straw about each big toe, to prevent slipping and to give
them a firmer grip. For any of these men a five-mile spurt on a good
road without a breathing spell is a small affair. A pair of them will
roll a jinrickisha along a country road at the rate of four miles an
hour, and they will do this eight hours a day. The general average of
the distance traversed in a day is 25 miles. Cockerill, who has
recently described these men, says that the majority of them die early.
The terrible physical strain brings on hypertrophy and valvular
diseases of the heart, and many of them suffer from hernia.
Occasionally one sees a veteran jinrickisha man, and it is interesting
to note how tenderly he is helped by his confreres.  They give him
preference as regards wages, help push his vehicle up heavy grades, and
show him all manner of consideration.

Figure 180 represents two Japanese porters and their usual load, which
is much more difficult to transport than a jinrickisha carriage. In
other Eastern countries, palanquins and other means of conveyance are
still borne on the shoulders of couriers, and it is not so long since
our ancestors made their calls in Sedan-chairs borne by sturdy porters.

Some of the letter-carriers of India make a daily journey of 30 miles.
They carry in one hand a stick, at the extremity of which is a ring
containing several little plates of iron, which, agitated during the
course, produce a loud noise designed to keep off ferocious beasts and
serpents. In the other hand they carry a wet cloth, with which they
frequently refresh themselves by wiping the countenance. It is said
that a regular Hindustanee carrier, with a weight of 80 pounds on his
shoulder,--carried, of course, in two divisions, hung on his neck by a
yoke,--will, if properly paid, lope along over 100 miles in twenty-four
hours--a feat which would exhaust any but the best trained runners.

The "go-as-you-please" pedestrians, whose powers during the past years
have been exhibited in this country and in England, have given us
marvelous examples of endurance, over 600 miles having been
accomplished in a six-days' contest. Hazael, the professional
pedestrian, has run over 450 miles in ninety-nine hours, and Albert has
traveled over 500 miles in one hundred and ten hours. Rowell, Hughes,
and Fitzgerald have astonishingly high records for long-distance
running, comparing favorably with the older, and presumably mythical,
feats of this nature. In California, C. A. Harriman of Truckee in
April, 1883, walked twenty-six hours without once resting, traversing
122 miles.

For the purpose of comparison we give the best modern records for
running:--

100 Yards.--9 3/5 seconds, made by Edward Donavan, at Natick, Mass.,
September 2, 1895.

220 Yards.--21 3/5 seconds, made by Harry Jewett, at Montreal,
September 24, 1892.

Quarter-Mile.--47 3/4 seconds, made by W. Baker, at Boston, Mass., July
1, 1886.

Half-Mile.--1 minute 53 2/3 seconds, made by C. J. Kirkpatrick, at
Manhattan Field, New York, September 21, 1895.

1 Mile.--4 minutes 12 3/4 seconds, made by W. G. George, at London,
England, August 23, 1886.

5 Miles.--24 minutes 40 seconds, made by J. White, in England, May 11,
1863.

10 Miles.--51 minutes 6 3/5 seconds, made by William Cummings, at
London, England, September 18,1895.

25 Miles.--2 hours 33 minutes 44 seconds, made by G. A. Dunning, at
London, England, December 26, 1881.

50 Miles.--5 hours 55 minutes 4 1/2 seconds, made by George Cartwright,
at London, England, February 21, 1887.

75 Miles.--8 hours 48 minutes 30 seconds, made by George Littlewood, at
London, England, November 24, 1884.

100 Miles.--13 hours 26 minutes 30 seconds, made by Charles Rowell at
New York, February 27, 1882.

In instances of long-distance traversing, rapidity is only a secondary
consideration, the remarkable fact being in the endurance of fatigue
and the continuity of the exercise. William Gale walked 1500 miles in a
thousand consecutive hours, and then walked 60 miles every twenty-four
hours for six weeks on the Lillie Bridge cinder path. He was five feet
five inches tall, forty-nine years of age, and weighed 121 pounds, and
was but little developed muscularly. He was in good health during his
feat; his diet for the twenty-four hours was 16 pounds of meat, five or
six eggs, some cocoa, two quarts of milk, a quart of tea, and
occasionally a glass of bitter ale, but never wine nor spirits. Strange
to say, he suffered from constipation, and took daily a compound
rhubarb pill. He was examined at the end of his feat by Gant. His pulse
was 75, strong, regular, and his heart was normal. His temperature was
97.25 degrees F., and his hands and feet warm; respirations were deep
and averaged 15 a minute.  He suffered from frontal headache and was
drowsy. During the six weeks he had lost only seven pounds, and his
appetite maintained its normal state.

Zeuner of Cincinnati refers to John Snyder of Dunkirk, whose
walking-feats were marvelous. He was not an impostor. During
forty-eight hours he was watched by the students of the Ohio Medical
College, who stated that he walked constantly; he assured them that it
did not rest him to sit down, but made him uncomfortable. The
celebrated Weston walked 5000 miles in one hundred days, but Snyder was
said to have traveled 25,000 miles in five hundred days and was
apparently no more tired than when he began.

Recently there was a person who pushed a wheelbarrow from San Francisco
to New York in one hundred and eighteen days. In 1809 the celebrated
Captain Barclay wagered that he could walk 1000 miles in one thousand
consecutive hours, and gained his bet with some hours to spare. In 1834
Ernest Mensen astonished all Europe by his pedestrian exploits. He was
a Norwegian sailor, who wagered that he could walk from Paris to Moscow
in fifteen days.  On June 25, 1834, at ten o'clock A.M., he entered the
Kremlin, after having traversed 2500 kilometers (1550 miles) in
fourteen days and eighteen hours. His performances all over Europe were
so marvelous as to be almost incredible. In 1836, in the service of the
East India Company, he was dispatched from Calcutta to Constantinople,
across Central Asia. He traversed the distance in fifty-nine days,
accomplishing 9000 kilometers (5580 miles) in one-third less time than
the most rapid caravan. He died while attempting to discover the source
of the Nile, having reached the village of Syang.

A most marvelous feat of endurance is recorded in England in the first
part of this century. It is said that on a wager Sir Andrew Leith Hay
and Lord Kennedy walked two days and a night under pouring rain, over
the Grampian range of mountains, wading all one day in a bog. The
distance traversed was from a village called Banchory on the river Dee
to Inverness. This feat was accomplished without any previous
preparation, both men starting shortly after the time of the wager.

Riders.--The feats of endurance accomplished by the couriers who ride
great distances with many changes of horses are noteworthy.  According
to a contemporary medical journal there is, in the Friend of India, an
account of the Thibetan couriers who ride for three weeks with
intervals of only half an hour to eat and change horses. It is the duty
of the officials at the Dak bungalows to see that the courier makes no
delay, and even if dying he is tied to his horse and sent to the next
station. The celebrated English huntsman, "Squire" Osbaldistone, on a
wager rode 200 miles in seven hours ten minutes and four seconds. He
used 28 horses; and as one hour twenty-two minutes and fifty-six
seconds were allowed for stoppages, the whole time, changes and all,
occupied in accomplishing this wonderful feat was eight hours and
forty-two minutes. The race was ridden at the Newmarket Houghton
Meeting over a four-mile course. It is said that a Captain Horne of the
Madras Horse Artillery rode 200 miles on Arab horses in less than ten
hours along the road between Madras and Bangalore. When we consider the
slower speed of the Arab horses and the roads and climate of India,
this performance equals the 200 miles in the shorter time about an
English race track and on thoroughbreds. It is said that this wonderful
horseman lost his life in riding a horse named "Jumping Jenny" 100
miles a day for eight days. The heat was excessive, and although the
horse was none the worse for the performance, the Captain died from the
exposure he encountered. There is a record of a Mr. Bacon of the Bombay
Civil Service, who rode one camel from Bombay to Allygur (perhaps 800
miles) in eight days.

As regards the physiology of the runners and walkers, it is quite
interesting to follow the effects of training on the respiration,
whereby in a measure is explained the ability of these persons to
maintain their respiratory function, although excessively exercising. A
curious discussion, persisted in since antiquity, is as to the supposed
influence of the spleen on the ability of couriers. For ages runners
have believed that the spleen was a hindrance to their vocation, and
that its reduction was followed by greater agility on the course. With
some, this opinion is perpetuated to the present day. In France there
is a proverb, "Courir comme un derate." To reduce the size of the
spleen, the Greek athletes used certain beverages, the composition of
which was not generally known; the Romans had a similar belief and
habit Pliny speaks of a plant called equisetum, a decoction of which
taken for three days after a fast of twenty-four hours would effect
absorption of the spleen. The modern pharmacopeia does not possess any
substance having a similar virtue, although quinin has been noticed to
diminish the size of the spleen when engorged in malarial fevers.
Strictly speaking, however, the facts are not analogous. Hippocrates
advises a moxa of mushrooms applied over the spleen for melting or
dissolving it. Godefroy Moebius is said to have seen in the village of
Halberstadt a courier whose spleen had been cauterized after incision;
and about the same epoch (seventeenth century) some men pretended to be
able to successfully extirpate the spleen for those who desired to be
couriers. This operation we know to be one of the most delicate in
modern surgery, and as we are progressing with our physiologic
knowledge of the spleen we see nothing to justify the old theory in
regard to its relations to agility and coursing.

Swimming.--The instances of endurance that we see in the aquatic sports
are equally as remarkable as those that we find among the runners and
walkers. In the ancient days the Greeks, living on their various
islands and being in a mild climate, were celebrated for their prowess
as swimmers. Socrates relates the feats of swimming among the
inhabitants of Delos. The journeys of Leander across the Hellespont are
well celebrated in verse and prose, but this feat has been easily
accomplished many times since, and is hardly to be classed as
extraordinary. Herodotus says that the Macedonians were skilful
swimmers; and all the savage tribes about the borders of waterways are
found possessed of remarkable dexterity and endurance in swimming.

In 1875 the celebrated Captain Webb swam from Dover to Calais. On
landing he felt extremely cold, but his body was as warm as when he
started. He was exhausted and very sleepy, falling in deep slumber on
his way to the hotel. On getting into bed his temperature was 98
degrees F. and his pulse normal. In five hours he was feverish, his
temperature rising to 101 degrees F. During the passage he was blinded
from the salt water in his eyes and the spray beating against his face.
He strongly denied the newspaper reports that he was delirious, and
after a good rest was apparently none the worse for the task. In 1876
he again traversed this passage with the happiest issue. In 1883 he was
engaged by speculators to swim the rapids at Niagara, and in attempting
this was overcome by the powerful currents, and his body was not
recovered for some days after. The passage from Dover to Calais has
been duplicated.

In 1877 Cavill, another Englishman, swam from Cape Griz-Nez to South
Forland in less than thirteen hours. In 1880 Webb swam and floated at
Scarborough for seventy-four consecutive hours--of course, having no
current to contend with and no point to reach.  This was merely a feat
of staying in the water. In London in 1881, Beckwith, swimming ten
hours a day over a 32-lap course for six days, traversed 94 miles.
Since the time of Captain Webb, who was the pioneer of modern
long-distance swimming, many men have attempted and some have
duplicated his feats; but these foolhardy performances have in late
years been diminishing, and many of the older feats are forbidden by
law.

Jumpers and acrobatic tumblers have been popular from the earliest
time. By the aid of springing boards and weights in their hands, the
old jumpers covered great distances. Phayllus of Croton is accredited
with jumping the incredible distance of 55 feet, and we have the
authority of Eustache and Tzetzes that this jump is genuine. In the
writings of many Greek and Roman historians are chronicled jumps of
about 50 feet by the athletes; if they are true, the modern jumpers
have greatly degenerated. A jump of over 20 feet to-day is considered
very clever, the record being 29 feet seven inches with weights, and 23
feet eight inches without weights, although much greater distances have
been jumped with the aid of apparatus, but never an approximation to 50
feet.  The most surprising of all these athletes are the tumblers, who
turn somersaults over several animals arranged in a row. Such feats are
not only the most amusing sights of a modern circus, but also the most
interesting as well. The agility of these men is marvelous, and the
force with which they throw themselves in the air apparently enables
them to defy gravity. In London, Paris, or New York one may see these
wonderful tumblers and marvel at the capabilities of human physical
development.

In September, 1895, M. F. Sweeney, an American amateur, at Manhattan
Field in New York jumped six feet 5 5/8 inches high in the running high
jump without weights. With weights, J. H.  Fitzpatrick at Oak Island,
Mass., jumped six feet six inches high. The record for the running high
kick is nine feet eight inches, a marvelous performance, made by C. C.
Lee at New Haven, Conn., March 19, 1887.

Extraordinary physical development and strength has been a grand means
of natural selection in the human species. As Guyot-Daubes remarks, in
prehistoric times, when our ancestors had to battle against hunger,
savage beasts, and their neighbors, and when the struggle for existence
was so extremely hard, the strong man alone resisted and the weak
succumbed. This natural selection has been perpetuated almost to our
day; during the long succession of centuries, the chief or the master
was selected on account of his being the strongest, or the most valiant
in the combat.  Originally, the cavaliers, the members of the nobility,
were those who were noted for their courage and strength, and to them
were given the lands of the vanquished. Even in times other than those
of war, disputes of succession were settled by jousts and tourneys.
This fact is seen in the present day among the lower animals, who in
their natural state live in tribes; the leader is usually the
strongest, the wisest, and the most courageous.

The strong men of all times have excited the admiration of their
fellows and have always been objects of popular interest. The Bible
celebrates the exploits of Samson of the tribe of Dan.  During his
youth he, single handed, strangled a lion; with the jaw-bone of an ass
he is said to have killed 1000 Philistines and put the rest to flight.
At another time during the night he transported from the village of
Gaza enormous burdens and placed them on the top of a mountain.
Betrayed by Delilah, he was delivered into the hands of his enemies and
employed in the most servile labors. When old and blind he was attached
to the columns of an edifice to serve as an object of public ridicule;
with a violent effort he overturned the columns, destroying himself and
3000 Philistines.

In the Greek mythology we find a great number of heroes, celebrated for
their feats of strength and endurance. Many of them have received the
name of Hercules; but the most common of these is the hero who was
supposed to be the son of Jupiter and Alemena. He was endowed with
prodigious strength by his father, and was pursued with unrelenting
hatred by Juno. In his infancy he killed with his hands the serpents
which were sent to devour him. The legends about him are innumerable.
He was said to have been armed with a massive club, which only he was
able to carry.  The most famous of his feats were the twelve labors,
with which all readers of mythology are familiar. Hercules,
personified, meant to the Greeks physical force as well as strength,
generosity, and bravery, and was equivalent to the Assyrian Hercules.
The Gauls had a Hercules-Pantopage, who, in addition to the ordinary
qualities attributed to Hercules, had an enormous appetite.

As late as the sixteenth century, and in a most amusing and picturesque
manner, Rabelais has given us the history of Gargantua, and even to
this day, in some regions, there are groups of stones which are
believed by ignorant people to have been thrown about by Gargantua in
his play. In their citations the older authors often speak of battles,
and in epic ballads of heroes with marvelous strength. In the army of
Charlemagne, after Camerarius, and quoted by Guyot-Daubes (who has made
an extensive collection of the literature on this subject and to whom
the authors are indebted for much information), there was found a giant
named Oenother, a native of a village in Suabia, who performed
marvelous feats of strength. In his history of Bavaria Aventin speaks
of this monster. To Roland, the nephew of Charlemagne, the legends
attributed prodigious strength; and, dying in the valley of
Roncesveaux, he broke his good sword "Durandal" by striking it against
a rock, making a breach, which is stilled called the "Breche de
Roland." Three years before his death, on his return from Palestine,
Christopher, Duke of Bavaria, was said to have lifted to his shoulders
a stone which weighed more than 340 pounds. Louis de Boufflers,
surnamed the "Robust," who lived in 1534, was noted for his strength
and agility. When he placed his feet together, one against the other,
he could find no one able to disturb them. He could easily bend and
break a horseshoe with his hands, and could seize an ox by the tail and
drag it against its will. More than once he was said to have carried a
horse on his shoulders. According to Guyot-Daubes there was, in the
last century, a Major Barsaba who could seize the limb of a horse and
fracture its bone. There was a tale of his lifting an iron anvil, in a
blacksmith's forge, and placing it under his coat.

To the Emperor Maximilian I was ascribed enormous strength; even in his
youth, when but a simple patriot, he vanquished, at the games given by
Severus, 16 of the most vigorous wrestlers, and accomplished this feat
without stopping for breath. It is said that this feat was the origin
of his fortune. Among other celebrated persons in history endowed with
uncommon strength were Edmund "Ironsides," King of England; the Caliph
Mostasem-Billah; Baudouin, "Bras-de-Fer," Count of Flanders; William
IV, called by the French "Fier-a-Bras," Duke of Aquitaine; Christopher,
son of Albert the Pious, Duke of Bavaria; Godefroy of Bouillon; the
Emperor Charles IV; Scanderbeg; Leonardo da Vinci; Marshal Saxe; and
the recently deceased Czar of Russia, Alexander III.

Turning now to the authentic modern Hercules, we have a man by the name
of Eckeberg, born in Anhalt, and who traveled under the name of
"Samson." He was exhibited in London, and performed remarkable feats of
strength. He was observed by the celebrated Desaguliers (a pupil of
Newton) in the commencement of the last century, who at that time was
interested in the physiologic experiments of strength and agility.
Desaguliers believed that the feats of this new Samson were more due to
agility than strength. One day, accompanied by two of his confreres,
although a man of ordinary strength, he duplicated some of Samson's
feats, and followed his performance by a communication to the Royal
Society. One of his tricks was to resist the strength of five or six
men or of two horses. Desaguliers claimed that this was entirely due to
the position taken. This person would lift a man by one foot, and bear
a heavy weight on his chest when resting with his head and two feet on
two chairs. By supporting himself with his arms he could lift a piece
of cannon attached to his feet.

A little later Desaguliers studied an individual in London named Thomas
Topham, who used no ruse in his feats and was not the skilful
equilibrist that the German Samson was, his performances being merely
the results of abnormal physical force. He was about thirty years old,
five feet ten inches in height and well proportioned, and his muscles
well developed, the strong ligaments showing under the skin. He ignored
entirely the art of appearing supernaturally strong, and some of his
feats were rendered difficult by disadvantageous positions. In the feat
of the German--resisting the force of several men or horses--Topham
exhibited no knowledge of the principles of physics, like that of his
predecessor, but, seated on the ground and putting his feet against two
stirrups, he was able to resist the traction of a single horse; when he
attempted the same feat against two horses he was severely strained and
wounded about the knees. According to Desaguliers, if Topham had taken
the advantageous positions of the German Samson, he could have resisted
not only two, but four horses. On another occasion, with the aid of a
bridle passed about his neck, he lifted three hogsheads full of water,
weighing 1386 pounds. If he had utilized the force of his limbs and his
loins, like the German, he would have been able to perform far more
difficult feats. With his teeth he could lift and maintain in a
horizontal position a table over six feet long, at the extremity of
which he would put some weight. Two of the feet of the table he rested
on his knees. He broke a cord five cm. in diameter, one part of which
was attached to a post and the other to a strap passed under his
shoulder. He was able to carry in his hands a rolling-pin weighing 800
pounds, about twice the weight a strong man is considered able to lift.

Tom Johnson was another strong man who lived in London in the last
century, but he was not an exhibitionist, like his predecessors. He was
a porter on the banks of the Thames, his duty being to carry sacks of
wheat and corn from the wharves to the warehouses. It was said that
when one of his comrades was ill, and could not provide support for his
wife and children, Johnson assumed double duty, carrying twice the
load. He could seize a sack of wheat, and with it execute the movements
of a club-swinger, and with as great facility. He became quite a
celebrated boxer, and, besides his strength, he soon demonstrated his
powers of endurance, never seeming fatigued after a lively bout. The
porters of Paris were accustomed to lift and carry on their shoulders
bags of flour weighing 159 kilograms (350 pounds) and to mount stairs
with them. Johnson, on hearing this, duplicated the feat with three
sacks, and on one occasion attempted to carry four, and resisted this
load some little time.  These four sacks weighed 1400 pounds.

Some years since there was a female Hercules who would get on her hands
and knees under a carriage containing six people, and, forming an arch
with her body, she would lift it off the ground, an attendant turning
the wheels while in the air to prove that they were clear from the
ground.

Guyot-Daubes considers that one of the most remarkable of all the men
noted for their strength was a butcher living in the mountains of
Margeride, known as Lapiada (the extraordinary).  This man, whose
strength was legendary in the neighboring country, one day seized a mad
bull that had escaped from his stall and held him by the horns until
his attendants could bind him. For amusement he would lie on his belly
and allow several men to get on his back; with this human load he would
rise to the erect position. One of Lapiada's great feats was to get
under a cart loaded with hay and, forming an arch with his body, raise
it from the ground, then little by little he would mount to his
haunches, still holding the cart and hay. Lapiada terminated his
Herculean existence in attempting a mighty effort. Having charged
himself alone with the task of placing a heavy tree-trunk in a cart, he
seized it, his muscles stiffened, but the blood gushed from his mouth
and nostrils, and he fell, overcome at last. The end of Lapiada
presents an analogue to that of the celebrated athlete, Polydamas, who
was equally the victim of too great confidence in his muscular force,
and who died crushed by the force that he hoped to maintain. Figures
181 and 183 portray the muscular development of an individual noted for
his feats of strength, and who exhibited not long since.

In recent years we have had Sebastian Miller, whose specialty was
wrestling and stone-breaking; Samson, a recent English exhibitionist,
Louis Cyr, and Sandow, who, in addition to his remarkable strength and
control over his muscles, is a very clever gymnast. Sandow gives an
excellent exposition of the so-called "checkerboard" arrangement of the
muscular fibers of the lower thoracic and abdominal regions, and in a
brilliant light demonstrates his extraordinary power over his muscles,
contracting muscles ordinarily involuntary in time with music, a feat
really more remarkable than his exhibition of strength.  Figures 182
and 184 show the beautiful muscular development of this remarkable man.

Joseph Pospischilli, a convict recently imprisoned in the Austrian
fortress of Olen, surprised the whole Empire by his wonderful feats of
strength. One of his tricks was to add a fifth leg to a common table
(placing the useless addition in the exact center) and then balance it
with his teeth while two full-grown gipsies danced on it, the music
being furnished by a violinist seated in the middle of the
well-balanced platform. One day when the prison in which this Hercules
was confined was undergoing repairs, he picked up a large carpenter's
bench with his teeth and held it balanced aloft for nearly a minute.
Since being released from the Olen prison, Pospischilli and his cousin,
another local "strong man" named Martenstine, have formed a combination
and are now starring Southern Europe, performing all kinds of startling
feats of strength. Among other things they have had a 30-foot bridge
made of strong timbers, which is used in one of their great muscle
acts. This bridge has two living piers--Pospischilli acting as one and
Martenstine the other.  Besides supporting this monstrous structure
(weight, 1866 pounds) upon their shoulders, these freaks of superhuman
strength allow a team of horses and a wagon loaded with a ton of
cobble-stones to be driven across it.

It is said that Selig Whitman, known as "Ajax," a New York policeman,
has lifted 2000 pounds with his hands and has maintained 450 pounds
with his teeth. This man is five feet 8 1/2 inches tall and weighs 162
pounds. His chest measurement is 40 inches, the biceps 17 inches, that
of his neck 16 1/2 inches, the forearm 11, the wrist 9 1/2, the thigh
23, and the calf 17.

One of the strongest of the "strong women" is Madame Elise, a
Frenchwoman, who performs with her husband. Her greatest feat is the
lifting of eight men weighing altogether about 1700 pounds.  At her
performances she supports across her shoulders a 700-pound dumb-bell,
on each side of which a person is suspended.

Miss Darnett, the "singing strong lady," extends herself upon her hands
and feet, face uppermost, while a stout platform, with a semicircular
groove for her neck, is fixed upon her chest, abdomen, and thighs by
means of a waist-belt which passes through brass receivers on the under
side of the board. An ordinary upright piano is then placed on the
platform by four men; a performer mounts the platform and plays while
the "strong lady" sings a love song while supporting possibly half a
ton.

Strength of the Jaws.--There are some persons who exhibit extraordinary
power of the jaw. In the curious experiments of Regnard and Blanchard
at the Sorbonne, it was found that a crocodile weighing about 120
pounds exerted a force between its jaws at a point corresponding to the
insertion of the masseter muscles of 1540 pounds; a dog of 44 pounds
exerted a similar force of 363 pounds.

It is quite possible that in animals like the tiger and lion the force
would equal 1700 or 1800 pounds. The anthropoid apes can easily break a
cocoanut with their teeth, and Guyot-Daubes thinks that possibly a
gorilla has a jaw-force of 200 pounds. A human adult is said to exert a
force of from 45 to 65 pounds between his teeth, and some individuals
exceed this average as much as 100 pounds. In Buffon's experiments he
once found a Frenchman who could exert a force of 534 pounds with his
jaws.

In several American circuses there have been seen women who hold
themselves by a strap between their teeth while they are being hauled
up to a trapeze some distance from the ground. A young mulatto girl by
the name of "Miss Kerra" exhibited in the Winter Circus in Paris;
suspended from a trapeze, she supported a man at the end of a strap
held between her teeth, and even permitted herself to be turned round
and round.

She also held a cannon in her teeth while it was fired. This feat has
been done by several others. According to Guyot-Daubes, at Epernay in
1882, while a man named Bucholtz, called "the human cannon," was
performing this feat, the cannon, which was over a yard long and
weighed nearly 200 pounds, burst and wounded several of the spectators.

There was another Hercules in Paris, who with his teeth lifted and held
a heavy cask of water on which was seated a man and varying weights,
according to the size of his audience, at the same time keeping his
hands occupied with other weights. Figure 185 represents a well-known
modern exhibitionist lifting with his teeth a cask on which are seated
four men. The celebrated Mlle.  Gauthier, an actress of the
Comedie-Francais, had marvelous power of her hands, bending coins,
rolling up silver plate, and performing divers other feats. Major
Barsaba had enormous powers of hand and fingers. He could roll a silver
plate into the shape of a goblet. Being challenged by a Gascon, he
seized the hand of his unsuspecting adversary in the ordinary manner of
salutation and crushed all the bones of the fingers, thus rendering
unnecessary any further trial of strength.

It is said that Marshal Saxe once visited a blacksmith ostensibly to
have his horse shod, and seeing no shoe ready he took a bar of iron,
and with his hands fashioned it into a horseshoe. There are Japanese
dentists who extract teeth with their wonderfully developed fingers.
There are stories of a man living in the village of Cantal who received
the sobriquet of "La Coupia" (The Brutal). He would exercise his
function as a butcher by strangling with his fingers the calves and
sheep, instead of killing them in the ordinary manner. It is said that
one day, by placing his hands on the shoulders of the strong man of a
local fair, he made him faint by the pressure exerted by his fingers.

Manual strangulation is a well-known crime and is quite popular in some
countries. The Thugs of India sometimes murdered their victims in this
way. Often such force is exerted by the murderer's fingers as to
completely fracture the cricoid cartilage.

In viewing the feats of strength of the exhibitionist we must bear in
consideration the numerous frauds perpetrated. A man of extraordinary
strength sometimes finds peculiar stone, so stratified that he is able
to break it with the force he can exert by a blow from the hand alone,
although a man of ordinary strength would try in vain. In most of these
instances, if one were to take a piece of the exhibitionist's stone, he
would find that a slight tap of the hammer would break it. Again, there
are many instances in which the stone has been found already separated
and fixed quite firmly together, placing it out of the power of an
ordinary man to break, but which the exhibitionist finds within his
ability. This has been the solution of the feats of many of the
individuals who invite persons to send them marked stones to use at
their performances. By skilfully arranging stout twine on the hands, it
is surprising how easily it is broken, and there are many devices and
tricks to deceive the public, all of which are more or less used by
"strong men."

The recent officially recorded feats of strength that stand unequaled
in the last decade are as follows:--

Weight-lifting.--Hands alone 1571 1/4 pounds, done by C. G.  Jefferson,
an amateur, at Clinton, Mass December 10, 1890; with harness, 3239
pounds, by W B. Curtis, at New York December 20 1868; Louis Cyr, at
Berthierville, Can., October 1, 1888, pushed up 3536 pounds of pig-iron
with his back, arms, and legs.

Dumb-bells.--H. Pennock, in New York, 1870, put up a 10-pound dumb-bell
8431 times in four hours thirty-four minutes; by using both hands to
raise it to the shoulder, and then using one hand alone, R. A. Pennell,
in New York, January 31, 1874, managed to put up a bell weighing 201
pounds 5 ounces; and Eugene Sandow, at London, February 11, 1891,
surpassed this feat with a 250-pound bell.

Throwing 16-pound hammer.--J. S. Mitchell, at Travers Island, N.  Y.,
October 8, 1892, made a record-throw of 145 feet 3/4 inch.

Putting 16-pound Shot.--George R. Gray, at Chicago, September 16, 1893,
made the record of 47 feet.

Throwing 50-pound Weight.--J. S. Mitchell, at New York, September 22,
1894, made the distance record of 35 feet 10 inches; and at Chicago,
September 16, 1893, made the height record of 15 feet 4 1/2 inches.

The class of people commonly known as contortionists by the laxity of
their muscles and ligaments are able to dislocate or preternaturally
bend their joints. In entertainments of an arena type and even in what
are now called "variety performances" are to be seen individuals of
this class. These persons can completely straddle two chairs, and do
what they call "the split;" they can place their foot about their neck
while maintaining the upright position; they can bend almost double at
the waist in such a manner that the back of the head will touch the
calves, while the legs are perpendicular with the ground; they can
bring the popliteal region over their shoulders and in this position
walk on their hands; they can put themselves in a narrow barrel; eat
with a fork attached to a heel while standing on their hands, and
perform divers other remarkable and almost incredible feats. Their
performances are genuine, and they are real physiologic curiosities.
Plate 6 represents two well-known contortionists in their favorite
feats.

Wentworth, the oldest living contortionist, is about seventy years of
age, but seems to have lost none of his earlier sinuosity. His chief
feat is to stow himself away in a box 23 X 29 X 16 inches. When inside,
six dozen wooden bottles of the same size and shape as those which
ordinarily contain English soda water are carefully stowed away, packed
in with him, and the lid slammed down. He bestows upon this act the
curious and suggestive name of "Packanatomicalization."

Another class of individuals are those who can either partially or
completely dislocate the major articulations of the body. Many persons
exhibit this capacity in their fingers. Persons vulgarly called "double
jointed" are quite common.

Charles Warren, an American contortionist, has been examined by several
medical men of prominence and descriptions of him have appeared from
time to time in prominent medical journals. When he was but a child he
was constantly tumbling down, due to the heads of the femurs slipping
from the acetabula, but reduction was always easy. When eight years old
he joined a company of acrobats and strolling performers, and was
called by the euphonious title of "the Yankee dish-rag." His muscular
system was well-developed, and, like Sandow, he could make muscles act
in concert or separately.

He could throw into energetic single action the biceps, the supinator
longus, the radial extensors, the platysma myoides, and many other
muscles. When he "strings," as he called it, the sartorius, that ribbon
muscle shows itself as a tight cord, extending from the front of the
iliac spine to the inner side of the knee. Another trick was to leave
flaccid that part of the serratus magnus which is attached to the
inferior angle of the scapula whilst he roused energetic contraction in
the rhomboids.  He could displace his muscles so that the lower angles
of the scapulae projected and presented the appearance historically
attributed to luxation of the scapula.

Warren was well informed on surgical landmarks and had evidently been a
close student of Sir Astley Cooper's classical illustrations of
dislocations. He was able so to contract his abdominal muscles that the
aorta could be distinctly felt with the fingers. In this feat nearly
all the abdominal contents were crowded beneath the diaphragm. On the
other hand, he could produce a phantom abdominal tumor by driving the
coils of the intestine within a peculiar grasp of the rectus and
oblique muscles. The "growth" was rounded, dull on percussion, and
looked as if an exploratory incision or puncture would be advisable for
diagnosis.

By extraordinary muscular power and extreme laxity of his ligaments, he
simulated all the dislocations about the hip joint.  Sometimes he
produced actual dislocation, but usually he said he could so distort
his muscles as to imitate in the closest degree the dislocations. He
could imitate the various forms of talipes, in such a way as to deceive
an expert. He dislocated nearly every joint in the body with great
facility. It was said that he could contract at will both pillars of
the fauces. He could contract his chest to 34 inches and expand it to
41 inches.

Warren weighed 150 pounds, was a total abstainer, and was the father of
two children, both of whom could readily dislocate their hips.

In France in 1886 there was shown a man who was called "l'homme
protee," or protean man. He had an exceptional power over his muscles.
Even those muscles ordinarily involuntary he could exercise at will. He
could produce such rigidity of stature that a blow by a hammer on his
body fell as though on a block of stone. By his power over his
abdominal muscles he could give himself different shapes, from the
portly alderman to the lean and haggard student, and he was even
accredited with assuming the shape of a "living skeleton." Quatrefages,
the celebrated French scientist, examined him, and said that he could
shut off the blood from the right side and then from the left side of
the body, which feat he ascribed to unilateral muscular action.

In 1893 there appeared in Washington, giving exhibitions at the
colleges there and at the Emergency Hospital, a man named Fitzgerald,
claiming to reside in Harrisburg, Pa., who made his living by
exhibiting at medical colleges over the country. He simulated all the
dislocations, claiming that they were complete, using manual force to
produce and reduce them. He exhibited a thorough knowledge of the
pathology of dislocations and of the anatomy of the articulations. He
produced the different forms of talipes, as well as all the major
hip-dislocations. When interrogated as to the cause of his enormous
saphenous veins, which stood out like huge twisted cords under the skin
and were associated with venous varicosity on the leg, he said he
presumed they were caused by his constantly compressing the saphenous
vein at the hip in giving his exhibitions, which in some large cities
were repeated several times a day.

Endurance of Pain.--The question of the endurance of pain is,
necessarily, one of comparison. There is little doubt that in the lower
classes the sensation of pain is felt in a much less degree than in
those of a highly intellectual and nervous temperament.  If we
eliminate the element of fear, which always predominates in the lower
classes, the result of general hospital observation will show this
distinction. There are many circumstances which have a marked influence
on pain. Patriotism, enthusiasm, and general excitement, together with
pride and natural obstinacy, prove the power of the mind over the body.
The tortures endured by prisoners of war, religious martyrs and
victims, exemplify the power of a strong will excited by deep emotion
over the sensation of pain. The flagellants, persons who expiated their
sins by voluntarily flaying themselves to the point of exhaustion, are
modern examples of persons who in religious enthusiasm inflict pain on
themselves. In the ancient times in India the frenzied zealots
struggled for positions from which they could throw themselves under
the car of the Juggernaut, and their intense emotions turned the pains
of their wounds into a pleasure.  According to the reports of her
Majesty's surgeons, there are at the present time in India native
Brahmins who hang themselves on sharp hooks placed in the flesh between
the scapulae, and remain in this position without the least visible
show of pain. In a similar manner they pierce the lips and cheeks with
long pins and bore the tongue with a hot iron. From a reliable source
the authors have an account of a man in Northern India who as a means
of self-inflicted penance held his arm aloft for the greater part of
each day, bending the fingers tightly on the palms. After a
considerable time the nails had grown or been forced through the palms
of the hands, making their exit on the dorsal surfaces.  There are many
savage rites and ceremonies calling for the severe infliction of pain
on the participants which have been described from time to time by
travelers. The Aztecs willingly sacrificed even their lives in the
worship of their Sun-god.

By means of singing and dancing the Aissaoui, in the Algerian town of
Constantine, throw themselves into an ecstatic state in which their
bodies seem to be insensible even to severe wounds.  Hellwald says they
run sharp-pointed irons into their heads, eyes, necks, and breasts
without apparent pain or injury to themselves. Some observers claim
they are rendered insensible to pain by self-induced hypnotism.

An account by Carpenter of the Algerian Aissaoui contained the
following lucid description of the performances of these people:--

"The center of the court was given up to the Aissaoui. These were 12
hollow-checked men, some old and some young, who sat cross-legged in an
irregular semicircle on the floor. Six of them had immense flat drums
or tambours, which they presently began to beat noisily. In front of
them a charcoal fire burned in a brazier, and into it one of them from
time to time threw bits of some sort of incense, which gradually filled
the place with a thin smoke and a mildly pungent odor.

"For a long time--it seemed a long time--this went on with nothing to
break the silence but the rhythmical beat of the drums. Gradually,
however, this had become quicker, and now grew wild and almost
deafening, and the men began a monotonous chant which soon was
increased to shouting. Suddenly one of the men threw himself with a
howl to the ground, when he was seized by another, who stripped him of
part of his garments and led him in front of the fire. Here, while the
pounding of the drums and the shouts of the men became more and more
frantic, he stood swaying his body backward and forward, almost
touching the ground in his fearful contortions, and wagging his head
until it seemed as if he must dislocate it from his shoulders. All at
once he drew from the fire a red-hot bar of iron, and with a yell of
horror, which sent a shiver down one's back, held it up before his
eyes. More violently than ever he swayed his body and wagged his head,
until he had worked himself up to a climax of excitement, when he
passed the glowing iron several times over the palm of each hand and
then licked it repeatedly with his tongue. He next took a burning coal
from the fire, and, placing it between his teeth, fanned it by his
breath into a white heat. He ended his part of the performance by
treading on red-hot coals scattered on the floor after which he resumed
his place with the rest. Then the next performer with a yell as before,
suddenly sprang to his feet and began again the same frantic
contortions, in the midst of which he snatched from the fire an iron
rod with a ball on one end, and after winding one of his eyelids around
it until the eyeball was completely exposed, he thrust its point in
behind the eye, which was forced far out on his cheek. It was held
there for a moment when it was withdrawn, the eye released, and then
rubbed vigorously a few times with the balled end of the rod.

"The drums all the time had been beaten lustily, and the men had kept
up their chant, which still went unceasingly on. Again a man sprang to
his feet and went through the same horrid motions. This time the
performer took from the fire a sharp nail and, with a piece of the
sandy limestone common to this region, proceeded with a series of
blood-curdling howls to hammer it down into the top of his head, where
it presently stuck upright, while he tottered dizzily around until it
was pulled out with apparent effort and with a hollow snap by one of
the other men.

"The performance had now fairly begun, and, with short intervals and
always in the same manner, the frenzied contortions first, another ate
up a glass lamp-chimney, which he first broke in pieces in his hands
and then crunched loudly with his teeth. He then produced from a tin
box a live scorpion, which ran across the floor with tail erect, and
was then allowed to attach itself to the back of his hand and his face,
and was finally taken into his mouth, where it hung suspended from the
inside of his cheek and was finally chewed and swallowed. A sword was
next produced, and after the usual preliminaries it was drawn by the
same man who had just given the scorpion such unusual opportunities
several times back and forth across his throat and neck, apparently
deeply imbedded in the flesh. Not content with this, he bared his body
at his waist, and while one man held the sword, edge upward, by the
hilt and another by the point, about which a turban had been wrapped,
he first stood upon it with his bare feet and then balanced himself
across it on his naked stomach, while still another of the performers
stood upon his back, whither he had sprung without any attempt to
mollify the violence of the action. With more yells and genuflections,
another now drew from the fire several iron skewers, some of which he
thrust into the inner side of his cheeks and others into his throat at
the larynx, where they were left for a while to hang.

"The last of the actors in this singular entertainment was a stout man
with a careworn face, who apparently regarded his share as a melancholy
duty which he was bound to perform, and the last part of it, I have no
doubt, was particularly painful. He first took a handful of hay, and,
having bared the whole upper part of his body, lighted the wisp at the
brazier and then passed the blazing mass across his chest and body and
over his arms and face. This was but a preliminary, and presently he
began to sway backward and forward until one grew dazed with watching
him. The drums grew noisier and noisier and the chant louder and
wilder.  The man himself had become maudlin, his tongue hung from his
mouth, and now and then he ejaculated a sound like the inarticulate cry
of an animal. He could only totter to the fire, out of which he
snatched the balled instrument already described, which he thereupon
thrust with a vicious stab into the pit of his stomach, where it was
left to hang. A moment after he pulled it out again, and, picking up
the piece of stone used before, he drove it with a series of resounding
blows into a new place, where it hung, drawing the skin downward with
its weight, until a companion pulled it out and the man fell in a heap
on the floor."

To-day it is only through the intervention of the United States troops
that some of the barbarous ceremonies of the North American Indians are
suppressed. The episode of the "Ghost-dance" is fresh in every mind.
Instances of self-mutilation, although illustrating this subject, will
be discussed at length in Chapter XIV.

Malingerers often endure without flinching the most arduous tests.
Supraorbital pressure is generally of little avail, and pinching,
pricking, and even incision are useless with these hospital impostors.
It is reported that in the City Hospital of St. Louis a negro submitted
to the ammonia-test, inhaling this vapor for several hours without
showing any signs of sensibility, and made his escape the moment his
guard was absent. A contemporary journal says:--

"The obstinacy of resolute impostors seems, indeed, capable of
emulating the torture-proof perseverance of religious enthusiasts and
such martyrs of patriotism as Mueius Scaevola or Grand Master Ruediger
of the Teutonic Knights, who refused to reveal the hiding place of his
companion even when his captors belabored him with red-hot irons.

"One Basil Rohatzek, suspected of fraudulent enlistment
(bounty-jumping, as our volunteers called it), pretended to have been
thrown by his horse and to have been permanently disabled by a
paralysis of the lower extremities. He dragged himself along in a
pitiful manner, and his knees looked somewhat bruised, but he was known
to have boasted his ability to procure his discharge somehow or other.
One of his tent mates had also seen him fling himself violently and
repeatedly on his knees (to procure those questionable bruises), and on
the whole there seemed little doubt that the fellow was shamming. All
the surgeons who had examined him concurred in that view, and the case
was finally referred to his commanding officer, General Colloredo. The
impostor was carried to a field hospital in a little Bohemian border
town and watched for a couple of weeks, during which he had been twice
seen moving his feet in his sleep. Still, the witnesses were not
prepared to swear that those changes of position might not have been
effected by a movement of the whole body. The suspect stuck to his
assertion, and Colloredo, in a fit of irritation, finally summoned a
surgeon, who actually placed the feet of the professed paralytic in
"aqua fortis," but even this rigorous method availed the cruel surgeon
nothing, and he was compelled to advise dismissal from the service.

"The martyrdom of Rohatzek, however, was a mere trifle compared with
the ordeal by which the tribunal of Paris tried in vain to extort a
confession of the would-be regicide, Damiens. Robert Damiens, a native
of Arras, had been exiled as an habitual criminal, and returning in
disguise made an attempt upon the life of Louis XV, January 5, 1757.
His dagger pierced the mantle of the King, but merely grazed his neck.
Damiens, who had stumbled, was instantly seized and dragged to prison,
where a convocation of expert torturers exhausted their ingenuity in
the attempt to extort a confession implicating the Jesuits, a
conspiracy of Huguenots, etc. But Damiens refused to speak. He could
have pleaded his inability to name accomplices who did not exist, but
he stuck to his resolution of absolute silence. They singed off his
skin by shreds, they wrenched out his teeth and finger-joints, they
dragged him about at the end of a rope hitched to a team of stout
horses, they sprinkled him from head to foot with acids and seething
oil, but Damiens never uttered a sound till his dying groan announced
the conclusion of the tragedy."

The apparent indifference to the pain of a major operation is sometimes
marvelous, and there are many interesting instances on record. When at
the battle of Dresden in 1813 Moreau, seated beside the Emperor
Alexander, had both limbs shattered by a French cannon-ball, he did not
utter a groan, but asked for a cigar and smoked leisurely while a
surgeon amputated one of his members. In a short time his medical
attendants expressed the danger and questionability of saving his other
limb, and consulted him. In the calmest way the heroic General
instructed them to amputate it, again remaining unmoved throughout the
operation.

Crompton records a case in which during an amputation of the leg not a
sound escaped from the patient's lips, and in three weeks, when it was
found necessary to amputate the other leg, the patient endured the
operation without an anesthetic, making no show of pain, and only
remarking that he thought the saw did not cut well. Crompton quotes
another case, in which the patient held a candle with one hand while
the operator amputated his other arm at the shoulder-joint. Several
instances of self-performed major operations are mentioned in Chapter
XIV.

Supersensitiveness to Pain.--Quite opposite to the foregoing instances
are those cases in which such influences as expectation, naturally
inherited nervousness, and genuine supersensitiveness make the
slightest pain almost unendurable. In many of these instances the state
of the mind and occasionally the time of day have a marked influence.
Men noted for their sagacity and courage have been prostrated by fear
of pain. Sir Robert Peel, a man of acknowledged superior physical and
intellectual power, could not even bear the touch of Brodie's finger to
his fractured clavicle. The authors know of an instance of a pugilist
who had elicited admiration by his ability to stand punishment and his
indomitable courage in his combats, but who fainted from the puncture
of a small boil on his neck.

The relation of pain to shock has been noticed by many writers.  Before
the days of anesthesia, such cases as the following, reported by Sir
Astley Cooper, seem to have been not unusual: A brewer's servant, a man
of middle age and robust frame, suffered much agony for several days
from a thecal abscess, occasioned by a splinter of wood beneath the
thumb. A few seconds after the matter was discharged by an incision,
the man raised himself by a convulsive effort from his bed and
instantly expired.

It is a well-known fact that powerful nerve-irritation, such as
produces shock, is painless, and this accounts for the fact that wounds
received during battle are not painful.

Leyden of Berlin showed to his class at the Charite Hospital a number
of hysteric women with a morbid desire for operation without an
anesthetic. Such persons do not seem to experience pain, and, on the
contrary, appear to have genuine pleasure in pain. In illustration,
Leyden showed a young lady who during a hysteric paroxysm had suffered
a serious fracture of the jaw, injuring the facial artery, and
necessitating quite an extensive operation. The facial and carotid
arteries had to be ligated and part of the inferior maxilla removed,
but the patient insisted upon having the operations performed without
an anesthetic, and afterward informed the operator that she had
experienced great pleasure throughout the whole procedure.

Pain as a Means of Sexual Enjoyment.--There is a form of sexual
perversion in which the pervert takes delight in being subjected to
degrading, humiliating, and cruel acts on the part of his or her
associate. It was named masochism from Sacher-Masoch, an Austrian
novelist, whose works describe this form of perversion.  The victims
are said to experience peculiar pleasure at the sight of a rival who
has obtained the favor of their mistress, and will even receive blows
and lashes from the rival with a voluptuous mixture of pain and
pleasure. Masochism corresponds to the passivism of Stefanowski, and is
the opposite of sadism, in which the pleasure is derived from
inflicting pain on the object of affection. Krafft-Ebing cites several
instances of masochism.

Although the enjoyment and frenzy of flagellation are well known, its
pleasures are not derived from the pain but by the undoubted
stimulation offered to the sexual centers by the castigation. The
delight of the heroines of flagellation, Maria Magdalena of Pazzi and
Elizabeth of Genton, in being whipped on the naked loins, and thus
calling up sensual and lascivious fancies, clearly shows the
significance of flagellation as a sexual excitant. It is said that when
Elizabeth of Genton was being whipped she believed herself united with
her ideal and would cry out in the loudest tones of the joys of love.

There is undoubtedly a sympathetic communication between the ramifying
nerves of the skin of the loins and the lower portion of the spinal
cord which contains the sexual centers. Recently, in cases of
dysmenorrhea, amenorrhea dysmenorrhagia, and like sexual disorders,
massage or gentle flagellation of the parts contiguous with the
genitalia and pelvic viscera has been recommended. Taxil is the
authority for the statement that just before the sexual act rakes
sometimes have themselves flagellated or pricked until the blood flows
in order to stimulate their diminished sexual power. Rhodiginus,
Bartholinus, and other older physicians mention individuals in whom
severe castigation was a prerequisite of copulation. As a ritual custom
flagellation is preserved to the present day by some sects.

Before leaving the subject of flagellation it should be stated that
among the serious after-results of this practice as a disciplinary
means, fatal emphysema, severe hemorrhage, and shock have been noticed.
There are many cases of death from corporal punishment by flogging.
Ballingal records the death of a soldier from flogging; Davidson has
reported a similar case, and there is a death from the same cause cited
in the Edinburgh Medical and Surgical Journal for 1846.

Idiosyncrasy is a peculiarity of constitution whereby an individual is
affected by external agents in a different manner from others. Begin
defines idiosyncrasy as the predominance of an organ, of a viscus, or a
system of organs. This definition does not entirely grasp the subject.
An idiosyncrasy is something inherent in the organization of the
individual, of which we only see the manifestation when proper causes
are set in action. We do not attempt to explain the susceptibility of
certain persons to certain foods and certain exposures. We know that
such is the fact. According to Begin's idea, there is scarcely any
separation between idiosyncrasy and temperament, whereas from what
would appear to be sound reasoning, based on the physiology of the
subject, a very material difference exists.

Idiosyncrasies may be congenital, hereditary, or acquired, and, if
acquired, may be only temporary. Some, purely of mental origin, are
often readily cured. One individual may synchronously possess an
idiosyncrasy of the digestive, circulatory, and nervous systems.
Striking examples of transitory or temporary idiosyncrasies are seen in
pregnant women.

There are certain so-called antipathies that in reality are
idiosyncrasies, and which are due to peculiarities of the ideal and
emotional centers. The organ of sense in question and the center that
takes cognizance of the image brought to it are in no way disordered.
In some cases the antipathy or the idiosyncrasy develops to such an
extent as to be in itself a species of monomania. The fear-maladies, or
"phobias," as they are called, are examples of this class, and,
belonging properly under temporary mental derangements, the same as
hallucinations or delusions, will be spoken of in another chapter.

Possibly the most satisfactory divisions under which to group the
material on this subject collected from literature are into examples of
idiosyncrasies in which, although the effect is a mystery, the sense is
perceptible and the cause distinctly defined and known, and those in
which sensibility is latent. The former class includes all the peculiar
antipathies which are brought about through the special senses, while
the latter groups all those strange instances in which, without the
slightest antipathy on the part of the subject, a certain food or drug,
after ingestion, produces an untoward effect.

The first examples of idiosyncrasies to be noticed will be those
manifested through the sense of smell. On the authority of Spigelius,
whose name still survives in the nomenclature of the anatomy of the
liver, Mackeuzie quotes an extraordinary case in a Roman Cardinal,
Oliver Caraffa, who could not endure the smell of a rose. This is
confirmed from personal observation by another writer, Pierius, who
adds that the Cardinal was obliged every year to shut himself up during
the rose season, and guards were stationed at the gates of his palace
to stop any visitors who might be wearing the dreadful flower. It is,
of course, possible that in this case the rose may not have caused the
disturbance, and as it is distinctly stated that it was the smell to
which the Cardinal objected, we may fairly conclude that what annoyed
him was simply a manifestation of rose-fever excited by the pollen.
There is also an instance of a noble Venetian who was always confined
to his palace during the rose season. However, in this connection Sir
Kenelm Digby relates that so obnoxious was a rose to Lady Heneage, that
she blistered her cheek while accidentally lying on one while she
slept. Ledelius records the description of a woman who fainted before a
red rose, although she was accustomed to wear white ones in her hair.
Cremer describes a Bishop who died of the smell of a rose from what
might be called "aromatic pain."

The organ of smell is in intimate relation with the brain and the
organs of taste and sight; and its action may thus disturb that of the
esophagus, the stomach, the diaphragm, the intestines, the organs of
generation, etc. Odorous substances have occasioned syncope, stupor,
nausea, vomiting, and sometimes death. It is said that the Hindoos, and
some classes who eat nothing but vegetables, are intensely nauseated by
the odors of European tables, and for this reason they are incapable of
serving as dining-room servants.

Fabricius Hildanus mentions a person who fainted from the odor of
vinegar. The Ephemerides contains an instance of a soldier who fell
insensible from the odor of a peony. Wagner knew a man who was made ill
by the odor of bouillon of crabs. The odors of blood, meat, and fat are
repugnant to herbivorous animals. It is a well-known fact that horses
detest the odor of blood.

Schneider, the father of rhinology, mentions a woman in whom the odor
of orange-flowers produced syncope. Odier has known a woman who was
affected with aphonia whenever exposed to the odor of musk, but who
immediately recovered after taking a cold bath.  Dejean has mentioned a
man who could not tolerate an atmosphere of cherries. Highmore knew a
man in whom the slightest smell of musk caused headache followed by
epistaxis. Lanzonius gives an account of a valiant soldier who could
neither bear the sight nor smell of an ordinary pink. There is an
instance on record in which the odor coming from a walnut tree excited
epilepsy. It is said that one of the secretaries of Francis I was
forced to stop his nostrils with bread if apples were on the table. He
would faint if one was held near his nose Schenck says that the noble
family of Fystates in Aquitaine had a similar peculiarity--an innate
hatred of apples. Bruyerinus knew a girl of sixteen who could not bear
the smell of bread, the slightest particle of which she would detect by
its odor. She lived almost entirely on milk. Bierling mentions an
antipathy to the smell of musk, and there is a case on record in which
it caused convulsions.  Boerhaave bears witness that the odor of cheese
caused nasal hemorrhage. Whytt mentions an instance in which tobacco
became repugnant to a woman each time she conceived, but after delivery
this aversion changed to almost an appetite for tobacco fumes.
Panaroli mentions an instance of sickness caused by the smell of
sassafras, and there is also a record of a person who fell helpless at
the smell of cinnamon. Wagner had a patient who detested the odor of
citron. Ignorant of this repugnance, he prescribed a potion in which
there was water of balm-mint, of an odor resembling citron. As soon as
the patient took the first dose he became greatly agitated and much
nauseated, and this did not cease until Wagner repressed the balm-mint.
There is reported the case of a young woman, rather robust, otherwise
normal, who always experienced a desire to go to stool after being
subjected to any nasal irritation sufficient to excite sneezing.

It has already been remarked that individuals and animals have their
special odors, certain of which are very agreeable to some people and
extremely unpleasant to others. Many persons are not able to endure the
emanations from cats, rats, mice, etc., and the mere fact of one of
these animals being in their vicinity is enough to provoke distressing
symptoms. Mlle. Contat, the celebrated French actress, was not able to
endure the odor of a hare. Stanislaus, King of Poland and Duke of
Lorraine, found it impossible to tolerate the smell of a cat. The
Ephemerides mentions the odor of a little garden-frog as causing
epilepsy. Ab Heers mentions a similar anomaly, fainting caused by the
smell of eels. Habit had rendered Haller insensible to the odor of
putrefying cadavers, but according to Zimmerman the odor of the
perspiration of old people, not perceptible to others, was intolerable
to him at a distance of ten or twelve paces. He also had an extreme
aversion for cheese. According to Dejan, Gaubius knew a man who was
unable to remain in a room with women, having a great repugnance to the
female odor. Strange as it may seem, some individuals are incapable of
appreciating certain odors.  Blumenbach mentions an Englishman whose
sense of smell was otherwise very acute, but he was unable to perceive
the perfume of the mignonette.

The impressions which come to us through the sense of hearing cause
sensations agreeable or disagreeable, but even in this sense we see
marked examples of idiosyncrasies and antipathies to various sounds and
tones. In some individuals the sensations in one ear differ from those
of the other. Everard Home has cited several examples, and Heidmann of
Vienna has treated two musicians, one of whom always perceived in the
affected ear, during damp weather, tones an octave lower than in the
other ear.  The other musician perceived tones an octave higher in the
affected ear. Cheyne is quoted as mentioning a case in which, when the
subject heard the noise of a drum, blood jetted from the veins with
considerable force. Sauvages has seen a young man in whom intense
headache and febrile paroxysm were only relieved by the noise from a
beaten drum. Esparron has mentioned an infant in whom an ataxic fever
was established by the noise of this instrument. Ephemerides contains
an account of a young man who became nervous and had the sense of
suffocation when he heard the noise made by sweeping. Zimmerman speaks
of a young girl who had convulsions when she heard the rustling of
oiled silk. Boyle, the father of chemistry, could not conquer an
aversion he had to the sound of water running through pipes. A
gentleman of the Court of the Emperor Ferdinand suffered epistaxis when
he heard a cat mew.  La Mothe Le Vayer could not endure the sounds of
musical instruments, although he experienced pleasurable sensations
when he heard a clap of thunder. It is said that a chaplain in England
always had a sensation of cold at the top of his head when he read the
53d chapter of Isaiah and certain verses of the Kings.  There was an
unhappy wight who could not hear his own name pronounced without being
thrown into convulsions. Marguerite of Valois, sister of Francis I,
could never utter the words "mort" or "petite verole," such a horrible
aversion had she to death and small-pox. According to Campani, the
Chevalier Alcantara could never say "lana," or words pertaining to
woolen clothing.  Hippocrates says that a certain Nicanor had the
greatest horror of the sound of the flute at night, although it
delighted him in the daytime. Rousseau reports a Gascon in whom
incontinence of urine was produced by the sound of a bagpipe. Frisch,
Managetta, and Rousse speak of a man in whom the same effect was
produced by the sound of a hurdy-gurdy. Even Shakespeare alludes to the
effects of the sound of bagpipes. Tissot mentions a case in which music
caused epileptic convulsions, and Forestus mentions a beggar who had
convulsions at the sound of a wooden trumpet similar to those used by
children in play. Rousseau mentions music as causing convulsive
laughter in a woman. Bayle mentions a woman who fainted at the sound of
a bell. Paullini cites an instance of vomiting caused by music, and
Marcellus Donatus mentions swooning from the same cause. Many people
are unable to bear the noise caused by the grating of a pencil on a
slate, the filing of a saw, the squeak of a wheel turning about an
axle, the rubbing of pieces of paper together, and certain similar
sounds.  Some persons find the tones of music very disagreeable, and
some animals, particularly dogs, are unable to endure it. In Albinus
the younger the slightest perceptible tones were sufficient to produce
an inexplicable anxiety. There was a certain woman of fifty who was
fond of the music of the clarionet and flute, but was not able to
listen to the sound of a bell or tambourine.  Frank knew a man who ran
out of church at the beginning of the sounds of an organ, not being
able to tolerate them. Pope could not imagine music producing any
pleasure. The harmonica has been noticed to produce fainting in
females. Fischer says that music provokes sexual frenzy in elephants.
Gutfeldt speaks of a peculiar idiosyncrasy of sleep produced by hearing
music. Delisle mentions a young person who during a whole year passed
pieces of ascarides and tenia, during which time he could not endure
music.

Autenreith mentions the vibrations of a loud noise tickling the fauces
to such an extent as to provoke vomiting. There are some emotional
people who are particularly susceptible to certain expressions. The
widow of Jean Calas always fell in a faint when she heard the words of
the death-decree sounded on the street.  There was a Hanoverian officer
in the Indian war against Typoo-Saib, a good and brave soldier, who
would feel sick if he heard the word "tiger" pronounced. It was said
that he had experienced the ravages of this beast.

The therapeutic value of music has long been known. For ages warriors
have been led to battle to the sounds of martial strains. David charmed
away Saul's evil spirit with his harp.  Horace in his 32d Ode Book 1,
concludes his address to the lyre:--

       "O laborum
  Dulce lenimen mihicumque calve,
  Rite vocanti;"

Or, as Kiessling of Berlin interprets:--

       "O laborum,
  Dulce lenimen medieumque, salve,
  Rite vocanti."

--"O, of our troubles the sweet, the healing sedative, etc."

Homer, Plutarch, Theophrastus, and Galen say that music cures
rheumatism, the pests, and stings of reptiles, etc. Diemerbroeck,
Bonet, Baglivi, Kercher, and Desault mention the efficacy of melody in
phthisis, gout, hydrophobia, the bites of venomous reptiles, etc. There
is a case in the Lancet of a patient in convulsions who was cured in
the paroxysm by hearing the tones of music. Before the French Academy
of Sciences in 1708, and again in 1718, there was an instance of a
dancing-master stricken with violent fever and in a condition of
delirium, who recovered his senses and health on hearing melodious
music. There is little doubt of the therapeutic value of music, but
particularly do we find its value in instances of neuroses. The
inspiration offered by music is well-known, and it is doubtless a
stimulant to the intellectual work. Bacon, Milton, Warburton, and
Alfieri needed music to stimulate them in their labors, and it is said
that Bourdaloue always played an air on the violin before preparing to
write.

According to the American Medico-Surgical Bulletin, "Professor
Tarchanoff of Saint Petersburg has been investigating the influence of
music upon man and other animals. The subject is by no means a new one.
In recent times Dagiel and Fere have investigated the effect of music
upon the respirations, the pulse, and the muscular system in man.
Professor Tarchanoff made use of the ergograph of Mosso, and found that
if the fingers were completely fatigued, either by voluntary efforts or
by electric excitation, to the point of being incapable of making any
mark except a straight line on the registering cylinder, music had the
power of making the fatigue disappear, and the finger placed in the
ergograph again commenced to mark lines of different heights, according
to the amount of excitation. It was also found that music of a sad and
lugubrious character had the opposite effect, and could check or
entirely inhibit the contractions. Professor Tarchanoff does not
profess to give any positive explanation of these facts, but he
inclines to the view that 'the voluntary muscles, being furnished with
excitomotor and depressant fibers, act in relation to the music
similarly to the heart--that is to say, that joyful music resounds
along the excitomotor fibers, and sad music along the depressant or
inhibitory fibers.' Experiments on dogs showed that music was capable
of increasing the elimination of carbonic acid by 16.7 per cent, and of
increasing the consumption of oxygen by 20.1 per cent. It was also
found that music increased the functional activity of the skin.
Professor Tarchanoff claims as the result of these experiments that
music may fairly be regarded as a serious therapeutic agent, and that
it exercises a genuine and considerable influence over the functions of
the body. Facts of this kind are in no way surprising, and are chiefly
of interest as presenting some physiologic basis for phenomena that are
sufficiently obvious.  The influence of the war-chant upon the warrior
is known even to savage tribes. We are accustomed to regard this
influence simply as an ordinary case of psychic stimuli producing
physiologic effects.

"Professor Tarchanoff evidently prefers to regard the phenomena as
being all upon the same plane, namely, that of physiology; and until we
know the difference between mind and body, and the principles of their
interaction, it is obviously impossible to controvert this view
successfully. From the immediately practical point of view we should
not ignore the possible value of music in some states of disease. In
melancholia and hysteria it is probably capable of being used with
benefit, and it is worth bearing in mind in dealing with insomnia.
Classical scholars will not forget that the singing of birds was tried
as a remedy to overcome the insomnia of Maecenas. Music is certainly a
good antidote to the pernicious habit of introspection and
self-analysis, which is often a curse both of the hysteric and of the
highly cultured. It would seem obviously preferable to have recourse to
music of a lively and cheerful character."

Idiosyncrasies of the visual organs are generally quite rare. It is
well-known that among some of the lower animals, e.g., the
turkey-cocks, buffaloes, and elephants, the color red is unendurable.
Buchner and Tissot mention a young boy who had a paroxysm if he viewed
anything red. Certain individuals become nauseated when they look for a
long time on irregular lines or curves, as, for examples, in
caricatures. Many of the older examples of idiosyncrasies of color are
nothing more than instances of color-blindness, which in those times
was unrecognized. Prochaska knew a woman who in her youth became
unconscious at the sight of beet-root, although in her later years she
managed to conquer this antipathy, but was never able to eat the
vegetable in question. One of the most remarkable forms of idiosyncrasy
on record is that of a student who was deprived of his senses by the
very sight of an old woman. On one occasion he was carried out from a
party in a dying state, caused, presumably, by the abhorred aspect of
the chaperons The Count of Caylus was always horror-stricken at the
sight of a Capuchin friar. He cured himself by a wooden image dressed
in the costume of this order placed in his room and constantly before
his view. It is common to see persons who faint at the sight of blood.
Analogous are the individuals who feel nausea in an hospital ward.

All Robert Boyle's philosophy could not make him endure the sight of a
spider, although he had no such aversion to toads, venomous snakes,
etc. Pare mentions a man who fainted at the sight of an eel, and
another who had convulsions at the sight of a carp.  There is a record
of a young lady in France who fainted on seeing a boiled lobster.
Millingen cites the case of a man who fell into convulsions whenever he
saw a spider. A waxen one was made, which equally terrified him. When
he recovered, his error was pointed out to him, and the wax figure was
placed in his hand without causing dread, and henceforth the living
insect no longer disturbed him. Amatus Lusitanus relates the case of a
monk who fainted when he beheld a rose, and never quitted his cell when
that flower was in bloom. Scaliger, the great scholar, who had been a
soldier a considerable portion of his life, confesses that he could not
look on a water-cress without shuddering, and remarks: "I, who despise
not only iron, but even thunderbolts, who in two sieges (in one of
which I commanded) was the only one who did not complain of the food as
unfit and horrible to eat, am seized with such a shuddering horror at
the sight of a water-cress that I am forced to go away." One of his
children was in the same plight as regards the inoffensive vegetable,
cabbage.  Scaliger also speaks of one of his kinsmen who fainted at the
sight of a lily. Vaughheim, a great huntsman of Hanover, would faint at
the sight of a roasted pig. Some individuals have been disgusted at the
sight of eggs. There is an account of a sensible man who was terrified
at the sight of a hedgehog, and for two years was tormented by a
sensation as though one was gnawing at his bowels. According to Boyle,
Lord Barrymore, a veteran warrior and a person of strong mind, swooned
at the sight of tansy. The Duke d'Epernon swooned on beholding a
leveret, although a hare did not produce the same effect. Schenck tells
of a man who swooned at the sight of pork. The Ephemerides contains an
account of a person who lost his voice at the sight of a crab, and also
cites cases of antipathy to partridges, a white hen, to a serpent, and
to a toad. Lehman speaks of an antipathy to horses; and in his
observations Lyser has noticed aversion to the color purple. It is a
strange fact that the three greatest generals of recent years,
Wellington, Napoleon, and Roberts, could never tolerate the sight of a
cat, and Henry III of France could not bear this animal in his room. We
learn of a Dane of herculean frame who had a horror of cats. He was
asked to a supper at which, by way of a practical joke, a live cat was
put on the table in a covered dish. The man began to sweat and shudder
without knowing why, and when the cat was shown he killed his host in a
paroxysm of terror. Another man could not even see the hated form even
in a picture without breaking into a cold sweat and feeling a sense of
oppression about the heart. Quercetanus and Smetius mention fainting at
the sight of cats. Marshal d'Abret was supposed to be in violent fear
of a pig.

As to idiosyncrasies of the sense of touch, it is well known that some
people cannot handle velvet or touch the velvety skin of a peach
without having disagreeable and chilly sensations come over them.
Prochaska knew a man who vomited the moment he touched a peach, and
many people, otherwise very fond of this fruit, are unable to touch it.
The Ephemerides speaks of a peculiar idiosyncrasy of skin in the axilla
of a certain person, which if tickled would provoke vomiting. It is
occasionally stated in the older writings that some persons have an
idiosyncrasy as regards the phases of the sun and moon. Baillou speaks
of a woman who fell unconscious at sunset and did not recover till it
reappeared on the horizon. The celebrated Chancellor Bacon, according
to Mead, was very delicate, and was accustomed to fall into a state of
great feebleness at every moon-set without any other imaginable cause.
He never recovered from his swooning until the moon reappeared.

Nothing is more common than the idiosyncrasy which certain people
display for certain foods. The trite proverb, "What is one man's meat
is another man's poison," is a genuine truth, and is exemplified by
hundreds of instances. Many people are unable to eat fish without
subsequent disagreeable symptoms. Prominent among the causes of
urticaria are oysters, crabs, and other shell fish, strawberries,
raspberries, and other fruits. The abundance of literature on this
subject makes an exhaustive collection of data impossible, and only a
few of the prominent and striking instances can be reported.

Amatus Lusitanus speaks of vomiting and diarrhea occurring each time a
certain Spaniard ate meat. Haller knew a person who was purged
violently by syrup of roses. The son of one of the friends of Wagner
would vomit immediately after the ingestion of any substance containing
honey. Bayle has mentioned a person so susceptible to honey that by a
plaster of this substance placed upon the skin this untoward effect was
produced. Whytt knew a woman who was made sick by the slightest bit of
nutmeg. Tissot observed vomiting in one of his friends after the
ingestion of the slightest amount of sugar. Ritte mentions a similar
instance.  Roose has seen vomiting produced in a woman by the slightest
dose of distilled water of linden. There is also mentioned a person in
whom orange-flower water produced the same effect. Dejean cites a case
in which honey taken internally or applied externally acted like
poison. It is said that the celebrated Haen would always have
convulsions after eating half a dozen strawberries. Earle and Halifax
attended a child for kidney-irritation produced by strawberries, and
this was the invariable result of the ingestion of this fruit. The
authors personally know of a family the male members of which for
several generations could not eat strawberries without symptoms of
poisoning. The female members were exempt from the idiosyncrasy. A
little boy of this family was killed by eating a single berry. Whytt
mentions a woman of delicate constitution and great sensibility of the
digestive tract in whom foods difficult of digestion provoked spasms,
which were often followed by syncopes. Bayle describes a man who
vomited violently after taking coffee. Wagner mentions a person in whom
a most insignificant dose of manna had the same effect.  Preslin speaks
of a woman who invariably had a hemorrhage after swallowing a small
quantity of vinegar. According to Zimmerman, some people are unable to
wash their faces on account of untoward symptoms. According to Ganbius,
the juice of a citron applied to the skin of one of his acquaintances
produced violent rigors.

Brasavolus says that Julia, wife of Frederick, King of Naples, had such
an aversion to meat that she could not carry it to her mouth without
fainting. The anatomist Gavard was not able to eat apples without
convulsions and vomiting. It is said that Erasmus was made ill by the
ingestion of fish; but this same philosopher, who was cured of a malady
by laughter, expressed his appreciation by an elegy on the folly. There
is a record of a person who could not eat almonds without a scarlet
rash immediately appearing upon the face. Marcellus Donatus knew a
young man who could not eat an egg without his lips swelling and purple
spots appearing on his face. Smetius mentions a person in whom the
ingestion of fried eggs was often followed by syncope. Brunton has seen
a case of violent vomiting and purging after the slightest bit of egg.
On one occasion this person was induced to eat a small morsel of cake
on the statement that it contained no egg, and, although fully
believing the words of his host, he subsequently developed prominent
symptoms, due to the trace of egg that was really in the cake. A letter
from a distinguished litterateur to Sir Morell Mackenzie gives a
striking example of the idiosyncrasy to eggs transmitted through four
generations. Being from such a reliable source, it has been deemed
advisable to quote the account in full: "My daughter tells me that you
are interested in the ill-effects which the eating of eggs has upon
her, upon me, and upon my father before us. I believe my grandfather,
as well as my father, could not eat eggs with impunity. As to my father
himself, he is nearly eighty years old; he has not touched an egg since
he was a young man; he can, therefore, give no precise or reliable
account of the symptoms the eating of eggs produce in him. But it was
not the mere 'stomach-ache' that ensued, but much more immediate and
alarming disturbances. As for me, the peculiarity was discovered when I
was a spoon-fed child. On several occasions it was noticed (that is my
mother's account) that I felt ill without apparent cause; afterward it
was recollected that a small part of a yolk of an egg had been given to
me. Eclaircissement came immediately after taking a single spoonful of
egg. I fell into such an alarming state that the doctor was sent for.
The effect seems to have been just the same that it produces upon my
daughter now,--something that suggested brain-congestion and
convulsions. From time to time, as a boy and a young man, I have eaten
an egg by way of trying it again, but always with the same result--a
feeling that I had been poisoned; and yet all the while I liked eggs.
Then I never touched them for years. Later I tried again, and I find
the ill-effects are gradually wearing off. With my daughter it is
different; she, I think, becomes more susceptible as time goes on, and
the effect upon her is more violent than in my case at any time.
Sometimes an egg has been put with coffee unknown to her, and she has
been seen immediately afterward with her face alarmingly changed--eyes
swollen and wild, the face crimson, the look of apoplexy. This is her
own account: 'An egg in any form causes within a few minutes great
uneasiness and restlessness, the throat becomes contracted and painful,
the face crimson, and the veins swollen. These symptoms have been so
severe as to suggest that serious consequences might follow.' To this I
may add that in her experience and my own, the newer the egg, the worse
the consequences."

Hutchinson speaks of a Member of Parliament who had an idiosyncrasy as
regards parsley. After the ingestion of this herb in food he always had
alarming attacks of sickness and pain in the abdomen, attended by
swelling of the tongue and lips and lividity of the face. This same man
could not take the smallest quantity of honey, and certain kinds of
fruit always poisoned him. There was a collection of instances of
idiosyncrasy in the British Medical Journal, 1859, which will be
briefly given in the following lines: One patient could not eat rice in
any shape without extreme distress. From the description given of his
symptoms, spasmodic asthma seemed to be the cause of his discomfort. On
one occasion when at a dinner-party he felt the symptoms of
rice-poisoning come on, and, although he had partaken of no dish
ostensibly containing rice, was, as usual, obliged to retire from the
table. Upon investigation it appeared that some white soup with which
he had commenced his meal had been thickened with ground rice. As in
the preceding case there was another gentleman who could not eat rice
without a sense of suffocation. On one occasion he took lunch with a
friend in chambers, partaking only of simple bread and cheese and
bottled beer. On being seized with the usual symptoms of rice-poisoning
he informed his friend of his peculiarity of constitution, and the
symptoms were explained by the fact that a few grains of rice had been
put into each bottle of beer for the purpose of exciting a secondary
fermentation. The same author speaks of a gentleman under treatment for
stricture who could not eat figs without experiencing the most
unpleasant formication of the palate and fauces. The fine dust from
split peas caused the same sensation, accompanied with running at the
nose; it was found that the father of the patient suffered from
hay-fever in certain seasons.  He also says a certain young lady after
eating eggs suffered from swelling of the tongue and throat,
accompanied by "alarming illness," and there is recorded in the same
paragraph a history of another young girl in whom the ingestion of
honey, and especially honey-comb, produced swelling of the tongue,
frothing of the mouth, and blueness of the fingers. The authors know of
a gentleman in whom sneezing is provoked on the ingestion of chocolate
in any form. There was another instance--in a member of the medical
profession--who suffered from urticaria after eating veal. Veal has the
reputation of being particularly indigestible, and the foregoing
instance of the production of urticaria from its use is doubtless not
an uncommon one.

Overton cites a striking case of constitutional peculiarity or
idiosyncrasy in which wheat flour in any form, the staff of life, an
article hourly prayed for by all Christian nations as the first and
most indispensable of earthly blessings, proved to one unfortunate
individual a prompt and dreadful poison. The patient's name was David
Waller, and he was born in Pittsylvania County, Va., about the year
1780. He was the eighth child of his parents, and, together with all
his brothers and sisters, was stout and healthy. At the time of
observation Waller was about fifty years of age. He had dark hair, gray
eyes, dark complexion, was of bilious and irascible temperament, well
formed, muscular and strong, and in all respects healthy as any man,
with the single exception of his peculiar idiosyncrasy. He had been the
subject of but few diseases, although he was attacked by the epidemic
of 1816. From the history of his parents and an inquiry into the health
of his ancestry, nothing could be found which could establish the fact
of heredity in his peculiar disposition.  Despite every advantage of
stature, constitution, and heredity, David Waller was through life,
from his cradle to his grave, the victim of what is possibly a unique
idiosyncrasy of constitution.  In his own words he declared: "Of two
equal quantities of tartar and wheat flour, not more than a dose of the
former, he would rather swallow the tartar than the wheat flour." If he
ate flour in any form or however combined, in the smallest quantity, in
two minutes or less he would have painful itching over the whole body,
accompanied by severe colic and tormina in the bowels, great sickness
in the stomach, and continued vomiting, which he declared was ten times
as distressing as the symptoms caused by the ingestion of tartar
emetic. In about ten minutes after eating the flour the itching would
be greatly intensified, especially about the head, face, and eyes, but
tormenting all parts of the body, and not to be appeased. These
symptoms continued for two days with intolerable violence, and only
declined on the third day and ceased on the tenth. In the
convalescence, the lungs were affected, he coughed, and in
expectoration raised great quantities of phlegm, and really resembled a
phthisical patient.  At this time he was confined to his room with
great weakness, similar to that of a person recovering from an
asthmatic attack.  The mere smell of wheat produced distressing
symptoms in a minor degree, and for this reason he could not, without
suffering, go into a mill or house where the smallest quantity of wheat
flour was kept. His condition was the same from the earliest times, and
he was laid out for dead when an infant at the breast, after being fed
with "pap" thickened with wheat flour. Overton remarks that a case of
constitutional peculiarity so little in harmony with the condition of
other men could not be received upon vague or feeble evidence, and it
is therefore stated that Waller was known to the society in which he
lived as an honest and truthful man. One of his female neighbors, not
believing in his infirmity, but considering it only a whim, put a small
quantity of flour in the soup which she gave him to eat at her table,
stating that it contained no flour, and as a consequence of the
deception he was bed-ridden for ten days with his usual symptoms. It
was also stated that Waller was never subjected to militia duty because
it was found on full examination of his infirmity that he could not
live upon the rations of a soldier, into which wheat flour enters as a
necessary ingredient. In explanation of this strange departure from the
condition of other men, Waller himself gave a reason which was deemed
equivalent in value to any of the others offered. It was as follows:
His father being a man in humble circumstances in life, at the time of
his birth had no wheat with which to make flour, although his mother
during gestation "longed" for wheat-bread. The father, being a kind
husband and responsive to the duty imposed by the condition of his
wife, procured from one of his opulent neighbors a bag of wheat and
sent it to the mill to be ground. The mother was given much uneasiness
by an unexpected delay at the mill, and by the time the flour arrived
her strong appetite for wheat-bread had in a great degree subsided.
Notwithstanding this, she caused some flour to be immediately baked
into bread and ate it, but not so freely as she had expected The bread
thus taken caused intense vomiting and made her violently and painfully
ill, after which for a considerable time she loathed bread. These facts
have been ascribed as the cause of the lamentable infirmity under which
the man labored, as no other peculiarity or impression in her gestation
was noticed. In addition it may be stated that for the purpose of
avoiding the smell of flour Waller was in the habit of carrying camphor
in his pocket and using snuff, for if he did not smell the flour,
however much might be near him, it was as harmless to him as to other
men.

The authors know of a case in which the eating of any raw fruit would
produce in a lady symptoms of asthma; cooked fruit had no such effect.

Food-Superstitions.--The superstitious abhorrence and antipathy to
various articles of food that have been prevalent from time to time in
the history of the human race are of considerable interest and well
deserve some mention here. A writer in a prominent journal has studied
this subject with the following result:--

"From the days of Adam and Eve to the present time there has been not
only forbidden fruit, but forbidden meats and vegetables. For one
reason or another people have resolutely refused to eat any and all
kinds of flesh, fish, fowl, fruits, and plants. Thus, the apple, the
pear, the strawberry, the quince, the bean, the onion, the leek, the
asparagus, the woodpecker, the pigeon, the goose, the deer, the bear,
the turtle, and the eel--these, to name only a few eatables, have been
avoided as if unwholesome or positively injurious to health and
digestion.

"As we all know, the Jews have long had an hereditary antipathy to
pork. On the other hand, swine's flesh was highly esteemed by the
ancient Greeks and Romans. This fact is revealed by the many references
to pig as a dainty bit of food. At the great festival held annually in
honor of Demeter, roast pig was the piece de resistance in the bill of
fare, because the pig was the sacred animal of Demeter. Aristophanes in
'The Frogs' makes one of the characters hint that some of the others
'smell of roast pig.' These people undoubtedly had been at the festival
(known as the Thesmophoria) and had eaten freely of roast pig, Those
who took part in another Greek mystery or festival (known as the
Eleusinia) abstained from certain food, and above all from beans.

"Again, as we all know, mice are esteemed in China and in some parts of
India. But the ancient Egyptians, Greeks, and Jews abhorred mice and
would not touch mouse-meat. Rats and field-mice were sacred in Old
Egypt, and were not to be eaten on this account. So, too, in some parts
of Greece, the mouse was the sacred animal of Apollo, and mice were fed
in his temples. The chosen people were forbidden to eat 'the weasel,
and the mouse, and the tortoise after his kind.' These came under the
designation of unclean animals, which were to be avoided.

"But people have abstained from eating kinds of flesh which could not
be called unclean. For example, the people of Thebes, as Herodotus
tells us, abstained from sheep. Then, the ancients used to abstain from
certain vegetables. In his 'Roman Questions' Plutarch asks: 'Why do the
Latins abstain strictly from the flesh of the woodpecker?' In order to
answer Plutarch's question correctly it is necessary to have some idea
of the peculiar custom and belief called 'totemism.' There is a stage
of society in which people claim descent from and kinship with beasts,
birds, vegetables, and other objects. This object, which is a 'totem,'
or family mark, they religiously abstain from eating.  The members of
the tribe are divided into clans or stocks, each of which takes the
name of some animal, plant, or object, as the bear, the buffalo, the
woodpecker, the asparagus, and so forth.  No member of the bear family
would dare to eat bear-meat, but he has no objection to eating buffalo
steak. Even the marriage law is based on this belief, and no man whose
family name is Wolf may marry a woman whose family name is also Wolf.

"In a general way it may be said that almost all our food prohibitions
spring from the extraordinary custom generally called totemism. Mr.
Swan, who was missionary for many years in the Congo Free State, thus
describes the custom: 'If I were to ask the Yeke people why they do not
eat zebra flesh, they would reply, 'Chijila,' i.e., 'It is a thing to
which we have an antipathy;' or better, 'It is one of the things which
our fathers taught us not to eat.' So it seems the word 'Bashilang'
means 'the people who have an antipathy to the leopard;' the
'Bashilamba,' 'those who have an antipathy to the dog,' and the
'Bashilanzefu,' 'those who have an antipathy to the elephant.' In other
words, the members of these stocks refuse to eat their totems, the
zebra, the leopard, or the elephant, from which they take their names.

"The survival of antipathy to certain foods was found among people as
highly civilized as the Egyptians, the Greeks, and the Romans. Quite a
list of animals whose flesh was forbidden might be drawn up. For
example, in Old Egypt the sheep could not be eaten in Thebes, nor the
goat in Mendes, nor the cat in Bubastis, nor the crocodile at Ombos,
nor the rat, which was sacred to Ra, the sun-god. However, the people
of one place had no scruples about eating the forbidden food of another
place. And this often led to religious disputes.

"Among the vegetables avoided as food by the Egyptians may be mentioned
the onion, the garlic, and the leek. Lucian says that the inhabitants
of Pelusium adored the onion. According to Pliny the Egyptians relished
the leek and the onion. Juvenal exclaims: 'Surely a very religious
nation, and a blessed place, where every garden is overrun with gods!'
The survivals of totemism among the ancient Greeks are very
interesting. Families named after animals and plants were not uncommon.
One Athenian gens, the Ioxidae, had for its ancestral plant the
asparagus. One Roman gens, the Piceni, took a woodpecker for its totem,
and every member of this family refused, of course, to eat the flesh of
the woodpecker. In the same way as the nations of the Congo Free State,
the Latins had an antipathy to certain kinds of food. However, an
animal or plant forbidden in one place was eaten without any
compunction in another place. 'These local rites in Roman times,' says
Mr. Lang, 'caused civil brawls, for the customs of one town naturally
seemed blasphemous to neighbors with a different sacred animal.  Thus
when the people of dog-town were feeding on the fish called
oxyrrhyncus, the citizens of the town which revered the oxyrrhyncus
began to eat dogs. Hence arose a riot.' The antipathy of the Jews to
pork has given rise to quite different explanations. The custom is
probably a relic of totemistic belief. That the unclean
animals--animals not to be eaten--such as the pig, the mouse, and the
weasel, were originally totems of the children of Israel, Professor
Robertson Smith believes is shown by various passages in the Old
Testament.

"When animals and plants ceased to be held sacred they were endowed
with sundry magical or mystic properties. The apple has been supposed
to possess peculiar virtues, especially in the way of health. 'The
relation of the apple to health,' says Mr. Conway, 'is traceable to
Arabia. Sometimes it is regarded as a bane. In Hessia it is said an
apple must not be eaten on New Year's Day, as it will produce an
abscess. But generally it is curative. In Pomerania it is eaten on
Easter morning against fevers; in Westphalia (mixed with saffron)
against jaundice; while in Silesia an apple is scraped from top to
stalk to cure diarrhea, and upward to cure costiveness.' According to
an old English fancy, if any one who is suffering from a wound in the
head should eat strawberries it will lead to fatal results. In the
South of England the folk say that the devil puts his cloven foot upon
the blackberries on Michaelmas Day, and hence none should be gathered
or eaten after that day. On the other hand, in Scotland the peasants
say that the devil throws his cloak over the blackberries and makes
them unwholesome after that day, while in Ireland he is said to stamp
on the berries. Even that humble plant, the cabbage, has been invested
with some mystery. It was said that the fairies were fond of its
leaves, and rode to their midnight dances on cabbage-stalks. The German
women used to say that 'Babies come out of the cabbage-heads.' The
Irish peasant ties a cabbage-leaf around the neck for sore throat.
According to Gerarde, the Spartans ate watercress with their bread,
firmly believing that it increased their wit and wisdom. The old
proverb is, 'Eat cress to learn more wit.'

"There is another phase to food-superstitions, and that is the theory
that the qualities of the eaten pass into the eater. Mr. Tylor refers
to the habit of the Dyak young men in abstaining from deer-meat lest it
should make them timid, while the warriors of some South American
tribes eat the meat of tigers, stags, and boars for courage and speed.
He mentions the story of an English gentleman at Shanghai who at the
time of the Taeping attack met his Chinese servant carrying home the
heart of a rebel, which he intended to eat to make him brave. There is
a certain amount of truth in the theory that the quality of food does
affect the mind and body. Buckle in his 'History of Civilization' took
this view, and tried to prove that the character of a people depends on
their diet."

Idiosyncrasies to Drugs.--In the absorption and the assimilation of
drugs idiosyncrasies are often noted; in fact, they are so common that
we can almost say that no one drug acts in the same degree or manner on
different individuals. In some instances the untoward action assumes
such a serious aspect as to render extreme caution necessary in the
administration of the most inert substances. A medicine ordinarily so
bland as cod-liver oil may give rise to disagreeable eruptions.
Christison speaks of a boy ten years old who was said to have been
killed by the ingestion of two ounces of Epsom salts without inducing
purgation; yet this common purge is universally used without the
slightest fear or caution. On the other hand, the extreme tolerance
exhibited by certain individuals to certain drugs offers a new phase of
this subject. There are well-authenticated cases on record in which
death has been caused in children by the ingestion of a small fraction
of a grain of opium. While exhibiting especial tolerance from peculiar
disposition and long habit, Thomas De Quincey, the celebrated English
litterateur, makes a statement in his "Confessions" that with impunity
he took as much as 320 grains of opium a day, and was accustomed at one
period of his life to call every day for "a glass of laudanum negus,
warm, and without sugar," to use his own expression, after the manner a
toper would call for a "hot-Scotch."

The individuality noted in the assimilation and the ingestion of drugs
is functional as well as anatomic. Numerous cases have been seen by all
physicians. The severe toxic symptoms from a whiff of cocain-spray, the
acute distress from the tenth of a grain of morphin, the gastric crises
and profuse urticarial eruptions following a single dose of
quinin,--all are proofs of it. The "personal equation" is one of the
most important factors in therapeutics, reminding us of the old rule,
"Treat the patient, not the disease."

The idiosyncrasy may be either temporary or permanent, and there are
many conditions that influence it. The time and place of
administration; the degree of pathologic lesion in the subject; the
difference in the physiologic capability of individual organs of
similar nature in the same body; the degree of human vitality
influencing absorption and resistance; the peculiar epochs of life; the
element of habituation, and the grade and strength of the drug,
influencing its virtue,--all have an important bearing on untoward
action and tolerance of poisons.

It is not in the province of this work to discuss at length the
explanations offered for these individual idiosyncrasies. Many authors
have done so, and Lewin has devoted a whole volume to this subject, of
which, fortunately, an English translation has been made by Mulheron,
and to these the interested reader is referred for further information.
In the following lines examples of idiosyncrasy to the most common
remedial substances will be cited, taking the drugs up alphabetically.

Acids.--Ordinarily speaking, the effect of boric acid in medicinal
doses on the human system is nil, an exceptionally large quantity
causing diuresis. Binswanger, according to Lewin, took eight gm. in two
doses within an hour, which was followed by nausea, vomiting, and a
feeling of pressure and fulness of the stomach which continued several
hours. Molodenkow mentions two fatal cases from the external employment
of boric acid as an antiseptic. In one case the pleural cavity was
washed out with a five per cent solution of boric acid and was followed
by distressing symptoms, vomiting, weak pulse, erythema, and death on
the third day. In the second case, in a youth of sixteen, death
occurred after washing out a deep abscess of the nates with the same
solution. The autopsy revealed no change or signs indicative of the
cause of death. Hogner mentions two instances of death from the
employment of 2 1/2 per cent solution of boric acid in washing out a
dilated stomach The symptoms were quite similar to those mentioned by
Molodenkow.

In recent years the medical profession has become well aware that in
its application to wounds it is possible for carbolic acid or phenol to
exercise exceedingly deleterious and even fatal consequences. In the
earlier days of antisepsis, when operators and patients were exposed
for some time to an atmosphere saturated with carbolic spray, toxic
symptoms were occasionally noticed. Von Langenbeck spoke of severe
carbolic-acid intoxication in a boy in whom carbolic paste had been
used in the treatment of abscesses. The same author reports two
instances of death following the employment of dry carbolized dressings
after slight operations. Kohler mentions the death of a man suffering
from scabies who had applied externally a solution containing about a
half ounce of phenol. Rose spoke of gangrene of the finger after the
application of carbolized cotton to a wound thereon. In some cases
phenol acts with a rapidity equal to any poison. Taylor speaks of a man
who fell unconscious ten seconds after an ounce of phenol had been
ingested, and in three minutes was dead. There is recorded an account
of a man of sixty-four who was killed by a solution containing slightly
over a dram of phenol. A half ounce has frequently caused death;
smaller quantities have been followed by distressing symptoms, such as
intoxication (which Olshausen has noticed to follow irrigation of the
uterus), delirium, singultus, nausea, rigors, cephalalgia, tinnitus
aurium, and anasarca. Hind mentions recovery after the ingestion of
nearly six ounces of crude phenol of 14 per cent strength. There was a
case at the Liverpool Northern Hospital in which recovery took place
after the ingestion with suicidal intent of four ounces of crude
carbolic acid. Quoted by Lewin, Busch accurately describes a case which
may be mentioned as characteristic of the symptoms of carbolism. A boy,
suffering from abscess under the trochanter, was operated on for its
relief. During the few minutes occupied by the operation he was kept
under a two per cent carbolic spray, and the wound was afterward
dressed with carbolic gauze. The day following the operation he was
seized with vomiting, which was attributed to the chloroform used as an
anesthetic. On the following morning the bandages were removed under
the carbolic spray; during the day there was nausea, in the evening
there was collapse, and carbolic acid was detected in the urine. The
pulse became small and frequent and the temperature sank to 35.5
degrees C. The frequent vomiting made it impossible to administer
remedies by the stomach, and, in spite of hypodermic injections and
external application of analeptics, the boy died fifty hours after
operation.

Recovery has followed the ingestion of an ounce of officinal
hydrochloric acid. Black mentions a man of thirty-nine who recovered
after swallowing 1 1/2 ounces of commercial hydrochloric acid. Johnson
reports a case of poisoning from a dram of hydrochloric acid.
Tracheotomy was performed, but death resulted.

Burman mentions recovery after the ingestion of a dram of dilute
hydrocyanic acid of Scheele's strength (2.4 am. of the acid). In this
instance insensibility did not ensue until two minutes after taking the
poison, the retarded digestion being the means of saving life.

Quoting Taafe, in 1862 Taylor speaks of the case of a man who swallowed
the greater part of a solution containing an ounce of potassium cyanid.
In a few minutes the man was found insensible in the street, breathing
stertorously, and in ten minutes after the ingestion of the drug the
stomach-pump was applied. In two hours vomiting began, and thereafter
recovery was rapid.

Mitscherlich speaks of erosion of the gums and tongue with hemorrhage
at the slightest provocation, following the long administration of
dilute nitric acid. This was possibly due to the local action.

According to Taylor, the smallest quantity of oxalic acid causing death
is one dram. Ellis describes a woman of fifty who swallowed an ounce of
oxalic acid in beer. In thirty minutes she complained of a burning pain
in the stomach and was rolling about in agony.  Chalk and water was
immediately given to her and she recovered.  Woodman reports recovery
after taking 1/2 ounce of oxalic acid.

Salicylic acid in medicinal doses frequently causes untoward symptoms,
such as dizziness, transient delirium, diminution of vision, headache,
and profuse perspiration; petechial eruptions and intense gastric
symptoms have also been noticed.

Sulphuric acid causes death from its corrosive action, and when taken
in excessive quantities it produces great gastric disturbance; however,
there are persons addicted to taking oil of vitriol without any
apparent untoward effect. There is mentioned a boot-maker who
constantly took 1/2 ounce of the strong acid in a tumbler of water,
saying that it relieved his dyspepsia and kept his bowels open.

Antimony.--It is recorded that 3/4 grain of tartar emetic has caused
death in a child and two grains in an adult. Falot reports three cases
in which after small doses of tartar emetic there occurred vomiting,
delirium, spasms, and such depression of vitality that only the
energetic use of stimulants saved life.  Beau mentions death following
the administration of two doses of 1 1/2 gr. of tartar emetic.
Preparations of antimony in an ointment applied locally have caused
necrosis, particularly of the cranium, and Hebra has long since
denounced the use of tartar emetic ointment in affections of the scalp.
Carpenter mentions recovery after ingestion of two drams of tartar
emetic. Behrends describes a case of catalepsy with mania, in which a
dose of 40 gr. of tartar emetic was tolerated, and Morgagni speaks of a
man who swallowed two drams, immediately vomited, and recovered.
Instances like the last, in which an excessive amount of a poison by
its sudden emetic action induces vomiting before there is absorption of
a sufficient quantity to cause death, are sometimes noticed. McCreery
mentions a case of accidental poisoning with half an ounce of tartar
emetic successfully treated with green tea and tannin. Mason reports
recovery after taking 80 gr. of tartar emetic.

Arsenic.--The sources of arsenical poisoning are so curious as to
deserve mention. Confectionery, wall-paper, dyes, and the like are
examples. In other cases we note money-counting, the colored candles of
a Christmas tree, paper collars, ball-wreaths of artificial flowers,
ball-dresses made of green tarlatan, playing cards, hat-lining, and
fly-papers.

Bazin has reported a case in which erythematous pustules appeared after
the exhibition during fifteen days of the 5/6 gr. of arsenic. Macnal
speaks of an eruption similar to that of measles in a patient to whom
he had given but three drops of Fowler's solution for the short period
of three days. Pareira says that in a gouty patient for whom he
prescribed 1/6 gr. of potassium arseniate daily, on the third day there
appeared a bright red eruption of the face, neck, upper part of the
trunk and flexor surfaces of the joints, and an edematous condition of
the eyelids. The symptoms were preceded by restlessness, headache, and
heat of the skin, and subsided gradually after the second or third day,
desquamation continuing for nearly two months. After they had subsided
entirely, the exhibition of arsenic again aroused them, and this time
they were accompanied by salivation.  Charcot and other French authors
have noticed the frequent occurrence of suspension of the sexual
instinct during the administration of Fowler's solution. Jackson speaks
of recovery after the ingestion of two ounces of arsenic by the early
employment of an emetic. Walsh reports a case in which 600 gr. of
arsenic were taken without injury. The remarkable tolerance of arsenic
eaters is well known. Taylor asserts that the smallest lethal dose of
arsenic has been two gr., but Tardieu mentions an instance in which ten
cgm. (1 1/2 gr.) has caused death.  Mackenzie speaks of a man who
swallowed a large quantity of arsenic in lumps, and received no
treatment for sixteen hours, but recovered. It is added that from two
masses passed by the anus 105 gr. of arsenic were obtained.

In speaking of the tolerance of belladonna, in 1859 Fuller mentioned a
child of fourteen who in eighteen days took 37 grains of atropin; a
child of ten who took seven grains of extract of belladonna daily, or
more than two ounces in twenty-six days; and a man who took 64 grains
of the extract of belladonna daily, and from whose urine enough atropin
was extracted to kill two white mice and to narcotize two others. Bader
has observed grave symptoms following the employment of a vaginal
suppository containing three grains of the extract of belladonna. The
dermal manifestations, such as urticaria and eruptions resembling the
exanthem of scarlatina, are too well known to need mention here.  An
enema containing 80 grains of belladonna root has been followed in five
hours by death, and Taylor has mentioned recovery after the ingestion
of three drams of belladonna. In 1864 Chambers reported to the Lancet
the recovery of a child of four years who took a solution containing
1/2 grain of the alkaloid. In some cases the idiosyncrasy to belladonna
is so marked that violent symptoms follow the application of the
ordinary belladonna plaster. Maddox describes a ease of poisoning in a
music teacher by the belladonna plaster of a reputable maker. She had
obscure eye-symptoms, and her color-sensations were abnormal. Locomotor
equilibration was also affected. Golden mentions two cases in which the
application of belladonna ointment to the breasts caused suppression of
the secretion of milk. Goodwin relates the history of a case in which
an infant was poisoned by a belladonna plaster applied to its mother's
breast and died within twenty-four hours after the first application of
the plaster. In 1881 Betancourt spoke of an instance of inherited
susceptibility to belladonna, in which the external application of the
ointment produced all the symptoms of belladonna poisoning. Cooper
mentions the symptoms of poisoning following the application of extract
of belladonna to the scrotum. Davison reports poisoning by the
application of belladonna liniment. Jenner and Lyman also record
belladonna poisoning from external applications.

Rosenthal reports a rare case of poisoning in a child eighteen months
old who had swallowed about a teaspoonful of benzin.  Fifteen minutes
later the child became unconscious. The stomach-contents, which were
promptly removed, contained flakes of bloody mucus. At the end of an
hour the radial pulse was scarcely perceptible, respiration was
somewhat increased in frequency and accompanied with a rasping sound.
The breath smelt of benzin. The child lay in quiet narcosis,
occasionally throwing itself about as if in pain. The pulse gradually
improved, profuse perspiration occurred, and normal sleep intervened.
Six hours after the poisoning the child was still stupefied. The urine
was free from albumin and sugar, and the next morning the little one
had perfectly recovered.

There is an instance mentioned of a robust youth of twenty who by a
mistake took a half ounce of cantharides. He was almost immediately
seized with violent heat in the throat and stomach, pain in the head,
and intense burning on urination. These symptoms progressively
increased, were followed by intense sickness and almost continual
vomiting. In the evening he passed great quantities of blood from the
urethra with excessive pain in the urinary tract. On the third day all
the symptoms were less violent and the vomiting had ceased. Recovery
was complete on the fifteenth day.

Digitalis has been frequently observed to produce dizziness, fainting,
disturbances of vision, vomiting, diarrhea, weakness of the pulse, and
depression of temperature. These phenomena, however, are generally
noticed after continued administration in repeated doses, the result
being doubtless due to cumulative action caused by abnormally slow
elimination by the kidneys.  Traube observed the presence of
skin-affection after the use of digitalis in a case of pericarditis.
Tardieu has seen a fluid-dram of the tincture of digitalis cause
alarming symptoms in a young woman who was pregnant. He also quotes
cases of death on the tenth day from ingestion of 20 grains of the
extract, and on the fifth day from 21 grams of the infusion. Kohuhorn
mentions a death from what might be called chronic digitalis poisoning.

There is a deleterious practice of some of the Irish peasantry
connected with their belief in fairies, which consists of giving a
cachetic or rachitic child large doses of a preparation of fox-glove
(Irish--luss-more, or great herb), to drive out or kill the fairy in
the child. It was supposed to kill an unhallowed child and cure a
hallowed one. In the Hebrides, likewise, there were many cases of
similar poisoning.

Epidemics of ergotism have been recorded from time to time since the
days of Galen, and were due to poverty, wretchedness, and famine,
resulting in the feeding upon ergotized bread. According to Wood,
gangrenous ergotism, or "Ignis Sacer" of the Middle Ages, killed 40,000
persons in Southwestern France in 922 A. D., and in 1128-29, in Paris
alone, 14,000 persons perished from this malady. It is described as
commencing with itchings and formications in the feet, severe pain in
the back, contractions in the muscles, nausea, giddiness, apathy, with
abortion in pregnant women, in suckling women drying of milk, and in
maidens with amenorrhea. After some time, deep, heavy aching in the
limbs, intense feeling of coldness, with real coldness of the surfaces,
profound apathy, and a sense of utter weariness develop; then a dark
spot appears on the nose or one of the extremities, all sensibility is
lost in the affected part, the skin assumes a livid red hue, and
adynamic symptoms in severe cases deepen as the gangrene spreads, until
finally death ensues.  Very generally the appetite and digestion are
preserved to the last, and not rarely there is a most ferocious hunger.
Wood also mentions a species of ergotism characterized by epileptic
paroxysms, which he calls "spasmodic ergotism." Prentiss mentions a
brunette of forty-two, under the influence of ergot, who exhibited a
peculiar depression of spirits with hysteric phenomena, although
deriving much benefit from the administration of the drug from the
hemorrhage caused by uterine fibroids. After taking ergot for three
days she felt like crying all the time, became irritable, and stayed in
bed, being all day in tears. The natural disposition of the patient was
entirely opposed to these manifestations, as she was even-tempered and
exceptionally pleasant.

In addition to the instance of the fatal ingestion of a dose of Epsom
salts already quoted, Lang mentions a woman of thirty-five who took
four ounces of this purge. She experienced burning pain in the stomach
and bowels, together with a sense of asphyxiation.  There was no
purging or vomiting, but she became paralyzed and entered a state of
coma, dying fifteen minutes after ingestion.

Iodin Preparations.--The eruptions following the administration of
small doses of potassium iodid are frequently noticed, and at the same
time large quantities of albumin have been seen in the urine. Potassium
iodid, although generally spoken of as a poisonous drug, by gradually
increasing the dose can be given in such enormous quantities as to be
almost beyond the bounds of credence, several drams being given at a
dose. On the other hand, eight grains have produced alarming symptoms.
In the extensive use of iodoform as a dressing instances of untoward
effects, and even fatal ones, have been noticed, the majority of them
being due to careless and injudicious application. In a French journal
there is mentioned the history of a man of twenty-five, suspected of
urethral ulceration, who submitted to the local application of one gram
of iodoform. Deep narcosis and anesthesia were induced, and two hours
after awakening his breath smelled strongly of iodoform. There are two
similar instances recorded in England.

Pope mentions two fatal cases of lead-poisoning from diachylon plaster,
self-administered for the purpose of producing abortion.  Lead
water-pipes, the use of cosmetics and hair-dyes, coloring matter in
confectionery and in pastry, habitual biting of silk threads,
imperfectly burnt pottery, and cooking bread with painted wood have
been mentioned as causes of chronic lead-poisoning.

Mercury.--Armstrong mentions recovery after ingestion of 1 1/2 drams of
corrosive sublimate, and Lodge speaks of recovery after a dose
containing 100 grains of the salt. It is said that a man swallowed 80
grains of mercuric chlorid in whiskey and water, and vomited violently
about ten minutes afterward. A mixture of albumin and milk was given to
him, and in about twenty-five minutes a bolus of gold-leaf and reduced
iron; in eight days he perfectly recovered. Severe and even fatal
poisoning may result from the external application of mercury. Meeres
mentions a case in which a solution (two grains to the fluid-ounce)
applied to the head of a child of nine for the relief of tinea
tonsurans caused diarrhea, profuse salivation, marked prostration, and
finally death. Washing out the vagina with a solution of corrosive
sublimate, 1:2000, has caused severe and even fatal poisoning. Bonet
mentions death after the inunction of a mercurial ointment, and
instances of distressing salivation from such medication are quite
common. There are various dermal affections which sometimes follow the
exhibition of mercury and assume an erythematous type. The
susceptibility of some persons to calomel, the slightest dose causing
profuse salivation and painful oral symptoms, is so common that few
physicians administer mercury to their patients without some knowledge
of their susceptibility to this drug. Blundel relates a curious case
occurring in the times when mercury was given in great quantities, in
which to relieve obstinate constipation a half ounce of crude mercury
was administered and repeated in twelve hours. Scores of globules of
mercury soon appeared over a vesicated surface, the result of a
previous blister applied to the epigastric region. Blundel, not
satisfied with the actuality of the phenomena, submitted his case to
Dr. Lister, who, after careful examination, pronounced the globules
metallic.

Oils.--Mauvezin tells of the ingestion of three drams of croton oil by
a child of six, followed by vomiting and rapid recovery.  There was no
diarrhea in this case. Wood quotes Cowan in mentioning the case of a
child of four, who in two days recovered from a teaspoonful of croton
oil taken on a full stomach. Adams saw recovery in an adult after
ingestion of the same amount.  There is recorded an instance of a woman
who took about an ounce, and, emesis being produced three-quarters of
an hour afterward by mustard, she finally recovered. There is a record
in which so small a dose as three minims is supposed to have killed a
child of thirteen months. According to Wood, Giacomini mentions a case
in which 24 grains of the drug proved fatal in as many hours.

Castor oil is usually considered a harmless drug, but the castor bean,
from which it is derived, contains a poisonous acrid principle, three
such beans having sufficed to produce death in a man. Doubtless some of
the instances in which castor oil has produced symptoms similar to
cholera are the results of the administration of contaminated oil.

The untoward effects of opium and its derivatives are quite numerous
Gaubius treated an old woman in whom, after three days, a single grain
of opium produced a general desquamation of the epidermis; this
peculiarity was not accidental, as it was verified on several other
occasions. Hargens speaks of a woman in whom the slightest bit of opium
in any form produced considerable salivation. Gastric disturbances are
quite common, severe vomiting being produced by minimum doses; not
infrequently, intense mental confusion, vertigo, and headache, lasting
hours and even days, sometimes referable to the frontal region and
sometimes to the occipital, are seen in certain nervous individuals
after a dose of from 1/4 to 5/6 gr. of opium. These symptoms were
familiar to the ancient physicians, and, according to Lewin, Tralles
reports an observation with reference to this in a man, and says
regarding it in rather unclassical Latin: "... per multos dies
ponderosissimum caput circumgestasse." Convulsions are said to be
observed after medicinal doses of opium. Albers states that twitching
in the tendons tremors of the hands, and even paralysis, have been
noticed after the ingestion of opium in even ordinary doses. The
"pruritus opii," so familiar to physicians, is spoken of in the older
writings. Dioscorides, Paulus Aegineta, and nearly all the writers of
the last century describe this symptom as an annoying and unbearable
affection. In some instances the ingestion of opium provokes an
eruption in the form of small, isolated red spots, which, in their
general character, resemble roseola. Rieken remarks that when these
spots spread over all the body they present a scarlatiniform
appearance, and he adds that even the mucous membranes of the mouth and
throat may be attacked with erethematous inflammation.  Behrend
observed an opium exanthem, which was attended by intolerable itching,
after the exhibition of a quarter of a grain. It was seen on the chest,
on the inner surfaces of the arms, on the flexor surfaces of the
forearms and wrists, on the thighs, and posterior and inner surfaces of
the legs, terminating at the ankles in a stripe-like discoloration
about the breadth of three fingers. It consisted of closely disposed
papules of the size of a pin-head, and several days after the
disappearance of the eruption a fine, bran-like desquamation of the
epidermis ensued. Brand has also seen an eruption on the trunk and
flexor surfaces, accompanied with fever, from the ingestion of opium.
Billroth mentions the case of a lady in whom appeared a feeling of
anxiety, nausea, and vomiting after ingestion of a small fraction of a
grain of opium; she would rather endure her intense pain than suffer
the untoward action of the drug. According to Lewin, Brochin reported a
case in which the idiosyncrasy to morphin was so great that 1/25 of a
grain of the drug administered hypodermically caused irregularity of
the respiration, suspension of the heart-beat, and profound narcosis.
According to the same authority, Wernich has called attention to
paresthesia of the sense of taste after the employment of morphin,
which, according to his observation, is particularly prone to supervene
in patients who are much reduced and in persons otherwise healthy who
have suffered from prolonged inanition. These effects are probably due
to a central excitation of a similar nature to that produced by
santonin. Persons thus attacked complain, shortly after the injection,
of an intensely sour or bitter taste, which for the most part ceases
after elimination of the morphin. Von Graefe and Sommerfrodt speak of a
spasm of accommodation occurring after ingestion of medicinal doses of
morphin. There are several cases on record in which death has been
produced in an adult by the use of 1/2 to 1/6 grain of morphin.
According to Wood, the maximum doses from which recovery has occurred
without emesis are 55 grains of solid opium, and six ounces of
laudanum. According to the same authority, in 1854 there was a case in
which a babe one day old was killed by one minim of laudanum, and in
another case a few drops of paregoric proved fatal to a child of nine
months.  Doubtful instances of death from opium are given, one in an
adult female after 30 grains of Dover's powder given in divided doses,
and another after a dose of 1/4 grain of morphin. Yavorski cites a
rather remarkable instance of morphin-poisoning with recovery: a female
took 30 grains of acetate of morphin, and as it did not act quickly
enough she took an additional dose of 1/2 ounce of laudanum. After this
she slept a few hours, and awoke complaining of being ill. Yavorski saw
her about an hour later, and by producing emesis, and giving coffee,
atropin, and tincture of musk, he saved her life. Pyle describes a
pugilist of twenty-two who, in a fit of despondency after a debauch (in
which he had taken repeated doses of morphin sulphate), took with
suicidal intent three teaspoonfuls of morphin; after rigorous treatment
he revived and was discharged on the next day perfectly well.
Potassium permanganate was used in this case. Chaffee speaks of
recovery after the ingestion of 18 grains of morphin without vomiting.

In chronic opium eating the amount of this drug which can be ingested
with safety assumes astounding proportions. In his "Confessions" De
Quincey remarks: "Strange as it may sound, I had a little before this
time descended suddenly and without considerable effort from 320 grains
of opium (8000 drops of laudanum) per day to 40 grains, or 1/8 part.
Instantaneously, and as if by magic, the cloud of profoundest
melancholy which rested on my brain, like some black vapors that I have
seen roll away from the summits of the mountains, drew off in one
day,--passed off with its murky banners as simultaneously as a ship
that has been stranded and is floated off by a spring-tide--

     'That moveth altogether if it move at all.'

Now, then, I was again happy; I took only a thousand drops of Laudanum
per day, and what was that? A latter spring had come to close up the
season of youth; my brain performed its functions as healthily as ever
before; I read Kant again, and again I understood him, or fancied that
I did." There have been many authors who, in condemning De Quincey for
unjustly throwing about the opium habit a halo of literary beauty which
has tempted many to destruction, absolutely deny the truth of his
statements. No one has any stable reason on which to found denial of De
Quincey's statements as to the magnitude of the doses he was able to
take; and his frankness and truthfulness is equal to that of any of his
detractors. William Rosse Cobbe, in a volume entitled "Dr. Judas, or
Portrayal of the Opium Habit," gives with great frankness of confession
and considerable purity of diction a record of his own experiences with
the drug. One entire chapter of Mr. Cobb's book and several portions of
other chapters are devoted to showing that De Quincey was wrong in some
of his statements, but notwithstanding his criticism of De Quincey, Mr.
Cobbe seems to have experienced the same adventures in his dreams,
showing, after all, that De Quincey knew the effects of opium even if
he seemed to idealize it. According to Mr. Cobbe, there are in the
United States upward of two millions of victims of enslaving drugs
entirely exclusive of alcohol. Cobbe mentions several instances in
which De Quincey's dose of 320 grains of opium daily has been
surpassed. One man, a resident of Southern Illinois, consumed 1072
grains a day; another in the same State contented himself with 1685
grains daily; and still another is given whose daily consumption
amounted to 2345 grains per day. In all cases of laudanum-takers it is
probable that analysis of the commercial laudanum taken would show the
amount of opium to be greatly below that of the official proportion,
and little faith can be put in the records of large amounts of opium
taken when the deduction has been made from the laudanum used. Dealers
soon begin to know opium victims, and find them ready dupes for
adulteration. According to Lewin, Samter mentions a case of
morphin-habit which was continued for three years, during which, in a
period of about three, hundred and twenty-three days, upward of 2 1/2
ounces of morphin was taken daily. According to the same authority,
Eder reports still larger doses. In the case observed by him the
patient took laudanum for six years in increasing doses up to one ounce
per day; for eighteen months, pure opium, commencing with 15 grains and
increasing to 2 1/4 drams daily; and for eighteen months morphin, in
commencing quantities of six grains, which were later increased to 40
grains a day. When deprived of their accustomed dose of morphin the
sufferings which these patients experience are terrific, and they
pursue all sorts of deceptions to enable them to get their enslaving
drug.  Patients have been known to conceal tubes in their mouths, and
even swallow them, and the authors know of a fatal instance in which a
tube of hypodermic tablets of the drug was found concealed in the
rectum.

The administration of such an inert substance as the infusion of
orange-peel has been sufficient to invariably produce nervous
excitement in a patient afflicted with carcinoma.

Sonnenschein refers to a case of an infant of five weeks who died from
the effects of one phosphorous match head containing only 1/100 grain
of phosphorus. There are certain people who by reason of a special
susceptibility cannot tolerate phosphorus, and the exhibition of it
causes in them nausea, oppression, and a feeling of pain in the
epigastric region, tormina and tenesmus, accompanied with diarrhea, and
in rare cases jaundice, sometimes lasting several months. In such
persons 1/30 grain is capable of causing the foregoing symptoms. In
1882 a man was admitted to Guy's Hospital, London, after he had taken
half of a sixpenny pot of phosphorous paste in whiskey, and was
subsequently discharged completely recovered.

A peculiar feature of phosphorus-poisoning is necrosis of the jaw. This
affection was first noticed in 1838, soon after the introduction of the
manufacture of phosphorous matches. In late years, owing to the
introduction of precautions in their manufacture, the disease has
become much less common. The tipping of the match sticks is
accomplished by dipping their ends in a warm solution of a composition
of phosphorus, chlorate of potassium, with particles of ground flint to
assist friction, some coloring agent, and Irish glue. From the contents
of the dipping-pans fumes constantly arise into the faces of the
workmen and dippers, and in cutting the sticks and packing the matches
the hands are constantly in contact with phosphorus. The region chiefly
affected in this poisoning is the jaw-bone, but the inflammation may
spread to the adjoining bones and involve the vomer, the zygoma, the
body of the spheroid bone, and the basilar process of the occipital
bone. It is supposed that conditions in which the periosteum is exposed
are favorable to the progress of the disease, and, according to Hirt,
workmen with diseased teeth are affected three times as readily as
those with healthy teeth, and are therefore carefully excluded from
some of the factories in America.

Prentiss of Washington, D.C., in 1881 reported a remarkable case of
pilocarpin idiosyncrasy in a blonde of twenty-five. He was consulted by
the patient for constipation. Later on symptoms of cystitis developed,
and an ultimate diagnosis of pyelitis of the right kidney was made.
Uremic symptoms were avoided by the constant use of pilocarpin. Between
December 16, 1880, and February 22, 1881, the patient had 22 sweats
from pilocarpin. The action usually lasted from two to six hours, and
quite a large dose was at length necessary. The idiosyncrasy noted was
found in the hair, which at first was quite light, afterward
chestnut-brown, and May 1, 1881, almost pure black. The growth of the
hair became more vigorous and thicker than formerly, and as its color
darkened it became coarser in proportion. In March, 1889, Prentiss saw
his patient, and at that time her hair was dark brown, having returned
to that color from black. Prentiss also reported the following case a
as adding another to the evidence that jaborandi will produce the
effect mentioned under favorable circumstances: Mrs. L., aged
seventy-two years, was suffering from Bright's disease (contracted
kidney). Her hair and eyebrows had been snow-white for twenty years.
She suffered greatly from itching of the skin, due to the uremia of the
kidney-disease; the skin was harsh and dry. For this symptom fluid
extract of jaborandi was prescribed with the effect of relieving the
itching. It was taken in doses of 20 or 30 drops several times a day,
from October, 1886, to February, 1888.  During the fall of 1887 it was
noticed by the nurse that the eyebrows were growing darker, and that
the hair of the head was darker in patches. These patches and the
eyebrows continued to become darker, until at the time of her death
they were quite black, the black tufts on the head presenting a very
curious appearance among the silver-white hairs surrounding them.

Quinin being such a universally used drug, numerous instances of
idiosyncrasy and intolerance have been recorded. Chevalier mentions
that through contact of the drug workmen in the manufacture of quinin
are liable to an affection of the skin which manifests itself in a
vesicular, papular, or pustular eruption on different parts of the
body. Vepan mentions a lady who took 1 1/2 grains and afterward 2 1/2
grains of quinin for neuralgia, and two days afterward her body was
covered with purpuric spots, which disappeared in the course of nine
days but reappeared after the administration of the drug was resumed.
Lewin says that in this case the severity of the eruption was in
accordance with the size of the dose, and during its existence there
was bleeding at the gums; he adds that Gouchet also noticed an eruption
of this kind in a lady who after taking quinin expectorated blood. The
petechiae were profusely spread over the entire body, and they
disappeared after the suspension of the drug. Dauboeuf, Garraway,
Hemming, Skinner, and Cobner mention roseola and scarlatiniform
erythema after minute doses of quinin.  In nearly all these cases the
accompanying symptoms were different. Heusinger speaks of a lady who,
after taking 1/2 grain of quinin, experienced headache, nausea, intense
burning, and edema, together with nodular erythema on the eyelids,
cheeks, and portion of the forehead. At another time 1 1/2 grains of
the drug gave rise to herpetic vesicles on the cheeks, followed by
branny desquamation on elimination of the drug. In other patients
intense itching is experienced after the ingestion of quinin.  Peters
cites an instance of a woman of sixty-five who, after taking one grain
of quinin, invariably exhibited after an hour a temperature of from 104
degrees to 105 degrees F., accelerated pulse, rigors, slight delirium,
thirst, and all the appearances of ill-defined fever, which would pass
off in from twelve to twenty-four hours. Peters witnessed this
idiosyncrasy several times and believed it to be permanent. The most
unpleasant of the untoward symptoms of quinin exhibition are the
disturbances of the organs of special sense. Photophobia, and even
transient amblyopia, have been observed to follow small doses. In the
examination of cases of the untoward effects of quinin upon the eye,
Knapp of New York found the power of sight diminished in various
degrees, and rarely amaurosis and immobility of the pupils. According
to Lewin, the perceptions of color and light are always diminished, and
although the disorder may last for some time the prognosis is
favorable. The varieties of the disturbances of the functions of the
ear range from tinnitus aurium to congestion causing complete deafness.
The gastro-intestinal and genito-urinary tracts are especially disposed
to untoward action by quinin. There is a case recorded in which, after
the slightest dose of quinin, tingling and burning at the meatus
urinarius were experienced. According to Lewin, there is mentioned in
the case reported by Gauchet a symptom quite unique in the literature
of quinin, viz., hemoptysis. Simon de Ronchard first noted the
occurrence of several cases of hemoptysis following the administration
of doses of eight grains daily. In the persons thus attacked the lungs
and heart were healthy. Hemoptysis promptly ceased with the suspension
of the drug. When it was renewed, blood again appeared in the sputa.
Taussig mentions a curious mistake, in which an ounce of quinin
sulphate was administered to a patient at one dose; the only symptoms
noticed were a stuporous condition and complete deafness. No antidote
was given, and the patient perfectly recovered in a week. In malarious
countries, and particularly in the malarial fevers of the late war,
enormous quantities of quinin were frequently given. In fact, at the
present day in some parts of the South quinin is constantly kept on the
table as a prophylactic constituent of the diet.

Skinner noticed the occurrence of a scarlatiniform eruption in a woman
after the dose of 1/165 grain of strychnin, which, however, disappeared
with the discontinuance of the drug. There was a man in London in 1865
who died in twenty minute's after the ingestion of 1/2 grain of
strychnin. Wood speaks of a case in which the administration of 1/100
grain killed a child three and one-half months old. Gray speaks of a
man who took 22 grains and was not seen for about an hour. He had
vomited some of it immediately after taking the dose, and was
successfully treated with chloral hydrate. A curious case is mentioned
in which three mustard plasters, one on the throat, one on the back of
the neck, and another on the left shoulder of a woman, produced
symptoms similar to strychnin poisoning. They remained in position for
about thirty minutes, and about thirty hours afterward a painful
stinging sensation commenced in the back of the neck, followed by
violent twitching of the muscles of the face, arms, and legs, which
continued in regular succession through the whole of the night, but
after twelve hours yielded to hot fomentations of poppy-heads applied
to the back of the neck. It could not be ascertained whether any
medicine containing strychnin had been taken, but surely, from the
symptoms, such must have been the case.

Tobacco.--O'Neill a gives the history of a farmer's wife, aged forty,
who wounded her leg against a sewing-machine, and by lay advice applied
a handful of chopped wet tobacco to it, from which procedure, strange
to say, serious nicotin-poisoning ensued. The pupils were dilated,
there were dimness of vision, confusion of thought, and extreme
prostration. The pulse was scarcely apparent, the skin was white and
wet with clammy perspiration.  Happily, strychnin was given in time to
effect recovery, and without early medical assistance she would
undoubtedly have succumbed. There are several similar cases on record.

Although not immediately related to the subject of idiosyncrasy, the
following case may be mentioned here: Ramadge speaks of a young
Frenchman, suffering from an obstinate case of gonorrhea, who was said
to have been completely cured by living in a newly painted house in
which he inhaled the odors or vapors of turpentine.

White speaks of a case of exanthematous eruption similar to that of
ivy-poison in mother and child, which was apparently caused by playing
with and burning the toy called "Pharaoh's serpent egg."

The idiosyncrasies noticed in some persons during coitus are quite
interesting. The Ephemerides mentions a person in whom coitus
habitually caused vomiting, and another in whom excessive sexual
indulgence provoked singultus. Sometimes exaggerated tremors or
convulsions, particularly at the moment of orgasm, are noticed. Females
especially are subject to this phenomenon, and it is seen sometimes in
birds.

Winn reports the case of a man who, when prompted to indulge in sexual
intercourse, was immediately prior to the act seized with a fit of
sneezing. Even the thought of sexual pleasure with a female was
sufficient to provoke this peculiar idiosyncrasy.

Sullivan mentions a bride of four weeks, who called at the doctor's
office, saying that in coitus her partner had no difficulty until the
point of culmination or orgasm, when he was seized with complete
numbness and lost all pleasurable sensation in the penis. The numbness
was followed by a sensation of pain, which was intensified on the
slightest motion, and which was at times so excruciating as to forbid
separation for upward of an hour, or until the penis had become
flaccid. The woman asked for advice for her unfortunate husband's
relief, and the case was reported as a means of obtaining suggestions
from the physicians over the country. In response, one theory was
advanced that this man had been in the habit of masturbating and had a
stricture of the membranous portion of the urethra, associated with an
ulcer of the prostate involving the ejaculatory ducts, or an
inflammatory condition of all the tissues compressed by the ejaculatory
muscles.

Hendrichsen quotes a case in which a spasmodic contraction of the
levator ani occurred during coitus, and the penis could not be
withdrawn while this condition lasted; and in support of this
circumstance Hendrichsen mentions that Marion Sims, Beigel, and Budin
describe spasmodic contractions of the levator and, constricting the
vagina; he also cites an instance under his personal observation in
which this spasm was excited by both vaginal and rectal examination,
although on the following day no such condition could be produced. In
this connection, among the older writers, Borellus gives the history of
a man who before coitus rubbed his virile member with musk, and,
similar to the connection of a dog and bitch, was held fast in his
wife's vagina; it was only after the injection of great quantities of
water to soften the parts that separation was obtained.  Diemerbroeck
confirms this singular property of musk by an analogous observation, in
which the ludicrous method of throwing cold water on the persons was
practised. Schurig also relates the history of a similar instance.

Among the peculiar effects of coitus is its deteriorating effect on the
healing process of wounds. Boerhaave, Pare, and Fabricius Hildanus all
speak of this untoward effect of venery, and in modern times Poncet has
made observations at a hospital in Lyons which prove that during the
process of healing wounds are unduly and harmfully influenced by
coitus, and cites confirmatory instances. Poncet also remarks that he
found on nine occasions, by placing a thermometer in the rectum, that
the temperature was about 1 degrees F. lower just before than after
coitus, and that during the act the temperature gradually rose above
normal.

There are many associate conditions which, under the exciting influence
of coitus, provoke harmful effects and even a fatal issue. Deguise
mentions a man who had coitus 18 times in ten hours with most
disastrous effects. Cabrolius speaks of a man who took a potion of
aphrodisiac properties, in which, among other things, he put an
enormous dose of cantharides. The anticipation of the effect of his
dose, that is, the mental influence, in addition to the actual
therapeutic effect, greatly distressed and excited him. Almost beyond
belief, it is said that he approached his wife eighty-seven times
during the night, spilling much sperm on the sleeping-bed. Cabrolius
was called to see this man in the morning, and found him in a most
exhausted condition, but still having the supposed consecutive
ejaculations. Exhaustion progressed rapidly, and death soon terminated
this erotic crisis.  Lawson is accredited with saying that among the
Marquesan tribe he knew of a woman who during a single night had
intercourse with 103 men.

Among the older writers there are instances reported in which erection
and ejaculation took place without the slightest pleasurable sensation.
Claudius exemplifies this fact in his report of a Venetian merchant who
had vigorous erections and ejaculations of thick and abundant semen
without either tingling or pleasure.

Attila, King of the Huns, and one of the most celebrated leaders of the
German hosts which overran the Roman Empire in its decline, and whose
enormous army and name inspired such terror that he was called the
"Scourge of God," was supposed to have died in coitus. Apoplexy,
organic heart disorders, aneurysms, and other like disorders are in
such cases generally the direct cause of death, coitus causing the
death indirectly by the excitement and exertion accompanying the act.

Bartholinus, Benedictus, Borellus, Pliny, Morgagni, Plater, a Castro,
Forestus, Marcellus Donatus, Schurig, Sinibaldus, Schenck, the
Ephemerides, and many others mention death during coitus; the older
writers in some cases attributed the fatal issue to excessive sexual
indulgence, not considering the possibility of the associate direct
cause, which most likely would have been found in case of a necropsy.

Suspended Animation.--Various opinions have been expressed as to the
length of time compatible with life during which a person can stay
under water. Recoveries from drowning furnish interesting examples of
the suspension of animation for a protracted period, but are hardly
ever reliable, as the subject at short intervals almost invariably
rises to the surface of the water, allowing occasional respiration.
Taylor mentions a child of two who recovered after ten minutes'
submersion; in another case a man recovered after fourteen minutes'
submersion. There is a case reported in this country of a woman who was
said to have been submerged twenty minutes. Guerard quotes a case
happening in 1774, in which there was submersion for an hour with
subsequent recovery; but there hardly seems sufficient evidence of this.

Green mentions submersion for fifteen minutes; Douglass, for fourteen
minutes; Laub, for fifteen minutes; Povall gives a description of three
persons who recovered after a submersion of twenty-five minutes. There
is a case in French literature, apparently well authenticated, in which
submersion for six minutes was followed by subsequent recovery.

There have been individuals who gave exhibitions of prolonged
submersion in large glass aquariums, placed in full view of the
audience. Taylor remarks that the person known some years ago in London
as "Lurline" could stay under water for three minutes.  There have been
several exhibitionists of this sort. Some of the more enterprising seat
themselves on an artificial coral, and surrounded by fishes of divers
hues complacently eat a meal while thus submerged. It is said that
quite recently in Detroit there was a performer who accomplished the
feat of remaining under water four minutes and eight seconds in full
view of the audience. Miss Lurline swam about in her aquarium, which
was brilliantly illuminated, ate, reclined, and appeared to be taking a
short nap during her short immersion. In Paris, some years since, there
was exhibited a creature called "l'homme-poisson," who performed feats
similar to Lurline, including the smoking of a cigarette held entirely
in his mouth. In all these exhibitions all sorts of artificial means
are used to make the submersion appear long. Great ceremony, music, and
the counting of the seconds in a loud voice from the stage, all tend to
make the time appear much longer than it really is. However, James
Finney in London, April 7, 1886, stayed under water four minutes,
twenty-nine and one-fourth seconds, and one of his feats was to pick up
70 or 80 gold-plated half-pennies with his mouth, his hands being
securely tied behind his back, and never emerging from his tank until
his feat was fully accomplished. In company with his sister he played a
game of "nap" under water, using porcelain cards and turning them to
the view of the audience.  "Professor Enochs" recently stayed under
water at Lowell, Mass., for four minutes, forty-six and one-fifth
seconds. The best previous record was four minutes, thirty-five
seconds, made by "Professor Beaumont" at Melbourne on December 16, 1893.

For the most satisfactory examples of prolonged submersion we must look
to the divers, particularly the natives who trade in coral, and the
pearl fishers. Diving is an ancient custom, and even legendary exploits
of this nature are recorded. Homer compares the fall of Hector's
chariot to the action of a diver; and specially trained men were
employed at the Siege of Syracuse, their mission being to laboriously
scuttle the enemy's vessels.  Many of the old historians mention
diving, and Herodotus speaks of a diver by the name of Scyllias who was
engaged by Xerxes to recover some articles of value which had been sunk
on some Persian vessels in a tempest. Egyptian divers are mentioned by
Plutarch, who says that Anthony was deceived by Cleopatra in a fishing
contest by securing expert divers to place the fish upon the hooks.
There was a historical or rather legendary character by the name of
Didion, who was noted for his exploits in the river Meuse. He had the
ability to stay under water a considerable length of time, and even to
catch fish while submerged.

There was a famous diver in Sicily at the end of the fifteenth century
whose feats are recorded in the writings of Alexander ab Alexandro,
Pontanus, and Father Kircher, the Jesuit savant. This man's name was
Nicolas, born of poor parents at Catania. From his infancy he showed an
extraordinary power of diving and swimming, and from his compatriots
soon acquired various names indicative of his capacity. He became very
well known throughout Sicily, and for his patron had Frederick, King of
Naples. In the present day, the sponge-fishers and pearl-fishers in the
West Indies, the Mediterranean, the Indian Seas, and the Gulf of Mexico
invite the attention of those interested in the anomalies of suspended
animation. There are many marvelous tales of their ability to remain
under water for long periods. It is probable that none remain submerged
over two minutes, but, what is more remarkable, they are supposed to
dive to extraordinary depths, some as much as 150 to 200 feet.
Ordinarily they remain under water from a minute to one and a half
minutes. Remaining longer, the face becomes congested, the eyes
injected; the sputum bloody, due to rupture of some of the minute
vessels in the lung. It is said by those who have observed them
carefully that few of these divers live to an advanced age. Many of
them suffer apoplectic attacks, and some of them become blind from
congestion of the ocular vessels. The Syrian divers are supposed to
carry weights of considerable size in their hands in order to
facilitate the depth and duration of submersion. It is also said that
the divers of Oceanica use heavy stones. According to Guyot-Daubes, in
the Philippine Isles the native pearl-fishers teach their children to
dive to the depth of 25 meters. The Tahitians, who excited the
admiration of Cook, are noted for their extraordinary diving.  Speaking
of the inhabitants of the island of Fakaraya, near Tahiti, de la
Quesnerie says that the pearl-fishers do not hesitate to dive to the
depth even of 100 feet after their coveted prizes. On the Ceylon coast
the mother-of-pearl fishers are under the direction of the English
Government, which limits the duration and the practice of this
occupation. These divers are generally Cingalese, who practice the
exercise from infancy.  As many as 500 small boats can be seen about
the field of operation, each equipped with divers. A single diver makes
about ten voyages under the water, and then rests in the bottom of the
boat, when his comrade takes his place. Among other native divers are
the Arabs of Algeria and some of the inhabitants of the Mexican coast.

It might be well to mention here the divers who work by means of
apparatus. The ancients had knowledge of contrivances whereby they
could stay under water some time. Aristotle speaks of an instrument by
which divers could rest under water in communication with the air, and
compares it with the trunk of an elephant wading a stream deeper than
his height. In the presence of Charles V diving bells were used by the
Greeks in 1540. In 1660 some of the cannon of the sunken ships of the
Spanish Armada were raised by divers in diving bells. Since then
various improvements in submarine armor have been made, gradually
evolving into the present perfected diving apparatus of to-day, by
which men work in the holds of vessels sunk in from 120 to 200 feet of
water. The enormous pressure of the water at these great depths makes
it necessary to have suits strong enough to resist it. Lambert, a
celebrated English diver, recovered L90,000 in specie from the steamer
Alphonso XII, a Spanish mail boat belonging to the Lopez line, which
sank off Point Gando, Grand Canary, in 26 1/2 fathoms of water. For
nearly six months the salvage party, despatched by the underwriters in
May, 1885, persevered in the operations; two divers lost their lives,
the golden bait being in the treasure-room beneath the three decks, but
Lambert finished the task successfully.

Deep-sea divers only acquire proficiency after long training. It is
said that as a rule divers are indisposed to taking apprentices, as
they are afraid of their vocation being crowded and their present ample
remuneration diminished. At present there are several schools. At
Chatham, England, there is a school of submarine mining, in which men
are trained to lay torpedoes and complete harbor defense. Most of these
divers can work six hours at a time in from 35 to 50 feet of water.
Divers for the Royal Navy are trained at Sheerness. When sufficiently
trained to work at the depth of 150 feet seamen-divers are fully
qualified, and are drafted to the various ships. They are connected
with an air-pump in charge of trustworthy men; they signal for their
tools and material, as well as air, by means of a special line for this
purpose. At some distance below the water the extraordinary weight of
the suits cannot be felt, and the divers work as well in armor as in
ordinary laboring clothes. One famous diver says that the only
unpleasant experience he ever had in his career as a diver, not
excepting the occasion of his first dive, was a drumming in the ears,
as a consequence of which, after remaining under water at a certain
work for nine hours, he completely lost the use of one ear for three
months, during which time he suffered agony with the earache. These men
exhibit absolute indifference to the dangers attached to their calling,
and some have been known to sleep many fathoms beneath the surface.
Both by means of their signal lines and by writing on a slate they keep
their associates informed of the progress of their work.

Suspension of the Pulse.--In some cases the pulse is not apparent for
many days before actual death, and there have been instances in which,
although the pulse ceased for an extended period, the patient made an
ultimate recovery. In reviewing the older literature we find that
Ballonius mentions an instance in which the pulse was not apparent for
fourteen days before complete asphyxia. Ramazzini describes a case of
cessation of the pulse four days before death. Schenck details the
history of a case in which the pulse ceased for three days and asphyxia
was almost total, but the patient eventually recovered. There is a
noteworthy observation, in which there was cessation of the pulse for
nine days without a fatal issue.

Some persons seem to have a preternatural control over their
circulatory system, apparently enabling them to produce suspension of
cardiac movement at will. Cheyne speaks of a Colonel Townshend who
appeared to possess the power of dying, as it were, at will,--that is,
so suspending the heart's action that no pulsation could be detected.
After lying in this state of lifelessness for a short period, life
would become slowly established without any consciousness or volition
on the man's part. The longest period in which he remained in this
death-like condition was about thirty minutes. A postmortem examination
of this person was awaited with great interest; but after his death
nothing was found to explain the power he possessed over his heart.

Saint Augustin knew of a priest named Rutilut who had the power of
voluntarily simulating death. Both the pulsation and respiration was
apparently abolished when he was in his lifeless condition. Burning and
pricking left visible effects on the skin after his recovery, but had
no apparent effect on his lethargy.  Chaille reports an instance of
voluntary suspension of the pulse.

Relative to hibernation, it is well-known that mice, snakes, and some
reptiles, as well as bees, sometimes seem to entirely suspend animation
for an extended period, and especially in the cold weather. In Russia
fish are transported frozen stiff, but return to life after being
plunged into cold water. A curious tale is told by Harley, from Sir
John Lubbock, of a snail brought from Egypt and thought to be dead. It
was placed on a card and put in position on a shelf in the British
Museum in March, 1845.  In March, 1850 after having been gummed to a
label for five years, it was noticed to have an apparent growth on its
mouth and was taken out and placed in water, when it soon showed signs
of life and ate cabbage leaves offered to it. It has been said, we
think with credible evidence, that cereal seeds found in the tombs with
mummies have grown when planted, and Harley quotes an instance of a
gentleman who took some berries, possibly the remnants of Pharaoh's
daughter's last meal, coming as they did from her mummified stomach
after lying dormant in an Egyptian tomb many centuries, and planted
them in his garden, where they soon grew, and he shortly had a bush as
flourishing as any of those emanating from fresh seeds.

Human hibernation is an extremely rare anomaly. Only the fakirs of
India seem to have developed this power, and even the gifted ones there
are seldom seen. Many theories have been advanced to explain this
ability of the fakirs, and many persons have discredited all the
stories relative to their powers; on the other hand, all who have
witnessed their exhibitions are convinced of their genuineness.
Furthermore, these persons are extremely scarce and are indifferent to
money; none has been enticed out of his own country to give
exhibitions. When one dies in a community, his place is never
filled--proving that he had no accomplices who knew any fraudulent
secret practices, otherwise the accomplice would soon step out to take
his place. These men have undoubtedly some extraordinary mode of
sending themselves into a long trance, during which the functions of
life are almost entirely suspended. We can readily believe in their
ability to fast during their periods of burial, as we have already
related authentic instances of fasting for a great length of time,
during which the individual exercised his normal functions.

To the fakir, who neither visibly breathes nor shows circulatory
movements, and who never moves from his place of confinement, fasting
should be comparatively easy, when we consider the number of men whose
minds were actively at work during their fasts, and who also exercised
much physical power.

Harley says that the fakirs begin their performances by taking a large
dose of the powerfully stupefying "bang," thus becoming narcotized. In
this state they are lowered into a cool, quiet tomb, which still
further favors the prolongation of the artificially induced vital
lethargy; in this condition they rest for from six to eight weeks. When
resurrected they are only by degrees restored to life, and present a
wan, haggard, debilitated, and wasted appearance. Braid is credited, on
the authority of Sir Claude Wade, with stating that a fakir was buried
in an unconscious state at Lahore in 1837, and when dug up, six weeks
later, he presented all the appearances of a dead person. The legs and
arms were shrunken and stiff, and the head reclined on the shoulder in
a manner frequently seen in a corpse.  There was no pulsation of the
heart or arteries of the arm or temple--in fact, no really visible
signs of life. By degrees this person was restored to life. Every
precaution had been taken in this case to prevent the possibility of
fraud, and during the period of interment the grave was guarded night
and day by soldiers of the regiment stationed at Lahore.

Honigberger, a German physician in the employ of Runjeet Singh, has an
account of a fakir of Punjaub who allowed himself to be buried in a
well-secured vault for such a long time that grain sown in the soil
above the vault sprouted into leaf before he was exhumed. Honigberger
affirms that the time of burial was over 40 days, and that on being
submitted to certain processes the man recovered and lived many years
after. Sir Henry Lawrence verified the foregoing statements. The chest
in which the fakir was buried was sealed with the Runjeet stamp on it,
and when the man was brought up he was cold and apparently lifeless.
Honigberger also states that this man, whose name was Haridas, was four
months in a grave in the mountains; to prove the absolute suspension of
animation, the chin was shaved before burial, and at exhumation this
part was as smooth as on the day of interment. This latter statement
naturally calls forth comment when we consider the instances that are
on record of the growth of beard and hair after death.

There is another account of a person of the same class who had the
power of suspending animation, and who would not allow his coffin to
touch the earth for fear of worms and insects, from which he is said to
have suffered at a previous burial.

It has been stated that the fakirs are either eunuchs or
hermaphrodites, social outcasts, having nothing in common with the
women or men of their neighborhood; but Honigberger mentions one who
disproved this ridiculous theory by eloping to the mountains with his
neighbor's wife.

Instances of recovery after asphyxia from hanging are to be found,
particularly among the older references of a time when hanging was more
common than it is to-day. Bartholinus, Blegny, Camerarius, Morgagni,
Pechlin, Schenck, Stoll, and Wepfer all mention recovery after hanging.
Forestus describes a case in which a man was rescued by provoking
vomiting with vinegar, pepper, and mustard seed. There is a case on
record in which a person was saved after hanging nineteen minutes.
There was a case of a man brought into the Hopital Saint-Louis
asphyxiated by strangulation, having been hung for some time. His
rectal temperature was only 93.3 degrees F., but six hours after it
rose to 101.6 degrees F., and he subsequently recovered. Taylor cites
the instance of a stout woman of forty-four who recovered from hanging.
When the woman was found by her husband she was hanging from the top of
a door, having been driven to suicide on account of his abuse and
intemperance. When first seen by Taylor she was comatose, her mouth was
surrounded by white froth, and the swollen tongue protruded from it.
Her face was bloated, her lips of a darkened hue, and her neck of a
brown parchment-color. About the level of the larynx, the epidermis was
distinctly abraded, indicating where the rope had been. The conjunctiva
was insensible and there was no contractile response of the pupil to
the light of a candle. The reflexes of the soles of the feet were
tested, but were quite in abeyance. There was no respiratory movement
and only slight cardiac pulsation. After vigorous measures the woman
ultimately recovered. Recovery is quite rare when the asphyxiation has
gone so far, the patients generally succumbing shortly after being cut
down or on the following day.  Chevers mentions a most curious case, in
which cerebral congestion from the asphyxiation of strangling was
accidentally relieved by an additional cut across the throat. The
patient was a man who was set upon by a band of Thugs in India, who,
pursuant to their usual custom, strangled him and his fellow-traveler.
Not being satisfied that he was quite dead, one of the band returned
and made several gashes across his throat. This latter action
effectually relieved the congestion caused by the strangulation and
undoubtedly saved his life, while his unmutilated companion was found
dead. After the wounds in his throat had healed this victim of the
Thugs gave such a good description of the murderous band that their
apprehension and execution soon followed.

Premature Burial.--In some instances simulation of death has been so
exact that it has led to premature interment. There are many such cases
on record, and it is a popular superstition of the laity that all the
gruesome tales are true of persons buried alive and returning to life,
only to find themselves hopelessly lost in a narrow coffin many feet
below the surface of the earth.  Among the lower classes the dread of
being buried before life is extinct is quite generally felt, and for
generations the medical profession have been denounced for their
inability to discover an infallible sign of death. Most of the
instances on record, and particularly those from lay journals, are
vivid exaggerations, drawn from possibly such a trivial sign as a
corpse found with the fist tightly clenched or the face distorted,
which are the inspiration of the horrible details of the dying
struggles of the person in the coffin. In the works of Fontenelle there
are 46 cases recorded of the premature interment of the living, in
which apparent has been mistaken for real death. None of these cases,
however, are sufficiently authentic to be reliable. Moreover, in all
modern methods of burial, even if life were not extinct, there could be
no possibility of consciousness or of struggling.  Absolute
asphyxiation would soon follow the closing of the coffin lid.

We must admit, however, that the mistake has been made, particularly in
instances of catalepsy or trance, and during epidemics of malignant
fevers or plagues, in which there is an absolute necessity of hasty
burial for the prevention of contagion. In a few instances on the
battle-field sudden syncope, or apparent death, has possibly led to
premature interment; but in the present day this is surely a very rare
occurrence. There is also a danger of mistake from cases of
asphyxiation, drowning, and similar sudden suspensions of the vital
functions.

It is said that in the eighty-fourth Olympiad, Empedocles restored to
life a woman who was about to be buried, and that this circumstance
induced the Greeks, for the future protection of the supposed dead, to
establish laws which enacted that no person should be interred until
the sixth or seventh day. But even this extension of time did not give
satisfaction, and we read that when Hephestion, at whose funeral
obsequies Alexander the Great was present, was to be buried his funeral
was delayed until the tenth day. There is also a legend that when
Acilius Aviola fell a victim to disease he was burned alive, and
although he cried out, it was too late to save him, as the fire had
become so widespread before life returned.

While returning to his country house Asclepiades, a physician
denominated the "God of Physic," and said to have been a descendant of
aesculapius, saw during the time of Pompey the Great a crowd of
mourners about to start a fire on a funeral pile. It is said that by
his superior knowledge he perceived indications of life in the corpse
and ordered the pile destroyed, subsequently restoring the supposed
deceased to life. These examples and several others of a similar nature
induced the Romans to delay their funeral rites, and laws were enacted
to prevent haste in burning, as well as in interment. It was not until
the eighth day that the final rites were performed, the days
immediately subsequent to death having their own special ceremonies.
The Turks were also fearful of premature interment and subjected the
defunct to every test; among others, one was to examine the
contractility of the sphincter and, which shows their keen observation
of a well-known modern medical fact.

According to the Memoirs of Amelot de la Houssaye, Cardinal Espinola,
Prime Minister to Philip II, put his hand to the embalmer's knife with
which he was about to be opened; It is said that Vesalius, sometimes
called the "Father of Anatomy," having been sent for to perform an
autopsy on a woman subject to hysteric convulsions, and who was
supposed to be dead, on making the first incision perceived by her
motion and cries that she was still alive. This circumstance, becoming
known, rendered him so odious that he had to leave the community in
which he practiced, and it is believed that he never entirely recovered
from the shock it gave him. The Abbe Prevost, so well known by his
works and the singularities of his life, was seized by apoplexy in the
Forest of Chantilly on October 23, 1763. His body was carried to the
nearest village, and the officers of justice proceeded to open it, when
a cry he sent forth frightened all the assistants and convinced the
surgeon in charge that the Abbe was not dead; but it was too late to
save him, as he had already received a mortal wound.

Massien speaks of a woman living in Cologne in 1571 who was interred
living, but was not awakened from her lethargy until a grave-digger
opened her grave to steal a valuable ring which she wore. This instance
has been cited in nearly every language.  There is another more recent
instance, coming from Poitiers, of the wife of a goldsmith named
Mernache who was buried with all her jewels. During the night a beggar
attempted to steal her jewelry, and made such exertion in extracting
one ring that the woman recovered and was saved. After this
resurrection she is said to have had several children. This case is
also often quoted. Zacchias mentions an instance which, from all
appearances, is authentic. It was that of a young man, pest-stricken
and thought to be dead, who was placed with the other dead for burial.
He exhibited signs of life, and was taken back to the pest-hospital.
Two days later he entered a lethargic condition simulating death, and
was again on his way to the sepulcher, when he once more recovered.

It is said that when the body of William, Earl of Pembroke, who died
April 10, 1630, was opened to be embalmed, the hand raised when the
first incision was made. There is a story of an occurrence which
happened on a return voyage from India. The wife of one of the
passengers, an officer in the army, to all appearances died. They were
about to resort to sea-burial, when, through the interposition of the
husband, who was anxious to take her home, the ship-carpenters started
to construct a coffin suitable for a long voyage, a process which took
several days, during which time she lay in her berth, swathed in robes
and ready for interment. When the coffin was at last ready the husband
went to take his last farewell, and removed the wedding-ring, which was
quite tightly on her finger. In the effort to do this she was aroused,
recovered, and arrived in England perfectly well.

It is said that when a daughter of Henry Laurens, the first President
of the American Congress, died of small-pox, she was laid out as dead,
and the windows of the room were opened for ventilation. While left
alone in this manner she recovered. This circumstance so impressed her
illustrious father that he left explicit directions that in case of his
death he should be burned. The same journal also contains the case of a
maid-servant who recovered thrice on her way to the grave, and who,
when really dead, was kept a preposterous length of time before burial.

The literature on this subject is very exhaustive, volumes having been
written on the uncertainty of the signs of death, with hundreds of
examples cited illustrative of the danger of premature interment. The
foregoing instances have been given as indicative of the general style
of narration; for further information the reader is referred to the
plethora of material on this subject.

Postmortem Anomalies.--Among the older writers startling movements of a
corpse have given rise to much discussion, and possibly often led to
suspicion of premature burial. Bartholinus describes motion in a
cadaver. Barlow says that movements were noticed after death in the
victims of Asiatic cholera. The bodies were cold and expressions were
death-like, but there were movements simulating natural life. The most
common was flexion of the right leg, which would also be drawn up
toward the body and resting on the left leg. In some cases the hand was
moved, and in one or two instances a substance was grasped as if by
reflex action. Some observers have stated that reflex movements of the
face were quite noticeable. These movements continued sometimes for
upward of an hour, occurring mostly in muscular subjects who died very
suddenly, and in whom the muscular irritability or nervous stimulus or
both had not become exhausted at the moment of dissolution. Richardson
doubts the existence of postmortem movements of respiration.

Snow is accredited with having seen a girl in Soho who, dying of
scarlet fever, turned dark at the moment of death, but in a few hours
presented such a life-line appearance and color as to almost denote the
return of life. The center of the cheeks became colored in a natural
fashion, and the rest of the body resumed the natural flesh color. The
parents refused to believe that death had ensued. Richardson remarks
that he had seen two similar cases, and states that he believes the
change is due to oxidation of the blood surcharged with carbon dioxid.
The moist tissues suffuse carbonized blood, and there occurs an osmotic
interchange between the carbon dioxid and the oxygen of the air
resulting in an oxygenation of the blood, and modification of the color
from dark venous to arterial red.

A peculiar postmortem anomaly is erection of the penis. The Ephemerides
and Morgagni discuss postmortem erection, and Guyon mentions that on
one occasion he saw 14 negroes hanged, and states that at the moment of
suspension erection of the penis occurred in each; in nine of these
blacks traces of this erectile state were perceived an hour after death.

Cadaveric perspiration has been observed and described by several
authors, and Paullini has stated that he has seen tears flow from the
eyes of a corpse.

The retardation of putrefaction of the body after death sometimes
presents interesting changes. Petrifaction or mummification of the body
are quite well known, and not being in the province of this work, will
be referred to collateral books on this subject; but sometimes an
unaccountable preservation takes place. In a tomb recently opened at
Canterbury Cathedral, a for the purpose of discovering what
Archbishop's body it contained, the corpse was of an extremely
offensive and sickening odor, unmistakably that of putrefaction. The
body was that of Hubert Walter, who died in 1204 A.D., and the
decomposition had been retarded, and was actually still in progress,
several hundred years after burial.

Retardation of the putrefactive process has been noticed in bodies some
years under water. Konig of Hermannstadt mentions a man who, forty
years previous to the time of report, had fallen under the waters of
Echoschacht, and who was found in a complete state of preservation.

Postmortem Growth of Hair and Nails.--The hair and beard may grow after
death, and even change color. Bartholinus recalls a case of a man who
had short, black hair and beard at the time of interment, but who, some
time after death, was found to possess long and yellowish hair.
Aristotle discusses postmortem growth of the hair, and Garmanus cites
an instance in which the beard and hair were cut several times from the
cadaver. We occasionally see evidences of this in the dissecting-rooms.
Caldwell mentions a body buried four years, the hair from which
protruded at the points where the joints of the coffin had given away.
The hair of the head measured 18 inches, that of the beard eight
inches, and that on the breast from four to six inches. Rosse of
Washington mentions an instance in which after burial the hair turned
from dark brown to red, and also cites a case in a Washington cemetery
of a girl, twelve or thirteen years old, who when exhumed was found to
have a new growth of hair all over her body. The Ephemerides contains
an account of hair suddenly turning gray after death.

Nails sometimes grow several inches after death, and there is on record
the account of an idiot who had an idiosyncrasy for long nails, and
after death the nails were found to have grown to such an extent that
they curled up under the palms and soles.

The untoward effects of the emotions on the vital functions are quite
well exemplified in medical literature. There is an abundance of cases
reported in which joy, fear, pride, and grief have produced a fatal
issue. In history we have the old story of the Lacedemonian woman who
for some time had believed her son was dead, and who from the sudden
joy occasioned by seeing him alive, herself fell lifeless. There is a
similar instance in Roman history. Aristotle, Pliny, Livy, Cicero, and
others cite instances of death from sudden or excessive joy. Fouquet
died of excessive joy on being released from prison. A niece of the
celebrated Leibnitz immediately fell dead on seeing a casket of gold
left to her by her deceased uncle.

Galen mentions death from joy, and in comment upon it he says that the
emotion of joy is much more dangerous than that of anger. In discussing
this subject, Haller says that the blood is probably sent with such
violence to the brain as to cause apoplexy. There is one case on record
in which after a death from sudden joy the pericardium was found full
of blood. The Ephemerides, Marcellus Donatus, Martini, and Struthius
all mention death from joy.

Death from violent laughter has been recorded, but in this instance it
is very probable that death was not due to the emotion itself, but to
the extreme convulsion and exertion used in the laughter. The
Ephemerides mentions a death from laughter, and also describes the
death of a pregnant woman from violent mirth. Roy, Swinger, and
Camerarius have recorded instances of death from laughter. Strange as
it may seem, Saint-Foix says that the Moravian brothers, a sect of
Anabaptists having great horror of bloodshed, executed their condemned
brethren by tickling them to death.

Powerfully depressing emotions, which are called by Kant "asthenic,"
such as great and sudden sorrow, grief, or fright, have a pronounced
effect on the vital functions, at times even causing death. Throughout
literature and history we have examples of this anomaly. In
Shakespeare's "Pericles," Thaisa, the daughter to Simonides and wife of
Pericles, frightened when pregnant by a threatened shipwreck, dies in
premature childbirth.

In Scott's "Guy Mannering," Mrs. Bertram, on suddenly learning of the
death of her little boy, is thrown into premature labor, followed by
death. Various theories are advanced in explanation of this anomaly. A
very plausible one is, that the cardiac palsy is caused by energetic
and persistent excitement of the inhibitory cardiac nerves. Strand is
accredited with saying that agony of the mind produces rupture of the
heart. It is quite common to hear the expression, "Died of a broken
heart;" and, strange to say, in some cases postmortem examination has
proved the actual truth of the saying. Bartholinus, Fabricius Hildanus,
Pliny, Rhodius, Schenck, Marcellus Donatus, Riedlin, and Garengeot
speak of death from fright and fear, and the Ephemerides describes a
death the direct cause of which was intense shame. Deleau, a celebrated
doctor of Paris, while embracing his favorite daughter, who was in the
last throes of consumption, was so overcome by intense grief that he
fell over her corpse and died, and both were buried together.

The fear of child-birth has been frequently cited as a cause of death
McClintock quotes a case from Travers of a young lady, happily married;
who entertained a fear of death in child-birth; although she had been
safely delivered, she suddenly and without apparent cause died in six
hours. Every region of the body was examined with minutest care by an
eminent physician, but no signs indicative of the cause of death were
found. Mordret cites a similar instance of death from fear of labor.
Morgagni mentions a woman who died from the disappointment of bearing a
girl baby when she was extremely desirous of a boy.

The following case, quoted from Lauder Brunton, shows the extent of
shock which may be produced by fear: Many years ago a janitor of a
college had rendered himself obnoxious to the students, and they
determined to punish him. Accordingly they prepared a block and an axe,
which they conveyed to a lonely place, and having appropriately dressed
themselves, some of them prepared to act as judges, and sent others of
their company to bring him before them. He first affected to treat the
whole affair as a joke, but was solemnly assured by the students that
they meant it in real earnest. He was told to prepare for immediate
death. The trembling janitor looked all around in the vain hope of
seeing some indication that nothing was really meant, but stern looks
met him everywhere. He was blindfolded, and made to kneel before the
block. The executioner's axe was raised, but, instead of the sharp
edge, a wet towel was brought sharply down on the back of the neck. The
bandage was now removed from the culprit's eyes, but to the horror and
astonishment of the students they found that he was dead. Such a case
may be due to heart-failure from fear or excitement.

It is not uncommon that death ensues from the shock alone following
blows that cause no visible injury, but administered to vital parts.
This is particularly true of blows about the external genital region,
or epigastrium, where the solar plexus is an active factor in
inhibition. Ivanhoff of Bulgaria in 1886 speaks of a man of forty-five
who was dealt a blow on the testicle in a violent street fight, and
staggering, he fell insensible. Despite vigorous medical efforts he
never regained consciousness and died in forty-five minutes. Postmortem
examination revealed everything normal, and death must have been caused
by syncope following violent pain. Watkins cites an instance occurring
in South Africa. A native shearing sheep for a farmer provoked his
master's ire by calling him by some nickname.  While the man was in a
squatting posture the farmer struck him in the epigastrium. He followed
this up by a kick in the side and a blow on the head, neither of which,
however, was as severe as the first blow. The man fell unconscious and
died. At the autopsy there were no signs indicative of death, which
must have been due to the shock following the blow on the epigastrium.

As illustrative of the sensitiveness of the epigastric region, Vincent
relates the following case: "A man received a blow by a stick upon the
epigastrium. He had an anxious expression and suffered from oppression.
Irregular heart-action and shivering were symptoms that gradually
disappeared during the day. In the evening his appetite returned and he
felt well; during the night he died without a struggle, and at the
autopsy there was absolutely nothing abnormal to be found." Blows upon
the neck often produce sudden collapse. Prize-fighters are well aware
of the effects of a blow on the jugular vein. Maschka, quoted by
Warren, reports the case of a boy of twelve, who was struck on the
anterior portion of the larynx by a stone. He fell lifeless to the
ground, and at autopsy no local lesion was found nor any lesion
elsewhere. The sudden death may be attributed in this case partly to
shock and partly to cerebral anemia.

Soldiers have been seen to drop lifeless on the battle-field without
apparent injury or organic derangement; in the olden times this death
was attributed to fear and fright, and later was supposed to be caused
by what is called "the wind of a cannon-ball." Tolifree has written an
article on this cause of sudden death and others have discussed it. By
some it is maintained that the momentum acquired by a cannon-ball
generates enough force in the neighboring air to prostrate a person in
the immediate vicinity of its path of flight.



CHAPTER X.

SURGICAL ANOMALIES OF THE HEAD AND NECK.

Injuries of such a delicate organ as the eye, in which the slightest
accident can produce such disastrous consequences, naturally elicit the
interest of all. Examples of exophthalmos, or protrusion of the eye
from the orbit from bizarre causes, are of particular interest. Among
the older writers we find Ficker and the Ephemerides giving instances
of exophthalmos from vomiting. Fabricius Hildanus mentions a similar
instance.  Salmuth, Verduc, and others mention extrusion of the eyeball
from the socket, due to excessive coughing. Ab Heers and Sennert
mention instances in which after replacement the sight was uninjured.
Tyler relates the case of a man who, after arising in the morning, blew
his nose violently, and to his horror his left eye extruded from the
orbit. With the assistance of his wife it was immediately replaced and
a bandage placed over it. When Tyler saw him the upper lid was slightly
swollen and discolored, but there was no hemorrhage.

Hutchinson describes extrusion of the eyeball from the orbit caused by
a thrust with a stick. There was paraphymotic strangulation of the
globe, entirely preventing replacement and necessitating excision.
Reyssie speaks of a patient who, during a fire, was struck in the right
eye by a stream of water from a hose, violently thrusting the eye
backward. Contracting under the double influence of shock and cold, the
surrounding tissues forced the eyeball from the orbit, and an hour
later Reyssie saw the patient with the eye hanging by the optic nerve
and muscles.  Its reduction was easy, and after some minor treatment
vision was perfectly restored in the injured organ. Thirty months after
the accident the patient had perfect vision, and the eye had never in
the slightest way discommoded him.

Bodkin mentions the case of a woman of sixty who fell on the key in a
door and completely avulsed her eye. In von Graefe's Archiv there is a
record of a man of seventy-five who suffered complete avulsion of the
eye by a cart-wheel passing over his head.  Verhaeghe records complete
avulsion of the eye caused by a man falling against the ring of a
sharp-worn key. Hamill describes the case of a young girl whose
conjunctiva was pierced by one of the rests of an ordinary gas-bracket.
Being hooked at one of its extremities the iron became entangled in
either the inferior oblique or external rectus muscles, and completely
avulsed the eyeball upon the cheek. The real damage could not be
estimated, as the patient never returned after the muscle was clipped
off close to its conjunctival insertion. Calhoun mentions an instance
of a little Esquimaux dog whose head was seized between the jaws of a
large Newfoundland with such force as to press the left eyeball from
the socket. The ball rested on the cheek, held by the taut optic nerve;
the cornea was opaque. The ball was carefully and gently replaced, and
sight soon returned to the eye.

In former days there was an old-fashioned manner of fighting called
"gouging." In this brutal contest the combatant was successful who
could, with his thumb, press his opponent's eyeball out. Strange to
say, little serious or permanently bad results followed such inhuman
treatment of the eye. Von Langenbeck of Berlin mentions an instance of
fracture of the superior maxilla, in which the eyeball was so much
displaced as to lodge in the antrum of Highmore. Von Becker of
Heidelberg reports the history of a case in which a blow from the horn
of a cow dislocated the eye so far back in the orbit as to present the
appearance of enucleation. The conjunctiva hid the organ from view, but
when it was pulled aside the eyeball was exposed, and in its remote
position still possessed the power of vision. In some cases in which
exophthalmos has been seemingly spontaneous, extreme laxity of the lids
may serve as an explanation. There is an instance on record in which a
Polish dew appeared in a Continental hospital, saying that while
turning in bed, without any apparent cause, his eyeball was completely
extruded. There have been people who prided themselves on their ability
to produce partial exophthalmos.

Rupture of the Eyeball.--Jessop mentions the case of a child of eight
who suffered a blow on the eye from a fall against a bedpost, followed
by compound rupture of the organ. The wound in the sclerotic was three
or four lines in length, and the rent in the conjunctiva was so large
that it required three sutures. The chief interest in this case was the
rapid and complete recovery of vision.

Adler reports a case of fracture of the superior maxillary in which the
dislocated bone-fragment of the lower orbital border, through pressure
on the inferior maxillary and counter pressure on the skull, caused
rupture of the conjunctiva of the left eye.

Serious Sequelae of Orbital Injuries.--In some instances injuries
primarily to the orbit either by extension or implication of the
cerebral contents provoke the most serious issues. Pointed instruments
thrust into the orbital cavity may by this route reach the brain. There
is a record of death caused by a wound of a cavernous sinus through the
orbit by the stem of a tobacco-pipe. Bower saw a woman at the
Gloucester Infirmary who had been stabbed in the eye by the end of an
umbrella. There was profuse hemorrhage from the nostrils and left eye,
but no signs indicative of its origin. Death shortly ensued, and at the
necropsy a fracture through the roof of the orbit was revealed, the
umbrella point having completely severed the optic nerve and divided
the ophthalmic artery. The internal carotid artery was wounded in
one-half of its circumference at its bend, just before it passes up
between the anterior clinoid process and the optic nerve. The cavernous
sinus was also opened. In this rare injury, although there was a
considerable quantity of clotted blood at the base of the brain, there
was no wound to the eyeball nor to the brain itself.

Pepper records a case in which a knife was thrust through the
spheroidal fissure, wounding a large meningeal vein, causing death from
intracranial hemorrhage. Nelaton describes an instance in which the
point of an umbrella wounded the cavernous sinus and internal carotid
artery of the opposite side, causing the formation of an arteriovenous
aneurysm which ultimately burst, and death ensued. Polaillon saw a boy
of eighteen who was found in a state of coma. It was stated that an
umbrella stick had been thrust up through the roof of the orbit and had
been withdrawn with much difficulty. The anterior lobe of the brain was
evidently much wounded; an incision was made in the forehead and a
portion of the frontal bone chiseled away entrance being thus effected,
the aura was incised, and some blood and cerebrospinal fluid escaped.
Five splinters were removed and a portion of the damaged
brain-substance, and a small artery was tied with catgut.  The debris
of the eyeball was enucleated and a drain was placed in the frontal
wound, coming out through the orbit. The patient soon regained
consciousness and experienced no bad symptoms afterward. The drains
were gradually withdrawn, the process of healing advanced rapidly, and
recovery soon ensued.

Annandale mentions an instance in which a knitting-needle penetrated
the brain through the orbit. Hewett speaks of perforation of the roof
of the orbit and injury to the brain by a lead-pencil.

Gunshot Injuries of the Orbit.--Barkan recites the case in which a
leaden ball 32/100 inch in diameter was thrown from a sling into the
left orbital cavity, penetrating between the eyeball and osseous wall
of the orbit without rupturing the tunics of the eye or breaking the
bony wall of the cavity. It remained lodged two weeks without causing
any pain or symptoms, and subsequently worked itself forward, contained
in a perfect conjunctival sac, in which it was freely movable.

Buchanan recites the case of a private in the army who was shot at a
distance of three feet away, the ball entering the inner canthus of the
right eye and lodging under the skin of the opposite side. The eye was
not lost, and opacity of the lower part of the cornea alone resulted.
Cold water and purging constituted the treatment.

It is said a that an old soldier of one of Napoleon's armies had a
musket-ball removed from his left orbit after twenty-four years'
lodgment. He was struck in the orbit by a musket-ball, but as at the
same time a companion fell dead at his side he inferred that the bullet
rebounded from his orbit and killed his comrade.  For twenty-four years
he had suffered from cephalalgia and pains and partial exophthalmos of
the left eye. After removal of the ball the eye partially atrophied.

Warren reports a case of a man of thirty-five whose eyeball was
destroyed by the explosion of a gun, the breech-pin flying off and
penetrating the head. The orbit was crushed; fourteen months afterward
the man complained of soreness on the hard palate, and the whole
breech-pin, with screw attached, was extracted. The removal of the pin
was followed by fissure of the hard palate, which, however, was
relieved by operation. The following is an extract of a report by
Wenyon of Fatshan, South China:--

"Tang Shan, Chinese farmer, thirty-one years of age, was injured in the
face by the bursting of a shot-gun. After being for upward of two
months under the treatment of native practitioners, he came to me on
December 4, 1891. I observed a cicatrix on the right side of his nose,
and above this a sinus, still unhealed, the orifice of which involved
the inner canthus of the right eye, and extended downward and inward
for about a centimeter. The sight of the right eye was entirely lost,
and the anterior surface of the globe was so uniformly red that the
cornea could hardly be distinguished from the surrounding conjunctiva.
There was no perceptible enlargement or protrusion of the eyeball, and
it did not appear to have sustained any mechanical injury or loss of
tissue. The ophthalmia and keratitis were possibly caused by the
irritating substances applied to the wound by the Chinese doctors. The
sinus on the side of the nose gave exit to a continuous discharge of
slightly putrid pus, and the patient complained of continuous headache
and occasional dizziness, which interfered with his work. The pain was
referred to the right frontal and temporal regions, and the skin on
this part of the head had a slight blush, but there was no superficial
tenderness.  The patient had been told by his native doctors, and he
believed it himself, that there was no foreign body in the wound; but
on probing it I easily recognized the lower edge of a hard metallic
substance at a depth of about one inch posteriorly from the orifice of
the sinus. Being unable to obtain any reliable information as to the
probable size or shape of the object, I cautiously made several
attempts to remove it through a slightly enlarged opening, but without
success. I therefore continued the incision along the side of the nose
to the nostril, thus laying open the right nasal cavity; then, seizing
the foreign body with a pair of strong forceps, I with difficulty
removed the complete breech-pin of a Chinese gun. Its size and shape
are accurately represented by the accompanying drawing. The breech-pin
measures a little over three inches in length, and weighs 21 ounces, or
75.6 grams. It had evidently lain at the back of the orbit, inclined
upward and slightly backward from its point of entrance, at an angle of
about 45 degrees. On its removal the headache was at once relieved and
did not return. In ten days the wound was perfectly healed and the
patient went back to his work. A somewhat similar case, but which
terminated fatally, is recorded in the American Journal of the Medical
Sciences of July, 1882."

The extent of permanent injury done by foreign bodies in the orbit is
variable. In some instances the most extensive wound is followed by the
happiest result, while in others vision is entirely destroyed by a
minor injury.

Carter reports a case in which a hat-peg 3 3/10 inches long and about
1/4 inch in diameter (upon one end of which was a knob nearly 1/2 inch
in diameter) was impacted in the orbit for from ten to twenty days, and
during this time the patient was not aware of the fact. Recovery
followed its extraction, the vision and movements of the eye being
unimpaired.

According to the Philosophical Transactions a laborer thrust a long
lath with great violence into the inner canthus of the left eye of his
fellow workman, Edward Roberts. The lath broke off short, leaving a
piece two inches long, 1/2 inch wide, and 1/4 inch thick, in situ.
Roberts rode about a mile to the surgery of Mr. Justinian Morse, who
extracted it with much difficulty; recovery followed, together with
restoration of the sight and muscular action. The lath was supposed to
have passed behind the eyeball. Collette speaks of an instance in which
186 pieces of glass were extracted from the left orbit, the whole mass
weighing 186 Belgian grains. They were blown in by a gust of wind that
broke a pane of glass; after extraction no affection of the brain or
eye occurred. Watson speaks of a case in which a chip of steel 3/8 inch
long was imbedded in cellular tissue of the orbit for four days, and
was removed without injury to the eye. Wordsworth reports a case in
which a foreign body was deeply imbedded in the orbit for six weeks,
and was removed with subsequent recovery.  Chisholm has seen a case in
which for five weeks a fly was imbedded in the culdesac between the
lower lid and the eyeball.

Foreign bodies are sometimes contained in the eyeball for many years.
There is an instance on record in which a wooden splinter, five mm.
long and two mm. broad, remained in the eye forty-seven years. It was
extracted, with the lens in which it was lodged, to relieve pain and
other distressing symptoms. Snell reports a case in which a piece of
steel was imbedded and encapsulated in the ciliary process twenty-nine
years without producing sympathetic irritation of its fellow, but
causing such pain as to warrant enucleation of this eye. Gunning speaks
of a piece of thorn 5/8 inch long, imbedded in the left eyeball of an
old man for six years, causing total loss of vision; he adds that,
after its removal, some improvement was noticed.

Williams mentions a stone-cutter whose left eye was put out by a piece
of stone. Shortly after this his right eye was wounded by a knife,
causing traumatic cataract, which was extracted by Sir William Wilde,
giving the man good sight for twelve years, after which iritis attacked
the right eye and produced a false membrane over the pupil so that the
man could not work. It was in this condition that he consulted
Williams, fourteen years after the loss of the left eye. The eye was
atrophied, and on examination a piece of stone was seen projecting from
it directly between the lids. The visible portion was 1/4 inch long,
and the end in the shrunken eye was evidently longer than the end
protruding. The sclera was incised, and, after fourteen years' duration
in the eye, the stone was removed.

Taylor reports the removal of a piece of bone which had remained
quiescent in the eye for fourteen years; after the removal of the eye
the bone was found adherent to the inner tunics. It resembled the lens
in size and shape. Williams mentions continual tolerance of foreign
bodies in the eyeball for fifteen and twenty-two years; and Chisholm
reports the lodgment of a fragment of metal in the iris for
twenty-three years. Liebreich extracted a piece of steel from the
interior of the eye where it had been lodged twenty-two years. Barkar
speaks of a piece of steel which penetrated through the cornea and
lens, and which, five months later, was successfully removed by the
extraction of the cataractous lens. Critchett gives an instance of a
foreign body being loose in the anterior chamber for sixteen years.
Rider speaks of the lodgment of a fragment of a copper percussion cap
in the left eye, back of the inner ciliary margin of the iris, for
thirty-five years; and Bartholinus mentions a thorn in the canthus for
thirty years. Jacob reports a case in which a chip of iron remained in
the eyeball twenty-eight years without giving indications for removal.
It was clearly visible, protruding into the anterior surface of the
iris, and although it was rusted by its long lodgment, sight in the eye
was fairly good, and there was no sign of irritation.

Snell gives an instance in which a piece of steel was imbedded close to
the optic disc with retention of sight. It was plainly visible by the
opthalmoscope eighteen months after the accident, when as yet no
diminution of sight was apparent. Smyly speaks of a portion of a
tobacco pipe which was successfully removed from the anterior chamber
by an incision through the cornea. Clark mentions a case in which
molten lead in the eye caused no permanent injury; and there are
several cases mentioned in confirmation of the statement that the eye
seems to be remarkably free from disastrous effects after this injury.

Williamson mentions eyelashes in the anterior chamber of the eye, the
result of a stab wound of this organ.

Contusion of the eyeball may cause dislocation of the lens into the
anterior chamber, and several instances have been recorded.  We regret
our inability to give the reference or authority for a report that we
have seen, stating that by one kick of a horse the lenses of both eyes
of a man were synchronously knocked through the eyeballs by the calkins
of the horseshoe. Oliver mentions extraction of a lens by a thrust of a
cow's horn.

Lowe speaks of rupture of the anterior capsule of the lens from violent
sneezing, with subsequent absorption of the lenticular substance and
restoration of vision. Trioen mentions a curious case of expulsion of
the crystalline lens from the eye in ophthalmia, through the formation
of a corneal fissure. The authors have personal knowledge of a case of
spontaneous extrusion of the lens through a corneal ulcer, in a case of
ophthalmia of the new-born.

Injury of the Eyeball by Birds.--There are several instances in which
birds have pierced the eyeball with their bills, completely destroying
vision. Not long since a prominent taxidermist winged a crane, picked
it up, and started to examine it, when it made one thrust with its bill
and totally destroyed his eyeball. In another instance a man was going
from the railroad station to his hotel in a gale of wind, when, as he
turned the corner of the street, an English sparrow was blown into his
face. Its bill penetrated his eyeball and completely ruined his sight.
There are several instances on record in which game fowls have
destroyed the eyes of their owners. In one case a game cock almost
completed the enucleation of the eye of his handler by striking him
with his gaff while preparing in a cock-pit.

Moorehead explains a rare accident to an eye as follows:--

"Mr. S. B. A., while attending to his bees, was stung by one upon the
right upper eyelid near its center. An employee, who was assisting in
the work, immediately discovered the sting driven in the lid and
cautiously extracted it, stating that he made sufficient traction to
lift the lid well away from the globe. In a few hours the lid became
much swollen, but the pain experienced at first had disappeared. Before
retiring for the night he began gentle massage of the lid, stroking it
horizontally with his finger. The edematous condition was by this means
much reduced in a short time. While thus engaged in stroking the lid he
suddenly experienced intense pain in the eye as if it had been pierced
by a sharp instrument. The suffering was very severe, and he passed a
wretched night, constantly feeling 'something in his eye.'

"The next morning, the trouble continuing, he came to me for relief.
Upon examination of the lid, no opening could be made out where the
sting had penetrated, and a minute inspection of the conjunctival
surface with a good glass failed to reveal any foreign substance.
Cleansing the lid thoroughly, and carefully inspecting with a lens
under strong light, a minute dark point was made out about the center
of the lid. Feeling that this might be the point of the sting, I had
recourse to several expedients for its removal, but without success.
Finally, with a fine knife, I succeeded in cutting down by the side of
the body and tilting it out. Examination with a 1/5 inch objective
confirmed my opinion that it was the point of the bee-sting.

"The barbed formation of the point explains how, under the stroking
with the finger, it was forced through the dense tarsal cartilage and
against the cornea of the eye."

There is a story told in La Medecine Moderne of a seamstress of Berlin
who was in the habit of allowing her dog to lick her face.  She was
attacked with a severe inflammation of the right eye, which had to be
enucleated, and was found full of tenia echinococcus, evidently derived
from the dog's tongue.

Gabb mentions a case of epistaxis in which the blood welled up through
the lacrimal ducts and suffused into the eye so that it was constantly
necessary to wipe the lower eyelid, and the discharge ceased only when
the nose stopped bleeding. A brief editorial note on epistaxis through
the eyes, referring to a case in the Medical News of November 30, 1895,
provoked further reports from numerous correspondents. Among others,
the following:--

"Dr. T. L. Wilson of Bellwood, Pa., relates the case of an old lady of
seventy-eight whom he found with the blood gushing from the nostrils.
After plugging the nares thoroughly with absorbent cotton dusted with
tannic acid he was surprised to see the blood ooze out around the
eyelids and trickle down the cheeks. This oozing continued for the
greater part of an hour, being controlled by applications of ice to
both sides of the nose."

"Dr. F. L. Donlon of New York City reports the case of a married woman,
about fifty years old, in whom epistaxis set in suddenly at 11 P.M.,
and had continued for several hours, when the anterior nares were
plugged. In a short time the woman complained that she could scarcely
see, owing to the welling up of blood in the eyes and trickling down
her face. The bleeding only ceased when the posterior nares also were
plugged."

"Dr. T. G. Wright of Plainville, Conn., narrates the case of a young
man whom he found in the night, bleeding profusely, and having already
lost a large amount of blood. Shortly after plugging both anterior and
posterior nares the blood found its way through the lacrimal ducts to
the eyes and trickled down the cheeks."

"Dr. Charles W. Crumb cites the case of a man, sixty-five years old,
with chronic nephritis, in whom a slight bruise of the nose was
followed by epistaxis lasting twenty-four hours. When the nares were
plugged blood escaped freely from the eyes. A cone-shaped bit of
sponge, saturated with ferrous sulphate, was passed into each anterior
naris, and another piece of sponge, similarly medicated, into either
posterior naris. The patient had been taking various preparations of
potassium, and it was thought that his blood contained a deficiency of
fibrin. Upon removal of the nasal plugs a catarrhal inflammation
developed which lasted a long time and was attended with considerable
purulent discharge."

Late Restoration of Sight.--There are some marvelous cases on record in
which, after many years of blindness, the surgeon has been able, by
operation, to restore the sight. McKeown gives the history of a blind
fiddler of sixty-three, who, when one and a half years old, had lost
the sight of both eyes after an attack of small-pox. Iridectomy was
performed, and after over sixty years of total blindness his sight was
restored; color-perception was good. Berncastle mentions a case of
extraction of double cataract and double iridectomy for occluded
pupils, which, after thirty years of blindness, resulted in the
recovery of good sight. The patient was a blind beggar of Sydney.

To those interested in this subject, Jauffret has a most interesting
description of a man by the name of Garin, who was born blind, who
talked at eight or nine months, showed great intelligence, and who was
educated at a blind asylum. At the age of twenty-four he entered the
hospital of Forlenze, to be operated upon by that famous oculist. Garin
had never seen, but could distinguish night or darkness by one eye
only, and recognized orange and red when placed close to that eye. He
could tell at once the sex and age of a person approximately by the
voice and tread, and formed his conclusions more rapidly in regard to
females than males. Forlenze diagnosed cataract, and, in the presence
of a distinguished gathering, operated with the happiest result. The
description that follows, which is quoted by Fournier and is readily
accessible to any one, is well worth reading, as it contains an account
of the first sensations of light, objects, distance, etc., and minor
analogous thoughts, of an educated and matured mind experiencing its
first sensations of sight.

Hansell and Clark say that the perplexities of learning to see after
twenty-six years of blindness from congenital disease, as described by
a patient of Franke, remind one of the experience of Shelley's
Frankenstein. Franke's patient was successfully operated on for
congenital double cataract, at twenty-six years of age. The author
describes the difficulties the patient had of recognizing by means of
vision the objects he had hitherto known through his other senses, and
his slowness in learning to estimate distances and the comparative size
of objects.

Sight is popularly supposed to be occasionally restored without the aid
of art, after long years of blindness. Benjamin Rush saw a man of
forty-five who, twelve years before, became blind without ascertainable
cause, and recovered his sight equally without reason. St. Clair
mentions Marshal Vivian, who at the age of one hundred regained sight
that for nearly forty years had gradually been failing almost to
blindness, and preserved this new sight to the time of his death.

There are many superstitions prevalent among uneducated people as to
"second sight," recovery of vision, etc., which render their reports of
such things untrustworthy. The real explanations of such cases are too
varied for discussion here.

Nyctalopia etymologically means night blindness, but the general usage,
making the term mean night-vision, is so strongly intrenched that it is
useless and confusing to attempt any reinstatement of the old
significance. The condition in which one sees better by night,
relatively speaking, than by day is due to some lesion of the macular
region, rendering it blind. At night the pupil dilates more than in the
day-time, and hence vision with the extramacular or peripheral portions
of the retina is correspondingly better. It is, therefore, a symptom of
serious retinal disease. All night-prowling animals have widely
dilatable pupils, and in addition to this they have in the retina a
special organ called the tapetum lucidum, the function of which is to
reflect to a focus in front of them the relatively few rays of light
that enter the widely-dilated pupil and thus enable them the better to
see their way. Hence the luminous appearance of the eyes of such
animals in the dark.

Hemeralopia (etymologically day-blindness, but by common usage meaning
day-vision or night-blindness) is a symptom of a peculiar degenerative
disease of the retina, called retinitis pigmentosa.  It also occurs in
some cases of extreme denutrition, numerous cases having been reported
among those who make the prolonged fasts customary in the Russian
church. In retinitis pigmentosa the peripheral or extramacular portions
of the retina are subject to a pigmentary degeneration that renders
them insensitive to light, and patients so afflicted are consequently
incapable of seeing at night as well as others. They stumble and run
against objects easily seen by the normal eye.

Snow-blindness occurs from prolonged exposure of the eyes to snow upon
which the sun is shining. Some years ago, some seventy laborers, who
were clearing away snow-drifts in the Caucasus, were seized, and thirty
of them could not find their way home, so great was the photophobia,
conjunctivitis, and lacrimation.  Graddy reports six cases, and many
others are constantly occurring.

Other forms of retinal injury from too great or too prolonged exposure
to light are "moon-blindness," due to sleeping with the eyes exposed to
bright moonlight, and that due to lightning--a case, e.g., being
reported by Knies. Silex also reports such a case and reviews the
reported cases, 25 in number, in ten of which cataract ensued. In the
Annual of the Universal Medical Sciences, 1888, there is a report of
seven cases of retinal injury with central scotoma, amblyopia, etc., in
Japanese medical students, caused by observation of the sun in eclipse.

In discussing the question of electric-light injuries of the eyes Gould
reviews the literature of the subject and epitomizes the cases reported
up to that time. They numbered 23. No patient was seriously or
permanently injured, and none was in a person who used the electric
light in a proper manner as an illuminant. All were in scientific
investigators or workmen about the light, who approached it too closely
or gazed at it too long and without the colored protecting spectacles
now found necessary by such workers.

Injuries to the Ear.--The folly of the practice of boxing children's
ears, and the possible disastrous results subsequent to this
punishment, are well exemplified throughout medical literature. Stewart
quotes four cases of rupture of the tympanum from boxing the ears, and
there is an instance of a boy of eight, who was boxed on the ear at
school, in whom subsequent brain-disease developed early, and death
followed. Roosa of New York mentions the loss of hearing following a
kiss on the ear.

Dalby, in a paper citing many different causes of rupture of the
tympanic membrane, mentions the following: A blow in sparring; violent
sneezing; blowing the nose; forcible dilatation of the Eustachian
canal; a thorn or twig of a tree accidentally thrust into the head;
picking the ear with a toothpick. In time of battle soldiers sometimes
have their tympanums ruptured by the concussion caused by the firing of
cannon. Dalby mentions an instance of an officer who was discharged for
deafness acquired in this manner during the Crimean War. He was
standing beside a mortar which, unexpectedly to him, was fired, causing
rupture of the tympanic membrane, followed by hemorrhage from the ear.
Similar cases were reported in the recent naval engagements between the
Chinese and Japanese. Wilson reports two cases of rupture of the
membrane tympani caused by diving. Roosa divides the causes into
traumatic, hemorrhagic, and inflammatory, and primary lesions of the
labyrinth, exemplifying each by numerous instances. Under traumatic
causes he mentions severe falls, blows about the head or face, constant
listening to a telegraphic instrument, cannonading, and finally eight
cases of boiler-makers' deafness. Roosa cites a curious case of sudden
and profound deafness in a young man in perfect health, while calling
upon the parents of his lady-love to ask her hand in marriage.  Strange
to say that after he had had a favorable reply he gradually recovered
his hearing! In the same paper there is an instance of a case of
deafness due to the sudden cessation of perspiration, and an instance
of tinnitus due to the excessive use of tobacco; Roosa also mentions a
case of deafness due to excessive mental employment.

Perforation of the Tympanum.--Kealy relates an instance in which a pin
was introduced into the left ear to relieve an intolerable itching. It
perforated the tympanum, and before the expiration of twenty-four hours
was coughed up from the throat with a small quantity of blood. The pin
was bent at an angle of about 120 degrees. Another similar case was
that of a girl of twenty-two who, while pricking her ear with a
hair-pin, was jerked or struck on the arm by a child, and the pin
forced into the ear; great pain and deafness followed, together with
the loss of taste on the same side of the tongue; after treatment both
of the disturbed senses were restored. A man of twenty was pricked in
the ear by a needle entering the meatus. He uttered a cry, fell
senseless, and so continued until the fourth day when he died.  The
whole auditory meatus was destroyed by suppuration. Gamgee tells of a
constable who was stabbed in the left ear, severing the middle
meningeal artery, death ensuing. In this instance, after digital
compression, ligature of the common carotid was practiced as a last
resort. There is an account of a provision-dealer's agent who fell
asleep at a public house at Tottenham. In sport an attendant tickled
his ear with a wooden article used as a pipe light. A quick,
unconscious movement forced the wooden point through the tympanum,
causing cerebral inflammation and subsequent death. There is a record
of death, in a child of nine, caused by the passage of a
knitting-needle into the auditory meatus.

Kauffmann reports a case of what he calls objective tinnitus aurium, in
which the noise originating in the patient's ears was distinctly
audible by others. The patient was a boy of fourteen, who had fallen on
the back of his head and had remained unconscious for nearly two weeks.
The noises were bilateral, but more distinct on the left than on the
right side. The sounds were described as crackling, and seemed to
depend on movements of the arch of the palate. Kauffmann expresses the
opinion that the noises were due to clonic spasm of the tensor velum
palati, and states that under appropriate treatment the tinnitus
gradually subsided.

The introduction of foreign bodies in the ear is usually accidental,
although in children we often find it as a result of sport or
curiosity. There is an instance on record of a man who was accustomed
to catch flies and put them in his ear, deriving from them a
pleasurable sensation from the tickling which ensued.  There have been
cases in which children, and even adults, have held grasshoppers,
crickets, or lady-birds to their ears in order to more attentively
listen to the noise, and while in this position the insects have
escaped and penetrated the auditory canal. Insects often enter the ears
of persons reposing in the fields with the ear to the ground. Fabricius
Hildanus speaks of a cricket penetrating the ear during sleep. Calhoun
mentions an instance of disease of the ear which he found was due to
the presence of several living maggots in the interior of the ear.  The
patient had been sleeping in a horse stall in which were found maggots
similar to those extracted from his ear. An analogous instance was seen
in a negro in the Emergency Hospital, Washington, D.C., in the summer
of 1894; and many others are recorded. The insects are frequently
removed only after a prolonged lodgment.

D'Aguanno gives an account of two instances of living larvae of the
musca sarcophaga in the ears of children. In one of the cases the
larvae entered the drum-cavity through a rupture in the tympanic
membrane. In both cases the maggots were removed by forceps. Haug has
observed a tic (ixodes ricinus) in the ear of a lad of seventeen. The
creature was killed by a mercuric-chlorid solution, and removed with a
probe.

There is a common superstition that centipedes have the faculty of
entering the ear and penetrating the brain, causing death. The authors
have knowledge of an instance in which three small centipedes were
taken from the ear of a policeman after remaining there three days;
during this time they caused excruciating pain, but there was no
permanent injury. The Ephemerides contains instances in which, while
yet living, worms, crickets, ants, and beetles have all been taken from
the ear. In one case the entrance of a cricket in the auditory canal
was the cause of death. Martin gives an instance in which larvae were
deposited in the ear. Stalpart van der Wiel relates an instance of the
lodgment of a living spider in the ear.

Far more common than insects are inanimate objects as foreign bodies in
the ear, and numerous examples are to be found in literature. Fabricius
Hildanus tells of a glass ball introduced into the auditory canal of a
girl of ten, followed by headache, numbness on the left side, and after
four or five years epileptic seizures, and atrophy of the arm. He
extracted it and the symptoms immediately ceased. Sabatier speaks of an
abscess of the brain caused by a ball of paper in the ear; and it is
quite common for persons in the habit of using a tampon of cotton in
the meatus to mistake the deep entrance of this substance for
functional derangement, and many cases of temporary deafness are simply
due to forgetfulness of the cause. A strange case is reported in a girl
of fourteen, who lost her tympanum from a profuse otorrhea, and who
substituted an artificial tympanum which was, in its turn, lost by deep
penetration, causing augmentation of the symptoms, of the cause of
which the patient herself seemed unaware. Sometimes artificial otoliths
are produced by the insufflation of various powders which become
agglutinated, and are veritable foreign bodies. Holman tells of a
negro, aged thirty-five, whose wife poured molten pewter in his ear
while asleep. It was removed, but total deafness was the result.

Alley mentions a New Orleans wharf laborer, in whose ear was poured
some molten lead; seventeen months afterward the lead was still
occupying the external auditory meatus. It is quite remarkable that the
lead should have remained such a length of time without causing
meningeal inflammation. There was deafness and palsy of that side of
the face. A fungous growth occupied the external portion of the ear;
the man suffered pain and discharge from the ear, and had also great
difficulty in closing his right eyelid. Morrison mentions an alcoholic
patient of forty who, on June 6, 1833, had nitric acid poured in her
right ear. There were no headache, febrile symptoms, stupor, or
vertigo. Debility alone was present. Two weeks after the injury
paralysis began on the right side, and six weeks from the injury the
patient died. This case is interesting from the novel mode of death,
the perfect paralysis of the arm, paralysis agitans of the body
(occurring as hemorrhage from the ear came on, and subsiding with it),
and extensive caries of the petrous bone, without sensation of pain or
any indicative symptoms.

There is an instance in a young girl in which a piece of pencil
remained in the right ear for seven years. Haug speaks of two beads
lying in the auditory canal for twenty-eight years without causing any
harm.

A boy of six introduced a carob-nut kernel into each ear. On the next
day incompetent persons attempted to extract the kernel from the left
side, but only caused pain and hemorrhage. The nut issued spontaneously
from the right side. In the afternoon the auditory canal was found
excoriated and red, and deep in the meatus the kernel was found,
covered with blood. The patient had been so excited and pained by the
bungling attempts at extraction that the employment of instruments was
impossible; prolonged employment of injections was substituted.
Discharge from the ear commenced, intense fever and delirium ensued,
and the patient had to be chloroformed to facilitate the operation of
extraction. The nut, when taken out, was found to have a consistency
much larger than originally, caused by the agglutination of wax and
blood.  Unfortunately the symptoms of meningitis increased; three days
after the operation coma followed, and on the next day death ensued. In
75 cases collected by Mayer, and cited by Poulet (whose work on
"Foreign Bodies" is the most extensive in existence), death as a
consequence of meningitis was found in three.

Fleury de Clermont mentions a woman of twenty-five who consulted him
for removal of a pin which was in her right ear. Vain attempts by some
of her lay-friends to extract the pin had only made matters worse. The
pin was directed transversely, and its middle part touched the membrane
tympanum. The mere touching of the pin caused the woman intense pain;
even after etherization it was necessary to construct a special
instrument to extract it.  She suffered intense cephalalgia and other
signs of meningitis; despite vigorous treatment she lost consciousness
and died shortly after the operation.

Winterbotham reports an instance in which a cherry-stone was removed
from the meatus auditorius after lodgment of upward of sixty years.
Marchal de Calvi mentions intermittent deafness for forty years, caused
by the lodgment of a small foreign body in the auditory canal. There is
an instance in which a carious molar tooth has been tolerated in the
same location for forty years.

Albucasius, Fabricius Hildanus, Pare, and others, have mentioned the
fact that seeds and beans have been frequently seen to increase in
volume while lodged in the auditory canal. Tulpius speaks of an infant,
playing with his comrades, who put a cherry-seed in his ear which he
was not able to extract. The seed increased in volume to such an extent
that it was only by surgical interference that it could be extracted,
and then such serious consequences followed that death resulted. Albers
reports an instance in which a pin introduced into the ear issued from
the pharynx.

Confusion of diagnosis is occasionally noticed in terrified or hysteric
persons. Lowenberg was called to see a child of five who had introduced
a button into his left ear. When he saw the child it complained of all
the pain in the right ear, and he naturally examined this ear first but
found nothing to indicate the presence of a foreign body. He examined
the ear supposed to be healthy and there found the button lying against
the tympanum.  This was explained by the fact that the child was so
pained and terrified by the previous explorations of the affected ear
that rather than undergo them again he presented the well ear for
examination. In the British Medical Journal for 1877 is an account of
an unjustified exploration of an ear for a foreign body by an
incompetent physician, who spent a half hour in exploration and
manipulation, and whose efforts resulted in the extraction of several
pieces of bone. The child died in one and a half hours afterward from
extreme hemorrhage, and the medical bungler was compelled to appear
before a coroner's jury in explanation of his ignorance.

In the external ear of a child Tansley observed a diamond which he
removed under chloroform. The mother of the child had pushed the body
further inward in her endeavors to remove it and had wounded the canal.
Schmiegelow reports a foreign body forced into the drum-cavity,
followed by rough extraction, great irritation, tetanus, and death; and
there are on record several cases of fatal meningitis, induced by rough
endeavors to extract a body from the external ear.

In the Therapeutic Gazette, August 15, 1896, there is a translation of
the report of a case by Voss, in which a child of five pushed a dry pea
in his ear. Four doctors spent several days endeavoring to extract it,
but only succeeded in pushing it in further. It was removed by
operation on the fifth day, but suppuration of the tympanic cavity
caused death on the ninth day.

Barclay reports a rare case of ensnared aural foreign body in a lady,
aged about forty years, who, while "picking" her left ear with a
so-called "invisible hair-pin" several hours before the consultation,
had heard a sudden "twang" in the ear, as if the hair-pin had broken.
And so, indeed, it had; for on the instant she had attempted to jerk it
quickly from the ear the sharp extremity of the inner portion of its
lower prong sprang away from its fellow, penetrated the soft tissues of
the floor of the external auditory canal, and remained imbedded there,
the separated end of this prong only coming away in her grasp. Every
attempt on her part to remove the hair-pin by traction on its
projecting prong--she durst not force it INWARD for fear of wounding
the drumhead--had served but to bury the point of the broken prong more
deeply into the flesh of the canal, thereby increasing her suffering.
Advised by her family physician not to delay, she forthwith sought
advice and aid. On examination, it was found that the lower prong of
the "invisible hair-pin" had broken at the outer end of its wavy
portion, and seemed firmly imbedded in the floor of the auditory canal,
now quite inflamed, at a point about one-third of its depth from the
outlet of the canal. The loop or turn of the hair-pin was about 1/2
inch from the flaccid portion of the drumhead, and, together with the
unbroken prong, it lay closely against the roof of the canal.
Projecting from the meatus there was enough of this prong to be easily
grasped between one's thumb and finger. Removal of the hair-pin was
effected by first inserting within the meatus a Gruber speculum,
encircling the unbroken projecting prong, and then raising the end of
the broken one with a long-shanked aural hook, when the hair-pin was
readily withdrawn. The wound of the canal-floor promptly healed.

In the severest forms of scalp-injuries, such as avulsion of the scalp
from the entangling of the hair in machinery, skin-grafting or
replantation is of particular value. Ashhurst reports a case which he
considers the severest case of scalp-wound that he had ever seen,
followed by recovery. The patient was a girl of fifteen, an operative
in a cotton-mill, who was caught by her hair between two rollers which
were revolving in opposite directions; her scalp being thus, as it
were, squeezed off from her head, forming a large horseshoe flap. The
linear extent of the wound was 14 inches, the distance between the two
extremities being but four inches. This large flap was thrown backward,
like the lid of a box, the skull being denuded of its pericranium for
the space of 2 1/2 by one inch in extent. The anterior temporal artery
was divided and bled profusely, and when admitted to the hospital the
patient was extremely depressed by shock and hemorrhage. A ligature was
applied to the bleeding vessel, and after it had been gently but
carefully cleansed the flap was replaced and held in place with gauze
and collodion dressing. A large compress soaked in warm olive oil was
then placed over the scalp, covered with oiled silk and with a
recurrent bandage. A considerable portion of the wound healed by
adhesions, and the patient was discharged, cured, in fifty-four days.
No exfoliation of bone occurred. Reverdin, a relative of the discoverer
of transplantation of skin, reported the case of a girl of twenty-one
whose entire scalp was detached by her hair being caught in machinery,
leaving a wound measuring 35 cm. from the root of the nose to the nape
of the neck, 28 cm. from one ear to the other, and 57 cm. in
circumference. Grafts from the rabbit and dog failed, and the skin from
the amputated stump of a boy was employed, and the patient was able to
leave the hospital in seven months. Cowley speaks of a girl of fourteen
whose hair was caught in the revolving shaft of a steam-engine, which
resulted in the tearing off of her whole scalp. A triangular portion of
the skin was hanging over her face, the apex of the triangle containing
short hair, from which the long hair had been detached. Both ears were
hanging down the neck, having been detached above. The right pinna was
entire, and the upper half of the left pinna had disappeared. The whole
of the head and back of the neck was denuded of skin. One of the
temporal arteries was ligated, and the scalp cleansed and reapplied.
The hanging ears and the skin of the forehead were successfully
restored to their proper position. The patient had no bad symptoms and
little pain, and the shock was slight. Where the periosteum had
sloughed the bone was granulating, and at the time of the report
skin-grafting was shortly to be tried.

Schaeffer has presented quite an extensive article on scalp-injuries in
which grafting and transplantation has been used, and besides reporting
his own he mentions several other cases. One was that of a young lady
of twenty-four. While at work under a revolving shaft in a laundry the
wind blew her hair and it was caught in the shaft. The entire skull was
laid bare from the margin of the eyelids to the neck. The nasal bones
were uncovered and broken, exposing the superior nasal meatus. The skin
of the eyelids was removed from within three mm. of their edges. The
lower margin of the wound was traceable from the lower portion of the
left external process of the frontal bone, downward and backward below
the left ear (which was entirely removed), thence across the neck, five
cm. below the superior curved line of the occipital bone, and forward
through the lower one-third of the right auricle to the right external
angular process of the frontal bone and margin of the right upper
eyelid, across the lid, nose, and left eyelid, to the point of
commencement. Every vessel and nerve supplying the scalp was destroyed,
and the pericranium was torn off in three places, one of the denuded
spots measuring five by seven cm. and another five by six cm. The neck
flap of the wound fell away from the muscular structures beneath it,
exposing the trapezius muscle almost one-half the distance to the
shoulder blade. The right ear was torn across in its lower third, and
hung by the side of the neck by a piece of skin less than five mm.
wide. The exposed surface of the wound measured 40 cm. from before
back, and 34 cm. in width near the temporal portion. The cranial
sutures were distinctly seen in several places, and only a few muscular
fibers of the temporal were left on each side. Hemorrhage was profuse
from the temporal, occipital, and posterior auricular arteries, which
were tied. The patient was seen three-quarters of an hour after the
injury, and the mangled scalp was thoroughly washed in warm carbolized
water, and stitched back in position, after the hair was cut from the
outer surface. Six weeks after the injury suppuration was still free,
and skin-grafting was commenced. In all, 4800 grafts were used, the
patient supplying at different times 1800 small grafts. Her own skin
invariably did better than foreign grafts. In ten months she had almost
completely recovered, and sight and hearing had returned. Figure 191
shows the extent of the injury, and the ultimate results of the
treatment.

Schaeffer also reports the case of a woman working in a button factory
at Union City, Conn., in 1871, who placed her head under a swiftly
turning shaft to pick up a button, when her hair caught in the shaft,
taking off her scalp from the nape of the neck to the eyebrows. The
scalp was cleansed by her physician, Dr. Bartlett, and placed on her
head about two hours after the accident, but it did not stay in
position. Then the head was covered twice by skin-grafts, but each time
the grafts were lost; but the third time a successful grafting was
performed and she was enabled to work after a period of two years. The
same authority also quotes Wilson and Way of Bristol, Conn., in an
account of a complete avulsion of the scalp, together with tearing of
the eyelid and ear. The result of the skin-grafting was not given.
Powell of Chicago gives an account of a girl of nineteen who lost her
scalp while working in the Elgin Watch Factory at Elgin, Illinois. The
wound extended across the forehead above the eyebrows, but the ears
were untouched.  Skin-grafting was tried in this case but with no
result, and the woman afterward lost an eye by exposure, from
retraction of the eyelid.

In some cases extensive wounds of the scalp heal without artificial aid
by simply cicatrizing over. Gross mentions such a case in a young lady,
who, in 1869, lost her scalp in a factory.  There is reported an
account of a conductor on the Union Pacific Railroad, who, near
Cheyenne, in 1869, was scalped by Sioux Indians. He suffered an
elliptic wound, ten by eight cm., a portion of the outer table of the
cranium being removed, yet the wound healed over.

Cerebral Injuries.--The recent advances in brain-surgery have, in a
measure, diminished the interest and wonder of some of the older
instances of major injuries of the cerebral contents with unimportant
after-results, and in reviewing the older cases we must remember that
the recoveries were made under the most unfavorable conditions, and
without the slightest knowledge of all important asepsis and antisepsis.

Penetration or even complete transfixion of the brain is not always
attended with serious symptoms. Dubrisay is accredited with the
description of a man of forty-four, who, with suicidal intent, drove a
dagger ten cm. long and one cm. wide into his brain. He had
deliberately held the dagger in his left hand, and with a mallet in his
right hand struck the steel several blows.  When seen two hours later
he claimed that he experienced no pain, and the dagger was sticking out
of his head. For half an hour efforts at extraction were made, but with
no avail. He was placed on the ground and held by two persons while
traction was made with carpenter's pliers. This failing, he was taken
to a coppersmith's, where he was fastened by rings to the ground, and
strong pinchers were placed over the dagger and attached to a chain
which was fastened to a cylinder revolved by steam force.  At the
second turn of the cylinder the dagger came out. During all the efforts
at extraction the patient remained perfectly cool and complained of no
pain. A few drops of blood escaped from the wound after the removal of
the dagger, and in a few minutes the man walked to a hospital where he
remained a few days without fever or pain. The wound healed, and he
soon returned to work. By experiments on the cadaver Dubrisay found
that the difficulty in extraction was due to rust on the steel, and by
the serrated edges of the wound in the bone.

Warren describes a case of epilepsy of seven months' standing, from
depression of the skull caused by a red hot poker thrown at the
subject's head. Striking the frontal bone just above the orbit, it
entered three inches into the cerebral substance.  Kesteven reports the
history of a boy of thirteen who, while holding a fork in his hand,
fell from the top of a load of straw.  One of the prongs entered the
head one inch behind and on a line with the lobe of the left ear and
passed upward and slightly backward to almost its entire length. With
some difficulty it was withdrawn by a fellow workman; the point was
bent on itself to the extent of two inches. The patient lived nine
days. Abel and Colman have reported a case of puncture of the brain
with loss of memory, of which the following extract is an epitome: "A
railway-fireman, thirty-six years old, while carrying an oil-feeder in
his hand, slipped and fell forward, the spout of the can being driven
forcibly into his face. There was transitory loss of consciousness,
followed by twitching and jerking movements of the limbs, most marked
on the left side, the legs being drawn up and the body bent forward.
There was no hemorrhage from mouth, nose, or ears. The metallic spout
of the oil-can was firmly fixed in the base of the skull, and was only
removed from the grasp of the bone by firm traction with forceps. It
had passed upward and toward the middle line, with its concavity
directed from the middle line. Its end was firmly plugged by bone from
the base of the skull. No hemorrhage followed its removal.  The wound
was cleansed and a simple iodoform-dressing applied.  The violent
jerking movements were replaced by a few occasional twitchings. It was
now found that the left side of the face and the left arm were
paralyzed, with inability to close the left eye completely. The man
became drowsy and confused, and was unable to give replies to any but
the simplest questions. The temperature rose to 102 degrees; the pupils
became contracted, the right in a greater degree than the left; both
reacted to light. The left leg began to lose power. There was complete
anesthesia of the right eyebrow and of both eyelids and of the right
cheek for an uncertain distance below the lower eyelid. The conjunctiva
of the right eye became congested, and a small ulcer formed on the
right cornea, which healed without much trouble. In the course of a few
days power began to return, first in the left leg and afterward, though
to a much less extent, in the left arm. For two weeks there was
drowsiness, and the man slept considerably. He was apathetic, and for
many days passed urine in bed. He could not recognize his wife or old
comrades, and had also difficulty in recognizing common objects and
their uses. The most remarkable feature was the loss of all memory of
his life for twenty years before the accident. As time went on, the
period included in this loss of memory was reduced to five years
preceding the accident.  The hemiplegia persisted, although the man was
able to get about.  Sensibility was lost to all forms of stimuli in the
right upper eyelid, forehead, and anterior part of the scalp,
corresponding with the distribution of the supraorbital and nasal
nerves. The cornea was completely anesthetic, and the right cheek, an
inch and a half external to the angle of the nose, presented a small
patch of anesthesia. There was undue emotional mobility, the patient
laughing or crying on slight provocation. The condition of
mind-blindness remained. It is believed that the spout of the oil-can
must have passed under the zygoma to the base of the skull, perforating
the great wing of the spheroid bone and penetrating the centrum ovale,
injuring the anterior fibers of the motor tract in the internal capsule
near the genu."

Figures 192 and 193 show the outline and probable course of the spout.

Beaumont reports the history of an injury in a man of forty-five, who,
standing but 12 yards away, was struck in the orbit by a rocket, which
penetrated through the spheroidal fissure into the middle and posterior
lobes of the left hemisphere. He did not fall at the time he was
struck, and fifteen minutes after the stick was removed he arose
without help and walked away.  Apparently no extensive cerebral lesion
had been caused, and the man suffered no subsequent cerebral symptoms
except, three years afterward, impairment of memory.

There is an account given by Chelius of an extraordinary wound caused
by a ramrod. The rod was accidentally discharged while being employed
in loading, and struck a person a few paces away.  It entered the head
near the root of the zygomatic arch, about a finger's breadth from the
outer corner of the right eye, passed through the head, emerging at the
posterior superior angle of the parietal bone, a finger's breadth from
the sagittal suture, and about the same distance above the superior
angle of the occipital bone. The wounded man attempted to pull the
ramrod out, but all his efforts were ineffectual. After the tolerance
of this foreign body for some time, one of his companions managed to
extract it, and when it was brought out it was as straight as the day
it left the maker's shop. Little blood was lost, and the wound healed
rapidly and completely; in spite of this major injury the patient
recovered.

Carpenter reports the curious case of an insane man who deliberately
bored holes through his skull, and at different times, at a point above
the ear, he inserted into his brain five pieces of No. 20 broom wire
from 2 1/16 to 6 3/4 inches in length, a fourpenny nail 2 1/4 inches
long, and a needle 1 5/8 inches long. Despite these desperate attempts
at suicide he lived several months, finally accomplishing his purpose
by taking an overdose of morphin. MacQueen has given the history of a
man of thirty-five, who drove one three-inch nail into his forehead,
another close to his occiput, and a third into his vertex an inch in
front and 1/4 inch to the left of the middle line. He had used a hammer
to effect complete penetration, hoping that death would result from his
injuries. He failed in this, as about five weeks later he was
discharged from the Princess Alice Hospital at Eastbourne, perfectly
recovered. There is a record of a man by the name of Bulkley who was
found, by a police officer in Philadelphia, staggering along the
streets, and was taken to the inebriate ward of the Blockley Hospital,
where he subsequently sank and died, after having been transferred from
ward to ward, his symptoms appearing inexplicable. A postmortem
examination revealed the fact that an ordinary knife-blade had been
driven into his brain on the right side, just above the ear, and was
completely hidden by the skin. It had evidently become loosened from
the handle when the patient was stabbed, and had remained in the brain
several days. No clue to the assailant was found.

Thudicum mentions the case of a man who walked from Strafford to
Newcastle, and from Newcastle to London, where he died, and in his
brain was found the breech-pin of a gun. Neiman describes a severe
gunshot wound of the frontal region, in which the iron breech-block of
an old-fashioned muzzle-loading gun was driven into the substance of
the brain, requiring great force for its extraction. The patient, a
young man of twenty-eight, was unconscious but a short time, and
happily made a good recovery. A few pieces of bone came away, and the
wound healed with only a slight depression of the forehead. Wilson
speaks of a child who fell on an upright copper paper-file, which
penetrated the right side of the occipital bone, below the external
orifice of the ear, and entered the brain for more than three inches;
and yet the child made a speedy recovery.

Baron Larrey knew of a man whose head was completely transfixed by a
ramrod, which extended from the middle of the forehead to the left side
of the nape of the neck; despite this serious injury the man lived two
days.

Jewett records the case of an Irish drayman who, without treatment,
worked for forty-seven days after receiving a penetrating wound of the
skull 1/4 inch in diameter and four inches deep. Recovery ensued in
spite of the delay in treatment.

Gunshot Injuries.--Swain mentions a patient who stood before a looking
glass, and, turning his head far around to the left, fired a pistol
shot into his brain behind the right ear. The bullet passed into his
mouth, and he spat it out. Some bleeding occurred from both the
internal and external wounds; the man soon began to suffer with a
troublesome cough, with bloody expectoration; his tongue was coated and
drawn to the right; he became slightly deaf in his right ear and
dragged his left leg in walking. These symptoms, together with those of
congestion of the lung, continued for about a week, when he died,
apparently from his pulmonary trouble.

Ford quotes the case of a lad of fifteen who was shot in the head, 3/4
inch anterior to the summit of the right ear, the ball escaping through
the left os frontis, 1 1/4 inch above the center of the brow. Recovery
ensued, with a cicatrix on the forehead, through which the pulsations
of the brain could be distinctly seen. The senses were not at all
deteriorated.

Richardson tells of a soldier who was struck by a Minie ball on the
left temporal bone; the missile passed out through the left frontal
bone 1/2 inch to the left of the middle of the forehead.  He was only
stunned, and twenty-four hours later his intellect was undisturbed.
There was no operation; free suppuration with discharges of fragments
of skull and broken-down substance ensued for four weeks, when the
wounds closed kindly, and recovery followed.

Angle records the case of a cowboy who was shot by a comrade in
mistake. The ball entered the skull beneath the left mastoid process
and passed out of the right eye. The man recovered.

Rice describes the case of a boy of fourteen who was shot in the head,
the ball directly traversing the brain substance, some of which
protruded from the wound. The boy recovered. The ball entered one inch
above and in front of the right ear and made its exit through the
lambdoidal suture posteriorly.

Hall of Denver, Col., in an interesting study of gunshot wounds of the
brain, writes as follows:--

"It is in regard to injuries involving the brain that the question of
the production of immediate unconsciousness assumes the greatest
interest. We may state broadly that if the medulla or the great centers
at the base of the brain are wounded by a bullet, instant
unconsciousness must result; with any other wounds involving the
brain-substance it will, with very great probability, result. But there
is a very broad area of uncertainty. Many instances have been recorded
in which the entrance of a small bullet into the anterior part of the
brain has not prevented the firing of a second shot on the part of the
suicide. Personally, I have not observed such a case, however.  But,
aside from the injuries by the smallest missiles in the anterior parts
of the brain, we may speak with almost absolute certainty with regard
to the production of unconsciousness, for the jar to the brain from the
blow of the bullet upon the skull would produce such a result even if
the damage to the brain were not sufficient to do so.

"Many injuries to the brain from bullets of moderate size and low
velocity do not cause more than a temporary loss of consciousness, and
the subjects are seen by the surgeon, after the lapse of half an hour
or more, apparently sound of mind.  These are the cases in which the
ball has lost its momentum in passing through the skull, and has
consequently done little damage to the brain-substance, excepting to
make a passage for itself for a short distance into the brain. It is
apparently well established that, in the case of the rifle-bullet of
high velocity, and especially if fired from the modern military weapons
using nitro-powders, and giving an enormous initial velocity to the
bullet, the transmission of the force from the displaced particles of
brain (and this rule applies to any other of the soft organs as well)
to the adjacent parts is such as to disorganize much of the tissue
surrounding the original track of the missile. Under these
circumstances a much slighter wound would be necessary to produce
unconsciousness or death than in the case of a bullet of low velocity,
especially if it were light in weight. Thus I have recorded elsewhere
an instance of instant death in a grizzly bear, an animal certainly as
tenacious of life as any we have, from a mere furrow, less than a
quarter of an inch in depth, through the cortex of the brain, without
injury of the skull excepting the removal of the bone necessary for the
production of this furrow. The jar to the brain from a bullet of great
velocity, as in this case, was alone sufficient to injure the organ
irreparably. In a similar manner I have known a deer to be killed by
the impact of a heavy rifle-ball against one horn, although there was
no evidence of fracture of the skull. On the other hand, game animals
often escape after such injuries not directly involving the brain,
although temporarily rendered unconscious, as I have observed in
several instances, the diagnosis undoubtedly being concussion of the
brain.

"Slight injury to the brain, and especially if it be unilateral, then,
may not produce unconsciousness. It is not very uncommon for a missile
from a heavy weapon to strike the skull, and be deflected without the
production of such a state. Near the town in which I formerly
practiced, the town-marshal shot at a negro, who resisted arrest, at a
distance of only a few feet, with a 44-caliber revolver, striking the
culprit on the side of the head.  The wound showed that the ball struck
the skull and plowed along under the scalp for several inches before
emerging, but it did not even knock the negro down, and no
unconsciousness followed later. I once examined an express-messenger
who had been shot in the occipital region by a weapon of similar size,
while seated at his desk in the car. The blow was a very glancing one
and did not produce unconsciousness, and probably, as in the case of
the negro, because it did not strike with sufficient directness."

Head Injuries with Loss of Cerebral Substance.--The brain and its
membranes may be severely wounded, portions of the cranium or cerebral
substance destroyed or lost, and yet recovery ensue.  Possibly the most
noted injury of this class was that reported by Harlow and commonly
known as "Bigelow's Case" or the "American Crow-bar Case." Phineas P.
Gage, aged twenty-five, a foreman on the Rutland and Burlington
Railroad, was employed September 13, 1847, in charging a hole with
powder preparatory to blasting. A premature explosion drove a
tamping-iron, three feet seven inches long, 1 1/4 inches in diameter,
weighing 13 1/4 pounds, completely through the man's head. The iron was
round and comparatively smooth; the pointed end entered first. The iron
struck against the left side of the face, immediately anterior to the
inferior maxillary and passed under the zygomatic arch, fracturing
portions of the spheroid bone and the floor of the left orbit; it then
passed through the left anterior lobe of the cerebrum, and, in the
median line, made its exit at the junction of the coronal and sagittal
sutures, lacerating the longitudinal sinus, fracturing the parietal and
frontal bones, and breaking up considerable of the brain; the globe of
the left eye protruded nearly one-half of its diameter. The patient was
thrown backward and gave a few convulsive movements of the extremities.
He was taken to a hotel 3/4 mile distant, and during the transportation
seemed slightly dazed, but not at all unconscious. Upon arriving at the
hotel he dismounted from the conveyance, and without assistance walked
up a long flight of stairs to the hall where his wound was to be
dressed. Harlow saw him at about six o'clock in the evening, and from
his condition could hardly credit the story of his injury, although his
person and his bed were drenched with blood. His scalp was shaved, the
coagula and debris removed, and among other portions of bone was a
piece of the anterior superior angle of each parietal bone and a
semicircular piece of the frontal bone, leaving an opening 3 1/2 inches
in diameter. At 10 P.M. on the day of the injury Gage was perfectly
rational and asked about his work and after his friends. After a while
delirium set in for a few days, and on the eleventh day he lost the
vision in the left eye. His convalescence was rapid and uneventful. It
was said that he discharged pieces of bone and cerebral substance from
his mouth for a few days. The iron when found was smeared with blood
and cerebral substance.

As was most natural such a wonderful case of cerebral injury attracted
much notice. Not only was the case remarkable in the apparent innocuous
loss of cerebral substance, but in the singular chance which exempted
the brain from either concussion or compression, and subsequent
inflammation. Professor Bigelow examined the patient in January, 1850,
and made a most excellent report of the case, and it is due to his
efforts that the case attained world-wide notoriety. Bigelow found the
patient quite recovered in his faculties of body and mind, except that
he had lost the sight of the injured eye. He exhibited a linear
cicatrix one inch long near the angle of the ramus of the left lower
jaw.  His left eyelid was involuntarily closed and he had no power to
overcome his ptosis. Upon the head, well covered by the hair, was a
large unequal depression and elevation. In order to ascertain how far
it might be possible for a bar of the size causing the injury to
traverse the skull in the track assigned to it, Bigelow procured a
common skull in which the zygomatic arches were barely visible from
above, and having entered a drill near the left angle of the inferior
maxilla, he passed it obliquely upward to the median line of the
cranium just in front of the junction of the sagittal and coronal
sutures. This aperture was then enlarged until it allowed the passage
of the bar in question, and the loss of substance strikingly
corresponded with the lesion said to have been received by the patient.
From the coronoid process of the inferior maxilla there was removed a
fragment measuring about 3/4 inch in length. This fragment, in the
patient's case, might have been fractured and subsequently reunited.
The iron bar, together with a cast of the patient's head, was placed in
the Museum of the Massachusetts Medical College.

Bigelow appends an engraving to his paper. In the illustration the
parts are as follows:--

(1) Lateral view of a prepared cranium representing the iron bar
traversing its cavity.

(2) Front view of same.

(3) Plan of the base seen from within. In these three figures the optic
foramina are seen to be intact and are occupied by small white rods.

(4) Cast taken from the shaved head of the patient representing the
appearance of the fracture in 1850, the anterior fragment being
considerably elevated in the profile view.

(5) The iron bar with length and diameter in proportion to the size of
the other figures.

Heaton reports a case in which, by an explosion, a tamping-iron was
driven through the chin of a man into the cerebrum. Although there was
loss of brain-substance, the man recovered with his mental faculties
unimpaired. A second case was that of a man who, during an explosion,
was wounded in the skull. There was visible a triangular depression,
from which, possibly, an ounce of brain-substance issued. This man also
recovered.

Jewett mentions a case in which an injury somewhat similar to that in
Bigelow's case was produced by a gas-pipe.

Among older writers, speaking of loss of brain-substance with
subsequent recovery, Brasavolus saw as much brain evacuated as would
fill an egg shell; the patient afterward had an impediment of speech
and grew stupid. Franciscus Arcaeus gives the narrative of a workman
who was struck on the head by a stone weighing 24 pounds falling from a
height. The skull was fractured; fragments of bone were driven into the
brain. For three days the patient was unconscious and almost lifeless.
After the eighth day a cranial abscess spontaneously opened, from the
sinciput to the occiput, and a large quantity of "corruption" was
evacuated.  Speech returned soon after, the eyes opened, and in twenty
days the man could distinguish objects. In four months recovery was
entire. Bontius relates a singular accident to a sailor, whose head was
crushed between a ship and a small boat; the greater part of the
occipital bone was taken away in fragments, the injury extending almost
to the foremen magnum. Bontius asserts that the patient was perfectly
cured by another surgeon and himself. Galen mentions an injury to a
youth in Smyrna, in whom the brain was so seriously wounded that the
anterior ventricles were opened; and vet the patient recovered.
Glandorp mentions a case of fracture of the skull out of which his
father took large portions of brain and some fragments of bone. He adds
that the man was afterward paralyzed an the opposite side and became
singularly irritable. In his "Chirurgical Observations," Job van
Meek'ren tells the story of a Russian nobleman who lost part of his
skull, and a dog's skull was supplied in its place. The bigoted divines
of the country excommunicated the man, and would not annul his sentence
until he submitted to have the bit of foreign bone removed.

Mendenhall reports the history of an injury to a laborer nineteen years
old. While sitting on a log a few feet from a comrade who was chopping
wood, the axe glanced and, slipping from the woodman's grasp, struck
him just above the ear, burying the "bit" of the axe in his skull. Two
hours afterward he was seen almost pulseless, and his clothing drenched
with blood which was still oozing from the wound with mixed
brain-substance and fragments of bone. The cut was horizontal on a
level with the orbit, 5 1/2 inches long externally, and, owing to the
convex shape of the axe, a little less internally. Small spicules of
bone were removed, and a cloth was placed on the battered skull to
receive the discharges for the inspection of the surgeon, who on his
arrival saw at least two tablespoonfuls of cerebral substance on this
cloth. Contrary to all expectation this man recovered, but, strangely,
he had a marked and peculiar change of voice, and this was permanent.
From the time of the reception of the injury his whole mental and moral
nature had undergone a pronounced change.  Before the injury, the
patient was considered a quiet, unassuming, and stupid boy, but
universally regarded as honest.  Afterward he became noisy,
self-asserting, sharp, and seemingly devoid of moral sense or honesty.
These new traits developed immediately, and more strikingly so soon as
convalescence was established.

Bergtold quotes a case reported in 1857 of extreme injury to the
cranium and its contents. While sleeping on the deck of a canal boat, a
man at Highspire was seriously injured by striking his head against a
bridge. When seen by the surgeon his hair was matted and his clothes
saturated with blood. There was a terrible gap in the scalp from the
superciliary ridge to the occipital bone, and, though full of clots,
the wound was still oozing. In a cloth on a bench opposite were rolled
up a portion of the malar bone, some fragments of the os frontis, one
entire right parietal bone, detached from its fellow along the sagittel
suture, and from the occipital along the lambdoidal suture, perhaps
taking with it some of the occipital bone together with some of the
squamous portion of the temporal bone. This bone was as clean of soft
parts as if it had been removed from a dead subject with a scalpel and
saw. No sight of the membranes or of the substance of the brain was
obtained. The piece of cranium removed was 6 3/4 inches in the
longitudinal diameter, and 5 3/4 inches in the short oval diameter. The
dressing occupied an hour, at the end of which the patient arose to his
feet and changed his clothes as though nothing had happened. Twenty-six
years after the accident there was slight unsteadiness of gait, and
gradual paralysis of the left leg and arm and the opposite side of the
face, but otherwise the man was in good condition. In place of the
parietal bone the head presented a marked deficiency as though a slice
of the skull were cut out. The depressed area measured five by six
inches. In 1887 the man left the hospital in Buffalo with the paralysis
improved, but his mental equilibrium could be easily disturbed. He
became hysteric and sobbed when scolded.

Buchanan mentions the history of a case in a woman of twenty-one, who,
while working in a mill, was struck by a bolt. Her skull was fractured
and driven into the brain comminuted. Hanging from the wound was a bit
of brain-substance, the size of a finger, composed of convolution as
well as white matter. The wound healed, there was no hernia, and at the
time of report the girl was conscious of no disturbance, not even a
headache. There was nothing indicative of the reception of the injury
except a scar near the edge of the hair on the upper part of the right
side of the forehead. Steele, in a school-boy of eight, mentions a case
of very severe injury to the bones of the face and head, with escape of
cerebral substance, and recovery. The injury was caused by falling into
machinery.

There was a seaman aboard of the U.S.S. "Constellation," who fell
through a hatchway from the masthead, landing on the vertex of the
head. There was copious bleeding from the ears, 50 to 60 fluid-ounces
of blood oozing in a few hours, mingled with small fragments of
brain-tissue. The next day the discharge became watery, and in it were
found small pieces of true brain-substance. In five weeks the man
returned to duty complaining only of giddiness and of a "stuffed-up"
head. In 1846 there is a record of a man of forty who fell from a
scaffold, erected at a height of 20 feet, striking on his head. He was
at first stunned, but on admission to the hospital recovered
consciousness. A small wound was found over the right eyebrow,
protruding from which was a portion of brain-substance. There was
slight hemorrhage from the right nostril, and some pain in the head,
but the pulse and respiration were undisturbed. On the following day a
fragment of the cerebral substance, about the size of a hazel-nut,
together with some brood-clots, escaped from the right nostril. In this
case the inner wall of the frontal sinus was broken, affording exit for
the lacerated brain.

Cooke and Laycock mention a case of intracranial injury with extensive
destruction of brain-substance around the Rolandic area; there was
recovery but with loss of the so called muscular sense. The patient, a
workman of twenty-nine, while cutting down a gum-tree, was struck by a
branch as thick as a man's arm, which fell from 100 feet overhead,
inflicting a compound comminuted fracture of the cranium. The right eye
was contused but the pupils equal; the vertex-wound was full of
brain-substance and pieces of bone, ten of which were removed, leaving
an oval opening four by three inches. The base of the skull was
fractured behind the orbits; a fissure 1/4 inch wide was discernible,
and the right frontal bone could be easily moved. The lacerated and
contused brain-substance was removed. Consciousness returned six days
after the operation. The accompanying illustrations (Figs.  196 and
197) show the extent of the injury. The lower half of the ascending
frontal convolution, the greater half of the sigmoid gyrus, the
posterior third of the lower and middle frontal convolutions, the base
and posterior end of the upper convolution, and the base of the
corresponding portion of the falciform lobe were involved. The sensory
and motor functions of the arm were retained in a relative degree.
There was power of simple movements, but complex movements were
awkward. The tactile localization was almost lost.

Morton mentions a patient of forty-seven, who was injured in a railroad
accident near Phoenixville, Pa.; there was a compound comminuted
fracture of the skull involving the left temporal, spheroid, and
superior maxillary bones. The side of the head and the ear were
considerably lacerated; several teeth were broken, and besides this
there was injury to the aura and cerebral substance. There was profound
coma for ten days and paralysis of the 1st, 2d, 3d, 4th, 6th, and 7th
cranial nerves, particularly affecting the left side of the face. There
was scarcely enough blood-supply left to the orbit to maintain life in
the globe. The man primarily recovered, but ninety-one days from the
injury he died of cerebral abscess.

There is the record of a curious brain-injury in a man of twenty-two,
who was struck on the skull by a circular saw. The saw cut directly
down into the brain, severing the superior longitudinal sinus, besides
tearing a branch of the meningeal artery. The wound was filled with
sawdust left by the saw while it was tearing through the parts. After
ordinary treatment the man recovered.

Bird reports a compound comminuted fracture of the left temporal
region, with loss of bone, together with six drams of brain-substance,
which, however, was followed by recovery. Tagert gives an instance of
compound depressed fracture of the skull, with loss of brain-substance,
in which recovery was effected without operative interference. Ballou,
Bartlett, Buckner, Capon, Carmichael, Corban, Maunder and many others,
cite instances of cranial fracture and loss of brain-substance, with
subsequent recovery. Halsted reports the history of a boy of seventeen,
who, while out fowling, had the breech-pin of a shot-gun blown out, the
sharp point striking the forehead in the frontal suture, crushing the
os frontis, destroying 1 3/4 inches of the longitudinal sinus, and
causing severe hemorrhage from both the longitudinal and frontal
sinuses. The pin was pulled out by the boy, who washed his own face,
and lay down; he soon became semi-comatose, in which condition he
remained for some days; but, after operation, he made complete recovery.

Loss of Brain-substance from Cerebral Tumor.--Koser is accredited with
reporting results of a postmortem held on a young man of twenty who
suffered from a cerebral tumor of considerable duration. It was stated
that, although there was a cavity in the brain at least five inches in
length, the patient, almost up to the time of death, was possessed of
the senses of touch, taste, hearing, and smell, showed considerable
control over his locomotor muscles, and could talk. In fact, he was
practically discommoded in no other way than by loss of vision, caused
by pressure on the optic centers. It was also stated that the retention
of memory was remarkable, and, up to within two weeks of his death, the
patient was able to memorize poems. The amount of involvement
discovered postmortem in cases similar to the preceding is astonishing.
At a recent pathologic display in London several remarkable specimens
were shown.

Extensive Fractures of the Skull. Jennings mentions an instance of
extensive fracture of the skull, 14 pieces of the cranium being found.
The patient lived five weeks and two days after the injury, the
immediate cause of death being edema of the lungs.  His language was
incoherent and full of oaths. Belloste, in his "Hospital Surgeon,"
states that he had under has care a most dreadful case of a girl of
eleven or twelve years, who received 18 or 19 cutlass wounds of the
head, each so violent as to chip out pieces of bone; but,
notwithstanding her severe injuries, she made recovery. At the
Emergency Hospital in Washington, D.C., there was received a negress
with at least six gaping wounds of the head, in some cases denuding the
periosteum and cutting the cranium. During a debauch the night before
she had been engaged in a quarrel with a negro with whom she lived, and
was struck by him several times on the head with an axe. She lay all
night unconscious, and was discovered the next morning with her hair
and clothes and the floor on which she lay drenched with blood.  The
ambulance was summoned to take her to the morgue, but on the arrival of
the police it was seen that feeble signs of life still existed. On
admission to the hospital she was semi-comatose, almost pulseless,
cold, and exhibiting all the signs of extreme hemorrhage and shock. Her
head was cleaned up, but her condition would not permit of any other
treatment than a corrosive-sublimate compress and a bandage of
Scultetus. She was taken to the hospital ward, where warmth and
stimulants were applied, after which she completely reacted. She
progressed so well that it was not deemed advisable to remove the
head-bandage until the fourth day, when it was seen that the wounds had
almost entirely healed and suppuration was virtually absent. The
patient rapidly and completely recovered, and her neighbors, on her
return home, could hardly believe that she was the same woman whom, a
few days before, they were preparing to take to the morgue.

A serious injury, which is not at all infrequent, is that caused by
diving into shallow water, or into a bath from which water has been
withdrawn. Curran mentions a British officer in India who, being
overheated, stopped at a station bath in which the previous night he
had had a plunge, and without examining, took a violent "header" into
the tank, confidently expecting to strike from eight to ten feet of
water. He dashed his head against the concrete bottom 12 feet below
(the water two hours previously having been withdrawn) and crushed his
brain and skull into an indistinguishable mass.

There are many cases on record in which an injury, particularly a
gunshot wound of the skull, though showing no external wound, has
caused death by producing a fracture of the internal table of the
cranium. Pare gives details of the case of a nobleman whose head was
guarded by a helmet and who was struck by a ball, leaving no external
sign of injury, but it was subsequently found that there was an
internal fracture of the cranium. Tulpius and Scultetus are among the
older writers reporting somewhat similar instances, and there are
several analogous cases reported as having occurred during the War of
the Rebellion. Boling reports a case in which the internal table was
splintered to a much greater extent than the external.

Fracture of the base of the skull is ordinarily spoken of as a fatal
injury, reported instances of recovery being extremely rare, but
Battle, in a paper on this subject, has collected numerous statistics
of nonfatal fracture of the base of the brain, viz.:--

                                        Male. Female.
  Anterior fossa, . . . . . . . . . . .    16    5
  Middle fossa, . . . . . . . . . . . .    50    6
  Posterior fossa,. . . . . . . . . . .    10    1
  Middle and anterior fossae, . . . . .    15    5
  Middle and posterior fossae,. . . . .     4    1
  Anterior, middle, and posterior fossae,   1    0
                                        ------ ------
                                           96    18  Total, 114.

In a paper on nonmortal fractures of the base of the skull, Lidell
gives an account of 135 cases. MacCormac reports a case of a boy of
nine who was run over by a carriage drawn by a pair of horses. He
suffered fracture of the base of the skull, of the bones of the face,
and of the left ulna, and although suppuration at the points of
fracture ensued, followed by an optic neuritis, an ultimate recovery
was effected. Ball, an Irish surgeon, has collected several instances
in which the base of the skull has been driven in and the condyle of
the jaw impacted in the opening by force transmitted through the lower
maxilla.

The tolerance of foreign bodies in the brain is most marvelous.  In the
ancient chronicles of Koenigsberg there is recorded the history of a
man who for fourteen years carried in his head a piece of iron as large
as his finger. After its long lodgment, during which the subject was
little discommoded, it finally came out by the palatine arch. There is
also an old record of a ball lodging near the sella turcica for over a
year, the patient dying suddenly of an entirely different accident.
Fabricius Hildanus relates the history of an injury, in which, without
causing any uncomfortable symptoms, a ball rested between the skull and
dura for six months.

Amatus Lusitanus speaks of a drunken courtesan who was wounded in a
fray with a long, sharp-pointed knife which was driven into the head.
No apparent injury resulted, and death from fever took place eight
years after the reception of the injury. On opening the head a large
piece of knife was found between the skull and dura. It is said that
Benedictus mentions a Greek who was wounded, at the siege of Colchis,
in the right temple by a dart and taken captive by the Turks; he lived
for twenty years in slavery, the wound having completely healed.
Obtaining his liberty, he came to Sidon, and five years after, as he
was washing his face, he was seized by a violent fit of sneezing, and
discharged from one of his nostrils a piece of the dart having an iron
point of considerable length.

In about 1884 there died in the Vienna Hospital a bookbinder of
forty-five, who had always passed as an intelligent man, but who had at
irregular intervals suffered from epileptic convulsions.  An iron nail
covered with rust was discovered in his brain; from the history of his
life and from the appearances of the nail it had evidently been lodged
in the cerebrum since childhood.

Slee mentions a case in which, after the death of a man from septic
peritonitis following a bullet-wound of the intestines, he found
postmortem a knife-blade 5/16 inch in width projecting into the brain
to the depth of one inch. The blade was ensheathed in a strong fibrous
capsule 1/2 inch thick, and the adjacent brain-structure was apparently
normal. The blade was black and corroded, and had evidently passed
between the sutures during boyhood as there was no depression or
displacement of the cranial bones. The weapon had broken off just on a
level with the skull, and had remained in situ until the time of death
without causing any indicative symptoms. Slee does not state the man's
age, but remarks that he was a married man and a father at the time of
his death, and had enjoyed the best of health up to the time he was
shot in the abdomen. Callaghan, quoted in Erichsen's "Surgery," remarks
that he knew of an officer who lived seven years with a portion of a
gun-breech weighing three ounces lodged in his brain.

Lawson mentions the impaction of a portion of a breech of a gun in the
forehead of a man for twelve years, with subsequent removal and
recovery. Waldon speaks of a similar case in which a fragment of the
breech weighing three ounces penetrated the cranium, and was lodged in
the brain for two months previous to the death of the patient.

Huppert tells of the lodgment of a slate-pencil three inches long in
the brain during lifetime, death ultimately being caused by a slight
head-injury. Larry mentions a person who for some time carried a six
ounce ball in the brain and ultimately recovered.  Peter removed a
musket-ball from the frontal sinus after six years' lodgment, with
successful issue. Mastin has given an instance in which the blade of a
pen-knife remained in the brain six months, recovery following its
removal. Camden reports a case in which a ball received in a gunshot
wound of the brain remained in situ for thirteen years; Cronyn mentions
a similar case in which a bullet rested in the brain for eight years.
Doyle successfully removed an ounce Minie ball from the brain after a
fifteen years' lodgment.

Pipe-stems, wires, shot, and other foreign bodies, are from time to
time recorded as remaining in the brain for some time. Wharton has
compiled elaborate statistics on this subject, commenting on 316 cases
in which foreign bodies were lodged in the brain, and furnishing all
the necessary information to persons interested in this subject.

Injuries of the nose, with marked deformity, are in a measure combated
by devices invented for restoring the missing portions of the injured
member. Taliacotius, the distinguished Italian surgeon of the sixteenth
century, devised an operation which now bears his name, and consists in
fashioning a nose from the fleshy tissues of the arm. The arm is
approximated to the head and held in this position by an apparatus or
system of bandages for about ten days, at which time it is supposed
that it can be severed, and further trimming and paring of the nose is
then practiced. A column is subsequently made from the upper lip. In
the olden days there was a timorous legend representing Taliacotius
making noses for his patients from the gluteal regions of other
persons, which statement, needless to say, is not founded on fact.
Various modifications and improvements on the a Talicotian method have
been made; but in recent years the Indian method, introduced by Carpue
into England in 1816, is generally preferred. Syme of Edinburgh, Wood,
and Ollier have devised methods of restoring the nose, which bear their
names.

Ohmann-Dumesnil reports a case of rhinophyma in a man of seventy-two,
an alcoholic, who was originally affected with acne rosacea, on whom he
performed a most successful operation for restoration. The accompanying
illustration shows the original deformity--a growth weighing two
pounds--and also pictures the appearance shortly after the operation.
This case is illustrative of the possibilities of plastic surgery in
the hands of a skilful and ingenious operator.

About 1892 Dr. J. P. Parker then of Kansas City, Mo., restored the
missing bridge of a patient's nose by laying the sunken part open in
two long flaps, denuding the distal extremity of the little finger of
the patient's right hand of nail, flesh, tendons, etc., and binding it
into the wound of the nose until firm union had taken place. The finger
was then amputated at the second joint and the plastic operation
completed, with a result pleasing both to patient and operator.

There is a case quoted of a young man who, when first seen by his
medical attendant, had all the soft parts of the nose gone, except
one-third of the left ala and a thin flap of the septum which was lying
on the upper lip. The missing member was ferreted out and cleansed, and
after an hour's separation sutured on. The nostrils were daily syringed
with a corrosive sublimate solution, and on the tenth day the dressing
was removed; the nose was found active and well, with the single
exception of a triangular notch on the right side, which was too
greatly bruised by the violence of the blow to recover. When we
consider the varicosity of this organ we can readily believe the
possibility of the foregoing facts, and there is little doubt that more
precaution in suturing severed portions of the nose would render the
operation of nose making a very rare one.

Maxwell mentions a curious case of attempted suicide in which the ball,
passing through the palatine process of the superior maxillary bone,
crushing the vomer to the extent of its own diameter, fell back through
the right nostril into the pharynx, was swallowed, and discharged from
the anus.

Deformities of the nose causing enormous development, or the condition
called "double-nose" by Bartholinus, Borellus, Bidault, and others, are
ordinarily results of a pathologic development of the sebaceous glands.
In some cases tumors develop from the root of the nose, forming what
appears to be a second nose. In other cases monstrous vegetations
divide the nose into many tumors. In the early portion of this century
much was heard about a man who was a daily habitue of the Palais-Royal
Gardens. His nose was divided into unequally sized tumors, covering
nearly his entire face. Similar instances have been observed in recent
years. Hey mentions a case in which the tumor extended to the lower
part of the under lip, which compressed the patient's mouth and
nostrils to such an extent that while sleeping, in order to insure
sufficient respiration, he had to insert a tin-tube into one of his
nostrils. Imbert de Lannes is quoted as operating on a former Mayor of
Angouleme. This gentleman's nose was divided into five lobes by
sarcomatous tumors weighing two pounds, occupying the external surface
of the face, adherent to the buccinator muscles to which they extended,
and covering the chin. In the upright position the tumors sealed the
nostrils and mouth, and the man had to bend his head before and after
respiration. In eating, this unfortunate: person had to lift his tumors
away from his mouth, and during sleep the monstrous growths were
supported in a sling attached to his night cap. He presented such a
hideous aspect that he was virtually ostracized from society The growth
had been in progress for twelve years, but during twenty-two months'
confinement in Revolutionary prisons the enlargement had been very
rapid. Fournier says that the most beautiful result followed the
operation which was considered quite hazardous.

Foreign bodies in the nose present phenomena as interesting as wounds
of this organ. Among the living objects which have been found in the
nose may be mentioned flies, maggots, worms, leeches, centipedes, and
even lizards. Zacutus Lusitanus tells of a person who died in two days
from the effects of a leech which was inadvertently introduced into the
nasal fossa, and there is a somewhat similar case of a military
pharmacist, a member of the French army in Spain, who drank some water
from a pitcher and exhibited, about a half hour afterward, a persistent
hemorrhage from the nose. Emaciation progressively continued, although
his appetite was normal. Three doctors, called in consultation,
prescribed bleeding, which, however, proved of no avail. Three weeks
afterward he carried in his nostril a tampon of lint, wet with an
astringent solution, and, on the next day, on blowing his nose, there
fell from the right nostril a body which he recognized as a leech.
Healey gives the history of four cases in which medicinal leeches were
removed from the mouth and posterior nares of persons who had, for some
days previously, been drinking turbid water. Sinclair mentions the
removal of a leech from the posterior nares.

In some regions, more particularly tropical ones, there are certain
flies that crawl into the nostrils of the inhabitants and deposit eggs,
in the cavities. The larvae develop and multiply with great rapidity,
and sometimes gain admission into the frontal sinus, causing intense
cephalalgia, and even death.

Dempster reports an instance of the lodgment of numerous live maggots
within the cavity of the nose, causing sloughing of the palate and
other complications. Nicholson mentions a case of ulceration and
abscess of the nostrils and face from which maggots were discharged.
Jarvis gives the history of a strange and repeated hemorrhage from the
nose and adjacent parts that was found to be due to maggots from the
ova of a fly, which had been deposited in the nose while the patient
was asleep. Tomlinson gives a case in which maggots traversed the
Eustachian tube, some being picked out of the nostrils, while others
were coughed up.  Packard records the accidental entrance of a
centipede into the nostril. There is an account of a native who was
admitted to the Madras General Hospital, saying that a small lizard had
crawled up his nose. The urine of these animals is very irritating,
blistering any surface it touches. Despite vigorous treatment the
patient died in consequence of the entrance of this little creature.

There have been instances among the older writers in which a pea has
remained in the nose for such a length of time as to present evidences
of sprouting. The Ephemerides renders an instance of this kind, and
Breschet cites the history of a young boy, who, in 1718, introduced a
pea into his nostril; in three days it had swollen to such an extent as
to fill the whole passage. It could not be extracted by an instrument,
so tobacco snuff was used, which excited sneezing, and the pea was
ejected.

Vidal and the Ephemerides report several instances of tolerance of
foreign bodies in the nasal cavities for from twenty to twenty-five
years. Wiesman, in 1893, reported a rhinolith, which was composed of a
cherry-stone enveloped in chalk, that had been removed after a sojourn
of sixty years, with intense ozena as a consequence of its lodgment.
Waring mentions the case of a housemaid who carried a rhinolith, with a
cherry-stone for a nucleus, which had been introduced twenty-seven
years before, and which for twenty-five years had caused no symptoms.
Grove describes a necrosed inferior turbinated bone, to which was
attached a coffee-grain which had been retained in the nostril for
twenty years., Hickman gives an instance of a steel ring which for
thirteen and a half years had been impacted in the nasopharyngeal fossa
of a child. It was detected by the rhinoscope and was removed. Parker
speaks of a gunbreech bolt which was removed from the nose after five
years' lodgment. Major mentions the removal of a foreign body from the
nose seven years after its introduction.

Howard removed a large thimble from the posterior nares, although it
had remained in its position for some time undetected. Eve reports a
case in which a thimble was impacted in the right posterior nares.
Gazdar speaks, of a case of persistent neuralgia of one-half of the
face, caused by a foreign body in the nose.  The obstruction was
removed after seven years' lodgment and the neuralgia disappeared.
Molinier has an observation on the extraction of a fragment of a
knife-blade which had rested four years in the nasal fossae, where the
blade had broken off during a quarrel.

A peculiar habit, sometimes seen in nervous individuals, is that of
"swallowing the tongue." Cohen claims that in some cases of supposed
laryngeal spasm the tongue is swallowed, occluding the larynx, and
sometimes with fatal consequences. There are possibly a half score of
cases recorded, but this anomaly is very rare, and Major is possibly
the only one who has to a certainty demonstrated the fact by a
laryngoscopic examination. By the laryngoscope he was enabled to
observe a paroxysm in a woman, in which the tongue retracted and
impinged on the epiglottis, but quickly recovered its position. Pettit
mentions suffocation from "tongue swallowing," both with and without
section of the frenum.  Schobinger cites a similar instance, due to
loosening of the frenum.

Analogous to the foregoing phenomenon is the habit of "tongue sucking."
Morris mentions a young lady of fifteen who spontaneously dislocated
her jaw, owing indirectly to this habit.  Morris says that from infancy
the patient was addicted to this habit, which was so audible as to be
heard in all parts of the room. The continued action of the pterygoid
muscles had so preternaturally loosened the ligaments and muscular
structures supporting the joint as to render them unable to resist the
violent action of "tongue sucking" even during sleep.

Injuries to the Tongue.--Hobbs describes a man of twenty-three who,
while working, had a habit of protruding his tongue. One day he was hit
under the chin by the chain of a crane on a pier, his upper teeth
inflicting a wound two inches deep, three inches from the tip, and
dividing the entire structure of the tongue except the arteries. The
edges of the wound were brought into apposition by sutures, and after
the removal of the latter perfect union and complete restoration of the
sensation of taste ensued. Franck mentions regeneration of a severed
tongue; and Van Wy has seen union of almost entirely severed parts of
the tongue. De Fuisseaux reports reunion of the tongue by suture after
almost complete transverse division.

There is an account of a German soldier who, May 2, 1813, was wounded
at the battle of Gross-Gorschen by a musket ball which penetrated the
left cheek, carrying away the last four molars of the upper jaw and
passing through the tongue, making exit on the left side, and forcing
out several teeth of the left lower jaw.  To his surprise, thirty years
afterward, one of the teeth was removed from an abscess of the tongue.
Baker speaks of a boy of thirteen who was shot at three yards distance.
The bullet knocked out two teeth and passed through the tongue,
although it produced no wound of the pharynx, and was passed from the
anus on the sixth day. Stevenson mentions a case of an organist who
fell forward when stooping with a pipe in his mouth, driving its stem
into the roof of the pharynx. He complained of a sore throat for
several days, and, after explanation, Stevenson removed from the soft
palate a piece of clay pipe nearly 1 1/4 inches long.  Herbert tells of
a case resembling carcinoma of the tongue, which was really due to the
lodgment of a piece of tooth in that organ.

Articulation Without the Tongue.--Total or partial destruction of the
tongue does not necessarily make articulation impossible.  Banon
mentions a man who had nothing in his mouth representing a tongue. When
he was young, he was attacked by an ulceration destroying every vestige
of this member. The epiglottis, larynx, and pharynx, in fact the
surrounding structures were normal, and articulation, which was at
first lost, became fairly distinct, and deglutition was never
interfered with. Pare gives a description of a man whose tongue was
completely severed, in consequence of which he lost speech for three
years, but was afterward able to make himself understood by an
ingenious bit of mechanism. He inserted under the stump of the tongue a
small piece of wood, in a most marvelous way replacing the missing
member. Articulation with the absence of some constituent of the vocal
apparatus has been spoken of on page 254.

Hypertrophy of the Tongue.--It sometimes happens that the tongue is so
large that it is rendered not only useless but a decided hindrance to
the performance of the ordinary functions into which it always enters.
Ehrlich, Ficker, Klein, Rodforffer, and the Ephemerides, all record
instances in which a large tongue was removed either by ligation or
amputation. Von Siebold records an instance in which death was caused
by the ligature of an abnormally sized tongue. There is a modern record
of three cases of enormous tongues, the result of simple hypertrophy.
In one case the tongue measured 6 1/4 inches from the angle of the
mouth about the sides and tip to the opposite angle, necessitating
amputation of the protruding portion.

Carnochan reports a case in which hypertrophy of the tongue was reduced
to nearly the normal size by first tying the external carotid, and six
weeks later the common carotid artery. Chalk mentions partial
dislocation of the lower jaw from an enlarged tongue. Lyford speaks of
enlargement of the tongue causing death.

The above conditions are known as macroglossia, which is a congenital
hypertrophy of the tongue analogous to elephantiasis.  It is of slow
growth, and as the organ enlarges it interferes with deglutition and
speech. It may protrude over the chin and reach even as far down as the
sternum.

The great enlargement may cause deformities of the teeth and lower jaw,
and even present itself as an enormous tumor in the neck. The
protruding tongue itself may ulcerate, possibly bleed, and there is
constant dribbling of saliva. The disease is probably due to congenital
defect aggravated by frequent attacks of glossitis, and the treatment
consists in the removal of the protruding portions by the knife,
ligation, the cautery, or ecraseur.

Living Fish in the Pharynx.--Probably the most interesting cases of
foreign bodies are those in which living fish enter the pharynx and
esophagus. Chevers has collected five cases in which death was caused
by living fish entering the mouth and occluding the air-passages. He
has mentioned a case in which a large catfish jumped into the mouth of
a Madras bheestie. An operation on the esophagus was immediately
commenced, but abandoned, and an attempt made to push the fish down
with a probang, which was, in a measure, successful. However, the
patient gave a convulsive struggle, and, to all appearances, died. The
trachea was immediately opened, and respiration was restored. During
the course of the night the man vomited up pieces of fish bone softened
by decomposition. In 1863 White mentions that the foregoing accident is
not uncommon among the natives of India, who are in the habit of
swimming with their mouths open in tanks abounding with fish. There is
a case in which a fisherman, having both hands engaged in drawing a
net, and seeing a sole-fish about eight inches long trying to escape
through the meshes of the net, seized it with his teeth. A sudden
convulsive effort of the fish enabled it to enter the fisherman's
throat, and he was asphyxiated before his boat reached the shore. After
death the fish was found in the cardiac end of the stomach. There is
another case of a man named Durand, who held a mullet between his teeth
while rebaiting his hook. The fish, in the convulsive struggles of
death, slipped down the throat, and because of the arrangement of its
scales it could be pushed down but not up; asphyxiation, however,
ensued. Stewart has extensively described the case of a native
"Puckally" of Ceylon who was the victim of the most distressing
symptoms from the impaction of a living fish in his throat. The native
had caught the fish, and in order to extract it placed its head between
his teeth, holding the body with the left hand and the hook with the
right. He had hardly extracted the hook, when the fish pricked his palm
with his long and sharp dorsal fin, causing him suddenly to release his
grasp on the fish and voluntarily open his mouth at the same time. The
fish quickly bolted into his mouth, and, although he grasped the tail
with his right hand, and squeezed his pharynx with his left, besides
coughing violently, the fish found its way into the esophagus. Further
attempts at extraction were dangerous and quite likely to fail; his
symptoms were distressing, he could not hold his head erect without the
most agonizing pain and he was almost prostrated from fright and
asphyxia; it was thought advisable to push the fish into the stomach,
and after an impaction of sixteen hours the symptoms were relieved. The
fish in this instance was the Anabas scandens or "walking perch" of
Ceylon, which derives its name from its power of locomotion on land and
its ability to live out of water for some time. It is from four to five
inches long and has a dorsal fin as sharp as a knife and directed
toward the tail, and pectoral fins following the same direction; these
would admit of entrance, but would interfere with extraction. MacLauren
reports the history of a young man who, after catching a fish, placed
it between his teeth. The fish, three inches long, by a sudden
movement, entered the pharynx. Immediately ensued suffocation, nausea,
vomiting, together with the expectoration of blood and mucus. There was
emphysema of the face, neck, and chest. The fish could be easily felt
impacted in the tissues, but, after swallowing much water and vinegar,
together with other efforts at extraction, the fins were
loosened--about twenty-four hours after the accident. By this time the
emphysema had extended to the scrotum. There was much expectoration of
muco-purulent fluid, and on the third day complete aphonia, but the
symptoms gradually disappeared, and recovery was complete in eight
days. Dantra is accredited with describing asphyxiation, accompanied by
great agony, in a man who, while swimming, had partially swallowed a
live fish. The fish was about three inches in length and one in
breadth, and was found lying on the dorsum of his tongue and, together
with numerous clots of blood, filled his mouth. Futile attempts to
extract the fish by forceps were made. Examination showed that the fish
had firmly grasped the patient's uvula, which it was induced to
relinquish when its head was seized by the forceps and pressed from
side to side. After this it was easily extracted and lived for some
time. There was little hemorrhage after the removal of the offending
object, and the blood had evidently come from the injuries to the sides
of the mouth, caused by the fins.  The uvula was bitten, not torn.
There is an interesting account of a native of India, who, while
fishing in a stream, caught a flat eel-like fish from fifteen to
sixteen inches long. After the fashion of his fellows he attempted to
kill the eel by biting off its head; in the attempt the fish slipped
into his gullet, and owing to its sharp fins could not be withdrawn.
The man died one hour later in the greatest agony; so firmly was the
eel impacted that even after death it could not be extracted, and the
man was buried with it protruding from his mouth.

A Leech in the Pharynx.--Granger, a surgeon in Her Majesty's Indian
Service, writes:--"Several days ago I received a note from the
political sirdar, asking me if I would see a man who said he had a
leech in his throat which he was unable to get rid of. I was somewhat
sceptical, and thought that possibly the man might be laboring under a
delusion. On going outside the fort to see the case, I found an old
Pathan graybeard waiting for me. On seeing me, he at once spat out a
large quantity of dark, half-clotted blood to assure me of the serious
nature of his complaint. His history--mostly made out with the aid of
interpreters--was that eleven days ago he was drinking from a
rain-water tank and felt something stick in his throat, which he could
not reject. He felt this thing moving, and it caused difficulty in
swallowing, and occasionally vomiting. On the following day he began to
spit up blood, and this continued until he saw me. He stated that he
once vomited blood, and that he frequently felt that he was going to
choke.

"On examining his throat, a large clot of blood was found to be
adherent to the posterior wall of the pharynx. On removing this clot of
blood, no signs of the presence of a leech could be detected. However,
on account of the symptoms complained of by the patient I introduced a
polypus forceps into the lower part of the pharynx and toward the
esophagus, where a body, distinctly moving, was felt. This body I
seized with the forceps, and with considerable force managed to remove
it. It was a leech between 2 1/2 and three inches in length, and with a
body of the size of a Lee-Metford bullet. No doubt during the eleven
days it had remained in the man's throat the leech had increased in
size.  Nevertheless it must have been an animal of considerable size
when the man attempted to swallow it. I send this case as a typical
example of the carelessness of natives of the class from which we
enlist our Sepoys, as to the nature of the water they drink. This man
had drunk the pea-soup like water of a tank dug in the side of the
hill, rather than go a few hundred yards to a spring where the water is
perfectly clear and pure. Though I have not met with another case of
leeches being taken with drinking water, I am assured that such cases
are occasionally met with about Agra and other towns in the North-West
Provinces. This great carelessness as to the purity or impurity of
their drinking water shows the difficulty medical officers must
experience in their endeavors to prevent the Sepoys of a regiment from
drinking water from condemned or doubtful sources during a cholera or
typhoid epidemic."

Foreign Bodies in the Pharynx and Esophagus.--Aylesbury mentions a boy
who swallowed a fish-hook while eating gooseberries. He tried to pull
it up, but it was firmly fastened, and a surgeon was called. By
ingeniously passing a leaden bullet along the line, the weight of the
lead loosened the hook, and both bullet and hook were easily drawn up.
Babbit and Battle report an ingenious method of removing a piece of
meat occluding the esophagus--the application of trypsin. Henry speaks
of a German officer who accidentally swallowed a piece of beer bottle,
3/8 x 1/8 inch, which subsequently penetrated the esophagus, and in its
course irritated the recurrent laryngeal and vagi, giving rise to the
most serious phlegmonous inflammation and distressing respiratory
symptoms. A peculiar case is that of the man who died after a fire at
the Eddystone Lighthouse. He was endeavoring to extinguish the flames
which were at a considerable distance above his head, and was looking
up with his mouth open, when the lead of a melting lantern dropped down
in such quantities as not only to cover his face and enter his mouth,
but run over his clothes.  The esophagus and tunica in the lower part
of the stomach were burned, and a great piece of lead, weighing over 7
1/2 ounces, was taken from the stomach after death.

Evans relates the history of a girl of twenty-one who swallowed four
artificial teeth, together with their gold plate; two years and eight
days afterward she ejected them after a violent attack of retching.
Gauthier speaks of a young girl who, while eating soup, swallowed a
fragment of bone. For a long time she had symptoms simulating phthisis,
but fourteen years afterward the bone was dislodged, and, although the
young woman was considered in the last stages of phthisis, she
completely recovered in six weeks. Gastellier has reported the case of
a young man of sixteen who swallowed a crown piece, which became lodged
in the middle portion of the esophagus and could not be removed. For
ten months the piece of money remained in this position, during which
the young man was never without acute pain and often had convulsions.
He vomited material, sometimes alimentary, sometimes mucus, pus, or
blood, and went into the last stage of marasmus. At last, after this
long-continued suffering, following a strong convulsion and syncope,
the coin descended to the stomach, and the young man expectorated great
quantities of pus. After thirty-five years, the coin had not been
passed by the rectum.

Instances of migration of foreign bodies from the esophagus are
repeatedly recorded. There is an instance of a needle which was
swallowed and lodged in the esophagus, but twenty-one months afterward
was extracted by an incision at a point behind the right ear. Kerckring
speaks of a girl who swallowed a needle which was ultimately extracted
from the muscles of her neck.  Poulet remarks that Vigla has collected
the most interesting of these cases of migration of foreign bodies.
Hevin mentions several cases of grains of wheat abstracted from
abscesses of the thoracic parietes, from thirteen to fifteen days after
ingestion.  Bonnet and Helmontius have reported similar facts.
Volgnarius has seen a grain of wheat make its exit from the axilla, and
Polisius mentions an abscess of the back from which was extracted a
grain of wheat three months after ingestion. Bally reports a somewhat
similar instance, in which, three months after ingestion, during an
attack of peripneumonia, a foreign body was extracted from an abscess
of the thorax, between the 2d and 3d ribs. Ambrose found a needle
encysted in the heart of a negress. She distinctly stated that she had
swallowed it at a time calculated to have been nine years before her
death. Planque speaks of a small bone perforating the esophagus and
extracted through the skin.

Abscess or ulceration, consequent upon periesophagitis, caused by the
lodgment of foreign bodies in the esophagus, often leads to the most
serious results. There is an instance of a soldier who swallowed a bone
while eating soup, who died on the thirty-first day from the rupture
internally of an esophageal abscess.  Grellois has reported the history
of a case of a child twenty-two months old, who suffered for some time
with impaction of a small bone in the esophagus. Less than three months
afterward the patient died with all the symptoms of marasmus, due to
difficult deglutition, and at the autopsy an abscess was seen in the
posterior wall of the pharynx, opposite the 3d cervical vertebra;
extensive caries was also noticed in the bodies of the 2d, 3d, and 4th
cervical vertebrae. Guattani mentions a curious instance in which a man
playing with a chestnut threw it in the air, catching it in his mouth.
The chestnut became lodged in the throat and caused death on the
nineteenth day. At the autopsy it was found that an abscess
communicating with the trachea had been formed in the pharynx and
esophagus.

A peculiarly fatal accident in this connection is that in which a
foreign body in the esophagus ulcerates, and penetrates one of the
neighboring major vessels. Colles mentions a man of fifty-six who,
while eating, perceived a sensation as of a rent in the chest. The pain
was augmented during deglutition, and almost immediately afterward he
commenced to expectorate great quantities of blood. On the following
day he vomited a bone about an inch long and died on the same day. At
the autopsy it was found that there was a rent in the posterior wall of
the esophagus, about 1/2 inch long, and a corresponding wound of the
aorta. There was blood in the pleura, pericardium, stomach, and
intestines. There is one case in which a man of forty-seven suddenly
died, after vomiting blood, and at the autopsy it was demonstrated that
a needle had perforated the posterior wall of the esophagus and wounded
the aorta. Poulet has collected 31 cases in which ulceration caused by
foreign bodies in the esophagus has resulted in perforation of the
walls of some of the neighboring vessels. The order of frequency was as
follows: aorta, 17; carotids, four; vena cava, two; and one case each
of perforation of the inferior thyroid artery, right coronary vein,
demi-azygos vein, the right subclavicular artery (abnormal), and the
esophageal artery. In three of the cases collected there was no autopsy
and the vessel affected was not known.

In a child of three years that had swallowed a half-penny, Atkins
reports rupture of the innominate artery. No symptoms developed, but
six weeks later, the child had an attack of ulcerative stomatitis, from
which it seemed to be recovering nicely, when suddenly it ejected two
ounces of bright red blood in clots, and became collapsed out of
proportion to the loss of blood. Under treatment, it rallied somewhat,
but soon afterward it ejected four ounces more of blood and died in a
few minutes. At the autopsy 3/4 pint of blood was found in the stomach,
and a perforation was discovered on the right side of the esophagus,
leading into a cavity, in which a blackened half-penny was found.  A
probe passed along the aorta into the innominate protruded into the
same cavity about the bifurcation of the vessel.

Denonvilliers has described a perforation of the esophagus and aorta by
a five-franc piece. A preserved preparation of this case, showing the
coin in situ, is in the Musee Dupuytren.  Blaxland relates the instance
of a woman of forty-five who swallowed a fish bone, was seized with
violent hematemesis, and died in eight hours. The necropsy revealed a
penetration of the aorta through the thoracic portion of the esophagus.
There is also in the Musee Dupuytren a preparation described by
Bousquet, in which the aorta and the esophagus were perforated by a
very irregular piece of bone. Mackenzie mentions an instance of death
from perforation of the aorta by a fish-bone.

In some cases penetration of the esophagus allows the further
penetration of some neighboring membrane or organ in the same manner as
the foregoing cases. Dudley mentions a case in which fatal hemorrhage
was caused by penetration of the esophagus and lung by a chicken-bone.
Buist speaks of a patient who swallowed two artificial teeth. On the
following day there was pain in the epigastrium, and by the fourth day
the pain extended to the vertebrae, with vomiting, delirium, and death
on the fifth day.  At the autopsy it was found that a foreign body,
seven cm. long had perforated the pericardium, causing a suppurative
pericarditis. Dagron reports a unique instance of death by purulent
infection arising from perforation of the esophagus by a pin. The
patient was a man of forty-two, and, some six weeks before he presented
himself for treatment, before swallowing had experienced a severe pain
low down in the neck. Five days before admission he had had a severe
chill, followed by sweating and delirium. He died of a supraclavicular
abscess on the fifth day; a black steel pin was found against the
esophagus and trachea.

In connection with foreign bodies in the esophagus, it might be
interesting to remark that Ashhurst has collected 129 cases of
esophagotomy for the removal of foreign bodies, resulting in 95
recoveries and 34 deaths. Gaudolphe collected 142 cases with 110
recoveries.

Injuries of the neck are usually inflicted with suicidal intent or in
battle. Cornelius Nepos says that while fighting against the
Lacedemonians, Epaminondas was sensible of having received a mortal
wound, and apprehending that the lance was stopping a wound in an
important vessel, remarked that he would die when it was withdrawn.
When he was told that the Boeotians had conquered, exclaiming "I die
unconquered," he drew out the lance and perished. Petrus de Largenta
speaks of a man with an arrow in one of his carotids, who was but
slightly affected before its extraction, but who died immediately after
the removal of the arrow. Among the remarkable recoveries from injuries
of the neck is that mentioned by Boerhaave, of a young man who lived
nine or ten days after receiving a sword-thrust through the neck
between the 4th and 5th vertebrae, dividing the vertebral artery.
Benedictus, Bonacursius, and Monroe, all mention recovery after cases
of cut-throat in which the esophagus as well as the trachea was
wounded, and food protruded from the external cut. Warren relates the
history of a case in which the vertebral artery was wounded by the
discharge of a pistol loaded with pebbles. The hemorrhage was checked
by compression and packing, and after the discharge of a pebble and a
piece of bone from the wound, the man was seen a month afterward in
perfect health. Corson of Norristown, Pa., has reported the case of a
quarryman who was stabbed in the neck with a shoemaker's knife,
severing the left carotid one inch below its division. He was seen
thirty minutes later in an apparently lifeless condition, but efforts
at resuscitation were successfully made. The hemorrhage ceased
spontaneously, and at the time of report, the man presented the
symptoms of one who had had his carotid ligated (facial atrophy on one
side, no pulse, etc.). Baron Larrey mentions a case of gunshot wound in
which the carotid artery was open at its division into internal and
external branches, and says that the wound was plugged by an
artilleryman until ligation, and in this primitive manner the patient
was saved. Sale reports the case of a girl of nineteen, who fell on a
china bowl that she had shattered, and wounded both the right common
carotid artery and internal jugular vein. There was profuse and
continuous hemorrhage for a time, and subsequently a false aneurysm
developed, which ruptured in about three months, giving rise to
enormous momentary hemorrhage; notwithstanding the severity of the
injury and the extent of the hemorrhage, complete recovery ensued. Amos
relates the instance of a woman named Mary Green who, after complete
division of all the vessels of the neck, walked 23 yards and climbed
over an ordinary bar-gate nearly four feet high.

Cholmeley reports the instance of a Captain of the First Madras
Fusileers, who was wounded at Pegu by a musket-ball penetrating his
neck. The common carotid was divided and for five minutes there was
profuse hemorrhage which, however, strange to say, spontaneously
ceased. The patient died in thirty-eight hours, supposedly from spinal
concussion or shock.

Relative to ligature of the common carotid artery, Ashhurst mentions
the fact that the artery has been ligated in 228 instances, with 94
recoveries. Ellis mentions ligature of both carotids in four and a half
days, as a treatment for a gunshot wound, with subsequent recovery.
Lewtas reports a case of ligation of the innominate and carotid
arteries for traumatic aneurysm (likely a hematoma due to a gunshot
injury of the subclavian artery). The patient was in profound collapse,
but steadily reacted and was discharged cured on the forty-fifth day,
with no perceptible pulse at the wrist and only a feeble beat in the
pulmonary artery.

Garengeot, Wirth, Fine, and Evers, all mention perforating wounds of
the trachea and esophagus with recoveries. Van Swieten and Hiester
mention cases in which part of the trachea was carried away by a ball,
with recovery. Monro, Tulpius, Bartholinus, and Pare report severance
of the trachea with the absence of oral breathing, in which the divided
portions were sutured, with successful results. In his "Theatro
Naturae," Bodinus says that William, Prince of Orange, lost the sense
of taste after receiving a wound of the larynx; according to an old
authority, a French soldier became mute after a similar accident.
Davies-Colley mentions a boy of eighteen who fell on a stick about the
thickness of the index finger, transfixing his neck from right to left;
he walked to a doctor's house, 250 yards away, with the stick in situ.
In about two weeks he was discharged completely well. During treatment
he had no hemorrhage of any importance, and his voice was not affected,
but for a while he had slight dysphagia.

Barker gives a full account of a barber who was admitted to a hospital
two and a half hours after cutting his throat. He had a deep wound
running transversely across the neck, from one angle of the jaw to the
other, cutting open the floor of the mouth and extending from the inner
border of the sternocleido-mastoid to the other, leaving the large
vessels of the neck untouched. The razor had passed through the
glosso-epiglottidean fold, a tip of the epiglottis, and through the
pharynx down to the spinal column. There was little hemorrhage, but the
man could neither swallow nor speak. The wound was sutured, tracheotomy
done, and the head kept fixed on the chest by a copper splint. He was
ingeniously fed by esophageal tubes and rectal enemata; in three weeks
speech and deglutition were restored. Shortly afterward the esophageal
tube was removed and recovery was virtually complete.  Little mentions
an extraordinary case of a woman of thirty-six who was discharged from
Garland's asylum, where she had been an inmate for three months. This
unfortunate woman had attempted suicide by self-decapitation from
behind forward. She was found, knife in hand, with a huge wound in the
back of the neck and her head bobbing about in a ghastly manner. The
incision had severed the skin, subcutaneous tissues and muscles, the
ligaments and bone, opening the spinal canal, but not cutting the cord.
The instrument used to effect this major injury was a blunt
potato-peeling knife. Despite this terrible wound the patient lived to
the sixth day.

Hislop records a case of cut-throat in a man of seventy-four. He had a
huge gaping wound of the neck, extending to within a half inch of the
carotids on each side. The trachea was almost completely severed, the
band left was not more than 1/4 inch wide. Hislop tied four arteries,
brought the ends of the trachea together with four strong silk sutures,
and, as the operation was in the country, he washed the big cavity of
the wound out with cold spring-water. He brought the superficial
surfaces together with ten interrupted sutures, and, notwithstanding
the patient's age, the man speedily recovered. This emphasizes the fact
that the old theory of leaving wounds of this nature open was
erroneous. Solly reports the case of a tailor of twenty-two who
attempted suicide by cutting through the larynx, entirely severing the
epiglottis and three-fourths of the pharynx. No bleeding point was
found, and recovery ensued.

Cowles describes the case of a soldier of thirty-five who, while
escaping from the patrols, was shot by the Officer of the Day with a
small bullet from a pistol. The ball entered the right shoulder,
immediately over the suprascapular notch, passed superficially upward
and forward into the neck, wounding the esophagus posteriorly at a
point opposite the thyroid cartilage, and lodged in the left side of
the neck. The patient had little hemorrhage, but had expectorated and
swallowed much blood. He had a constant desire to swallow, which
continued several days. The treatment was expectant; and in less than
three weeks the soldier was returned to duty. From the same authority
there is a condensation of five reports of gunshot wounds of the neck,
from all of which the patients recovered and returned to duty.

Braman describes the case of a man on whom several injuries were
inflicted by a drunken companion. The first wound was slight; the
second a deep flesh-wound over the trapezius muscle; the third extended
from the right sterno-cleido-mastoid midway upward to the middle of the
jaw and down to the rapine of the trachea. The external jugular, the
external thyroid, and the facial arteries were severed. Braman did not
find it necessary to ligate, but was able to check the hemorrhage with
lint and persulphate of iron, in powder, with pressure. After fourteen
hours the wound was closed; the patient recovered, and was returned to
duty in a short time.

Thomas has reported the case of a man sixty-five years old who in an
attempt at suicide with a penknife, had made a deep wound in the left
side of the neck. The sternohyoid and omohyoid muscles were divided;
the internal jugular vein was cut through, and its cut ends were
collapsed and 3/4 inch apart; the common carotid artery was cut into,
but not divided; the thyroid cartilage was notched, and the external
and anterior jugular veins were severed. Clamp-forceps were immediately
applied to the cut vessels and one on each side the aperture in the
common carotid from which a small spurt of blood, certainly not half a
teaspoonful, came out. The left median basilic vein was exposed by an
incision, and 20 ounces of warm saline solution were slowly perfused,
an ordinary glass syringe with a capacity of five ounces, with an
India-rubber tubing attached to a canula in the vein being employed.
After seven ounces of fluid had been injected, the man made a short,
distinct inspiration; at ten ounces a deeper one (the radial pulse
could now be felt beating feebly); at 15 ounces the breathing became
regular and deep; at 18 ounces the man opened his eyes, but did not
appear to be conscious. The clamped vessels were now tied with catgut
and the wound cleansed with phenol lotion and dressed with
cyanid-gauze.  The man was surrounded by hot-water bottles and the foot
of the bed elevated 18 inches. In the course of an hour the patient had
recovered sufficiently to answer in a squeaky voice to his name when
called loudly. Improvement proceeded rapidly until the twenty-second
day, when violent hemorrhage occurred, preceded a few hours previously
by a small trickle, easily controlled by pressure. The wound was at
once opened and blood found oozing from the distal extremities of the
carotid artery and jugular vein, which were promptly clamped. The
common carotid artery was not sound, so that ligatures were applied to
the internal and external carotids and to the internal jugular with a
small branch entering into it. The patient was in great collapse, but
quickly rallied, only to suffer renewed hemorrhage from the internal
carotid nine days later. This was controlled by pressure with sponges,
and a quart of hot water was injected into the rectum.  From this time
on the patient made a slow recovery, a small sinus in the lower part of
the neck disappearing on the removal of the catgut ligature.

Adams describes the case of a woman who attempted suicide with a common
table-knife, severing the thyroid, cricoid, and first three rings of
the trachea, and lacerating the sternohyoid and thyroid arteries; she
finally recovered.

There is a curious case of suicide of a woman who, while under the
effects of opium, forced the handle of a mirror into her mouth. From
all appearances, the handle had broken off near the junction and she
had evidently fallen forward with the remaining part in her mouth,
driving it forcibly against the spine, and causing the point of the
handle to run downward in front of the cervical vertebrae. On
postmortem examination, a sharp piece of wood about two inches long,
corresponding to the missing portion of the broken mirror handle, was
found lying between the posterior wall of the esophagus and the spine.
Hennig mentions a case of gunshot wound of the neck in which the musket
ball was lodged in the posterior portion of the neck and was
subsequently discharged by the anus.

Injuries of the cervical vertebrae, while extremely grave, and declared
by some authors to be inevitably fatal, are, however, not always
followed by death or permanently bad results. Barwell mentions a man of
sixty-three who, in a fit of despondency, threw himself from a window,
having fastened a rope to his neck and to the window-sill. He fell 11
or 12 feet, and in doing so suffered a subluxation of the 4th cervical
vertebra. It slowly resumed the normal position by the elasticity of
the intervertebral fibrocartilage, and there was complete recovery in
ten days.  Lazzaretto reports the history of the case of a seaman whose
atlas was dislocated by a blow from a falling sail-yard. The
dislocation was reduced and held by adhesive strips, and the man made a
good recovery. Vanderpool of Bellevue Hospital, N.Y., describes a
fracture of the odontoid process caused by a fall on the back of the
head; death, however, did not ensue until six months later. According
to Ashhurst, Philips, the elder Cline, Willard Parker, Bayard, Stephen
Smith, May, and several other surgeons, have recorded complete recovery
after fracture of the atlas and axis. The same author also adds that
statistic investigation shows that as large a proportion as 18 per cent
of injuries of the cervical vertebrae occurring in civil practice,
recover. However, the chances of a fatal issue in injuries of the
vertebrae vary inversely with the distance of the point of injury from
the brain. Keen has recorded a case in which a conoidal ball lodged in
the body of the third cervical vertebra, from which it was extracted
six weeks later. The paralysis, which, up to the time of extraction,
had affected all four limbs, rapidly diminished. In about five weeks
after the removal of the bullet nearly the entire body of the 3d
cervical vertebra, including the anterior half of the transverse
process and vertebral foremen, was spontaneously discharged. Nearly
eight years afterward Keen saw the man still living, but with his right
shoulder and arm diminished in size and partly paralyzed.

Doyle reports a case of dislocated neck with recovery. During a runaway
the patient was thrown from his wagon, and was soon after found on the
roadside apparently dead. Physicians who were quickly summoned from the
immediate neighborhood detected faint signs of life; they also found a
deformity of the neck, which led them to suspect dislocation. An
ambulance was called, and without any effort being made to relieve the
deformity the man was placed in it and driven to his home about a mile
distant. The jolting over the rough roads greatly aggravated his
condition. When Doyle saw the patient, his general appearance presented
a hopeless condition, but being satisfied that a dislocation existed,
Doyle immediately prepared to reduce it. Two men were told to grasp the
feet and two more the head, and were directed to make careful but
strong extension. At the same time the physician placed his right hand
against the neck just over the pomum Adami, and his left against the
occiput, and, while extension was being made, he flexed the head
forward until the chin nearly touched the breast, after which the head
was returned to its normal position. The manipulation was accompanied
by a clicking sensation, caused by the replacement of the dislocated
vertebra. The patient immediately showed signs of relief and improved
rapidly.  Perceptible but feeble movements were made by all the limbs
except the right arm. The patient remained in a comatose condition for
eight or nine days, during which he had enuresis and intestinal torpor.
He suffered from severe concussion of the brain, which accounted for
his prolonged coma. Delirium was present, but he was carefully watched
and not allowed to injure himself. His recovery was tedious and was
delayed by several relapses. His first complaint after consciousness
returned (on the tenth day) was of a sense of constriction about the
neck, us if he were being choked. This gradually passed off, and his
improvement went on without development of any serious symptoms.  At
the time of report he appeared in the best of health and was quite able
to attend to his daily avocations. Doyle appends to his report the
statement that among 394 cases embraced in Ashhurst's statistics, in
treatment of dislocations in the cervical region, the mortality has
been nearly four times greater when constitutional or general treatment
has been relied on exclusively than when attempts had been made to
reduce the dislocation by extension, rotation, etc. Doyle strongly
advocates attempts at reduction in such cases.

Figure 205 represents a photograph of Barney Baldwin, a switchman of
the Louisville and Nashville Railroad, who, after recovery from
cervical dislocation, exhibited himself about the country, never
appearing without his suspensory apparatus.

Acheson records a case of luxation of the cervical spine with recovery
after the use of a jury-mast. The patient was a man of fifty-five, by
trade a train-conductor. On July 10, 1889, he fell backward in front of
a train, his head striking between the ties; the brake-body caught his
body, pushing it forward on his head, and turned him completely over.
Three trucks passed over him.  When dragged from beneath the train, his
upper extremities were paralyzed. At noon the next day, nineteen hours
after the accident, examination revealed bruises over the body, and he
suffered intense pain at the back of the neck and base of the skull.
Posteriorly, the neck presented a natural appearance; but anteriorly,
to use the author's description, his neck resembled a combined case of
mumps and goiter. The sternomastoid muscle bulged at the angle of the
jaw, and was flaccid, and his "Adam's apple" was on a level with the
chin. Sensation in the upper extremities was partially restored, and,
although numb, he now had power of movement in the arms and hands, but
could not rotate his neck. A diagnosis of cervical dislocation was
made, and violent extension, with oscillation forward and backward, was
practiced, and the abnormal appearance subsided at once. No crepitus
was noticed. On the fourth day there was slight hemorrhage from the
mouth, which was more severe on the fifth and sixth days. The lower jaw
had been forced past the upper, until the first molar had penetrated
the tissues beneath the tongue. A plaster-of-Paris apparatus was
applied, and in two months was exchanged for one of sole-leather. In
rising from the recumbent position the man had to lift his head with
his hands. Fifty days after the accident he suffered excruciating pain
at the change of the weather, and at the approach of a storm the
joints, as well as the neck, were involved. It was believed (one
hundred and seven days after the accident) that both fracture and
luxation existed. His voice had become guttural, but examination of the
fauces was negative. The only evidence of paralysis was in the fingers,
which, when applied to anything, experienced the sensation of touching
gravel. The mottling of the tissues of the neck, which appeared about
the fiftieth day, had entirely disappeared.

According to Thorburn, Hilton had a patient who lived fourteen years
with paraplegia due to fracture of the 5th, 6th, and 7th cervical
vertebrae. Shaw is accredited with a case in which the patient lived
fifteen months, the fracture being above the 4th cervical vertebra.

In speaking of foreign bodies in the larynx and trachea, the first to
be considered will be liquids. There is a case on record of an infant
who was eating some coal, and being discovered by its mother was forced
to rapidly swallow some water. In the excitement, part of the fluid
swallowed fell into the trachea, and death rapidly ensued. It is hardly
necessary to mention the instances in which pus or blood from ruptured
abscesses entered the trachea and caused subsequent asphyxiation. A
curious instance is reported by Gaujot of Val-de-Grace of a soldier who
was wounded in the Franco-Prussian war, and into whose wound an
injection of the tincture of iodin was made. The wound was of such an
extent as to communicate with a bronchus, and by this means the iodin
entered the respiratory tract, causing suffocation. According to
Poulet, Vidal de Cassis mentions an inmate of the Charite Hospital, in
Paris, who, full of wine, had started to vomit; he perceived Corvisart,
and knew he would be questioned, therefore he quickly closed his mouth
to hide the proofs of his forbidden ingestion. The materials in his
mouth were forced into the larynx, and he was immediately asphyxiated.
Laennec, Merat, and many other writers have mentioned death caused by
the entrance of vomited materials into the air-passages. Parrot has
observed a child who died by the penetration of chyme into the
air-passages. The bronchial mucous and underlying membrane were already
in a process of digestion.  Behrend, Piegu, and others cite analogous
instances.

The presence of a foreign body in the larynx is at all times the cause
of distressing symptoms, and, sometimes, a substance of the smallest
size will cause death. There is a curious accident recorded that
happened to a young man of twenty-three, who was anesthetized in order
to extract a tooth. A cork had been placed between the teeth to keep
the mouth open. The tooth was extracted but slipped from the forceps,
and, together with the cork, fell into the pharynx. The tooth was
ejected in an effort at vomiting, but the cork entered the larynx, and,
after violent struggles, asphyxiation caused death in an hour. The
autopsy demonstrated the presence of the cork in the larynx. A somewhat
analogous case, though not ending fatally, was reported by Hertz of a
woman of twenty-six, who was anesthetized for the extraction of the
right second inferior molar. The crown broke off during the operation,
and immediately after the extraction she had a fit of coughing. About
fifteen days later she experienced pain in the lungs. Her symptoms
increased to the fifth week, when she became so feeble as to be
confined to her bed. A body seemed to be moving in the trachea,
synchronously with respiration. At the end of the fifth week the
missing crown of the tooth was expelled after a violent fit of
coughing; the symptoms immediately ameliorated, and recovery was rapid
thereafter. Aronsohn speaks of a child who was playing with a toy
wind-instrument, and in his efforts to forcibly aspirate air through
it, the child drew the detached reed into the respiratory passages,
causing asphyxiation. At the autopsy the foreign body was found at the
superior portion of the left bronchus. There are other cases in which,
while sucking oranges or lemons, seeds have been aspirated; and there
is a case in which, in a like manner, the claw of a crab was drawn into
the air-passages. There are two cases mentioned in which children
playing with toy balloons, which they inflated with their breath, have,
by inspiration, reversed them and drawn the rubber of the balloon into
the opening of the glottis, causing death. Aronsohn, who has already
been quoted, and whose collection of instances of this nature is
probably the most extensive, speaks of a child in the street who was
eating an almond; a carriage threw the child down and he suddenly
inspired the nut into the air-passages, causing immediate asphyxia The
same author also mentions a soldier walking in the street eating a
plum, who, on being struck by a horse, suddenly started and swallowed
the seed of the fruit.  After the accident he had little pain or
oppression, and no coughing, but twelve hours afterward he rejected the
seed in coughing.

A curious accident is that in which a foreign body thrown into the air
and caught in the mouth has caused immediate asphyxiation. Suetonius
transmits the history of a young man, a son of the Emperor Claudius,
who, in sport, threw a small pear into the air and caught it in his
mouth, and, as a consequence, was suffocated. Guattani cites a similar
instance of a man who threw up a chestnut, which, on being received in
the mouth, lodged in the air-passages; the man died on the nineteenth
day.  Brodie reported the classic observation of the celebrated
engineer, Brunel, who swallowed a piece of money thrown into the air
and caught in his mouth. It fell into the open larynx, was inspired,
causing asphyxiation, but was removed by inversion of the man's body.

Sennert says that Pope Adrian IV died from the entrance of a fly into
his respiratory passages; and Remy and Gautier record instances of the
penetration of small fish into the trachea.  There are, again,
instances of leeches in this location.

Occasionally the impaction of artificial teeth in the neighborhood of
the larynx has been unrecognized for many years.  Lennox Browne reports
the history of a woman who was supposed to have either laryngeal
carcinoma or phthisis, but in whom he found, impacted in the larynx, a
plate with artificial teeth attached, which had remained in this
position twenty-two months unrecognized and unknown. The patient, when
questioned, remembered having been awakened in the night by a violent
attack of vomiting, and finding her teeth were missing assumed they
were thrown away with the ejections. From that time on she had suffered
pain and distress in breathing and swallowing, and became the subject
of progressive emaciation. After the removal of the impacted plate and
teeth she soon regained her health.  Paget speaks of a gentleman who
for three months, unconsciously, carried at the base of the tongue and
epiglottis, very closely fitted to all the surface on which it rested,
a full set of lost teeth and gold palate-plate. From the symptoms and
history it was suspected that he had swallowed his set of false teeth,
but, in order to prevent his worrying, he was never informed of this
suspicion, and he never once suspected the causes of his symptoms.

Wrench mentions a case illustrative of the extent to which imagination
may produce symptoms simulating those ordinarily caused by the
swallowing of false teeth. This man awoke one morning with his nose and
throat full of blood, and noticed that his false teeth, which he seldom
removed at night, were missing.  He rapidly developed great pain and
tumor in the larynx, together with difficulty in deglutition and
speech. After a fruitless search, with instrumental and laryngoscopic
aid, the missing teeth were found--in a chest of drawers; the symptoms
immediately subsided when the mental illusion was relieved.

There is a curious case of a man drowned near Portsmouth. After the
recovery of his body it was seen that his false teeth were impacted at
the anterior opening of the glottis, and it was presumed that the shock
caused by the plunge into the cold water had induced a violent and deep
inspiration which carried the teeth to the place of impaction.

Perrin reports a case of an old man of eighty-two who lost his life
from the impaction of a small piece of meat in the trachea and glottis.
In the Musee Valde-Grace is a prepared specimen of this case showing
the foreign body in situ. In the same museum Perrin has also deposited
a preparation from the body of a man of sixty-two, who died from the
entrance of a morsel of beef into the respiratory passages. At the
postmortem a mobile mass of food about the size of a hazel-nut was
found at the base of the larynx at the glossoepiglottic fossa. About
the 5th ring of the trachea the caliber of this organ was obstructed by
a cylindric alimentary bolus about six inches long, extending almost to
the bronchial division. Ashhurst shows a fibrinous cast, similar to
that found in croup, caused by a foreign body removed by Wharton,
together with a shawl-pin, from a patient at the Children's Hospital
seven hours after the performance of tracheotomy. Search for the
foreign body at the time of the operation was prevented by profuse
hemorrhage.

The ordinary instances of foreign bodies in the larynx and trachea are
so common that they will not be mentioned here. Their variety is
innumerable and it is quite possible for more than two to be in the
same location simultaneously. In his treatise on this subject Gross
says that he has seen two, three, and even four substances
simultaneously or successively penetrate the same location. Berard
presented a stick of wood extracted from the vocal cords of a child of
ten, and a few other similar instances are recorded.

The Medical Press and Circular finds in an Indian contemporary some
curious instances of misapplied ingenuity on the part of certain
habitual criminals in that country. The discovery on a prisoner of a
heavy leaden bullet about 3/4 inch in diameter led to an inquiry as to
the object to which it was applied. It was ascertained that it served
to aid in the formation of a pouch-like recess at the base of the
epiglottis. The ball is allowed to slide down to the desired position,
and it is retained there for about half an hour at a time. This
operation is repeated many times daily until a pouch the desired size
results, in which criminals contrive to secrete jewels, money, etc., in
such a way as to defy the most careful search, and without interfering
in any way with speech or respiration. Upward of 20 prisoners at
Calcutta were found to be provided with this pouch-formation. The
resources of the professional malingerer are exceedingly varied, and
testify to no small amount of cunning.  The taking of internal
irritants is very common, but would-be in-patients very frequently
overshoot the mark and render recovery impossible. Castor-oil seeds,
croton beans, and sundry other agents are employed with this object in
view, and the medical officers of Indian prisons have to be continually
on the lookout for artificially induced diseases that baffle diagnosis
and resist treatment. Army surgeons are not altogether unfamiliar with
these tricks, but compared with the artful Hindoos the British soldier
is a mere child in such matters.

Excision of the larynx has found its chief indication in carcinoma, but
has been employed in sarcoma, polyps, tuberculosis, enchondroma,
stenosis, and necrosis. Whatever the procedure chosen for the
operation, preliminary tracheotomy is a prerequisite. It should be made
well below the isthmus of the thyroid gland, and from three to fifteen
days before the laryngectomy. This affords time for the lungs to become
accustomed to the new manner of breathing, and the trachea becomes
fixed to the anterior wall of the neck.

Powers and White have gathered 69 cases of either total or partial
extirpation of the larynx, to which the 240 cases collected and
analyzed by Eugene Kraus, in 1890, have been added.  The histories of
six new cases are given. Of the 309 operations, 101, or 32 per cent of
the patients, died within the first eight weeks from shock, hemorrhage,
pneumonia, septic infection, or exhaustion. The cases collected by
these authors show a decrease in the death ratio in the total
excision,--29 per cent as against 36 per cent in the Kraus tables. The
mortality in the partial operation is increased, being 38 per cent as
opposed to 25 per cent. Cases reported as free from the disease before
the lapse of three years are of little value, except in that they
diminish, by so much, the operative death-rate. Of 180 laryngectomies
for carcinoma prior to January 1, 1892, 72, or 40 per cent, died as a
result of the operation; 51 of the remaining 108 had recurrence during
the first year, and 11, or ten per cent of the survivors, were free
from relapse three or more years after operation. In 77 cases of
partial laryngectomy for cancer, 26, or 33 per cent, died during the
first two months; of the remaining 51, seven cases, or 13 per cent, are
reported as free from the disease three or more years after the
operation.

Injuries destroying great portions of the face or jaw, but not causing
death, are seldom seen, except on the battle-field, and it is to
military surgery that we must look for the most striking instances of
this kind. Ribes mentions a man of thirty-three who, in the Spanish
campaign in 1811, received an injury which carried away the entire body
of the lower jaw, half of each ramus, and also mangled in a great
degree the neighboring soft parts. He was transported from the field of
battle, and, despite enormous hemorrhage and suppuration, in two months
recovered. At the time of report the wounded man presented no trace of
the inferior maxillary bone, but by carrying the finger along the side
of the pharynx in the direction of the superior dental arch the
coronoid apophyses could be recognized, and about six lines nearer the
temporal extremity the ramus could be discovered. The tongue was
missing for about one-third its length, and was thicker than natural
and retracted on the hyoid bone. The sublingual glands were adherent to
the under part of the tongue and were red and over-developed. The
inferior parts of the cheeks were cicatrized with the lateral and
superior regions of the neck, and with the base of the tongue and the
hyoid bone. The tongue was free under and in front of the larynx. The
patient used a gilded silver plate to fix the tongue so that
deglutition could be carried on.  He was not able to articulate sounds,
but made himself understood through the intervention of this plate,
which was fixed to a silver chin. The chin he used to maintain the
tongue-plate, to diminish the deformity, and to retain the saliva,
which was constantly dribbling on the neck. The same author quotes the
instance of a man of fifty, who, during the siege of Alexandria in
1801, was struck in the middle of his face, obliquely, by a cannonball,
from below upward and from right to left. A part of the right malar
bone, the two superior maxillary bones, the nasal bones, the cartilage,
the vomer, the middle lamina of the ethmoid, the left maxillary bone, a
portion of the left zygomatic arch, and a great portion of the inferior
maxilla were carried away, or comminuted, and all the soft parts
correspondingly lacerated. Several hours afterward this soldier was
counted among the number of dead, but Larrey, the surgeon-in-chief of
the army, with his typical vigilance and humanity, remarked that the
patient gave signs of life, and that, despite the magnitude of his
wound, he did not despair of his recovery. Those portions in which
attrition was very great were removed, and the splinters of bone taken
out, showing an enormous wound. Three months were necessary for
cicatrization, but it was not until the capitulation of Marabou, at
which place he was wounded, that the patient was returned to France. At
this time he presented a hideous aspect. There were no signs of nose,
nor cartilage separating the entrance of the nostrils, and the vault of
the nasal fossa could be easily seen. There was a part of the posterior
region of the right superior maxilla, but the left was entirely
gone--in fact, the man presented an enormous triangular opening in the
center of the face, as shown by the accompanying illustration. The
tongue and larynx were severely involved, and the sight in the left eye
was lost. This patient continually wore a gilded silver mask, which
covered his deformity and rendered articulation a little less
difficult. The saliva continually dribbled from the mouth and from the
inferior internal portion of his mask, compelling him to carry some
substance to receive the dribblings. Whymper mentions an analogous
instance of a gunner who had his whole lower jaw torn away by a shell,
but who recovered and used an ingenious contrivance in the shape of a
silver mask for remedying the loss of the parts. Steiner mentions a
wound from a cannon-ball, which carried away the left half of the
inferior maxilla, stripping the soft parts as high as the malar, and on
the left side of the neck to within 1 1/2 inches of the clavicle,
laying bare the transverse processes of the 2d and 3d vertebrae, end
exposing the external carotid and most of its branches.

It sometimes happens that a foreign body, such as the breech of a gun,
may be imbedded for some time in the face, with subsequent safe
removal. Keith mentions an instance of the successful removal of the
breech of a fowling-piece from the face, at the root of the nose, after
a lodgment of four months; and Fraser cites an analogous instance in
which the breech was imbedded in the bones of the face for eight years
Smith records an instance in which a broken piece of tobacco-pipe
penetrated the cheek, remained there for seven months, but was
successfully extracted.

Before leaving accidents to the head and neck, a most curious case,
cited by O'Neill, will be briefly reviewed. A boy of twelve was
entrusted to carry a new iron pot to the destination of its purchaser.
Probably to facilitate transportation, the boy removed his hat and
placed the pot obliquely on the back part of his head, but a sudden
movement caused it to slip forward and downward over the head.
Unavailing efforts were made at the time and after he reached home, to
remove the pot from his head, but in vain, and he continued all the
night greatly prostrated by fright, hunger, and thirst, together with
the efforts at removal.  The next morning he was taken to a neighboring
blacksmith, who, by greasing one of his fingers, managed to insinuate
it between the head and pot. Placing the other side of the pot against
an anvil he struck over the location of his finger a quick, heavy tap
with a hammer, and the pot fell to pieces. The little patient was much
exhausted by all his treatment and want of sleep, and, in fact, could
hardly have endured his situation much longer.



CHAPTER XI.

SURGICAL ANOMALIES OF THE EXTREMITIES.

Reunion of Digits.--An interesting phenomenon noticed in relation to
severed digits is their wonderful capacity for reunion.  Restitution of
a severed part, particularly if one of considerable function, naturally
excited the interest of the older writers. Locher has cited an instance
of avulsion of the finger with restitution of the avulsed portion; and
Brulet, Van Esh, Farmer, Ponteau, Regnault, and Rosenberg cite
instances of reunion of a digit after amputation or severance. Eve's
"Remarkable Cases in Surgery" contains many instances of reunion of
both fingers and thumbs, and in more recent years several other similar
cases have been reported. At the Emergency Hospital in Washington,
D.C., there was a boy brought in who had completely severed one of his
digits by a sharp bread-cutter. The amputated finger was wrapped up in
a piece of brown paper, and, being apparently healthy and the wound
absolutely clean, it was fixed in the normal position on the stump, and
covered by a bichlorid dressing. In a short time complete function was
restored. In this instance no joint was involved, the amputation being
in the middle of the 2d phalanx. Staton has described a case in which
the hand was severed from the arm by an accidental blow from an axe.
The wound extended from the styloid process directly across to the
trapezium, dividing all the muscles and blood-vessels, cutting through
bones. A small portion of the skin below the articulation, with the
ulna, remained intact. After an unavoidable delay of an hour, Staton
proceeded to replace the hand with silver sutures, adhesive plaster,
and splints. On the third day pulsation was plainly felt in the hand,
and on the fourteenth day the sutures were removed. After some time the
patient was able to extend the fingers of the wounded member, and
finally to grasp with all her wonted strength.

The reproduction or accidental production of nails after the original
part has been torn away by violence or destroyed by disease, is quite
interesting. Sometimes when the whole last phalanx has been removed,
the nail regrows at the tip of the remaining stump. Tulpius seems to
have met with this remarkable condition. Marechal de Rougeres, Voigtel,
and Ormancey have related instances of similar growths on the 2d
phalanx after the loss of the 1st. For several months a woman had
suffered from an ulcer of the middle finger of the right hand, in
consequence of a whitlow; there was loss of the 3d phalanx, and the
whole of the articular surface and part of the compact bony structure
of the 2d. On examining the sore, Ormangey saw a bony sequestrum which
appeared to keep it open. He extracted this, and, until cicatrization
was complete, he dressed the stump with saturnine cerate. Some months
afterward Ormangey saw with astonishment that the nail had been
reproduced; instead of following the ordinary direction, however, it
lay directly over the face of the stump, growing from the back toward
the palmer aspect of the stump digit, as if to cover and protect the
stump. Blandin has observed a case of the same description. A third
occurred at the Hopital de la Charite, in a woman, who, in consequence
of a whitlow, had lost the whole of the 3d phalanx of one of the
forefingers. The soft and fleshy cushion which here covered the 2d
phalanx was terminated by a small, blackish nail, like a grain of spur
rye.  It is probable that in these cases the soft parts of the 3d
phalanx, and especially the ungual matrix, had not been wholly
destroyed. In his lectures Chevalier speaks of analogous cases.

In some instances avulsion of a finger is effected in a peculiar
manner. In 1886 Anche reported to his confreres in Bordeaux a rare
accident of this nature that occurred to a carpenter. The man's finger
was caught between a rope and the block of a pulley.  By a sudden and
violent movement on his part he disengaged the hand but left the 3d
finger attached to the pulley. At first examination the wound looked
like that of an ordinary amputation by the usual oval incision; from
the center of the wound the proximal fragment of the 1st phalanx
projected. Polaillon has collected 42 similar instances, in none of
which, however, was the severance complete.

It occasionally happens that in avulsion of the finger an entire tendon
is stripped up and torn off with the detached member.  Vogel describes
an instance of this nature, in which the long flexor of the thumb was
torn off with that digit. In the Surgical Museum at Edinburgh there is
preserved a thumb and part of the flexor longus pollicis attached,
which were avulsed simultaneously. Nunnely has seen the little finger
together with the tendon and body of the longer flexor muscle avulsed
by machinery. Stone details the description of the case of a boy named
Lowry, whose left thumb was caught between rapidly twisting strands of
a rope, and the last phalanx, the neighboring soft parts, and also the
entire tendon of the flexor longus pollicis were instantly torn away.
There was included even the tendinous portion of that small slip of
muscle taking its origin from the anterior aspect of the head and upper
portion of the ulna, and which is so delicate and insignificant as to
be generally overlooked by anatomists. There was great pain along the
course of the tract of abstraction of the tendon.

Pinkerton describes a carter of thirty-one who was bitten on the thumb
by a donkey. The man pulled violently in one direction, and the donkey,
who had seized the thumb firmly with his teeth, pulled forcibly in the
other direction until the tissues gave way and the man ran off, leaving
his thumb in the donkey's mouth. The animal at once dropped the thumb,
and it was picked up by a companion who accompanied the man to the
hospital. On examination the detached portion was found to include the
terminal phalanx of the thumb, together with the tendon of the flexor
longus pollicis measuring ten inches, about half of which length had a
fringe of muscular tissue hanging from the free borders, indicating the
extent and the penniform arrangement of the fibers attached to it.
Meyer cites a case in which the index finger was torn off and the
flexor muscle twisted from its origin. The authors know of an
unreported case in which a man running in the street touched his hand
to a hitching block he was passing; a ring on one of his fingers caught
in the hook of the block, and tore off the finger with the attached
tendon and muscle. There is a similar instance of a Scotch gentleman
who slipped, and, to prevent falling, he put out his hand to catch the
railing. A ring on one of his fingers became entangled in the railing
and the force of the fall tore off the soft parts of the finger
together with the ring.

The older writers mentioned as a curious fact that avulsion of the arm,
unaccompanied by hemorrhage, had been noticed. Belchier, Carmichael,
and Clough report instances of this nature, and, in the latter case,
the progress of healing was unaccompanied by any uncomfortable
symptoms. In the last century Hunezoysky observed complete avulsion of
the arm by a cannon-ball, without the slightest hemorrhage. The
Ephemerides contains an account of the avulsion of the hand without any
bleeding, and Woolcomb has observed a huge wound of the arm from which
hemorrhage was similarly absent. Later observations have shown that in
this accident absence of hemorrhage is the rule and not the exception.
The wound is generally lacerated and contused and the mouths of the
vessels do not gape, but are twisted and crushed. The skin usually
separates at the highest point and the muscles protrude, appearing to
be tightly embraced and almost strangulated by the skin, and also by
the tendons, vessels, and nerves which, crushed and twisted with the
fragments of bone, form a conical stump.  Cheselden reports the history
of a case, which has since become classic, that he observed in St.
Thomas' Hospital in London, in 1837. A miller had carelessly thrown a
slip-knot of rope about his wrist, which became caught in a revolving
cog, drawing him from the ground and violently throwing his body
against a beam.  The force exerted by the cog drawing on the rope was
sufficient to avulse his whole arm and shoulder-blade. There was
comparatively little hemorrhage and the man was insensible to pain;
being so dazed and surprised he really was unconscious of the nature of
his injury until he saw his arm in the wheel.

According to Billroth the avulsion of an arm is usually followed by
fatal shock. Fischer, however, relates the case of a lion-tamer whose
whole left arm was torn from the shoulder by a lion; the loss of blood
being very slight and the patient so little affected by shock that he
was able to walk to the hospital.

Mussey describes a boy of sixteen who had his left arm and
shoulder-blade completely torn from his body by machinery. The patient
became so involved in the bands that his body was securely fastened to
a drum, while his legs hung dangling. In this position he made about 15
revolutions around the drum before the motion of the machinery could be
effectually stopped by cutting off the water to the great wheel. When
he was disentangled from the bands and taken down from the drum a huge
wound was seen at the shoulder, but there was not more than a pint of
blood lost. The collar-bone projected from the wound about half an
inch, and hanging from the wound were two large nerves (probably the
median and ulnar) more than 20 inches long.  He was able to stand on
his feet and actually walked a few steps; as his frock was opened, his
arm, with a clot of blood, dropped to the floor. This boy made an
excellent recovery. The space between the plastered ceiling and the
drum in which the revolutions of the body had taken place was scarcely
7 1/2 inches wide. Horsbeck's case was of a negro of thirty-five who,
while pounding resin on a 12-inch leather band, had his hand caught
between the wheel and band. His hand, forearm, arm, etc., were rapidly
drawn in, and he was carried around until his shoulder came to a large
beam, where the body was stopped by resistance against the beam, fell
to the floor, and the arm and scapula were completely avulsed and
carried on beyond the beam. In this case, also, the man experienced
little pain, and there was comparatively little hemorrhage. Maclean
reports the history of an accident to a man of twenty-three who had
both arms caught between a belt and the shaft while working in a woolen
factory, and while the machinery was in full operation. He was carried
around the shaft with great velocity until his arms were torn off at a
point about four inches below the shoulder-joint on each side. The
patient landed on his feet, the blood spurting from each brachial
artery in a large stream. His fellow-workmen, without delay, wound a
piece of rope around each bleeding member, and the man recovered after
primary amputation of each stump.  Will gives an excellent instance of
avulsion of the right arm and scapula in a girl of eighteen, who was
caught in flax-spinning machinery. The axillary artery was seen lying
in the wound, pulsating feebly, but had been efficiently closed by the
torsion of the machinery. The girl recovered.

Additional cases of avulsion of the upper extremity are reported by
Aubinais, Bleynie, Charles, George, James, Jones, Marcano, Belchier,
Braithwaite, and Hendry.

Avulsion of the Lower Extremity.--The symptoms following avulsion of
the upper extremity are seen as well in similar accidents to the leg
and thigh, although the latter are possibly the more fatal. Horlbeck
quotes Benomont's description of a small boy who had his leg torn off
at the knee by a carriage in motion; the child experienced no pain, and
was more concerned about the punishment he expected to receive at home
for disobedience than about the loss of his leg. Carter speaks of a boy
of twelve who incautiously put the great toe of his left foot against a
pinion wheel of a mill in motion. The toe was fastened and drawn into
the mill, the leg following almost to the thigh. The whole left leg and
thigh, together with the left side of the scrotum, were torn off; the
boy died as a result of his injuries.

Ashurst reported to the Pathological Society of Philadelphia the case
of a child of nine who had its right leg caught in the spokes of a
carriage wheel. The child was picked up unconscious, with its thigh
entirely severed, and the bone broken off about the middle third; about
three inches higher the muscles were torn from the sheaths and appeared
as if cut with a knife. The great sciatic nerve was found hanging 15
inches from the stump, having given way from its division in the
popliteal space. The child died in twelve hours. One of the most
interesting features of the case was the rapid cooling of the body
after the accident and prolongation of the coolness with slight
variations until death ensued. Ashurst remarks that while the cutaneous
surface of the stump was acutely sensitive to the touch, there was no
manifestation of pain evinced upon handling the exposed nerve.

With reference to injuries to the sciatic nerve, Kuster mentions the
case of a strong man of thirty, who in walking slipped and fell on his
back. Immediately after rising to his feet he felt severe pain in the
right leg and numbness in the foot. He was unable to stand, and was
carried to his house, where Kuster found him suffering great pain. The
diagnosis had been fracture of the neck of the femur, but as there was
no crepitation and passive movements caused but little pain, Kuster
suspected rupture of the sciatic nerve. The subsequent history of the
case confirmed this diagnosis. The patient was confined to bed six
weeks, and it was five months afterward before he was able to go about,
and then only with a crutch and a stick.

Park mentions an instance of rupture of the sciatic nerve caused by a
patient giving a violent lurch during an operation at the hip-joint.

The instances occasionally observed of recovery of an injured leg after
extensive severance and loss of substance are most marvelous. Morton
mentions a boy of sixteen, who was struck by one of the blades of a
reaping machine, and had his left leg cut through about 1 1/4 inches
above the ankle-joint. The foot was hanging by the portion of skin
corresponding to the posterior quarter of the circumference of the leg,
together with the posterior tibial vessels and nerves. These were the
only structures escaping division, although the ankle-joint itself was
intact. There was comparatively little hemorrhage and no shock; a
ligature was applied to the vessels, the edges of the wound were drawn
together by wire sutures, and the cut surfaces of the tibia were placed
in as good apposition as possible, although the lower fragment
projected slightly in front of the upper. The wound was dressed and
healing progressed favorably; in three months the wound had filled up
to such an extent that the man was allowed to go on crutches. The
patient was discharged in five months, able to walk very well, but
owing to the loss of the function of the extensor tendons the toes
dragged.

Washington reports in full the case of a boy of eleven, who, in handing
a fowling piece across a ditch, was accidentally shot.  The contents of
the gun were discharged through the leg above the ankle, carrying away
five-sixths of the structure--at the time of the explosion the muzzle
of the gun was only two feet away from his leg. The portions removed
were more than one inch of the tibia and fibula (irregular fractures of
the ends above and below), a corresponding portion of the posterior
tibial muscle, and the long flexors of the great and small toes, as
well as the tissue interposed between them and the Achilles tendon. The
anterior tibial artery was fortunately uninjured. The remaining
portions consisted of a strip of skin two inches in breadth in front of
the wound, the muscles which it covered back of the wound, the Achilles
tendon, and another piece of skin, barely enough to cover the tendon.
The wound was treated by a bran-dressing, and the limb was saved with a
shortening of but 1 1/2 inches.

There are several anomalous injuries which deserve mention.  Markoe
observed a patient of seventy-two, who ruptured both the quadriceps
tendons of each patella by slipping on a piece of ice, one tendon first
giving way, and followed almost immediately by the other. There was the
usual depression immediately above the upper margin of the patella, and
the other distinctive signs of the accident. In three months both
tendons had united to such an extent that the patient was able to walk
slowly. Gibney records a case in which the issue was not so successful,
his patient being a man who, in a fall ten years previously, had
ruptured the right quadriceps tendon, and four years later had suffered
the same accident on the opposite side. As a result of his injuries, at
the time Gibney saw him, he had completely lost all power of extending
the knee-joint. Partridge mentions an instance, in a strong and healthy
man, of rupture of the tendon of the left triceps cubiti, caused by a
fall on the pavement. There are numerous cases in which the tendo
Achillis has recovered after rupture,--in fact, it is unhesitatingly
severed when necessity demands it, sufficient union always being
anticipated. None of these cases of rupture of the tendon are unique,
parallel instances existing in medical literature in abundance.

Marshall had under his observation a case in which the femoral artery
was ruptured by a cart wheel passing over the thigh, and death ensued
although there were scarcely any external signs of contusion and
positively no fracture. Boerhaave cites a curious instance in which a
surgeon attempted to stop hemorrhage from a wounded radial artery by
the application of a caustic, but the material applied made such
inroads as to destroy the median artery and thus brought about a fatal
hemorrhage.

Spontaneous fractures are occasionally seen, but generally in advanced
age, although muscular action may be the cause. There are several cases
on record in which the muscular exertion in throwing a stone or ball,
or in violently kicking the leg, has fractured one or both of the bones
of an extremity. In old persons intracapsular fracture may be caused by
such a trivial thing as turning in bed, and even a sudden twist of the
ankle has been sufficient to produce this injury. In a boy of thirteen
Storrs has reported fracture of the femur within the acetabulum.  In
addition to the causes enumerated, inflammation of osseous tissue, or
osteoid carcinoma, has been found at the seat of a spontaneous fracture.

One of the most interesting subjects in the history of surgery is the
gradual evolution of the rational treatment of dislocations.  Possibly
no portion of the whole science was so backward as this.  Thirty-five
centuries ago Darius, son of Hydaspis, suffered a simple luxation of
the foot; it was not diagnosed in this land of Apis and of the deified
discoverer of medicine. Among the wise men of Egypt, then in her acme
of civilization, there was not one to reduce the simple luxation which
any student of the present day would easily diagnose and successfully
treat. Throughout the dark ages and down to the present century, the
hideous and unnecessary apparatus employed, each decade bringing forth
new types, is abundantly pictured in the older books on surgery; in
some almost recent works there are pictures of windlasses and of
individuals making superhuman efforts to pull the luxated member
back--all of which were given to the student as advisable means of
treatment.

Relative to anomalous dislocations the field is too large to be
discussed here, but there are two recent ones worthy of mention.
Bradley relates an instance of death following a subluxation of the
right humerus backward on the scapula It could not be reduced because
the tendon of the biceps lay between the head of the humerus and a
piece of the bone which was chipped off.

Baxter-Tyrie reports a dislocation of the shoulder-joint, of unusual
origin, in a man who was riding a horse that ran away up a steep hill.
After going a few hundred yards the animal abated its speed, when the
rider raised his hand to strike. Catching sight of the whip, the horse
sprang forward, while the man felt an acute pain and a sense of
something having given way at his shoulder. He did not fall off, but
rode a little further and was helped to dismount. On examination a
subcoracoid dislocation of the head of the humerus was found. The
explanation is that as the weight of the whip was inconsiderable (four
ounces) the inertia of the arm converted it into a lever of the first
order. Instead of fulfilling its normal function of preventing
displacement, the coraco-acromial arch acted as a fulcrum. The limb
from the fingers to that point acted as the "long arm," and the head
and part of the neck of the humerus served as the "short arm." The
inertia of the arm, left behind as it were, supplied the power, while
the ruptured capsular ligament and displacement of the head of the bone
would represent the work done.

Congenital Dislocations.--The extent and accuracy of the knowledge
possessed by Hippocrates on the subject of congenital dislocations have
excited the admiration of modern writers, and until a comparatively
recent time examples of certain of the luxations described by him had
not been recorded. With regard, for instance, to congenital
dislocations at the shoulder-joint, little or nothing was known save
what was contained in the writings of Hippocrates, till R. M. Smith and
Guerin discussed the lesion in their works.

Among congenital dislocations, those of the hips are most common--in
fact, 90 per cent of all. They are sometimes not recognizable until
after the lapse of months and sometimes for years, but their
causes--faulty developments of the joint, paralysis, etc.--are supposed
to have existed at birth. One or both joints may be involved, and
according to the amount of involvement the gait is peculiar. As to the
reduction of such a dislocation, the most that can be done is to
diminish the deformity and functional disability by traction and
palliative measures with apparatus. The normal structure of the joint
does not exist, and therefore the dislocation admits of no reduction.
Congenital dislocations of the shoulder are also seen, owing to faulty
development of the glenoid fossa; and at the knee, the leg generally
being in extreme hyperextension, the foot sometimes resting on the
abdomen. Congenital luxation of the femora, when it appears in adult
women is a prominent factor in dystocia.  There is a dislocation found
at birth, or occurring shortly after, due to dropsy of the joint in
utero; and another form due to succeeding paralysis of groups of
muscles about the joint.

The interesting instances of major amputations are so numerous and so
well known as to need no comment here. Amputation of the hip with
recovery is fast becoming an ordinary operation; at Westminster
Hospital in London, there is preserved the right humerus and scapula,
presenting an enormous bulk, which was removed by amputation at the
shoulder-joint, for a large lymphosarcoma growing just above the
clavicle. The patient was a man of twenty-two, and made a good
recovery. Another similar preparation is to be seen in London at St.
Bartholomew's Hospital.

Simultaneous, synchronous, or consecutive amputations of all the limbs
have been repeatedly performed. Champeuois reports the case of a
Sumatra boy of seven, who was injured to such an extent by an explosion
as to necessitate the amputation of all his extremities, and, despite
his tender age and the extent of his injuries, the boy completely
recovered. Jackson, quoted by Ashhurst, had a patient from whom he
simultaneously amputated all four limbs for frost-bite.

Muller reports a case of amputation of all four limbs for frost-bite,
with recovery. The patient, aged twenty-six, while traveling to his
home in Northern Minnesota, was overtaken by a severe snow storm, which
continued for three days; on December 13th he was obliged to leave the
stage in a snow-drift on the prairie, about 110 miles distant from his
destination. He wandered over the prairie that day and night, and the
following four days, through the storm, freezing his limbs, nose, ears,
and cheeks, taking no food or water until, on December 16th, he was
found in a dying condition by Indian scouts, and taken to a
station-house on the road. He did not reach the hospital at Fort
Ridgely until the night of December 24th--eleven days after his first
exposure. He was almost completely exhausted, and, after thawing the
ice from his clothes, stockings, and boots,--which had not been removed
since December 13th,--it was found that both hands and forearms were
completely mortified up to the middle third, and both feet and legs as
far as the upper third; both knees over and around the patellae, and
the alae and tip of the nose all presented a dark bluish appearance and
fairly circumscribed swelling. No evacuation of the bowels had taken
place for over two weeks, and as the patient suffered from singultus
and constant pain over the epigastric region, a light cathartic was
given, which, in twenty-four hours, gave relief.  The four frozen limbs
were enveloped in a solution of zinc chlorid. The frozen ears and
cheeks healed in due time, and the gangrenous parts of the nose
separated and soon healed, with the loss of the tip and parts of the
alae, leaving the septum somewhat exposed. On January 10th the lines of
demarcation were distinct and deep on all four limbs, though the
patient, seconded by his wife, at first obstinately opposed operative
interference; on January 13th, after a little hesitancy, the man
consented to an amputation of the arms. This was successfully carried
out on both forearms, at the middle third, the patient losing hardly
any blood and complaining of little pain. The great relief afforded by
this operation so changed his aversion to being operated upon that on
the next day he begged to have both legs amputated in the same manner,
which was done, three days afterward, with the same favorable result.
After some minor complications the patient left for his home, perfectly
recovered, June 9, 1866.

Begg of Dundee successfully performed quadruple amputation on a woman,
the victim of idiopathic gangrene. With artificial limbs she was able
to earn a livelihood by selling fancy articles which she made herself.
This woman died in 1885, and the four limbs, mounted on a lay figure,
were placed in the Royal College of Surgeons, in London. Wallace, of
Rock Rapids, Iowa, has successfully removed both forearms, one leg, and
half of the remaining foot, for frost-bite. Allen describes the case of
a boy of eight who was run over by a locomotive, crushing his right
leg, left foot, and left forearm to such an extent as to necessitate
primary triple amputation at the left elbow, left foot, and right leg,
the boy recovering. Ashhurst remarks that Luckie, Alexander, Koehler,
Lowman, and Armstrong have successfully removed both legs and one arm
simultaneously for frost-bite, all the patients making excellent
recoveries in spite of their mutilations; he adds that he himself has
successfully resorted to synchronous amputation of the right hip-joint
and left leg for a railroad injury occurring in a lad of fifteen, and
has twice synchronously amputated three limbs from the same patient,
one case recovering.

Wharton reports a case of triple major amputation on a negro of
twenty-one, who was run over by a train. His right leg was crushed at
the knee, and the left leg crushed and torn off in the middle third;
the right forearm and hand were crushed. In order to avoid chill and
exposure, he was operated on in his old clothes, and while one limb was
being amputated the other was being prepared. The most injured member
was removed first.  Recovery was uninterrupted.

There are two cases of spontaneous amputation worthy of record.
Boerhaave mentions a peasant near Leyden, whose axillary artery was
divided with a knife, causing great effusion of blood, and the patient
fainted. The mouth of the vessel was retracted so far as to render
ligature impossible, and the poor man was abandoned to what was
considered an inevitable fate by his unenlightened attendants.
Expecting to die every moment, he continued several days in a languid
state, but the hemorrhage ceased spontaneously, and the arm decayed,
shrunk, and dried into a mummified stump, which he carried about for
quite a while. Rooker speaks of a fracture of the forearm, near the
lower part of the middle third, in a patient aged fourteen. Incipient
gangrene below the seat of fracture, with associate inflammation,
developed; but on account of the increasing gangrene it was determined
to amputate. On the fifth day the line of demarcation extended to the
spine of the scapula, laying bare the bone and exposing the acromion
process and involving the pectoral muscles. It was again decided to let
Nature continue her work. The bones exfoliated, the spine and the
acromial end of the scapula came away, and a good stump was formed.
Figure 212 represents the patient at the age of twenty-eight.

By ingenious mechanical contrivances persons who have lost an extremity
are enabled to perform the ordinary functions of the missing member
with but slight deterioration. Artificial arms, hands, and legs have
been developed to such a degree of perfection that the modern
mechanisms of this nature are very unlike the cumbersome and intricate
contrivances formerly used.

Le Progres Medical contains an interesting account of a curious contest
held between dismembered athletes at Nogent-Sur-Marne, a small town in
the Department of the Seine, in France. Responding to a general
invitation, no less than seven individuals who had lost either leg or
thigh, competed in running races for prizes.  The enterprising cripples
were divided into two classes: the cuissards, or those who had lost a
thigh, and jambards, or those who had lost a leg; and, contrary to what
might have been expected, the grand champion came from the former
class. The distance in each race was 200 meters. M. Roullin, whose
thigh, in consequence of an accident, was amputated in 1887, succeeded
in traversing the course in the remarkable time of thirty seconds
(about 219 yards); whereas M. Florrant, the speediest jambard, required
thirty-six seconds to run the same distance; and was, moreover,
defeated by two other cuissards besides the champion.  The junior race
was won in thirty-five seconds, and this curious day's sport was ended
by a course de consolation, which was carried off in thirty-three
seconds by M. Mausire, but whether he was a cuissard or a jambard was
not stated.

On several occasions in England, cricket matches have been organized
between armless and legless men. In Charles Dickens' paper, "All the
Year Round," October 5, 1861, there is a reference to a cricket match
between a one-armed eleven and a one-legged eleven. There is a recent
report from De Kalb, Illinois, of a boy of thirteen who had lost both
legs and one arm, but who was nevertheless enabled to ride a bicycle
specially constructed for him by a neighboring manufacturer. With one
hand he guided the handle bar, and bars of steel attached to his stumps
served as legs. He experienced no trouble in balancing the wheel; it is
said that he has learned to dismount, and soon expects to be able to
mount alone; although riding only three weeks, he has been able to
traverse one-half a mile in two minutes and ten seconds. While the
foregoing instance is an exception, it is not extraordinary in the
present day to see persons with artificial limbs riding bicycles, and
even in Philadelphia, May 30, 1896, there was a special bicycle race
for one-legged contestants.

The instances of interesting cases of foreign bodies in the extremities
are not numerous. In some cases the foreign body is tolerated many
years in this location. There are to-day many veterans who have bullets
in their extremities. Girdwood speaks of the removal of a foreign body
after twenty-five years' presence in the forearm. Pike mentions a man
in India, who, at the age of twenty-two, after killing a wounded hare
in the usual manner by striking it on the back of the neck with the
side of the hand, noticed a slight cut on the hand which soon healed
but left a lump under the skin. It gave him no trouble until two months
before the time of report, when he asked to have the lump removed,
thinking it was a stone. It was cut down upon and removed, and proved
to be the spinous process of the vertebra of a hare. The bone was
living and healthy and had formed a sort of arthrodial joint on the
base of the phalanx of the little finger and had remained in this
position for nearly twenty-two years.

White has described a case in which a nail broken off in the foot,
separated into 26 splinters, which, after intense suffering, were
successfully removed. There was a case recently reported of a man
admitted to the Bellevue Hospital, New York, whose arm was supposed to
have been fractured by an explosion, but instead of which 11 feet of
lead wire were found in it by the surgeons. The man was a machinist in
the employ of the East River Lead Co., and had charge of a machine
which converted molten lead into wire. This machine consists of a steel
box into which the lead is forced, being pressed through an aperture
1/8 inch in diameter by hydraulic pressure of 600 tons. Reaching the
air, the lead becomes hard and is wound on a large wheel in the form of
wire. Just before the accident this small aperture had become clogged,
and the patient seized the projecting wire in his hand, intending to
free the action of the machine, as he had previously done on many
occasions, by a sharp, strong pull; but in so doing an explosion
occurred, and he was hurled to the floor unconscious. While on the way
to the hospital in the ambulance, he became conscious and complained of
but little pain except soreness of the left arm about the elbow. The
swelling, which had developed very rapidly, made it impossible for the
surgeons to make an examination, but on the following day, when the
inflammation had subsided sufficiently, a diagnosis of fracture of the
bones of the arm was made. There was no external injury of the skin of
any magnitude, and the surgeons decided to cut down on the trifling
contusion, and remove what appeared to be a fragment of bone, lodged
slightly above the wrist. An anesthetic was administered, and an
incision made, but to the amazement of the operators, instead of bone,
a piece of wire one inch in length and 1/8 inch in diameter was
removed. On further exploration piece after piece of the wire was taken
out until finally the total length thus removed aggregated 11 feet, the
longest piece measuring two feet and the shortest 1/4 inch. The wire
was found imbedded under the muscles of the arm, and some of it had
become wedged between the bones of the forearm. Probably the most
remarkable feature of this curious accident was the fact that there was
no fracture or injury to the bone, and it was thought possible that the
function of the arm would be but little impaired.

Tousey reports a case of foreign body in the axilla that was taken for
a necrotic fragment of the clavicle. The patient was a boy of sixteen,
who climbed up a lamp-post to get a light for his bicycle lamp; his
feet slipped off the ornamental ledge which passed horizontally around
the post about four feet from the ground, and he fell. In the fall a
lead pencil in his waistcoat pocket caught on the ledge and was driven
into the axilla, breaking off out of sight. This was supposed to be a
piece of the clavicle, and was only discovered to be a pencil when it
was removed six weeks after.

There are several diseases of the bone having direct bearing on the
anomalies of the extremities which should have mention here.
Osteomalacia is a disease of the bones in adult life, occurring most
frequently in puerperal women, but also seen in women not in the
puerperal state, and in men. It is characterized by a progressive
softening of the bone-substance, from a gradual absorption of the lime
salts, and gives rise to considerable deformity, and occasionally to
spontaneous fracture.

Rachitis or rickets is not a disease of adult life, but of infancy and
childhood, and never occurs after the age of puberty.  It seldom begins
before six months or after three years. There are several theories as
to its causation, one being that it is due to an abnormal development
of acids. There is little doubt that defective nutrition and bad
hygienic surroundings are prominent factors in its production. The
principal pathologic change is seen in the epiphyseal lines of long
bones and beneath the periosteum. Figure 213 shows the appearance
during life of a patient with the highest grade of rachitis, and it can
be easily understood what a barrier to natural child-birth it would
produce. In rachitis epiphyseal swellings are seen at the wrists and
ankle-joints, and in superior cases at the ends of the phalanges of the
fingers and toes. When the shaft of a long bone is affected, not only
deformity, but even fracture may occur.  Under these circumstances the
humerus and femur appear to be the bones most likely to break; there is
an associate deformity of the head, known as "craniotabes," together
with pigeon-breast and various spinal curvature. The accompanying
illustration is from a drawing of a skeleton in the Warren Museum in
Boston. The subject was an Indian, twenty-one years of age, one of the
Six Nations.  His mode of locomotion was by a large wooden bowl, in
which he sat and moved forward by advancing first one side of the bowl
and then the other, by means of his hands. The nodules or "adventitious
joints" were the result of imperfect ossification, or, in other words,
of motion before ossification was completed.

Analogous to rachitis is achondroplasia, or the so called fetal
rickets--a disease in which deformity results from an arrest, absence,
or perversion of the normal process of enchondral ossification. It is
decidedly an intrauterine affection, and the great majority of fetuses
die in utero. Thomson reports three living cases of achondroplasia. The
first was a child five months of age, of pale complexion, bright and
intelligent, its head measuring 23 inches in length. There was a narrow
thorax showing the distinct beads of rickets; the upper and lower limbs
were very short, but improved under antirachitic treatment. The child
died of pneumonia. The other two cases were in adults, one thirty-nine
and the other thirty-six. The men were the same height, 49 inches, and
resembled each other in all particulars.  They both enjoyed good
health, and, though somewhat dwarfed, were of considerable
intelligence. Neither had married. Both the upper and; lower limbs
showed exaggerations of the normal curves; the hands and feet were
broad and short; the gait of both of these little men was waddling, the
hunk swaying when they attempted to make any rapid progress.

Osteitis deformans is a hyperplasia of bone described by Paget in 1856.
Paget's patient was a gentleman of forty-six who had always enjoyed
good health; without assignable cause he began to be subject to aching
pains in the thighs and legs. The bones of the left leg began to
increase in size, and a year or two later the left femur; also enlarged
considerably. During a period of twenty years these changes were
followed by a growth of other bones. The spine became firm and; rigid,
the head increased 5 1/4 inches in circumference. The bones of the face
were not affected. When standing, the patient had a peculiar bowed
condition of the legs, with marked flexure at the knees. He finally
died of osteosarcoma, originating in the left radius, Paget collected
eight cases, five of whom died of malignant disease. The postmortem of
Paget's case showed extreme thickening in the bones affected, the femur
and cranium particularly showing osteoclerosis. Several cases have been
recorded in this country; according to Warren, Thieberge analyzed 43
cases; 21 were men, 22 women; the disease appeared usually after forty.

Acromegaly is distinguished from osteitis deformans in that it is
limited to hypertrophy of the hands, feet, and face, and it usually
begins earlier. In gigantism the so-called "giant growth of bones" is
often congenital in character, and is unaccompanied by inflammatory
symptoms.

The deformities of the articulations may be congenital but in most
cases are acquired. When these are of extreme degree, locomotion is
effected in most curious ways. Ankylosis at unnatural angles and even
complete reversion of the joints has been noticed. Pare gives a case of
reversion, and of crooked hands and feet; and Barlow speaks of a child
of two and three-quarter years with kyphosis, but mobility of the
lumbar region, which walked on its elbows and knees. The pathology of
this deformity is obscure, but there might have been malposition in
utero. Wilson presented a similar case before the Clinical Society of
London, in 1888. The "Camel-boy," exhibited some years ago throughout
the United States, had reversion of the joints, which resembled those
of quadrupeds. He walked on all fours, the mode of progression
resembling that of a camel.

Figure 216 represents Orloff, "the transparent man," an exhibitionist,
showing curious deformity of the long bones and atrophy of the
extremities. He derived his name from the remarkable transparency of
his deformed members to electric light, due to porosity of the bones
and deficiency of the overlying tissues.

Figure 217, taken from Hutchinson's "Archives of Surgery," represents
an extreme case of deformity of the knee-joints in a boy of seven, the
result of severe osteoarthritis. The knees and elbows were completely
ankylosed.

Infantile spinal paralysis is often the cause of distressing
deformities, forbidding locomotion in the ordinary manner. In a paper
on the surgical and mechanical treatment of such deformities Willard
mentions a boy of fourteen, the victim of infantile paralysis, who at
the age of eleven had never walked, but dragged his legs along. His
legs were greatly twisted, and there was flexion at right angles at the
hips and knees. There was equinovarus in the left foot and equinovalgus
in the right.  By an operation of subcutaneous section at the hips,
knees, and feet, with application of plaster-of-Paris and extension,
this hopeless cripple walked with crutches in two months, and with an
apparatus consisting of elastic straps over the quadriceps femoris,
peroneals, and weakened muscles, the valgus-foot being supported
beneath the sole. In six months he was walking long distances; in one
year he moved speedily on crutches. Willard also mentions another case
of a girl of eleven who was totally unable to support the body in the
erect position, but could move on all fours, as shown in figure 219.
There was equinovarus in the right foot and valgus in the left. The
left hip was greatly distorted, not only in the direction of flexion,
but there was also twisting of the femoral neck, simulating
dislocation. This patient was also operated on in the same manner as
the preceding one.

Relative to anomalous increase or hypertrophy of the bones of the
extremities, Fischer shows that an increase in the length of bone may
follow slight injuries. He mentions a boy of twelve, who was run over
by a wagon and suffered a contusion of the bones of the right leg. In
the course of a year this leg became 4 1/2 cm.  longer than the other,
and the bones were also much thicker than in the other. Fischer also
reports several cases of abnormal growth of bone following necrosis. A
case of shortening 3 3/4 cm., after a fracture, was reduced to one cm.
by compensatory growth. Elongation of the bone is also mentioned as the
result of the inflammation of the joint. Warren also quotes Taylor's
case of a lady who fell, injuring, but not fracturing, the thigh.
Gradual enlargement, with an outward curving of the bone, afterward
took place.



CHAPTER XII.

SURGICAL ANOMALIES OF THE THORAX AND ABDOMEN.

Injuries of the lung or bronchus are always serious, but contrary to
the general idea, recovery after extensive wound of the lung is quite a
common occurrence. Even the older writers report many instances of
remarkable recoveries from lung-injuries, despite the primitive and
dirty methods of treatment. A review of the literature previous to this
century shows the names of Arcaeus, Brunner, Collomb, Fabricius
Hildanus, Vogel, Rhodius, Petit, Guerin, Koler, Peters, Flebbe, and
Stalpart, as authorities for instances of this nature. In one of the
journals there is a description of a man who was wounded by a
broad-sword thrust in the mediastinum. After death it was found that
none of the viscera were wounded, and death was attributed to the fact
that the in-rush of air counterbalancing the pressure within the lungs
left them to their own contractile force, with resultant collapse,
obstruction to the circulation, and death. It is said that Vesalius
demonstrated this condition on the thorax of a pig.

Gooch gives an instance of a boy of thirteen who fell from the top of a
barn upon the sharp prow of a plough, inflicting an oblique wound from
the axilla to below the sternum, slightly above the insertion of the
diaphragm. Several ribs were severed, and the left thoracic cavity was
wholly exposed to view, showing the lungs, diaphragm, and pericardium
all in motion. The lungs soon became gangrenous, and in this horrible
state the patient lived twelve days. One of the curious facts noticed
by the ancient writers was the amelioration of the symptoms caused by
thoracic wounds after hemorrhage from other locations; and naturally,
in the treatment of such injuries, this circumstance was used in
advocacy of depletion. Monro speaks of a gentleman who was wounded in a
duel, and who had all the symptoms of hemothorax; his condition was
immediately relieved by the evacuation of a considerable quantity of
bloody matter with the urine. Swammerdam records a similar case, and
Fabricius ab Aquapendente noticed a case in which the opening in the
thorax showed immediate signs of improvement after the patient voided
large quantities of bloody urine. Glandorp also calls attention to the
foregoing facts. Nicolaus Novocomensis narrates the details of the case
of one of his friends, suffering from a penetrating wound of the
thorax, who was relieved and ultimately cured by a bloody evacuation
with the stool.

There is an extraordinary recovery reported in a boy of fifteen who, by
falling into the machinery of an elevator, was severely injured about
the chest. There were six extensive lacerations, five through the skin
about six inches long, and one through the chest about eight inches
long. The 3d, 4th, 5th, and 6th ribs were fractured and torn apart, and
about an inch of the substance of the 4th rib was lost. Several jagged
fragments were removed; a portion of the pleura, two by four inches,
had been torn away, exposing the pericardium and the left lung, and
showing the former to have been penetrated and the latter torn. The
lung collapsed completely, and for three or four months no air seemed
to enter it, but respiration gradually returned. The lacerated
integument could only be closed approximately by sutures. It is worthy
of remark that, although extremely pale, the patient complained of but
little pain, and exhibited only slight symptoms of shock. The pleural
cavity subsequently filled with a dirty serum, but even this did not
interfere with the healing of the wound and the restoration of the
lung; the patient recovered without lateral curvature.

Bartholf reports a case of rapid recovery after perforating wound of
the lung. The pistol-ball entered the back 1 1/2 inches to the right of
the spinous process of the 6th dorsal vertebra, and passed upward and
very slightly inward toward the median line.  Its track could be
followed only 1 1/4 inches. Emphysema appeared fifteen minutes after
the reception of the wound, and soon became pronounced throughout the
front and side of the neck, a little over the edge of the lower jaw,
and on the chest two inches below the sternum and one inch below the
clavicle. In four hours respiration became very frequent, short, and
gasping, the thoracic walls and the abdomen scarcely moving. The man
continued to improve rapidly, the emphysema disappeared on the seventh
day, and eighteen days after the reception of the wound he was
discharged. There was slight hemorrhage from the wound at the time, but
the clot dried and closed the wound, and remained there until it was
removed on the morning of his discharge, leaving a small, dry, white
cicatrix.

Loss of Lung-tissue.--The old Amsterdam authority, Tulpius, has
recorded a case in which a piece of lung of about three fingers'
breadth protruded through a large wound of the lung under the left
nipple. This wound received no medical attention for forty-eight hours,
when the protruding portion of lung was thought to be dead, and was
ligated and cut off; it weighed about three ounces. In about two weeks
the wound healed with the lung adherent to it and this condition was
found six years later at the necropsy of this individual. Tulpius
quoted Celaus and Hippocrates as authorities for the surgical treatment
of this case. In 1787 Bell gave an account of a case in which a large
portion of the lung protruded and was strangulated by the edges of the
thoracic wound, yet the patient made a good recovery.  Fabricius
Hildanus and Ruysch record instances of recovery in which large pieces
of lung have been cut off; and it is said that with General Wolfe at
Quebec there was another officer who was shot through the thorax and
who recovered after the removal of a portion of the lung. In a letter
to one of his medical friends Roscius says that he succeeded in cutting
off part of a protruding, livid, and gangrenous lung, after a
penetrating wound of the chest, with a successful result. Hale reports
a case of a penetrating stab-wound in which a piece of lung was removed
from a man of twenty-five.

Tait claims that surgical treatment, as exemplified by Biondi's
experiment in removing portions of lung from animals, such as dogs,
sheep, cats, etc., is not practical; he adds that his deductions are
misleading, as the operation was done on healthy tissue and in deep and
narrow-chested animals. Excision of diseased portions of the lung has
been practised by Kronlein (three cases), Ruggi of Bologna (two cases),
Block, Milton, Weinlechner; one of Kronlein's patients recovered and
Milton's survived four months, but the others promptly succumbed after
the operation. Tuffier is quoted as showing a patient, aged
twenty-nine, upon whom, for beginning tuberculosis, he had performed
pneumonectomy four years before. At the operation he had removed the
diseased area at the apex of the right lung, together with sound tissue
for two cm. in every direction.  Tuffier stated that the result of his
operation had been perfectly successful and the patient had shown no
suspicious symptoms since.

Rupture of the Lung Without Fracture.--It is quite possible for the
lung to be ruptured by external violence without fracture of the ribs;
there are several such cases on record. The mechanism of this rare and
fatal form of injury has been very aptly described by Gosselin as due
to a sudden pressure exerted on the thoracic wall at the moment of full
inspiration, there being a spasm of the glottis or obstruction of the
larynx, in consequence of which the lung bursts. An extravasation of
air occurs, resulting in the development of emphysema, pneumothorax,
etc.  Subsequently pleurisy, pneumonia, or even pus in the pleural
cavity often result. Hemoptysis is a possible, but not a marked
symptom. The mechanism is identical with that of the bursting of an
inflated paper bag when struck by the hand. Other observers discard
this theory of M. Gosselin and claim that the rupture is due to direct
pressure, as in the cases in which the heart is ruptured without
fracture of the ribs. The theory of Gosselin would not explain these
cardiac ruptures from external violence on the thoracic walls, and,
therefore, was rejected by some.  Pare, Morgagni, Portal, Hewson Smith,
Dupuytren, Laennec, and others mention this injury. Gosselin reports
two cases terminating in recovery. Ashurst reports having seen three
cases, all of which terminated fatally before the fifth day; he has
collected the histories of 39 cases, of which 12 recovered. Otis has
collected reports of 25 cases of this form of injury from military
practice exclusively. These were generally caused by a blow on the
chest, by a piece of shell, or other like missile.  Among the 25 cases
there were 11 recoveries. As Ashhurst very justly remarks, this injury
appears more fatal in civil than in military life.

Pyle reports a case successfully treated, as follows:--

"Lewis W., ten years old, white, born in Maryland, and living now in
the District of Columbia, was brought in by the Emergency Hospital
ambulance, on the afternoon of November 10th, with a history of having
been run over by a hose-cart of the District Fire Department. The boy
was in a state of extreme shock, having a weak, almost imperceptible
pulse; his respirations were shallow and rapid, and his temperature
subnormal. There were no signs of external injury about his thoracic
cavity and no fracture of the ribs could be detected, although
carefully searched for; there was marked emphysema; the neck and side
of the face were enormously swollen with the extravasated air; the
tissues of the left arm were greatly infiltrated with air, which
enabled us to elicit the familiar crepitus of such infiltration when an
attempt at the determination of the radial pulse was made.
Consciousness was never lost. There were several injuries to the face
and scalp; and there was hemorrhage from the nose and mouth, which was
attributed to the fact that the patient had fallen on his face,
striking both nose and lip. This was confirmed subsequently by the
absence of any evidences of hemoptysis during the whole period of
convalescence. The saliva was not even blood-streaked; therefore, it
can be said with verity that there was no hemoptysis. Shortly after
admission the patient reacted to the stimulating treatment, his pulse
became stronger, and all evidences of threatened collapse disappeared.
He rested well the first night and complained of no pain, then or
subsequently. The improvement was continuous. The temperature remained
normal until the evening of the fifth day, when it rose to 102.2
degrees, end again, on the evening of the sixth, to 102.3 degrees. This
rise was apparently without significance as the patient at no time
seemed disturbed by it. On the eighth day the temperature again reached
the normal and has since remained there. The boy is apparently well
now, suffers no inconvenience, and has left the hospital, safe from
danger and apparently free from any pulmonary embarrassment. He uses
well-developed diaphragmatic breathing which is fully sufficient."

Pollock reports the case of a boy of seven, whose lung was ruptured by
a four-wheeled cab which ran over him. He was discharged well in
thirty-two days. Bouilly speaks of recovery in a boy of seventeen,
after a rupture of the lung without fracture.  There are several other
interesting cases of recovery on record.

There are instances of spontaneous rupture of the lung, from severe
cough. Hicks speaks of a child of ten months suffering with a severe
cough resembling pertussis, whose lung ruptured about two weeks after
the beginning of the cough, causing death on the second day. Ferrari
relates a curious case of rupture of the lung from deep inspiration.

Complete penetration or transfixion of the thoracic cavity is not
necessarily fatal, and some marvelous instances of recovery after
injuries of this nature, are recorded. Eve remarks that General Shields
was shot through the body by a discharge of a cannon at Cerro Gordo,
and was given up as certain to die. The General himself thought it was
grape-shot that traversed his chest. He showed no signs of hemoptysis,
and although in great pain, was able to give commands after reception
of the wound. In this case, the ball had evidently entered within the
right nipple, had passed between the lungs, through the mediastinum,
emerging slightly to the right of the spine. Guthrie has mentioned a
parallel instance of a ball traversing the thoracic cavity, the patient
completely recovering after treatment. Girard, Weeds, Meacham, Bacon,
Fryer and others report cases of perforating gunshot wounds of the
chest with recovery.

Sewell describes a case of transfixion of the chest in a youth of
eighteen. After mowing and while carrying his scythe home, the patient
accidentally fell on the blade; the point passed under the right
axilla, between the 3d and 4th right ribs, horizontally through the
chest, and came out through corresponding ribs of the opposite side,
making a small opening. He fell to the ground and lay still until his
brother came to his assistance; the latter with great forethought and
caution carefully calculated the curvature of the scythe blade, and
thus regulating his direction of tension, successfully withdrew the
instrument. There was but little hemoptysis and the patient soon
recovered. Chelius records an instance of penetration of the chest by a
carriage shaft, with subsequent recovery. Hoyland mentions a man of
twenty-five who was discharging bar-iron from the hold of a ship; in a
stooping position, preparatory to hoisting a bundle on deck, he was
struck by one of the bars which pinned him to the floor of the hold,
penetrating the thorax, and going into the wood of the flooring to the
extent of three inches, requiring the combined efforts of three men to
extract it. The bar had entered posteriorly between the 9th and 10th
ribs of the left side, and had traversed the thorax in an upward and
outward direction, coming out anteriorly between the 5th and 6th ribs,
about an inch below and slightly external to the nipple. There was
little constitutional disturbance, and the man was soon discharged
cured. Brown records a case of impalement in a boy of fourteen. While
running to a fire, he struck the point of the shaft of a carriage,
which passed through his left chest, below the nipple. There was,
strangely, no hemorrhage, and no symptoms of so severe an injury; the
boy recovered.

There is deposited in the Museum of the Royal College of Surgeons in
London, a mast-pivot, 15 inches in length and weighing between seven
and eight pounds, which had passed obliquely through the body of a
sailor. The specimen is accompanied by a colored picture of the
sufferer himself in two positions. The name of the sailor was Taylor,
and the accident occurred aboard a brig lying in the London docks. One
of Taylor's mates was guiding the pivot of the try-sail into the main
boom, when a tackle gave way. The pivot instantly left the man's hand,
shot through the air point downward striking Taylor above the heart,
passing out lower down posteriorly, and then imbedded itself in the
deck. The unfortunate subject was carried at once to the London
Hospital, and notwithstanding his transfixion by so formidable an
instrument, in five months Taylor had recovered sufficiently to walk,
and ultimately returned to his duties as a seaman.

In the same museum, near to this spike, is the portion of a shaft of
the carriage which passed through the body of a gentleman who happened
to be standing near the vehicle when the horse plunged violently
forward, with the result that the off shaft penetrated his body under
the left arm, and came out from under the right arm, pinning the
unfortunate man to the stable door. Immediately after the accident the
patient walked upstairs and got in bed; his recovery progressed
uninterruptedly, and his wounds were practically healed at the end of
nine weeks; he is reported to have lived eleven years after this
terrible accident.

In the Indian Medical Gazette there is an account of a private of
thirty-five, who was thrown forward and off his horse while endeavoring
to mount. He fell on a lance which penetrated his chest and came out
through the scapula. The horse ran for about 100 yards, the man hanging
on and trying to stop him. After the extraction of the lance the
patient recovered. Longmore gives an instance of complete transfixion
by a lance of the right side of the chest and lung, the patient
recovering. Ruddock mentions cases of penetrating wounds of both lungs
with recovery.

There is a most remarkable instance of recovery after major thoracic
wounds recorded by Brokaw. In a brawl, a shipping clerk received a
thoracic wound extending from the 3d rib to within an inch of the
navel, 13 1/2 inches long, completely severing all the muscular and
cartilaginous structures, including the cartilages of the ribs from the
4th to the 9th, and wounding the pleura and lung. In addition there was
an abdominal wound 6 1/2 inches long, extending from the navel to about
two inches above Poupart's ligament, causing almost complete intestinal
evisceration. The lung was partially collapsed. The cartilages were
ligated with heavy silk, and the hemorrhage checked by ligature and by
packing gauze in the inter-chondral spaces. The patient speedily
recovered, and was discharged in a little over a month, the only
disastrous result of his extraordinary injuries being a small ventral
hernia.

In wounds of the diaphragm, particularly those from stabs and gunshot
injuries, death is generally due to accompanying lesions rather than to
injury. Hollerius, and Alexander Benedictus, made a favorable diagnosis
of wounds made in the fleshy portions of the diaphragm, but despaired
of those in the tendinous portions.  Bertrand, Fabricius Hildanus, la
Motte, Ravaton, Valentini, and Glandorp, record instances of recovery
from wounds of the diaphragm.

There are some peculiar causes of diaphragmatic injuries on record,
laughter, prolonged vomiting, excessive eating, etc., being mentioned.
On the other hand, in his "Essay on Laughter (du Ris)," Joubert quotes
a case in which involuntary laughter was caused by a wound of the
diaphragm; the laughter mentioned in this instance was probably caused
by convulsive movements of the diaphragm, due to some unknown
irritation of the phrenic nerve.  Bremuse gives an account of a man who
literally split his diaphragm in two by the ingestion of four plates of
potato soup, numerous cups of tea and milk, followed by a large dose of
sodium bicarbonate to aid digestion. After this meal his stomach
swelled to an enormous extent and tore the diaphragm on the right side,
causing immediate death.

The diaphragm may be ruptured by external violence (a fall on the chest
or abdomen), or by violent squeezing (railroad accidents, etc.), or
according to Ashhurst, by spasmodic contraction of the part itself. If
the injury is unaccompanied by lesion of the abdominal or thoracic
viscera, the prognosis is not so unfavorable as might be supposed.
Unless the laceration is extremely small, protrusion of the stomach or
some other viscera into the thoracic cavity will almost invariably
result, constituting the condition known as internal or diaphragmatic
hernia. Pare relates the case of a Captain who was shot through the
fleshy portion of the diaphragm, and though the wound was apparently
healed, the patient complained of a colicky pain.  Eight months
afterward the patient died in a violent paroxysm of this pain. At the
postmortem by Guillemeau, a man of great eminence and a pupil of Pare,
a part of the colon was found in the thorax, having passed through a
wound in the diaphragm. Gooch saw a similar case, but no history of the
injury could be obtained. Bausch mentions a case in which the omentum,
stomach, and pancreas were found in the thoracic cavity, having
protruded through an extensive opening in the diaphragm. Muys, Bonnet,
Blancard, Schenck, Sennert, Fantoni, and Godefroy record instances in
which, after rupture of the diaphragm, the viscera have been found in
the thorax; there are many modern cases on record. Internal hernia
through the diaphragm is mentioned by Cooper, Bowles, Fothergill,
Monro, Ballonius, Derrecagiax, and Schmidt. Sir Astley Cooper mentioned
a case of hernia ventriculi from external violence, wherein the
diaphragm was lacerated without any fracture of the ribs. The man was
aged twenty-seven, and being an outside passenger on a coach (and also
intoxicated), when it broke down he was projected some distance,
striking the ground with considerable force. He died on the next day,
and the diagnosis was verified at the necropsy, the opening in the
diaphragm causing stricture of the bowel.

Postempski successfully treated a wound of the diaphragm complicated
with a wound of the omentum, which protruded between the external
opening between the 10th and 11th ribs; he enlarged the wound, forced
the ribs apart, ligated and cut off part of the omentum, returned its
stump to the abdomen, and finally closed both the wound in the
diaphragm and the external wound with sutures. Quoted by Ashhurst,
Hunter recorded a case of gunshot wound, in which, after penetrating
the stomach, bowels, and diaphragm the ball lodged in the thoracic
cavity, causing no difficulty in breathing until shortly before death,
and even then the dyspnea was mechanical--from gaseous distention of
the intestines.

Peritonitis in the thoracic cavity is a curious condition which may be
brought about by a penetrating wound of the diaphragm. In 1872 Sargent
communicated to the Boston Society for Medical Improvement an account
of a postmortem examination of a woman of thirty-seven, in whom he had
observed major injuries twenty years before. At that time, while
sliding down some hay from a loft, she was impaled on the handle of a
pitchfork which entered the vagina, penetrated 22 inches, and was
arrested by an upper left rib, which it fractured; further penetration
was possibly prevented by the woman's feet striking the floor. Happily
there was no injury to the bladder, uterus, or intestines. The
principal symptoms were hemorrhage from the vagina and intense pain
near the fractured rib, followed by emphysema. The pitchfork-handle was
withdrawn, and was afterward placed in the museum of the Society, the
abrupt bloody stain, 22 inches from the rounded end, being plainly
shown. During twenty years the woman could never lie on her right side
or on her back, and for half of this time she spent most of the night
in the sitting position. Her last illness attracted little attention
because her life had been one of suffering. After death it was found
that the cavity in the left side of the chest was entirely filled with
abdominal viscera. The opening in the diaphragm was four inches in
diameter, and through it had passed the stomach, transverse colon, a
few inches of the descending colon, and a considerable portion of the
small intestines. The heart was crowded to the right of the sternum and
was perfectly healthy, as was also the right lung. The left lung was
compressed to the size of a hand.  There were marked signs of
peritonitis, and in the absence of sufficient other symptoms, it could
be said that this woman had died of peritonitis in the left thoracic
cavity.

Extended tolerance of foreign bodies loose in the thoracic cavity has
been noticed. Tulpins mentions a person who had a sponge shut up in his
thoracic cavity for six weeks; it was then voided by the mouth, and the
man recovered. Fabricius Hildanus relates a similar instance in which a
sponge-tent was expelled by coughing.  Arnot reports a case in which a
piece of iron was found in a cyst in the thorax, where it had remained
for fourteen years. Leach gives a case in which a bullet was impacted
in the chest for forty-two years. Snyder speaks of a fragment of
knife-blade which was lodged in the chest twelve years and finally
coughed up.

Foreign Bodies in the Bronchi.--Walnut kernels, coins, seeds, beans,
corks, and even sponges have been removed from the bronchi. In the
presence of Sir Morrell Mackenzie, Johnston of Baltimore removed a toy
locomotive from the subglottic cavity by tracheotomy and thyreotomy.
The child had gone to sleep with the toy in his mouth and had
subsequently swallowed it. Eldredge presented a hopeless consumptive,
who as a child of five had swallowed an umbrella ferrule while
whistling through it, and who expelled it in a fit of coughing
twenty-three years after. Eve of Nashville mentions a boy who placed a
fourpenny nail in a spool to make a whistle, and, by a violent
inspiration, drew the nail deep into the left bronchus. It was removed
by tracheotomy.  Liston removed a large piece of bone from the right
bronchus of a woman, and Houston tells of a case in which a molar tooth
was lodged in a bronchus causing death on the eleventh day. Warren
mentions spontaneous expulsion of a horse-shoe nail from the bronchus
of a boy of two and one-half years. From Dublin, in 1844, Houston
reports the case of a girl of sixteen who inhaled the wooden peg of a
small fiddle and in a fit of coughing three months afterward expelled
it from the lungs. In 1849 Solly communicated the case of a man who
inhaled a pebble placed on his tongue to relieve thirst. On removal
this pebble weighed 144 grains. Watson of Murfreesboro removed a
portion of an umbrella rib from a trachea, but as he failed to locate
or remove the ferrule, the case terminated fatally. Brigham mentions a
child of five who was seized with a fit of coughing while she had a
small brass nail in her mouth; pulmonary phthisis ensued, and in one
year she died. At the postmortem examination the nail was found near
the bifurcation of the right bronchus, and, although colored black, was
not corroded.

Marcacci reported an observation of the removal of a bean from the
bronchus of a child of three and a half years. The child swallowed the
bean while playing, immediately cried, and became hoarse. No one having
noticed the accident, a diagnosis of croup was made and four leeches
were applied to the neck. The dyspnea augmented during the night, and
there was a whistling sound with each respiratory movement. On the next
day the medical attendants suggested the possibility of a foreign body
in the larynx.  Tracheotomy was performed but the dyspnea continued,
showing that the foreign body was lodged below the incision. The blood
of one of the cut vessels entered the trachea and caused an extra
paroxysm of dyspnea, but the clots of blood were removed by curved
forceps. Marcacci fils practised suction, and placed the child on its
head, but in vain. A feather was then introduced in the wound with the
hope that it would clean the trachea and provoke respiration; when the
feather was withdrawn the bean followed. The child was much
asphyxiated, however, and five or six minutes elapsed before the first
deep inspiration. The wound was closed, the child recovered its voice,
and was well four days afterward. Annandale saw a little patient who
had swallowed a bead of glass, which had lodged in the bronchus. He
introduced the handle of a scalpel into the trachea, producing
sufficient irritation to provoke a brusque expiration, and at the
second attempt the foreign body was expelled. Hulke records the case of
a woman, the victim of a peculiar accident happening during the
performance of tracheotomy, for an affection of the larynx. The
internal canule of the tracheotomy-tube fell into the right bronchus,
but was removed by an ingenious instrument extemporaneously devised
from silver wire. A few years ago in this country there was much public
excitement and newspaper discussion over the daily reports which came
from the bedside of a gentleman who had swallowed a cork, and which had
become lodged in a bronchus. Tracheotomy was performed and a special
corkscrew devised to extract it, but unfortunately the patient died of
slow asphyxiation and exhaustion. Herrick mentions the case of a boy of
fourteen months who swallowed a shawl-pin two inches long, which
remained in the lungs four years, during which time there was a
constant dry and spasmodic cough, and corresponding depression and
emaciation. When it was ultimately coughed up it appeared in one large
piece and several smaller ones, and was so corroded as to be very
brittle. After dislodgment of the pin there was subsidence of the cough
and rapid recovery.

Lapeyre mentions an elderly gentleman who received a sudden slap on the
back while smoking a cigarette, causing him to start and take a very
deep inspiration. The cigarette was drawn into the right bronchus,
where it remained for two months without causing symptoms or revealing
its presence. It then set up a circumscribed pneumonia and cardiac
dropsy which continued two months longer, at which time, during a
violent fit of coughing, the cigarette was expelled enveloped in a
waxy, mucus-like matter. Louis relates the case of a man who carried a
louis-d'or in his lung for six and a half years.

There is a case on record of a man who received a gunshot wound, the
ball entering behind the left clavicle and passing downward and across
to the right clavicle. Sometime afterward this patient expectorated two
pieces of bone and a piece of gum blanket in which he was enveloped at
the time of the injury. Carpenter describes a case of fatal pleuritis,
apparently due to the presence of four artificial teeth which had been
swallowed thirteen years before.

Cardiac Injuries.--For ages it has been the common opinion relative to
injuries of the heart that they are necessarily fatal and that, as a
rule, death immediately follows their reception.  Notwithstanding this
current belief a careful examination of the literature of medicine
presents an astounding number of cases in which the heart has been
positively wounded, and the patients have lived days, months, and even
recovered; postmortem examination, by revealing the presence of
cicatrices in the heart, confirming the original diagnosis. This
question is one of great interest as, in recent years, there has been
constant agitation of the possibility of surgical procedures in cardiac
as well as cerebral injuries. Del Vecchio has reported a series of
experiments on dogs with the conclusion that in case of wounds in human
beings suture of the heart is a possible operation. In this connection
he proposes the following operative procedure: Two longitudinal
incisions to be made from the lower border of the 3d rib to the upper
border of the 7th rib, one running along the inner margin of the
sternum, the other about ten mm. inside the nipple-line. These
incisions are joined by a horizontal cut made in the fourth intercostal
space. The 4th, 5th, and 6th ribs and cartilages are divided and the
outer cutaneous flaps turned up; pushing aside the pleura with the
finger, expose the pericardium and incise it longitudinally; suture the
heart-wound by interrupted sutures. Del Vecchio adds that Fischer has
collected records of 376 cases of wounds of the heart with a mortality
two to three minutes after the injury of 20 per cent. Death may occur
from a few seconds to nine months after the accident. Keen and Da Costa
quote Del Vecchio, and, in comment on his observations, remark that
death in cases of wound of the heart is due to pressure of effused
blood in the pericardial sac, and, because this pressure is itself a
cheek to further hemorrhage, there seems, as far as hemorrhage is
concerned, to be rather a question whether operative interference may
not be itself more harmful than beneficial. It might be added that the
shock to the cardiac action might be sufficient to check it, and at
present we would have no sure means of starting pulsation if once
stopped. In heart-injuries, paracentesis, followed, if necessary, by
incision of the pericardium, is advised by some surgeons.

Realizing the fatality of injuries of the heart, in consequence of
which almost any chance by operation should be quickly seized by
surgeons rather than trust the lives of patients to the infinitesimal
chance of recovery, it would seem that the profession should carefully
consider and discuss the feasibility of any procedure in this
direction, no matter how hypothetic.

Hall states that his experience in the study of cardiac wounds, chiefly
on game-animals, would lead him to the conclusion that transverse
wounds the lower portions of the heart, giving rise to punctures rather
than extensive lacerations, do not commonly cause cessation of life for
a time varying from some considerable fraction of a minute to many
minutes or even hours, and especially if the puncture be valvular in
character, so as to prevent the loss of much blood. However, if the
wound involve the base of the organ, with extensive laceration of the
surrounding parts, death is practically instantaneous. It would seem
that injury to the muscular walls of the heart is much less efficient
in the production of immediate death than destruction of the cardiac
nervous mechanism, serious irritation of the latter producing almost
instantaneous death from shock. In addition, Hall cites several of the
instances on which he based his conclusions. He mentions two wild geese
which flew respectively 1/4 and 3/4 of a mile after having been shot
through the heart, each with a pellet of BB shot, the base in each
instance being uninjured; in several instances antelope and deer ran
several rods after being shot with a rifle ball in a similar manner; on
the other hand, death was practically instantaneous in several of these
animals in which the base of the heart was extensively lacerated.
Again, death may result instantaneously from wounds of the precordial
region, or according to Erichsen, if held directly over the heart, from
the discharge of a pistol containing powder alone, a result
occasionally seen after a blow on the precordial region. It is well,
however, to state that in times of excitement, one may receive an
injury which will shortly prove fatal, and yet not be aware of the fact
for some time, perhaps even for several minutes. It would appear that
the nervous system is so highly tuned at such times, that it does not
respond to reflex irritations as readily as in the absence of
excitement.

Instances of Survival after Cardiac Injuries.--We briefly cite the
principal interesting instances of cardiac injuries in which death has
been delayed for some time, or from which the patient ultimately
recovered.

Pare relates the case of a soldier who received a blow from a halberd,
penetrating the left ventricle, and who walked to the surgeon's tent to
have his wound dressed and then to his own tent 260 yards away.
Diemerbroeck mentions two instances of long survival after cardiac
injuries, in one of which the patient ran 60 paces after receiving the
wound, had complete composure of mind, and survived nine days. There is
an instance in which a man ran 400 paces after penetration of the left
ventricle, and lived for five hours. Morand gives an instance of
survival for five days after wound of the right ventricle. Saucerotte
speaks of survival for three days after injury to the heart.

Babington speaks of a case of heart-injury, caused by transfixion by a
bayonet, in which the patient survived nine hours. Other older cases
are as follows: l'Ecluse, seven days; the Ephemerides, four and six
days; Col de Vilars, twelve days; Marcucci, eighteen days; Bartholinus,
five days; Durande, five days; Boyer, five days; Capelle, twenty six
hours; Fahner, eleven days; Marigues, thirteen days; Morgagni, eight
days; la Motte, twelve hours; Rhodius, Riedlin, two days; Saviard,
eleven days; Sennert, three days; Triller, fourteen days; and Tulpius,
two and fifteen days; and Zittman, eight days.

The Duc de Berri, heir to the French throne, who was assassinated in
1826, lived several hours with one of his ventricles opened.  His
surgeon, Dupuytren, was reprimanded for keeping the wound open with a
probe introduced every two hours, but this procedure has its advocates
at the present day. Randall mentions a gunshot wound of the right
ventricle which did not cause death until the sixty-seventh day. Grant
describes a wound in which a ball from a revolver entered a little to
the right of the sternum, between the cartilages of the 5th and 6th
ribs, and then entered the right ventricle about an inch from the apex.
It emerged from the lower part, passed through the diaphragm, the
cardiac end of the stomach, and lodged in the left kidney. The patient
remained in a state of collapse fifteen hours after being shot, and
with little or no nourishment lived twenty-six days. At the postmortem
examination the wounds in the organs were found to be healed, but the
cicatrices were quite evident. Bowling gives a case of gunshot wound of
the shoulder in which death resulted eleven weeks after, the bullet
being found in the left ventricle of the heart. Thompson has reported a
bayonet wound of the heart, after the reception of which the patient
lived four days. The bayonet entered the ventricle about 1 1/2 inches
from the left apex, traversing the left wall obliquely, and making exit
close to the septum ventriculorum. Roberts mentions a man who ran 60
yards and lived one hour after being shot through both lungs and the
right auricle. Curran mentions the case of a soldier who, in 1809, was
wounded by a bullet which entered his body to the left of the sternum,
between the 2d and 3d ribs. He was insensible a half hour, and was
carried aboard a fighting ship crowded with sailors. There was little
hemorrhage from his wound, and he survived fourteen days. At the
postmortem examination some interesting facts were revealed. It was
found that the right ventricle was transversely opened for about an
inch, the ball having penetrated its anterior surface, near the origin
of the pulmonary artery. The ball was found loose in the pericardium,
where it had fallen during the necropsy. There was a circular lacerated
opening in the tricuspid valve, and the ball must have been in the
right auricle during the fourteen days in which the man lived. Vite
mentions an example of remarkable tenacity of life after reception of a
cardiac wound, the subject living four days after a knife-wound
penetrating the chest into the pericardial sac and passing through the
left ventricle of the heart into the opposite wall. Boone speaks of a
gunshot wound in which death was postponed until the thirteenth day.
Bullock mentions a case of gunshot wound in which the ball was found
lodged in the cavity of the ventricle four days and eighteen hours
after infliction of the wound. Carnochan describes a penetrating wound
of the heart in a subject in whom life had been protracted eleven days.
After death the bullet was found buried and encysted in the heart.
Holly reports a case of pistol-shot wound through the right ventricle,
septum, and aorta, with the ball in the left ventricle. There was
apparent recovery in fourteen days and sudden death on the fifty-fifth
day.

Hamilton gives an instance of a shoemaker sixty-three years old who,
while carrying a bundle, fell with rupture of the heart and lived
several minutes. On postmortem examination an opening in the heart was
found large enough to admit a blowpipe. Noble speaks of duration of
life for five and a half days after rupture of the heart; and there are
instances on record in which life has been prolonged for thirteen hours
and for fifty-three hours after a similar injury. Glazebrook reports
the case of a colored man of thirty, of powerful physique, who was
admitted to the Freedmen's Hospital, Washington, D.C., at 12.30 A.M.,
on February 5, 1895.  Upon examination by the surgeons, an incised
wound was discovered one inch above the left nipple, 3 1/4 inches to
the left of the median line, the incision being 2 1/4 inches in length
and its direction parallel with the 3d rib. The man's general condition
was fairly good, and the wound was examined. It was impossible to trace
its depth further than the 3d rib, although probing was resorted to; it
was therefore considered a simple wound, and dressed accordingly.
Twelve hours later symptoms of internal hemorrhage were noticed, and at
8 A.M., February 6th, the man died after surviving his injury
thirty-two hours. A necropsy was held three hours after death, and an
oblique incision 3/4 inch in length was found through the cartilage-end
of the 3d rib. A similar wound was next found in the pericardium, and
upon examining the heart there was seen a clean, incised wound 1/2 inch
in length, directly into the right ventricle, the endocardial wound
being 3/8 inch long. Both the pericardium and left pleura were
distended with fresh blood and large clots.  Church reports a case of
gunshot wound of the heart in a man of sixty-seven who survived three
hours. The wound had been made by a pistol bullet (32 caliber), was
situated 1 1/4 inches below the mammary line, and slightly to the left
of the center of the sternum; through it considerable blood had
escaped. The postmortem examination showed that the ball had pierced
the sternum just above the xiphoid cartilage, and had entered the
pericardium to the right and at the lower part. The sac was filled with
blood, both fresh and clotted. There was a ragged wound in the anterior
wall 1/2 inch in diameter. The wound of exit was 5/8 inch in diameter.
After traversing the heart the ball had penetrated the diaphragm,
wounded the omentum in several places, and become lodged under the skin
posteriorly between the 9th and 10th ribs. Church adds that the "Index
Catalogue of the Surgeon-General's Library" at Washington contains 22
cases of direct injury to the heart, all of which lived longer than his
case: 17 lived over three days; eight lived over ten days; two lived
over twenty-five days; one died on the fifty-fifth day, and there were
three well-authenticated recoveries. Purple tabulates a list of 42
cases of heart-injury which survived from thirty minutes to seventy
days.

Fourteen instances of gunshot wounds of the heart have been collected
from U.S. Army reports, in all of which death followed very promptly,
except in one instance in which the patient survived fifty hours. In
another case the patient lived twenty-six hours after reception of the
injury, the conical pistol-ball passing through the anterior margin of
the right lobe of the lung into the pericardium, through the right
auricle, and again entered the right pleural cavity, passing through
the posterior margin of the lower lobe of the right lung; at the
autopsy it was found in the right pleural cavity. The left lung and
cavity were perfectly normal. The right lung was engorged and somewhat
compressed by the blood in the pleural cavity. The pericardium was much
distended and contained from six to eight ounces of partially
coagulated blood. There was a fibrinous clot in the left ventricle.

Nonfatal Cardiac Injuries.--Wounds of the heart are not necessarily
fatal. Of 401 cases of cardiac injury collected by Fischer there were
as many as 50 recoveries, the diagnosis being confirmed in 33 instances
by an autopsy in which there were found distinct signs of the cardiac
injury. By a peculiar arrangement of the fibers of the heart, a wound
transverse to one layer of fibers is in the direction of another layer,
and to a certain extent, therefore, valvular in function; it is
probably from this fact that punctured wounds of the heart are often
attended with little or no bleeding.

Among the older writers, several instances of nonfatal injuries to the
heart are recorded. Before the present century scientists had observed
game-animals that had been wounded in the heart in the course of their
lives, and after their ultimate death such direct evidence as the
presence of a bullet or an arrow in their hearts was found. Rodericus a
Veiga tells the story of a deer that was killed in hunting, and in
whose heart was fixed a piece of arrow that appeared to have been there
some time. Glandorp experimentally produced a nonfatal wound in the
heart of a rabbit. Wounds of the heart, not lethal, have been reported
by Benivenius, Marcellus Donatus, Schott, Stalpart van der Wiel, and
Wolff. Ollenrot reports an additional instance of recovery from
heart-injury, but in his case the wound was only superficial.

There is a recent case of a boy of fourteen, who was wounded in the
heart by a pen-knife stab. The boy was discharged cured from the
Middlesex Hospital, but three months after the reception of the injury
he was taken ill and died. A postmortem examination showed that the
right ventricle had been penetrated in a slanting direction; the cause
of death was apoplexy, produced by the weakening and thinning of the
heart's walls, the effect of the wound. Tillaux reports the case of a
man of sixty-five, the victim of general paralysis, who passed into his
chest a blade 16 cm. long and 2 mm. broad. The wound of puncture was 5
cm. below the nipple and 2 cm. to the outside. The left side of the
chest was emphysematous and ecchymosed. The heart-sounds were regular,
and the elevation of the skin by the blade coincided with the
ventricular systole. The blade was removed on the following day, and
the patient gradually improved. Some thirteen months after he had
expectoration of blood and pus and soon died. At the necropsy it was
seen that the wound had involved both lungs; the posterior wall of the
ventricle and the inferior lobe of the right lung were traversed from
before backward, and from left to right, but the ventricular cavity was
not penetrated. Strange to say, the blade had passed between the
vertebral column and the esophagus, and to the right of the aorta, but
had wounded neither of these organs.

O'Connor mentions a graduate of a British University who, with suicidal
intent, transfixed his heart with a darning-needle. It was extracted by
a pair of watchmaker's pliers. In five days the symptoms had all
abated, and the would-be suicide was well enough to start for the
Continent. Muhlig was consulted by a mason who, ten years before, had
received a blow from a stiletto near the left side of the sternum. The
cicatrix was plainly visible, but the man said he had been able to
perform his daily labors, although at the present time suffering from
intense dyspnea and anasarca. A loud bellows-sound could be heard,
which the man said had been audible since the time of reception of the
injury. This was a double bruit accompanying systole, and entirely
obscuring the physical signs. From this time the man speedily failed,
and after his death there were cicatricial signs found, particularly on
the wall of the left ventricle, together with patency of the
interventricular septum, with signs of cicatrization about this rent.
At the side of the left ventricle the rent was twice as large and lined
with cicutricial tissue.

Stelzner mentions a young student who attempted suicide by thrusting a
darning-needle into his heart. He complained of pain and dyspnea; in
twenty-four hours his symptoms increased to such an extent that
operation was deemed advisable on account of collapse. The 5th rib was
resected and the pleural cavity opened.  When the pericardial sac was
incised, a teaspoonful of turbid fluid oozed out, and the needle was
felt in an oblique position in the right ventricle. By pressure of a
finger passed under the heart, the eye of the needle was pressed
through the anterior wall and fixed on the operator's finger-nail. An
attempt to remove by the forceps failed, as the violent movements of
the heart drew the needle back into the cavity. About this stage of the
operation an unfortunate accident happened--the iodoform tampon, which
protected the exposed pleural cavity, was drawn into this cavity during
a deep inspiration, and could not be found. Notwithstanding subsequent
pneumothorax and extensive pleuritic effusion, the patient made a good
recovery at the end of the fourth week and at the time of report it was
still uncertain whether the needle remained in the heart or had
wandered into the mediastinum. During the discussion which followed the
report of this case, Hahn showed a portion of a knitting-needle which
had been removed from the heart of a girl during life. The extraction
was very slow in order to allow of coagulation along the course of the
wound in the heart, and to guard against hemorrhage into the
pericardial sac, which is so often the cause of death in punctured
wounds of this organ. Hahn remarked that the pulse, which before the
removal had been very rapid, sank to 90.

Marks reports the case of a stab-wound penetrating the left 9th
intercostal space, the diaphragm, pleura, pericardium, and apex of the
heart. It was necessary to enlarge the wound, and, under an anesthetic,
after removing one and one-half inches of the 9th and 10th ribs, the
wound was thoroughly packed with iodoform gauze and in twenty-one days
the patient recovered. Lavender mentions an incised wound of the heart
penetrating the right ventricle, from which the patient recovered.
Purple gives, an account of a recovery from a wound penetrating both
ventricles.  The diagnosis was confirmed by a necropsy nine years
thereafter.  Stoll records a nonfatal injury to the heart.

Mastin reports the case of a man of thirty-two who was shot by a
38-caliber Winchester, from an ambush, at a distance of 110 yards. The
ball entered near the chest posteriorly on the left side just below and
to the outer angle of the scapula, passed between the 7th and 8th ribs,
and made its exit from the intercostal space of the 4th and 5th ribs, 2
1/4 inches from the nipple. A line drawn from the wound of entrance to
that of exit would pass exactly through the right ventricle. After
receiving the wound the man walked about twenty steps, and then,
feeling very weak from profuse hemorrhage from the front of the wound,
he sat down. With little or no treatment the wound closed and steady
improvement set in; the patient was discharged in three weeks. As the
man was still living at last reports, the exact amount of damage done
in the track of the bullet is not known, although Mastin's supposition
is that the heart was penetrated.

Mellichamp speaks of a gunshot wound of the heart with recovery, and
Ford records an instance in which a wound of the heart by a buckshot
was followed by recovery. O'Connor reports a case under his observation
in which a pistol-ball passed through three of the four cavities of the
heart and lodged in the root of the right lung. The patient, a boy of
fifteen, died of the effects of cardiac disease three years and two
months later. Bell mentions a case in which, six years after the
receipt of a gunshot wound of the chest, a ball was found in the right
ventricle. Christison speaks of an instance in which a bullet was found
in the heart of a soldier in Bermuda, with no apparent signs of an
opening to account for its entrance. There is a case on record of a boy
of fourteen who was shot in the right shoulder, the bullet entering
through the right upper border of the trapezius, two inches from the
acromion process. Those who examined him supposed the ball was lodged
near the sternal end of the clavicle, four or five inches from where it
entered. In about six weeks the boy was at his labors. Five years later
he was attacked with severe pneumonia and then first noticed tumultuous
action of the heart which continued to increase after his recovery.
Afterward the pulsation could be heard ten or 12 feet away. He died of
another attack of pneumonia fifteen years later and the heart was found
to be two or three times its natural size, soft and flabby, and, on
opening the right ventricle, a bullet was discovered embedded in its
walls. There was no scar of entrance discernible, though the
pericardium was adherent. Biffi of Milan describes the case of a
lunatic who died in consequence of gangrene of the tongue from a bite
in a paroxysm of mania. At the necropsy a needle, six cm. in length,
was found transfixing the heart, with which the relatives of the
deceased said he had stabbed himself twenty-two months prior to his
death. There is a collection of cases in which bullets have been lodged
in the heart from twenty to thirty years.

Balch reports a case in which a leaden bullet remained twenty years in
the walls of the heart. Hamilton mentions an instance of gunshot wound
of the heart, in which for twenty years a ball was embedded in the wall
of the right ventricle, death ultimately being caused by pneumonia.
Needles have quite frequently been found in the heart after death;
Graves, Leaming, Martin, Neill, Piorry, Ryerson, and others record such
cases. Callender mentions recovery of the patient after removal of a
needle from the heart.

Garangeot mentions an aged Jesuit of seventy-two, who had in the
substance of his heart a bone 4 1/2 inches long and possibly an inch
thick. This case is probably one of ossification of the cardiac muscle;
in the same connection Battolini says that the heart of Pope Urban VII
contained a bone shaped like the Arab T.

Among the older writers we frequently read of hairs, worms, and snakes
being found in the cavities of the heart. The Ephemerides, Zacutus
Lusitanus, Pare, Swinger, Riverius, and Senac are among the authorities
who mention this circumstance. The deception was possibly due to the
presence of loose and shaggy membrane attached to the endocardial
lining of the heart, or in some cases to echinococci or trichine. A
strange case of foreign body in the heart was reported some time since
in England. The patient had swallowed a thorn of the Prunus spinosa
(Linn.), which had penetrated the esophagus and the pericardium and
entered the heart. A postmortem examination one year afterward
confirmed this, as a contracted cicatrix was plainly visible on the
posterior surface of the heart about an inch above the apex, through
which the thorn had penetrated the right ventricle and lodged in the
tricuspid valve. The supposition was that the thorn had been swallowed
while eating radishes. Buck mentions a case of hydatid cysts in the
wall of the left ventricle, with rupture of the cysts and sudden death.

It is surprising the extent of injury to the pericardium Nature will
tolerate. In his "Comment on the Aphorisms of Hippocrates," Cardanus
says that he witnessed the excision of a portion of the pericardium
with the subsequent cure of the patient. According to Galen, Marulus,
the son of Mimographus, recovered after a similar operation. Galen also
adds, that upon one occasion he removed a portion of carious sternum
and found the pericardium in a putrid state, leaving a portion of the
heart naked. It is said that in the presence of Leucatel and several
theologians, Francois Botta opened the body of a man who died after an
extended illness and found the pericardium putrefied and a great
portion of the heart destroyed, but the remaining portion still
slightly palpitating.  In this connection Young mentions a patient of
sixty-five who in January, 1860, injured his right thumb and lost the
last joint by swelling and necrosis. Chloroform was administered to
excise a portion of the necrosed bone and death ensued. Postmortem
examination revealed gangrene of the heart and a remarkable tendency to
gangrene elsewhere (omentum, small intestines, skin, etc.). Recently,
Dalton records a remarkable case of stab-wound of the pericardium with
division of the intercostal artery, upon which he operated. An incision
eight inches long was made over the 4th rib, six inches of the rib were
resected, the bleeding intercostal artery was ligated, the blood was
turned out of the pericardial cavity, this cavity being irrigated with
hot water.  The wound in the pericardium, which was two inches long,
was sutured and the external wound was closed. Recovery followed.
Harris gives an instance of a man who was injured by a bar of iron
falling on his shoulder, producing a compound fracture of the ribs as
low as the 7th, and laying the heart and lungs bare without seriously
injuring the pericardium.

Rupture of the heart from contusion of the chest is not always
instantly fatal. According to Ashhurst, Gamgee has collected 28 cases
of rupture of this viscus, including one observed by himself. In nine
of these cases there was no fracture, and either no bruise of the
parietes or a very slight one. The pericardium was intact in at least
half of the cases, and in 22 in which the precise seat of lesion was
noticed the right ventricle was ruptured in eight, the left in three,
the left auricle in seven, the right in four. The longest period during
which any patient survived the injury was fourteen hours.

Among the older writers who note this traumatic injury are Fine, who
mentions concussion rupturing the right ventricle, and Ludwig, who
reports a similar accident. Johnson mentions rupture of the left
ventricle in a paroxysm of epilepsy. There is another species of
rupture of the heart which is not traumatic, in which the rupture
occurs spontaneously, the predisposing cause being fatty degeneration,
dilatation, or some other pathologic process in the cardiac substance.
It is quite possible that the older instances of what was known as
"broken-heart," which is still a by-word, were really cases in which
violent emotion had produced rupture of a degenerated cardiac wall.
Wright gives a case of spontaneous rupture of the heart in which death
did not occur for forty-eight hours. Barth has collected 24 cases of
spontaneous rupture of the heart, and in every instance the seat of
lesion was in the left ventricle. It was noticed that in some of these
cases the rupture did not take place all at once, but by repeated minor
lacerations, death not ensuing in some instances for from two to eleven
days after the first manifestation of serious symptoms. A more recent
analysis is given by Meyer of cases reported since 1870: Meyer collects
25 cases of rupture of the left ventricle seven of the right ventricle,
and four of the right auricle. Within the last year Collings has
reported a case of idiopathic rupture of the heart in a man of
fifty-three, who had always lived a temperate life, and whose only
trouble had been dyspepsia and a weak heart. There was no history of
rheumatism or rheumatic fever. The man's father had died suddenly of
heart disease. After feeling out of sorts for a time, the man
experienced severe pain in the precordium and felt too ill to leave his
bed. He gradually became worse and sick after taking food. Speech
became thick, the mouth was drawn to the right, and the right eye was
partially closed. The left arm became paralyzed, then the right leg.
The tongue deviated to the right on protrusion. The sphincters were
unaffected. The heart sounds were faint and without added sounds. The
man was moved to a water-bed, his body and head being kept horizontal,
and great care being taken to avoid sudden movement. Later, when his
pelvis was raised to allow the introduction of a bed-pan, almost
instantaneous death ensued. Upon postmortem examination prolonged and
careful search failed to reveal any microscopic change in the brain,
its vessels, or the meninges. On opening the pericardium it was found
to be filled with blood-clot, and on washing this away a laceration
about 1 1/2 inches in length was found in the left ventricle; the
aperture was closed by a recent clot. The cavities of the heart were
dilated, the walls thin and in advanced stage of fatty degeneration.
There was no valvular disease. The aorta and its main branches were
atheromatous. Both lungs contained calcifying tubercle; the abdomen was
loaded with fat; the spleen was soft; the kidneys were engorged, but
otherwise healthy.

Stokes gives the case of a man who was severely crushed between the
arms of a water-wheel of great size and the embankment on which the
axle of the wheel was supported; a peculiar factor of the injury being
that his heart was displaced from left to right.  At the time of
report, after recovery from the injury, the patient exhibited
remarkable tolerance of great doses of digitalis. When not taking
digitalis, his pulse was 100 to 120, regular, and never intermittent.

Hypertrophy of the Heart.--The heart of a man of ordinary size weighs
nine ounces, and that of a woman eight; in cases of hypertrophy, these
weights may be doubled, although weights above 25 ounces are rare.
According to Osler, Beverly Robinson describes a heart weighing 53
ounces, and Dulles has reported one weighing 48 ounces. Among other
modern records are the following: Fifty and one-half ounces, 57 ounces,
and one weighing four pounds and six ounces. The Ephemerides contains
an incredible account of a heart that weighed 14 pounds. Favell
describes a heart that only weighed 3 1/2 ounces.

Wounds of the aorta are almost invariably fatal, although cases are
recorded by Pelletan, Heil, Legouest, and others, in which patients
survived such wounds for from two months to several years. Green
mentions a case of stab-wound in the suprasternal fossa. The patient
died one month after of another cause, and at the postmortem
examination the aorta was shown to have been opened; the wound in its
walls was covered with a spheric, indurated coagulum. No attempt at
union had been made.

Zillner observed a penetrating wound of the aorta after which the
patient lived sixteen days, finally dying of pericarditis.  Zillner
attributed this circumstance to the small size of the wound, atheroma
and degeneration of the aorta and slight retraction of the inner coat,
together with a possible plugging of the pericardial opening. In 1880
Chiari said that while dissecting the body of a man who died of
phthisis, he found a false aneurysm of the ascending aorta with a
transverse rupture of the vessel by the side of it, which had
completely cicatrized.  Hill reports the case of a soldier who was
stabbed with a bowie-knife nine inches long and three inches wide. The
blade passed through the diaphragm, cut off a portion of the liver, and
severed the descending aorta at a point about the 7th dorsal vertebra;
the soldier lived over three hours after complete division of this
important vessel. Heil reports the case of a man of thirty-two, a
soldier in the Bavarian army, who, in a quarrel in 1812, received a
stab in the right side. The instrument used was a common table-knife,
which was passed between the 5th and 6th ribs, entering the left lung,
and causing copious hemorrhage.  The patient recovered in four months,
but suffered from amaurosis which had commenced at the time of the
stab. Some months afterward he contracted pneumonia and was readmitted
to the hospital, dying in 1813. At the postmortem the cicatrix in the
chest was plainly visible, and in the ascending aorta there was seen a
wound, directly in the track of the knife, which was of irregular
border and was occupied by a firm coagulum of blood.  The vessel had
been completely penetrated, as, by laying it open, an internal cicatrix
was found corresponding to the other. Fatal hemorrhage had been avoided
in this case by the formation of coagulum in the wound during the
syncope immediately following the stab, possibly aided by extended
exposure to cold.

Sundry Cases.--Sandifort mentions a curious case of coalescence of the
esophagus and aorta, with ulceration and consequent rupture of the
aorta, the hemorrhage proceeding from the stomach at the moment of
rupture.

Heath had a case of injury to the external iliac artery from external
violence, with subsequent obliteration of the vessel.  When the patient
was discharged no pulse could be found in the leg.

Dismukes reports a case in which the patient had received 13 wounds,
completely severing the subclavian artery, and, without any medical or
surgical aid, survived the injury two hours.

Illustrative of the degree of hemorrhage which may follow an injury so
slight as that of falling on a needle we cite an instance, reported by
a French authority, of a child who picked up a needle, and, while
running with it to its mother, stumbled and fell, the needle
penetrating the 4th intercostal space, the broadened end of it
remaining outside of the wound. The mother seized the needle between
her teeth and withdrew it, but the child died, before medical aid could
be summoned, from internal hemorrhage, causing pulmonary pressure and
dyspnea.

Rupture of the esophagus is attributable to many causes. Dryden
mentions vomiting as a cause, and Guersant reports the case of a little
girl of seven, who, during an attack of fever, ruptured her esophagus
by vomiting. In 1837 Heyfelder reported the case of a drunkard, who, in
a convulsion, ruptured his esophagus and died. Williams mentions a case
in which not only the gullet, but also the diaphragm, was ruptured in
vomiting. In this country, Bailey and Fitz have recorded cases of
rupture of the esophagus.  Brewer relates a parallel instance of
rupture from vomiting. All the foregoing cases were linear ruptures,
but there is a unique case given by Boerhaave in 1724, in which the
rent was transverse. Ziemssen and Mackenzie have both translated from
the Latin the report of this case which is briefly as follows: The
patient, Baron de Wassenaer, was fifty years of age, and, with the
exception that he had a sense of fulness after taking moderate meals,
he was in perfect health. To relieve this disagreeable feeling he was
in the habit of taking a copious draught of an infusion of "blessed
thistle" and ipecacuanha. One day, about 10.30 in the evening, when he
had taken no supper, but had eaten a rather hearty dinner, he was
bothered by a peculiar sensation in his stomach, and to relieve this he
swallowed about three tumbler-fuls of his usual infusion, but to no
avail. He then tried to excite vomiting by tickling the fauces, when,
in retching, he suddenly felt a violent pain; he diagnosed his own case
by saying that it was "the bursting of something near the pit of the
stomach." He became prostrated and died in eighteen and one-half hours;
at the necropsy it was seen that without any previously existing signs
of disease the esophagus had been completely rent across in a
transverse direction.

Schmidtmuller mentions separation of the esophagus from the stomach;
and Flint reports the history of a boy of seven who died after being
treated for worms and cerebral symptoms. After death the contents of
the stomach were found in the abdominal cavity, and the esophagus was
completely separated from the stomach.  Flint believed the separation
was postmortem, and was possibly due to the softening of the stomach by
the action of the gastric acids. In this connection may be mentioned
the case reported by Hanford of a man of twenty-three who had an attack
of hematemesis and melanema two years before death. A postmortem was
made five hours after death, and there was so much destruction of the
stomach by a process resembling digestion that only the pyloric and
cardiac orifices were visible. Hanford suggests that this was an
instance of antemortem digestion of the stomach which physiologists
claim is impossible.

Nearly all cases of rupture of the stomach are due to carcinoma, ulcer,
or some similar condition, although there have been instances of
rupture from pressure and distention. Wunschheim reports the case of a
man of fifty-two who for six months presented symptoms of gastric
derangement, and who finally sustained spontaneous rupture of the
posterior border of the stomach due to overdistention. There was a tear
two inches long, beginning near the cardiac end and running parallel to
the lesser curvature. The margin of the tear showed no evidence of
digestion. There were obstructing esophageal neoplasms about 10 1/3
inches from the teeth, which prevented vomiting. In reviewing the
literature Wunschheim found only six cases of spontaneous rupture of
the stomach. Arton reports the case of a negro of fifty who suffered
from tympanites. He was a hard drinker and had been aspirated several
times, gas heavily laden with odors of the milk of asafetida being
discharged with a violent rush. The man finally died of his malady, and
at postmortem it was found that his stomach had burst, showing a slit
four inches long. The gall bladder contained two quarts of inspissated
bile. Fulton mentions a case of rupture of the esophageal end of a
stomach in a child.  The colon was enormously distended and the walls
thickened. When three months old it was necessary to puncture the bowel
for distention. Collins describes spontaneous rupture of the stomach in
a woman of seventy-four, the subject of lateral curvature of the spine,
who had frequent attacks of indigestion and tympanites. On the day of
death there was considerable distention, and a gentle purgative and
antispasmodic were given.  Just before death a sudden explosive sound
was heard, followed by collapse. A necropsy showed a rupture two inches
long and two inches from the pyloric end. Lallemand mentions an
instance of the rupture of the coats of the stomach by the act of
vomiting.  The patient was a woman who had suffered with indigestion
five or six months, but had been relieved by strict regimen. After
indulging her appetite to a greater extent than usual, she experienced
nausea, and made violent and ineffectual efforts to discharge the
contents of the stomach. While suffering great agony she experienced a
sensation as if something was tearing in the lower part of her belly.
The woman uttered several screams, fell unconscious, and died that
night. Postmortem examination showed that the anterior and middle part
of the stomach were torn obliquely to the extent of five inches. The
tear extended from the smaller toward the greater curvature. The edges
were thin and irregular and presented no marks of disease. The cavity
of the peritoneum was full of half-digested food. The records of St.
Bartholomew's Hospital, London, contain the account of a man of
thirty-four who for two years had been the subject of paroxysmal pain
in the stomach. The pains usually continued for several hours and
subsided with vomiting. At St. Bartholomew's he had an attack of
vomiting after a debauch. On the following day he was seized with
vomiting accompanied by nausea and flatus, and after a sudden attack of
pain at the pit of the stomach which continued for two hours, he died.
A ragged opening at the esophageal orifice, on the anterior surface of
the stomach was found. This tear extended from below the lesser
curvature to its extremity, and was four inches long. There were no
signs of gastric carcinoma or ulcer.

Clarke reports the case of a Hindoo of twenty-two, under treatment for
ague, who, without pain or vomiting, suddenly fell into collapse and
died twenty-three hours later. He also mentions a case of rupture of
the stomach of a woman of uncertain history, who was supposed to have
died of cholera. The examination of the bodies of both cases showed
true rupture of the stomach and not mere perforation. In both cases, at
the time of rupture, the stomach was empty, and the gastric juice had
digested off the capsules of the spleens, thus allowing the escape of
blood into the abdominal cavities. The seats of rupture were on the
anterior walls. In the first case the coats of the stomach were
atrophied and thin. In the second the coats were healthy and not even
softened. There was absence of softening, erosion, or rupture on the
posterior walls.

As illustrative of the amount of paralytic distention that is possible,
Bamberger mentions a case in which 70 pounds of fluid filled the
stomach.

Voluntary Vomiting.--It is an interesting fact that some persons
exhibit the power of contracting the stomach at will and expelling its
contents without nausea. Montegre mentions a distinguished member of
the Faculty of Paris, who, by his own volition and without nausea or
any violent efforts, could vomit the contents of his stomach. In his
translation of "Spallanzani's Experiments on Digestion" Sennebier
reports a similar instance in Geneva, in which the vomiting was brought
about by swallowing air.

In discussing wounds and other injuries of the stomach no chapter would
be complete without a description of the celebrated case of Alexis St.
Martin, whose accident has been the means of contributing so much to
the knowledge of the physiology of digestion. This man was a French
Canadian of good constitution, robust and healthy, and was employed as
a voyageur by the American Fur Company. On June 16, 1822, when about
eighteen years of age, he was accidentally wounded by a discharge from
a musket.  The contents of the weapon, consisting of powder and
duck-shot, entered his left side from a distance of not more than a
yard off. The charge was directed obliquely forward and inward,
literally blowing off the integument and muscles for a space about the
size of a man's hand, carrying away the anterior half of the 6th rib,
fracturing the 5th rib, lacerating the lower portion of the lowest lobe
of the left lung, and perforating the diaphragm and the stomach. The
whole mass of the discharge together with fragments of clothing were
driven into the muscles and cavity of the chest. When first seen by Dr.
Beaumont about a half hour after the accident, a portion of the lung,
as large as a turkey's egg was found protruding through the external
wound.  The protruding lung was lacerated and burnt. Immediately below
this was another protrusion, which proved to be a portion of the
stomach, lacerated through all its coats. Through an orifice, large
enough to admit a fore-finger, oozed the remnants of the food he had
taken for breakfast. His injuries were dressed; extensive sloughing
commenced, and the wound became considerably enlarged. Portions of the
lung, cartilages, ribs, and of the ensiform process of the sternum came
away. In a year from the time of the accident, the wound, with the
exception of a fistulous aperture of the stomach and side, had
completely cicatrized. This aperture was about 2 1/2 inches in
circumference, and through it food and drink constantly extruded unless
prevented by a tent-compress and bandage. The man had so far recovered
as to be able to walk and do light work, his digestion and appetite
being normal. Some months later a small fold or doubling of the
stomachal coats slightly protruded until the whole aperture was filled,
so as to supersede the necessity of a compress, the protruding coats
acting as a valve when the stomach was filled. This valvular protrusion
was easily depressed by the finger. St. Martin suffered little pain
except from the depression of the skin. He took his food and drink like
any healthy person, and for eleven years remained under Dr. Beaumont's
own care in the Doctor's house as a servant. During this time were
performed the experiments on digestion which are so well known. St.
Martin was at all times willing to lend himself in the interest of
physiologic science. In August, 1879, The Detroit Lancet contains
advices that St. Martin was living at that time at St. Thomas, Joliette
County, Province of Quebec, Canada. At the age of seventy-nine he was
comparatively strong and well, and had always been a hard worker. At
this time the opening in the stomach was nearly an inch in diameter,
and in spite of its persistence his digestion had never failed him.

Spizharny relates a remarkable case of gastric fistula in the loin, and
collects 61 cases of gastric fistula, none of which opened in the loin.
The patient was a girl of eighteen, who had previously had
perityphlitis, followed by abscesses about the navel and lumbar region.
Two fistulae were found in the right loin, and were laid open into one
canal, which, after partial resection of the 12th rib, was dilated and
traced inward and upward, and found to be in connection with the
stomach. Food was frequently found on the dressings, but with the
careful use of tampons a cure was effected.

In the olden times wounds of the stomach were not always fatal.  The
celebrated anatomist, Fallopius, successfully treated two cases in
which the stomach was penetrated so that food passed through the wound.
Jacobus Orthaeus tells us that in the city of Fuldana there was a
soldier who received a wound of the stomach, through which food passed
immediately after being swallowed; he adds that two judicious surgeons
stitched the edges of the wound to the integuments, thereby effecting a
cure. There is another old record of a gastric fistula through which
some aliment passed during the period of eleven years.

Archer tells of a man who was stabbed by a negro, the knife entering
the cartilages of the 4th rib on the right side, and penetrating the
stomach to the extent of two inches at a point about two inches below
the xiphoid cartilage. The stomachal contents, consisting of bacon,
cabbage, and cider, were evacuated. Shortly after the reception of the
injury, an old soldier sewed up the wound with an awl, needle, and
wax-thread; Archer did not see the patient until forty-eight hours
afterward, at which time he cleansed and dressed the wound. After a
somewhat protracted illness the patient recovered, notwithstanding the
extent of injury and the primitive mode of treatment.

Travers mentions the case of a woman of fifty-three who, with suicidal
intent, divided her abdominal parietes below the navel with a razor,
wounding the stomach in two places. Through the wound protruded the
greater part of the larger curvature of the stomach; the arch of the
colon and the entire greater omentum were both strangulated. A small
portion of the coats of the stomach, including the wound, was nipped
up, a silk ligature tied about it, and the entrails replaced. Two
months afterward the patient had quite recovered, though the ligature
of the stomach had not been seen in the stool. Clements mentions a
robust German of twenty-two who was stabbed in the abdomen with a dirk,
producing an incised wound of the stomach. The patient recovered and
was returned to duty the following month.

There are many cases on record in which injury of the stomach has been
due to some mistake or accident in the juggling process of
knife-swallowing or sword-swallowing. The records of injuries of this
nature extend back many hundred years, and even in the earlier days the
delicate operation of gastrotomy, sometimes with a successful issue,
was performed upon persons who had swallowed knives. Gross mentions
that in 1502 Florian Mathias of Bradenberg removed a knife nine inches
long from the stomach of a man of thirty-six, followed by a successful
recovery. Glandorp, from whom, possibly, Gross derived his information,
relates this memorable case as being under the direction of Florianus
Matthaesius of Bradenburg. The patient, a native of Prague, had
swallowed a knife eight or nine inches long, which lay pointing at the
superior portion of the stomach. After it had been lodged in this
position for seven weeks and two days gastrotomy was performed, and the
knife extracted; the patient recovered. In 1613 Crollius reports the
case of a Bohemian peasant who had concealed a knife in his mouth,
thinking no one would suspect he possessed the weapon; while he was
excited it slipped into the stomach, from whence it subsequently
penetrated through to the skin; the man recovered. There is another old
case of a man at Prague who swallowed a knife which some few weeks
afterward made its exit from an abdominal abscess. Gooch quotes the
case of a man, belonging to the Court of Paris, who, nine months after
swallowing a knife, voided it at the groin. In the sixteenth century
Laurentius Joubert relates a similar case, the knife having remained in
the body two years. De Diemerbroeck mentions the fact that a knife ten
inches long was extracted by gastrotomy, and placed among the rarities
in the anatomic chamber of the University at Leyden. The operation was
done in 1635 at Koenigsberg, by Schwaben, who for his surgical prowess
was appointed surgeon to the King of Poland. The patient lived eight
years after the operation.

It is said that in 1691, while playing tricks with a knife 6 1/2 inches
long, a country lad of Saxony swallowed it, point first.  He came under
the care of Weserern, physician to the Elector of Brandenburgh, who
successfully extracted it, two years and seven months afterward, from
the pit of the lad's stomach. The horn haft of the knife was
considerably digested. In 1720 Hubner of Rastembourg operated on a
woman who had swallowed an open knife.  After the incision it was found
that the knife had almost pierced the stomach and had excited a slight
suppuration. After the operation recovery was very prompt.

Bell of Davenport, Iowa, performed gastrotomy on a man, who, while
attempting a feat of legerdemain, allowed a bar of lead, 10 1/8 inches
long, 1 1/2 inches wide, and 9 1/2 ounces in weight, to slip into his
stomach. The bar was removed and the patient recovered. Gussenbauer
gives an account of a juggler who turned his head to bow an
acknowledgment of applause while swallowing a sword; he thus brought
his upper incisors against the sword, which broke off and slipped into
his stomach. To relieve suffocation the sword was pushed further down.
Gastrotomy was performed, and the piece of sword 11 inches long was
extracted; as there was perforation of the stomach before the
operation, the patient died of peritonitis.

An hour after ingestion, Bernays of St. Louis successfully removed a
knife 9 1/2 inches long. By means of an army-bullet forceps the knife
was extracted easily through an incision 5/8 inch long in the walls of
the stomach. Gross speaks of a man of thirty who was in the habit of
giving exhibitions of sword-swallowing in public houses, and who
injured his esophagus to such an extent as to cause abscess and death.
In the Journal of the American Medical Association, March 1, 1896,
there is an extensive list of gastrotomies performed for the removal of
knives and other foreign bodies, from the seventeenth century to the
present time.

The physiologic explanation of sword-swallowing is quite interesting.
We know that when we introduce the finger, a spoon, brush, etc., into
the throat of a patient, we cause extremely disagreeable symptoms.
There is nausea, gagging, and considerable hindrance with the function
of respiration. It therefore seems remarkable that there are people
whose physiologic construction is such that, without apparent
difficulty, they are enabled to swallow a sword many inches long. Many
of the exhibitionists allow the visitors to touch the stomach and
outline the point of the sabre through the skin. The sabre used is
usually very blunt and of rounded edges, or if sharp, a guiding tube of
thin metal is previously swallowed. The explanation of these
exhibitions is as follows: The instrument enters the mouth and pharynx,
then the esophagus, traverses the cardiac end of the stomach, and
enters the latter as far as the antrum of the pylorus, the small
culdesac of the stomach. In their normal state in the adult these
organs are not in a straight line, but are so placed by the passage of
the sword. In the first place the head is thrown back, so that the
mouth is in the direction of the esophagus, the curves of which
disappear or become less as the sword proceeds; the angle that the
esophagus makes with the stomach is obliterated, and finally the
stomach is distended in the vertical diameter and its internal curve
disappears, thus permitting the blade to traverse the greater diameter
of the stomach. According to Guyot-Daubes, these organs, in a straight
line, extend a distance of from 55 to 62 cm., and consequently the
performer is enabled to swallow an instrument of this length. The
length is divided as follows:--

  Mouth and pharynx, . . . . . . . . . . . . 10 to 12 cm.
  Esophagus, . . . . . . . . . . . . . . . . 25 to 28 cm.
  Distended stomach, . . . . . . . . . . . . 20 to 22 cm.
                                            -------------
                                             55 to 62 cm.

These acrobats with the sword have rendered important service to
medicine. It was through the good offices of a sword-swallower that the
Scotch physician, Stevens, was enabled to make his experiments on
digestion. He caused this assistant to swallow small metallic tubes
pierced with holes. They were filled, according to Reaumur's method,
with pieces of meat. After a certain length of time he would have the
acrobat disgorge the tubes, and in this way he observed to what degree
the process of digestion had taken place. It was also probably the
sword-swallower who showed the physicians to what extent the pharynx
could be habituated to contact, and from this resulted the invention of
the tube of Faucher, the esophageal sound, ravage of the stomach, and
illumination of this organ by electric light. Some of these individuals
also have the faculty of swallowing several pebbles, as large even as
hen's eggs, and of disgorging them one by one by simple contractions of
the stomach.  From time to time individuals are seen who possess the
power of swallowing pebbles, knives, bits of broken glass, etc., and,
in fact, there have been recent tricky exhibitionists who claimed to be
able to swallow poisons, in large quantities, with impunity.  Henrion,
called "Casaandra," a celebrated example of this class, was born at
Metz in 1761. Early in life he taught himself to swallow pebbles,
sometimes whole and sometimes after breaking them with his teeth. He
passed himself off as an American savage; he swallowed as many as 30 or
40 large pebbles a day, demonstrating the fact by percussion on the
epigastric region.  With the aid of salts he would pass the pebbles and
make them do duty the next day. He would also swallow live mice and
crabs with their claws cut. It was said that when the mice were
introduced into his mouth, they threw themselves into the pharynx where
they were immediately suffocated and then swallowed. The next morning
they would be passed by the rectum flayed and covered with a mucous
substance. Henrion continued his calling until 1820, when, for a
moderate sum, he was induced to swallow some nails and a plated iron
spoon 5 1/2 inches long and one inch in breadth. He died seven days
later.

According to Bonet, there was a man by the name of Pichard who
swallowed a razor and two knives in the presence of King Charles II of
England, the King himself placing the articles into the man's mouth. In
1810 Babbington and Curry are accredited with citing the history of an
American sailor in Guy's Hospital, London, who frequently swallowed
penknives for the amusement of his audiences. At first he swallowed
four, and three days later passed them by the anus; on another occasion
he swallowed 14 of different sizes with the same result. Finally he
attempted to gorge himself with 17 penknives, but this performance was
followed by horrible pains and alarming abdominal symptoms. His
excrement was black from iron. After death the cadaver was opened and
14 corroded knives were found in the stomach, some of the handles being
partly digested; two were found in the pelvis and one in the abdominal
cavity. Pare recalls the instance of a shepherd who suffered
distressing symptoms after gulping a knife six inches long. Afterward
the knife was abstracted from his groin. Fabricius Hildanus cites a
somewhat similar case.

Early in the century there was a man known as the "Yankee
knife-swallower," whose name was John Cummings, an American sailor, who
had performed his feats in nearly all the ports of the world. One of
his chief performances was swallowing a billiard ball. Poland mentions
a man (possibly Cummings) who, in 1807, was admitted to Guy's Hospital
with dyspeptic symptoms which he attributed to knife-swallowing. His
story was discredited at first; but after his death, in March, 1809,
there were 30 or 40 fragments of knives found in his stomach. One of
the back-springs on a knife had transfixed the colon and rectum.  In
the Edinburgh Philosophical Journal for 1825 there is an account of a
juggler who swallowed a knife which remained in his stomach and caused
such intense symptoms that gastrotomy was advised; the patient,
however, refused operation.

Drake reports a curious instance of polyphagia. The person described
was a man of twenty-seven who pursued the vocation of a
"sword-swallower." He had swallowed a gold watch and chain with a seal
and key attached; at another time he swallowed 34 bullets and voided
them by the anus. At Poughkeepsie, N.Y., in August, 1819, in one day
and night he swallowed 19 pocket-knives and 41 copper cents. This man
had commenced when a lad of fifteen by swallowing marbles, and soon
afterward a small penknife. After his death his esophagus was found
normal, but his stomach was so distended as to reach almost to the
spine of the ilium, and knives were found in the stomach weighing one
pound or more. In his exhibitions he allowed his spectators to hear the
click of the knives and feel them as low down as the anterior superior
spine of the ilium.

The present chief of the dangerous "profession" of sword-swallowing is
Chevalier Cliquot, a French Canadian by birth, whose major trick is to
swallow a real bayonet sword, weighted with a cross-bar and two
18-pound dumbbells. He can swallow without difficulty a 22-inch cavalry
sword; formerly, in New York, he gave exhibitions of swallowing
fourteen 19-inch bayonet swords at once. A negro, by the name of Jones,
exhibiting not long since in Philadelphia, gave hourly exhibitions of
his ability to swallow with impunity pieces of broken glass and china.

Foreign Bodies in the Alimentary Canal.--In the discussion of the
foreign bodies that have been taken into the stomach and intestinal
tract possibly the most interesting cases, although the least
authentic, are those relating to living animals, such as fish, insects,
or reptiles. It is particularly among the older writers that we find
accounts of this nature. In the Ephemerides we read of a man who
vomited a serpent that had crept into his mouth, and of another person
who ejected a beetle that had gained entrance in a similar manner. From
the same authority we find instances of the vomiting of live fish,
mice, toads, and also of the passage by the anus of live snails and
snakes. Frogs vomited are mentioned by Bartholinus, Dolaeus,
Hellwigius, Lentilus, Salmuth, and others. Vege mentions a man who
swallowed a young chicken whole. Paullini speaks of a person who, after
great pain, vomited a mouse which he had swallowed. Borellus,
Bartholinus, Thoner, and Viridet, are among the older authorities
mentioning persons who swallowed toads. Hippocrates speaks of asphyxia
from a serpent which had crawled into the mouth.

Borellus states that he knew a case of a person who vomited a
salamander. Plater reports the swallowing of eels and snails.  Rhodius
mentions persons who have eaten scorpions and spiders with impunity.
Planchon writes of an instance in which a live spider was ejected from
the bowel; and Colini reports the passage of a live lizard which had
been swallowed two days before, and there is another similar case on
record. Marcellus Donatus records an instance in which a viper, which
had previously crawled into the mouth, had been passed by the anus.
There are also recorded instances in French literature in which persons
affected with pediculosis, have, during sleep, unconsciously swallowed
lice which were afterward found in the stools.

There is an abundance of cases in which leeches have been accidentally
swallowed. Pliny, Aetius, Dioscorides, Scribonius-Largus, Celsus,
Oribasius, Paulus Aegineta, and others, describe such cases.
Bartholinus speaks of a Neapolitan prince who, while hunting, quenched
his thirst in a brook, putting his mouth in the running water. In this
way he swallowed a leech, which subsequently caused annoying hemorrhage
from the mouth. Timaeus mentions a child of five who swallowed several
leeches, and who died of abdominal pains, hemorrhage, and convulsions.
Rhodius, Riverius, and Zwinger make similar observations. According to
Baron Larrey the French soldiers in Napoleon's Egyptian campaign
occasionally swallowed leeches.  Grandchamp and Duval have commented on
curious observations of leeches in the digestive tract. Dumas and
Marques also speak of the swallowing of leeches. Colter reports a case
in which beetles were vomited. Wright remarks on Banon's case of
fresh-water shrimps passed from the human intestine. Dalton, Dickman,
and others, have discussed the possibility of a slug living in the
stomach of man. Pichells speaks of a case in which beetles were
expelled from the stomach; and Pigault gives an account of a living
lizard expelled by vomiting. Fontaine, Gaspard, Vetillart, Ribert,
MacAlister, and Waters record cases in which living caterpillars have
been swallowed.

Sundry Cases.--The variety of foreign bodies that have been swallowed
either accidentally or for exhibitional or suicidal purposes is
enormous. Nearly every imaginable article from the minutest to the most
incredible size has been reported. To begin to epitomize the literature
on this subject would in itself consume a volume, and only a few
instances can be given here, chosen in such a way as to show the
variety, the effects, and the possibilities of their passage through
the intestinal canal.

Chopart says that in 1774 the belly of a ravenous galley-slave was
opened, and in the stomach were found 52 foreign bodies, including a
barrel-hoop 19 inches long, nails, pieces of pipe, spoons, buckles,
seeds, glass, and a knife. In the intestines of a person Agnew found a
pair of suspenders, a mass of straw, and three roller-bandages, an inch
in width and diameter. Velpeau mentions a fork which was passed from
the anus twenty months after it was swallowed. Wilson mentions an
instance of gastrotomy which was performed for the extraction of a fork
swallowed sixteen years before. There is an interesting case in which,
in a delirium of typhoid fever, a girl of twenty-two swallowed two iron
forks, which were subsequently expelled through an abdominal abscess. A
French woman of thirty-five, with suicidal intent, swallowed a
four-pronged fork, which was removed four years afterward from the
thigh. For two years she had suffered intense pain in both thighs. In
the Royal College of Surgeons in London there is a steel button-hook 3
1/2 inches in length which was accidentally swallowed, and was passed
three weeks later by the anus, without having given rise to any symptom.

Among the insane a favorite trait seems to be swallowing nails.  In the
Philosophical Transactions is an account of the contents of the stomach
of an idiot who died at thirty-three. In this organ were found nine
cart-wheel nails, six screws, two pairs of compasses, a key, an iron
pin, a ring, a brass pommel weighing nine ounces, and many other
articles. The celebrated Dr. Lettsom, in 1802, spoke of an idiot who
swallowed four pounds of old nails and a pair of compasses. A lunatic
in England e swallowed ten ounces of screws and bits of crockery, all
of which were passed by the anus. Boardman gives an account of a child
affected with hernia who swallowed a nail 2 1/2 inches long. In a few
days the nail was felt in the hernia, but in due time it was passed by
the rectum. Blower reports an account of a nail passing safely through
the alimentary canal of a baby. Armstrong mentions an insane
hair-dresser of twenty-three, in whose stomach after death were found
30 or more spoon handles, 30 nails, and other minor articles.

Closmadenc reported a remarkable case which was extensively quoted. The
patient was an hysteric young girl, an inmate of a convent, to whom he
was called to relieve a supposed fit of epilepsy. He found her
half-asphyxiated, and believed that she had swallowed a foreign body.
He was told that under the influence of exaggerated religious scruples
this girl inflicted penance upon herself by swallowing earth and holy
medals. At the first dose of the emetic, the patient made a strong
effort to vomit, whereupon a cross seven cm. long appeared between her
teeth. This was taken out of her mouth, and with it an enormous rosary
220 cm. long, and having seven medals attached to it. Hunt recites a
case occurring in a pointer dog, which swallowed its collar and chain,
only imperfectly masticating the collar. The chain and collar were
immediately missed and search made for them. For several days the dog
was ill and refused food. Finally the gamekeeper saw the end of the
chain hanging from the dog's anus, and taking hold of it, he drew out a
yard of chain with links one inch long, with a cross bar at the end two
inches in length; the dog soon recovered. The collar was never found,
and had apparently been digested or previously passed.

Fear of robbery has often led to the swallowing of money or jewelry.
Vaillant, the celebrated doctor and antiquarian, after a captivity of
four months in Algiers, was pursued by Tunis pirates, and swallowed 15
medals of gold; shortly after arriving at Lyons he passed them all at
stool. Fournier and Duret published the history of a galley slave at
Brest in whose stomach were found 52 pieces of money, their combined
weight being one pound, 10 1/4 ounces. On receiving a sentence of three
years' imprisonment, an Englishman, to prevent them being taken from
him, swallowed seven half-crowns. He suffered no bad effects, and the
coins not appearing the affair was forgotten. While at stool some
twenty months afterward, having taken a purgative for intense abdominal
pain, the seven coins fell clattering into the chamber. Hevin mentions
the case of a man who, on being captured by Barbary pirates, swallowed
all the money he had on his person.  It is said that a certain Italian
swallowed 100 louis d'ors at a time.

It occasionally happens that false teeth are accidentally swallowed,
and even passed through the intestinal tract. Easton mentions a young
man who accidentally swallowed some artificial teeth the previous
night, and, to further their passage through the bowel, he took a dose
of castor oil. When seen he was suffering with pain in the stomach, and
was advised to eat much heavy food and avoid aperients. The following
day after several free movements he felt a sharp pain in the lower part
of his back. A large enema was given and the teeth and plate came away.
The teeth were cleansed and put back in his mouth, and the patient
walked out. Nine years later the same accident again happened to the
man but in spite of treatment nothing was seen of the teeth for a month
afterward, when a body appeared in the rectum which proved to be a gold
plate with the teeth in it. In The Lancet of December 10, 1881, there
is an account of a vulcanite tooth-plate which was swallowed and passed
forty-two hours later. Billroth mentions an instance of gastrotomy for
the removal of swallowed artificial teeth, with recovery; and another
case in which a successful esophagotomy was performed. Gardiner
mentions a woman of thirty-three who swallowed two false teeth while
supping soup. A sharp angle of the broken plate had caught in a fold of
the cardiac end of the stomach and had caused violent hematemesis.
Death occurred seventeen hours after the first urgent symptoms.

In the Museum of the Royal College of Surgeons in London there is an
intestinal concretion weighing 470 grains, which was passed by a woman
of seventy who had suffered from constipation for many years. Sixteen
years before the concretion was passed she was known to have swallowed
a tooth. At one side of the concretion a piece had been broken off
exposing an incisor tooth which represented the nucleus of the
formation. Manasse recently reported the case of a man of forty-four
whose stomach contained a stone weighing 75 grams. He was a joiner and,
it was supposed, habitually drank some alcoholic solution of shellac
used in his trade. Quite likely the shellac had been precipitated in
the stomach and gave rise to the calculus.

Berwick mentions a child of eight months who was playing with a
detached organ-handle, and put it in its mouth. Seeing this the mother
attempted to secure the handle, but it was pushed into the esophagus. A
physician was called, but nothing was done, and the patient seemed to
suffer little inconvenience. Three days later the handle was expelled
from the anus. Teakle reports the successful passage through the
alimentary canal of the handle of a music-box. Hashimoto,
Surgeon-General of the Imperial Japanese Army, tells of a woman of
forty-nine who was in the habit of inducing vomiting by irritating her
fauces and pharynx with a Japanese toothbrush--a wooden instrument six
or seven inches long with bristles at one end. In May, 1872, she
accidentally swallowed this brush. Many minor symptoms developed, and
in eleven months there appeared in the epigastric region a fluctuating
swelling, which finally burst, and from it extended the end of the
brush. After vainly attempting to extract the brush the attending
physician contented himself with cutting off the projecting portion.
The opening subsequently healed; and not until thirteen years later did
the pain and swelling return. On admission to the hospital in October,
1888, two fistulous openings were seen in the epigastric region, and
the foreign body was located by probing. Finally, on November 19, 1888,
the patient was anesthetized, one of the openings enlarged, and the
brush extracted. Five weeks later the openings had all healed and the
patient was restored to health.

Garcia reports an interesting instance of foreign body in a man between
forty-five and fifty. This man was afflicted with a syphilitic
affection of the mouth, and he constructed a swab ten inches long with
which to cleanse his fauces. While making the application alone one
day, a spasmodic movement caused him to relinquish his grasp on the
handle, and the swab disappeared. He was almost suffocated, and a
physician was summoned; but before his arrival the swab had descended
into the esophagus. Two weeks later, gastro-peritoneal symptoms
presented, and as the stick was located, gastrotomy was proposed; the
patient, however, would not consent to an operation. On the
twenty-sixth day an abscess formed on the left side below the nipple,
and from it was discharged a large quantity of pus and blood. Four days
after this, believing himself to be better, the man began to redress
the wound, and from it he saw the end of a stick protruding. A
physician was called, and by traction the stick was withdrawn from
between the 3d and 4th ribs; forty-nine days after the accident the
wound had healed completely. Two years afterward the patient had an
attack of cholera, but in the fifteen subsequent years he lived an
active life of labor.

Occasionally an enormous mass of hair has been removed from the
stomach. A girl of twenty a with a large abdominal swelling was
admitted to a hospital. Her illness began five years previously, with
frequent attacks of vomiting, and on three occasions it was noticed
that she became quite bald. Abdominal section was performed, the
stomach opened, and from it was removed a mass of hair which weighed
five pounds and three ounces. A good recovery ensued. In the Museum of
St. George's Hospital, London, are masses of hair and string taken from
the stomach and duodenum of a girl of ten. It is said that from the age
of three the patient had been in the habit of eating these articles.
There is a record in the last century of a boy of sixteen who ate all
the hair he could find; after death his stomach and intestines were
almost completely lined with hairy masses. In the Journal of the
American Medical Association, March 1, 1896, there is a report of a
case of hair-swallowing.

Foreign Bodies in the Intestines.--White relates the history of a case
in which a silver spoon was swallowed and successfully excised from the
intestinal canal. Houston mentions a maniac who swallowed a rusty iron
spoon 11 inches long. Fatal peritonitis ensued and the spoon was found
impacted in the last acute turn of the duodenum. In 1895, in London,
there was exhibited a specimen, including the end of the ileum with the
adjacent end of the colon, showing a dessert spoon which was impacted
in the latter.  The spoon was seven inches long, and its bowl measured
1 1/2 inches across. There was much ulceration of the mucous membrane.
This spoon had been swallowed by a lunatic of twenty-two, who had made
two previous ineffectual attempts at suicide. Mason describes the case
of a man of sixty-five who, after death by strangulated hernia, was
opened, and two inches from the ileocecal valve was found an earthen
egg-cup which he had swallowed. Mason also relates the instance of a
man who swallowed metal balls 2 1/2 inches in diameter; and the case of
a Frenchman who, to prevent the enemy from finding them, swallowed a
box containing despatches from Napoleon. He was kept prisoner until the
despatches were passed from his bowels. Denby discovered a large
egg-cup in the ileum of a man. Fillion mentions an instance of recovery
following the perforation of the jejunum by a piece of horn which had
been swallowed. Madden tells of a person, dying of intestinal
obstruction, in whose intestines were found several ounces of crude
mercury and a plum-stone. The mercury had evidently been taken for
purgative effect. Rodenbaugh mentions a most interesting case of beans
sprouting while in the bowel.  Harrison relates a curious case in which
the swallowed lower epiphysis of the femur of a rabbit made its way
from the bowel to the bladder, and was discharged thence by the urethra.

In cases of appendicitis foreign bodies have been found lodged in or
about the vermiform appendix so often that it is quite a common lay
idea that appendicitis is invariably the result of the lodgment of some
foreign body accidentally swallowed. In recent years the literature of
this subject proves that a great variety of foreign bodies may be
present. A few of the interesting cases will be cited in the following
lines:--

In the New England Medical Journal, 1843, is an account of a vermiform
appendix which was taken from the body of a man of eighty-eight who had
died of pneumothorax. During life there were no symptoms of disease of
the appendix, and after death no adhesions were found, but this organ
was remarkably long, and in it were found 122 robin-shot. The old
gentleman had been excessively fond of birds all his life, and was
accustomed to bolt the meat of small birds without properly chewing it;
to this fact was attributed the presence of these shot in the appendix.
A somewhat similar case was that of a man who died in the Hotel-Dieu in
1833. The ileum of this man contained 92 shot and 120 plum stones.
Buckler reports a case of appendicitis in a child of twelve, in which a
common-sized bird-shot was found in the appendix. Packard presented a
case of appendicitis in which two pieces of rusty and crooked wire, one
2 1/2 and the other 1 1/2 inches long, were found in the omentum,
having escaped from the appendix. Howe describes a case in which a
double oat, with a hard envelope, was found in the vermiform appendix
of a boy of four years and one month of age. Prescott reports a case of
what he calls fatal colic from the lodgment of a chocolate-nut in the
appendix; and Noyes relates an instance of death in a man of thirty-one
attributed to the presence of a raisin-seed in the vermiform appendix.
Needles, pins, peanuts, fruit-stones, peas, grape-seeds, and many
similar objects have been found in both normal and suppurative
vermiform appendices.

Intestinal Injuries.--The degree of injury that the intestinal tract
may sustain, and after recovery perform its functions as usual, is most
extraordinary; and even when the injury is of such an extent as to be
mortal, the persistence of life is remarkable.  It is a well known fact
that in bull-fights, after mortal injuries of the abdomen and bowels,
horses are seen to struggle on almost until the sport is finished.
Fontaine reports a case of a Welsh quarryman who was run over by a
heavy four-horse vehicle.  The stump of a glass bottle was crushed into
the intestinal cavity, and the bowels protruded and were bruised by the
wheels of the wagon. The grit was so firmly ground into the bowel that
it was impossible to remove it; yet the man made a complete recovery.
Nicolls has the case of a man of sixty-nine, a workhouse maniac, who on
August 20th attempted suicide by running a red-hot poker into his
abdomen. His wound was dressed and he was recovering, but on September
11th he tore the cast off his abdomen, and pulled out of the wound the
omentum and 32 inches of colon, which he tore off and threw between his
pallet and the wall. Strange to say he did not die until eight days
after this horrible injury.

Tardieu relates the case of a chemist who removed a large part of the
mesentery with a knife, and yet recovered. Delmas of Montpellier
reports the history of a wagoner with complete rupture of the
intestines and rupture of the diaphragm, and who yet finished his
journey, not dying until eighteen hours after.

Successful Intestinal Resection.--In 1755 Nedham of Norfolk reported
the case of a boy of thirteen who was run over and eviscerated. It was
found necessary to remove 57 inches of the protruding bowel, but the
boy made a subsequent recovery.  Koebererle of Strasburg performed an
operation on a woman of twenty-two for the relief of intestinal
obstruction. On account of numerous strictures it was found necessary
to remove over two yards of the small intestine; the patient recovered
without pain or trouble of any kind. In his dissertation on "Ruptures"
Arnaud remarks that he cut away more than seven feet of gangrenous
bowel, his patient surviving. Beehe reports recovery after the removal
of 48 inches of intestine. The case was one of strangulation of an
umbilical hernia.

Sloughing of the Intestine Following Intussusception.--Lobstein
mentions a peasant woman of about thirty who was suddenly seized with
an attack of intussusception of the bowel, and was apparently in a
moribund condition when she had a copious stool, in which she evacuated
three feet of bowel with the mesentery attached. The woman recovered,
but died five months later from a second attack of intussusception, the
ileum rupturing and peritonitis ensuing. There is a record in this
country of a woman of forty-five who discharged 44 inches of intestine,
and who survived for forty-two days. The autopsy showed the sigmoid
flexure gone, and from the caput ceci to the termination the colon only
measured 14 inches. Vater gives a history of a penetrating abdominal
wound in which a portion of the colon hung from the wound during
fourteen years, forming an artificial anus.

Among others mentioning considerable sloughing of intestine following
intussusception, and usually with complete subsequent recovery, are
Bare, 13 inches of the ileum; Blackton, nine inches; Bower, 14 inches;
Dawson, 29 inches; Sheldon, 4 1/2 feet; Stanley, three feet; Tremaine,
17 inches; and Grossoli, 40 cm.

Rupture of the Intestines.--It is quite possible for the intestine to
be ruptured by external violence, and cases of rupture of all parts of
the bowel have been recorded. Titorier gives the history of a case in
which the colon was completely separated from the rectum by external
violence. Hinder reports the rupture of the duodenum by a violent kick.
Eccles, Ely, and Pollock also mention cases of rupture of the duodenum.
Zimmerman, Atwell, and Allan report cases of rupture of the colon.

Operations upon the gastrointestinal tract have been so improved in the
modern era of antisepsis that at the present day they are quite common.
There are so many successful cases on record that the whole subject
deserves mention here.

Gastrostomy is an operation for establishing a fistulous opening in the
stomach through the anterior wall. Many operations have been devised,
but the results of this maneuver in malignant disease have not thus far
been very satisfactory. It is quite possible that, being an operation
of a serious nature, it is never performed early enough, the patient
being fatally weakened by inanition. Gross and Zesas have collected,
respectively, 207 and 162 cases with surprisingly different rates of
mortality: that of Gross being only 29.47 per cent, while that of Zesas
was for cicatricial stenoses 60 per cent, and for malignant cases 84
per cent. It is possible that in Zesas's statistics the subjects were
so far advanced that death would have resulted in a short time without
operation. Gastrotomy we have already spoken of.

Pyloroplasty is an operation devised by Heineke and Mikulicz, and is
designed to remove the mechanic obstruction in cicatricial stenoses of
the pylorus, at the same time creating a new pylorus.

Gastroenterostomy and pylorectomy are operations devised for the relief
of malignant disease of the pylorus, the diseased portions being
removed and the parts resected.

Gastrectomy or extirpation of the stomach is considered by most
surgeons entirely unjustifiable, as there is seldom hope of cure or
prospect of amelioration. La Tribune Medicale for January 16, 1895,
gives an abstract of Langenbuch's contribution upon total extirpation
of the stomach. Three patients were treated, of whom two died. In the
first case, on opening the abdominal cavity the stomach was found very
much contracted, presenting extensive carcinomatous infiltration on its
posterior surface. After division of the epiploon section was made at
the pylorus and at the cardiac extremities; the portions removed
represented seven-eighths of the stomach. The pylorus was stitched to
the remains of the cardiac orifice, making a cavity about the size of a
hen's egg. In this case a cure was accomplished in three weeks.  The
second case was that of a man in whom almost the entire stomach was
removed, and the pyloric and cardiac ends were stitched together in the
wound of the parietes. The third case was that of a man of sixty-two
with carcinoma of the pylorus.  After pylorectomy, the line of suture
was confined with iodoform-gauze packing. Unfortunately the patient
suffered with bronchitis, and coughing caused the sutures to give way;
the patient died of inanition on the twenty-third day.

Enterostomy, or the formation of a fecal fistula above the ileocecal
valve, was performed for the first time by Nelaton in 1840, but the
mortality since 1840 has been so great that in most cases it is deemed
inadmissible.

Colostomy, an operation designed to make a fistulous opening in any
portion of the rectum, was first practiced by Littre. In early times
the mortality of inguinal colostomy was about five per cent, but has
been gradually reduced until Konig reports 20 cases with only one death
from peritonitis, and Cripps 26 cases with only one death. This will
always retain its place in operative surgery as a palliative and
life-saving operation for carcinomatous stenosis of the lower part of
the colon, and in cases of carcinoma of the rectum in which operation
is not feasible.

Intestinal anastomosis, whereby two portions of a severed or resected
bowel can be intimately joined, excluding from fecal circulation the
portion of bowel which has become obstructed, was originally suggested
by Maisonneuve, and was studied experimentally by von Hacken. Billroth
resorted to it, and Senn modified it by substituting decalcified
bone-plates for sutures.  Since that time, Abbe, Matas, Davis, Brokaw,
Robinson, Stamm, Baracz, and Dawburn, have modified the material of the
plates used, substituting catgut rings, untanned leather, cartilage,
raw turnips, potatoes, etc. Recently Murphy of Chicago has invented a
button, which has been extensively used all over the world, in place of
sutures and rings, as a means of anastomosis. Hardly any subject has
had more discussion in recent literature than the merits of this
ingenious contrivance.

Foreign Bodies in the Rectum.--Probably the most celebrated case of
foreign body introduced into the rectum is the classic one mentioned by
Hevin. Some students introduced the frozen tail of a pig in the anus of
a French prostitute. The bristles were cut short, and having prepared
the passage with oil, they introduced the tail with great force into
the rectum, allowing a portion to protrude. Great pain and violent
symptoms followed; there was distressing vomiting, obstinate
constipation, and fever. Despite the efforts to withdraw the tail, the
arrangement of the bristles which allowed entrance, prevented removal.
On the sixth day, in great agony, the woman applied to Marchettis, who
ingeniously adopted the simple procedure of taking a long hollow reed,
and preparing one of its extremities so that it could be introduced
into the rectum, he was enabled to pass the reed entirely around the
tail and to withdraw both. Relief was prompt, and the removal of the
foreign body was followed by the issue of stercoraceous matter which
had accumulated the six days it had remained in situ.

Tuffet is quoted as mentioning a farmer of forty-six who, in
masturbation, introduced a barley-head into his urethra. It was found
necessary to cut the foreign body out of the side of the glans. A year
later he put in his anus a cylindric snuff-box of large size, and this
had to be removed by surgical methods.  Finally, a drinking goblet was
used, but this resulted in death, after much suffering and lay
treatment. In his memoirs of the old Academy of Surgery in Paris,
Morand speaks of a monk who, to cure a violent colic, introduced into
his fundament a bottle of l'eau de la reine de Hongrie, with a small
opening in its mouth, by which the contents, drop by drop, could enter
the intestine. He found he could not remove the bottle, and violent
inflammation ensued. It was at last necessary to secure a boy with a
small hand to extract the bottle. There is a record of a case in which
a tin cup or tumbler was pushed up the rectum and then passed into the
colon where it caused gangrene and death. It was found to measure 3 1/2
by 3 1/2 by two inches. There is a French case in which a preserve-pot
three inches in diameter was introduced into the rectum, and had to be
broken and extracted piece by piece.

Cloquet had a patient who put into his rectum a beer glass and a
preserving pot. Montanari removed from the rectum of a man a mortar
pestle 30 cm. long, and Poulet mentions a pederast who accidentally
killed himself by introducing a similar instrument, 55 cm. long, which
perforated his intestine. Studsgaard mentions that in the pathologic
collection at Copenhagen there is a long, smooth stone, 17 cm. long,
weighing 900 gm., which a peasant had introduced into his rectum to
relieve prolapsus. The stone was extracted in 1756 by a surgeon named
Frantz Dyhr. Jeffreys speaks of a person who, to stop diarrhea,
introduced into his rectum a piece of wood measuring seven inches.

There is a remarkable case recorded of a stick in the anus of a man of
sixty, the superior extremity in the right hypochondrium, the inferior
in the concavity of the sacrum. The stick measured 32 cm. in length;
the man recovered. It is impossible to comprehend this extent of
straightening of the intestine without great twisting of the mesocolon.
Tompsett mentions that he was called to see a workman of sixty-five,
suffering from extreme rectal hemorrhage. He found the man very feeble,
without pulse, pale, and livid. By digital examination he found a hard
body in the rectum, which he was sure was not feces. This body he
removed with a polyp-forceps, and found it to be a cylindric
candle-box, which measured six inches in circumference, 2 1/2 in
length, and 1 1/2 in diameter. The removal was followed by a veritable
flood of fecal material, and the man recovered. Lane reports
perforation of the rectum by the introduction of two large pieces of
soap; there was coincident strangulated hernia.

Hunter mentions a native Indian, a resident of Coorla, who had
introduced a bullock's horn high up into his abdomen, which neither he
nor his friends could extract. He was chloroformed and placed in the
lithotomy position, his buttocks brought to the edge of the bed, and
after dilatation of the sphincter, by traction with the fingers and
tooth-forceps, the horn was extracted. It measured 11 inches long. The
young imbecile had picked it up on the road, where it had been rendered
extremely rough by exposure, and this caused the difficulty in
extraction.

In Nelson's Northern Lancet, 1852, there is the record of a case of a
man at stool, who slipped on a cow's horn, which entered the rectum and
lodged beyond the sphincter. It was only removed with great difficulty.

A convict at Brest put up his rectum a box of tools. Symptoms of
vomiting, meteorism, etc., began, and became more violent until the
seventh day, when he died. After death, there was found in the
transverse colon, a cylindric or conic box, made of sheet iron, covered
with skin to protect the rectum and, doubtless, to aid expulsion. It
was six inches long and five inches broad and weighed 22 ounces. It
contained a piece of gunbarrel four inches long, a mother-screw steel,
a screw-driver, a saw of steel for cutting wood four inches long,
another saw for cutting metal, a boring syringe, a prismatic file, a
half-franc piece and four one-franc pieces tied together with thread, a
piece of thread, and a piece of tallow, the latter presumably for
greasing the instruments. On investigation it was found that these
conic cases were of common use, and were always thrust up the rectum
base first. In excitement this prisoner had pushed the conic end up
first, thus rendering expulsion almost impossible. Ogle gives an
interesting case of foreign body in the rectum of a boy of seventeen.
The boy was supposed to be suffering with an abdominal tumor about the
size of a pigeon's egg under the right cartilages; it had been noticed
four months before. On admission to the hospital the lad was suffering
with pain and jaundice; sixteen days later he passed a stick ten inches
long, which he reluctantly confessed that he had introduced into the
anus.  During all his treatment he was conscious of the nature of his
trouble, but he suffered rather than confess. Studsgaard mentions a man
of thirty-five who, for the purpose of stopping diarrhea, introduced
into his rectum a preserve-bottle nearly seven inches long with the
open end uppermost. The next morning he had violent pain in the
abdomen, and the bottle could be felt through the abdominal wall. It
was necessary to perform abdominal section through the linea alba,
divide the sigmoid flexure, and thus remove the bottle. The intestine
was sutured and the patient recovered. The bottle measured 17 cm. long,
five cm. in diameter at its lower end, and three cm. at its upper end.

Briggs reports a case in which a wine glass was introduced into the
rectum, and although removed twenty-four hours afterward, death ensued.
Hockenhull extracted 402 stones from the rectum of a boy of seven.
Landerer speaks of a curious case in which the absorptive power of the
rectum was utilized in the murder of a boy of fifteen. In order to come
into the possession of a large inheritance the murderess poisoned the
boy by introducing the ends of some phosphorous matches into his
rectum, causing death that night; there was intense inflammation of the
rectum. The woman was speedily apprehended, and committed suicide when
her crime was known.

Complete transfixion of the abdomen does not always have a fatal issue.
In fact, two older writers, Wisemann and Muys, testify that it is quite
possible for a person to be transfixed without having any portion of
the intestines or viscera wounded. In some nations in olden times, the
extremest degree of punishment was transfixion by a stake. In his
voyages and travels, in describing the death of the King of Demaa at
the hands of his page, Mendez Pinto says that instead of being reserved
for torture, as were his successors Ravaillac, and Gerard, the slayer
of William the Silent, the assassin was impaled alive with a long stake
which was thrust in at his fundament and came out at the nape of his
neck. There is a record of a man of twenty-five, a soldier in the
Chinese war of 1860, who, in falling from his horse, was accidentally
transfixed by a bayonet. The steel entered his back two inches to the
left of the last dorsal vertebra, and reappeared two inches to the left
and below the umbilicus; as there was no symptom of visceral wound
there were apparently no injuries except perforation of the parietes
and the peritoneum.  The man recovered promptly.

Ross reports a case of transfixion in a young male aborigine, a native
of New South Wales, who had received a spear-wound in the epigastrium
during a quarrel; extraction was impossible because of the
sharp-pointed barbs; the spear was, therefore, sawed off, and was
removed posteriorly by means of a small incision. The edges of the
wound were cleansed, stitched, and a compress and bandage applied.
During the night the patient escaped and joined his comrades in the
camp, and on the second day was suffering with radiating pains and
distention. The following day it was found that the stitches and
plaster had been removed, and the anterior wound was gaping and
contained an ichorous discharge.  The patient was bathing the wound
with a decoction of the leaves of the red-gum tree. Notwithstanding
that the spear measured seven inches, and the interference of
treatment, the abdominal wound closed on the sixth day, and recovery
was uninterrupted.  Gilkrist mentions an instance in which a ramrod was
fired into a soldier's abdomen, its extremity lodging in the spinal
column, without causing the slightest evidence of wounds of the
intestines or viscera. A minute postmortem examination was held some
time afterward, the soldier having died by drowning, but the results
were absolutely negative as regards any injury done by the passage of
the ramrod.

Humphreys says that a boy of eleven, while "playing soldier" with
another boy, accidentally fell on a rick-stake. The stake was slightly
curved at its upper part, being 43 inches long and three inches in
circumference, and sharp-pointed at its extremity. As much as 17 1/2
inches entered the body of the lad. The stake entered just in front of
the right spermatic cord, passed beneath Poupart's ligament into the
cavity of the abdomen, traversed the whole cavity across to the left
side; it then entered the thorax by perforating the diaphragm,
displaced the heart by pushing it to the right of the sternum, and
pierced the left lung. It then passed anteriorly under the muscles and
integument in the axillary space, along the upper third of the humerus,
which was extended beyond the head, the external skin not being
ruptured.  The stick remained in situ for four hours before attempts at
extraction were made. On account of the displacement of the heart it
was decided not to give chloroform. The boy was held down by four men,
and Humphreys and his assistant made all the traction in their power.
After removal not more than a teaspoonful of blood followed. The heart
still remained displaced, and a lump of intestine about the size of an
orange protruded from the wound and was replaced. The boy made a slow
and uninterrupted recovery, and in six weeks was able to sit up. The
testicle sloughed, but five months later, when the boy was examined, he
was free from pain and able to walk. There was a slight enlargement of
the abdomen and a cicatrix of the wound in the right groin. The right
testicle was absent, and the apex of the heart was displaced about an
inch.

Woodbury reports the case of a girl of fourteen, who fell seven or
eight feet directly upon an erect stake in a cart; the tuberosity was
first struck, and then the stake passed into the anus, up the rectum
for two inches, thence through the rectal wall, and through the body in
an obliquely upward direction.  Striking the ribs near the left nipple
it fractured three, and made its exit. The stake was three inches in
circumference, and 27 inches of its length passed into the body, six or
seven inches emerging from the chest. This girl recovered so rapidly
that she was able to attend school six weeks afterward. In a case
reported by Bailey a middle-aged woman, while sliding down a hay-stack,
struck directly upon a pitchfork handle which entered the vagina; the
whole weight of the woman was successfully maintained by the cellular
tissue of the uterovaginal culdesac.

Minot speaks of the passage of one prong of a pitchfork through the
body of a man of twenty-one, from the perineum to the umbilicus; the
man recovered.

Hamilton reports a case of laceration of the perineum with penetration
of the pelvic cavity to the depth of ten inches by a stick 3/4 inch
thick. Prowse mentions the history of a case of impalement in a man of
thirty-four, who, coming down a hay-stack, alighted on the handle of a
pitchfork which struck him in the middle of the scrotum, and passed up
between the skin and fascia to the 10th rib. Recovery was prompt.

There are several cases on record in which extensive wounds of the
abdominal parietes with protrusion and injury to the intestine have not
been followed by death. Injuries to the intestines themselves have
already been spoken of, but there are several cases of evisceration
worthy of record.

Doughty says that at midnight on June 7, 1868, he was called to see a
man who had been stabbed in a street altercation with a negro. When
first seen in the street, the patient was lying on his back with his
abdomen exposed, from which protruded an enormous mass of intestines,
which were covered with sand and grit; the small intestine (ileum) was
incised at one point and scratched at another by the passing knife. The
incision, about an inch in length, was closed with a single stitch of
silk thread, and after thorough cleansing the whole mass was returned
to the abdominal cavity. In this hernial protrusion were recognized
four or five feet of the ileum, the cecum with its appendix, part of
the ascending colon with corresponding portions of the mesentery; the
distribution of the superior mesentery, made more apparent by its
living pulsation, was more beautifully displayed in its succession of
arches than in any dissection that Doughty had ever witnessed.
Notwithstanding the extent of his injuries the patient recovered, and
at last reports was doing finely.

Barnes reports the history of a negro of twenty-five who was admitted
to the Freedmen's Hospital, New Orleans, May 15, 1867, suffering from
an incised wound of the abdomen, from which protruded eight inches of
colon, all of the stomach, and nearly the whole of the small
intestines. About 2 1/2 feet of the small intestine, having a whitish
color, appeared to be filled with food and had much of the
characteristic feeling of a sausage. The rest of the small intestine
had a dark-brown color, and the stomach and colon, distended with gas,
were leaden-colored. The viscera had been exposed to the atmosphere for
over an hour.  Having nothing but cold Mississippi water to wash them
with, Barnes preferred returning the intestines without any attempt at
removing blood and dirt further than wiping with a cambric handkerchief
and the stripping they would naturally be subjected to in being
returned through the opening. In ten minutes they were returned; they
were carefully examined inch by inch for any wound, but none was found.
Three silver sutures were passed through the skin, and a firm compress
applied. The patient went to sleep shortly after his wound was dressed,
and never had a single subsequent bad symptom; he was discharged on May
24th, the wound being entirely healed, with the exception of a
cartilage of a rib which had not reunited.

Rogers mentions the case of a carpenter of thirty-six who was struck by
a missile thrown by a circular saw, making a wound two inches above the
umbilicus and to the left. Through the opening a mass of intestines and
a portion of the liver, attached by a pedicle, protruded. A portion of
the liver was detached, and the liver, as well as the intestines, were
replaced, and the man recovered.

Baillie, Bhadoory, Barker, Edmundson, Johnson, and others, record
instances of abdominal wounds accompanied by extensive protrusion of
the intestines, and recovery. Shah mentions an abdominal wound with
protrusion of three feet of small intestine. By treatment with ice,
phenol, and opium, recovery was effected without peritonitis.

Among nonfatal perforating gunshot wounds of the abdomen, Loring:
reports the case of a private in the First Artillery who recovered
after a double gunshot perforation of the abdomen. One of the balls
entered 5 1/2 inches to the left of the umbilicus, and two inches above
the crest of the ilium, making its exit two inches above the crest of
the ilium, on a line with and two inches from the 4th lumbar vertebra.
The other ball entered four inches below and to the rear of the left
nipple, making its exit four inches directly below the point of
entrance. In their passages these balls did not wound any of the
viscera, and with the exception of traumatic fever there was no
disturbance of the health of the patient. Schell records the case of a
soldier who was wounded July 3, 1867, by a conoid ball from a Remington
revolver of the Army pattern. The ball entered on the left side of the
abdomen, its lower edge grazing the center of Poupart's ligament, and
passing backward, inward, and slightly upward, emerged one inch to the
left of the spinous process of the sacrum. On July 6th all the symptoms
of peritonitis made their appearance. On July 11th there was free
discharge of fecal matter from both anterior and posterior wounds. This
discharge continued for three days and then ceased. By August 12th both
wounds were entirely healed. Mineer reports a case of a wound from a
revolver-ball entering the abdomen, passing through the colon, and
extracted just above the right ilium. Under simple treatment the
patient recovered and was returned to duty about ten weeks afterward.

There are a number of cases on record in which a bullet entering the
abdominal cavity is subsequently voided either by the bladder or by the
bowel. Ducachet mentions two cases at the Georgetown Seminary Hospital
during the late war in which Minie balls entering the abdominal wall
were voided by the anus in a much battered condition. Bartlett reports
the case of a young man who was accidentally shot in the abdomen with a
Colt's revolver.  Immediately after the accident he complained of
constant and pressing desire to void his urine. While urinating on the
evening of the third day, the ball escaped from the urethra and fell
with a click into the chamber. After the discharge of the ball the
intolerable symptoms improved, and in two or three weeks there was
complete recovery. Hoag mentions a man who was wounded by a round
musket-ball weighing 400 grains. It had evidently passed through the
lung and diaphragm and entered the alimentary canal; it was voided by
the rectum five days after the injury. Lenox mentions the fact of a
bullet entering the abdominal wall and subsequently being passed from
the rectum. Day and Judkins report similar cases. Rundle speaks of the
lodgment of a bullet, and its escape, after a period of seven and
one-half years, into the alimentary canal, causing internal
strangulation and death.

Wounds of the liver often end very happily, and there are many cases on
record in which such injuries have been followed by recovery, even when
associated with considerable loss of liver-substance. In the older
records, Glandorp and Scultetus mention cures after large wounds of the
liver. Fabricius Hildanus reports a case that ended happily, in which a
piece of liver was found in the wound, having been separated by a
sword-thrust.  There is a remarkable example of recovery after multiple
visceral wounds, self-inflicted by a lunatic. This man had 18 wounds,
14 having penetrated the abdomen, the liver, colon, and the jejunum
being injured; by frequent bleeding, strict regimen, dressing, etc., he
recovered his health and senses, but relapsing a year and a half later,
he again attempted suicide, which gave the opportunity for a postmortem
to learn the extent of the original injuries. Plater, Schenck,
Cabrolius, the Ephemerides, and Nolleson mention recovery after wounds
of the liver. Salmuth and the Ephemerides report questionable instances
in which portions of the liver were ejected in violent vomiting.
Macpherson describes a wound of the liver occurring in a Hindoo of
sixty who had been struck by a spear. A portion of the liver was
protruding, and a piece weighing 1 1/4 ounces was removed, complete
recovery following.

Postempski mentions a case of suture of the liver after a stab-wound.
Six sutures of chromicized cat-gut were carefully tightened and
fastened with a single loop. The patient left his bed on the sixth day
and completely recovered. Gann reports a case of harpoon-wound of the
liver. While in a dory spearing fish in the Rio Nuevo, after a sudden
lurch of the boat, a young man of twenty-eight fell on the sharp point
of a harpoon, which penetrated his abdomen. About one inch of the
harpoon was seen protruding from below the tip of the ensiform
cartilage; the harpoon was seven inches long. It was found that the
instrument had penetrated the right lobe of the liver; on passing the
hand backward along the inferior surface of the liver, the point could
be felt projecting through its posterior border. On account of two
sharp barbs on the spear-point, it was necessary to push the harpoon
further in to disengage the barbs, after which it was easily removed.
Recovery followed, and the patient was discharged in twenty-one days.

Romme discusses the subject of punctured wounds of the liver, as a
special text using the case of the late President Carnot. He says that
in 543 cases of traumatism of the liver collected by Elder, 65 were
caused by cutting or sharp-pointed instruments. Of this group, 23
recovered and 42 died. The chief causes of death were hemorrhage and
peritonitis. The principal symptoms of wounds of the liver, such as
traumatic shock, collapse, local and radiating pains, nausea, vomiting,
and respiratory disturbances were all present in the case of President
Carnot. From an experience gained in the case of the President, Romme
strongly recommends exploratory celiotomy in all penetrating wounds of
the liver. Zeidler reports three cases of wound of the liver in which
recovery ensued. The hemorrhage in one case was arrested by the tampon,
and in the other by the Pacquelin cautery.

McMillan describes a man of twenty who was kicked by a horse over the
liver and rupturing that organ. A large quantity of offensive fluid was
drawn off from the liver, and the man recovered. Frazer reports a case
of rupture of liver and kidney in a boy of thirteen who was squeezed
between the tire and driving chain of a mill, but who recovered despite
his serious symptoms. Allen mentions recovery after an extensive
incised wound of the abdomen, liver, and lung. Massie cites an instance
of gunshot wound of the right hypochondrium, with penetration and
protrusion of the liver. The patient, a boy of seven, recovered after
excision of a small part of the protruding liver. Lawson Tait has
incised the liver to the extent of three inches, evacuated two gallons
of hydatids, and obtained successful recovery in ten weeks.

There are several cases of wound of the liver followed by recovery
reported by surgeons of the United States Army.  Whitehead mentions a
man of twenty-two who on June 3, 1867, was shot in the liver by a slug
from a pistol. At the time of the injury he bled freely from the wound
of entrance continuing to lose blood and bile until daylight the next
morning, when the hemorrhage ceased, but the flow of bile kept on. By
June 10th there was considerable improvement, but the wound discharged
blood-clots, bile, and serum. When the patient left the hospital on
July 15th the wound was healthy, discharging less than 1 1/2 ounces
during the twenty-four hours, of a mixture of free bile, and bile mixed
with thick material. When last heard from--July 27, 1867--the patient
was improving finely in flesh and strength.  McKee mentions a
commissary-sergeant stationed at Santa Fe, New Mexico, who recovered
after a gunshot wound of the liver. Hassig reports the case of a
private of twenty-six who was wounded in a fray near Paducah, Kentucky,
by a conoid ball, which passed through the liver. The ball was cut out
the same day. The patient recovered and was returned to duty in May,
1868. Patzki mentioned a private in the Sixth Cavalry, aged
twenty-five, who recovered from a gunshot wound of the abdomen,
penetrating the right lobe of the liver and the gall-bladder.

Resection of the Liver.--It is remarkable to what extent portions of
the liver may be resected by the knife, cautery, or ligature, and the
patient recover. Langenbuch records a case in which he successfully
removed the greater portion of the left lobe of a woman of thirty. The
lobe had been extensively deformed by tight lacing, and caused serious
inconvenience. There was considerable hemorrhage, but the vessels were
secured, and the woman made a good recovery. McWhinnie, in The Lancet,
records a case of dislodgment of an enlarged liver from tight lacing.
Terrilon mentions an instance in which a portion of the liver was
removed by ligature after celiotomy. The ligature was removed in seven
days, and the sphacelated portion of the liver came off with it.  A
cicatrix was completed at the end of six weeks, and the patient, a
woman of fifty-three, made an excellent recovery.  Bastianelli
discusses those cases in which portions of the liver, having been
constricted from the general body of the organ and remaining attached
by a pedicle, give rise to movable tumors of the abdomen. He records
such a case in a woman of thirty-seven who had five children. A piece
of liver weighing 500 grams was removed, and with it the gall-bladder,
and the patient made an uninterrupted recovery. Tricomi reports a case
in which it was found necessary to remove the left lobe of the liver.
An attempt had been made to remove a liver-tumor the size of a fist by
constricting the base with an elastic ligature. This attempt was a
failure, and cure was also unsuccessfully attempted by wire ligature
and the thermocautery. The growth was cut away, bleeding was arrested
by the thermocautery and by iron-solution, the wound entirely healed,
and the patient recovered. Valerian von Meister has proved that the
liver has marvelous powers of regeneration, and that in rabbits, cats,
and dogs, even three-fourths of the organ may be reproduced in from
forty-five to sixty-five days.  This regeneration is brought about
chiefly by hypertrophy of the lobules.

Floating liver is a rare malady in which the liver forms an abdominal
prominence that may be moved about, and which changes its situation as
the patient shifts the attitude. The condition usually arises from a
lax abdominal wall following repeated pregnancies. The accompanying
illustration exhibits a typical case verified by postmortem examination.

Hypertrophy of the Liver.--The average weight of the normal liver is
from 50 to 55 ounces, but as noted by Powell, it may become so
hypertrophic as to weigh as much as 40 pounds. Bonet describes a liver
weighing 18 pounds; and in his "Medical and Surgical Observations,"
Gooch speaks of a liver weighing 28 pounds.  Vieussens, the celebrated
anatomist, reports an instance in which the liver weighed 20 pounds,
and in his "Aphorisms," Vetter cites a similar instance. In 1811 Kraus
of Germany describes a liver weighing 25 pounds; modern instances of
enlarged liver are too numerous to be quoted here.

Rupture of the gall-bladder, although generally followed by death, is
not always fatal. In such cases bile is usually found in the abdominal
cavity. Fergus mentions a case in which, after this accident, the
patient was considered convalescent and was walking about, when, on the
seventh day, peritonitis suddenly developed and proved fatal in two
days. Several cases of this accident have been reported as treated
successfully by incision and drainage (Lane) or by inspiration (Bell).
In these cases large quantities of bile escaped into the abdominal
cavity.  Peritonitis does not necessarily follow. Cholecystotomy for
the relief of the distention of the gall-bladder from obstruction of
the common or cystic duct and for the removal of gall-stones was first
performed in 1867 by Bobbs of Indianapolis, but it is to Marion Sims,
in 1878, that perfection of the operation is due. It has been gradually
improved and developed, until today it is a most successful operation.
Tait reports 54 cases with 52 perfect recoveries. Cholyecystectomy, or
excision of the gall-bladder, was first practiced in 1880 by Langenbuch
of Berlin, and is used in cases in which gall-stones are repeatedly
forming. Ashhurst's statistics show only four deaths in 28 cases.

At St. Bartholomew's Hospital, in London, is a preserved specimen of a
gall-bladder which had formed the contents of a hernial sac, and which,
near the fundus, shows a constriction caused by the femoral ring. It
was taken from a woman of forty-five who was admitted into the hospital
with a strangulated femoral hernia.  The sac was opened and its
contents were returned. The woman died in a few days from peritonitis.
The gall-bladder was found close to the femoral ring, and showed a
marked constriction. The liver was misshapen from tight lacing,
elongated and drawn downward toward the ring. There was no evidence
that any portion of intestine or other structure besides the
gall-bladder had passed through the ring.

The fatality of rupture of the spleen is quite high. Out of 83 cases of
injury to this organ collected by Elder, and quoted by MacCormac, only
11 recovered; but the mortality is less in punctured or incised wounds
of this organ, the same authorities mentioning 29 recoveries out of 35
cases. In his "Surgery" Gooch says that at the battle of Dettingen one
of Sir Robert Rich's Dragoons was left all night on the field,
weltering in his blood, his spleen hanging out of his body in a
gangrenous state. The next morning he was carried to the surgeons who
ligated the large vessels, and extirpated the spleen; the man recovered
and was soon able to do duty. In the Philosophical Transactions there
is a report of a man who was wounded in the spleen by a large
hunting-knife. Fergusson found the spleen hanging from the wound and
ligated it. It separated in ten days and the patient recovered.

Williams reports a stab-wound of the spleen in a negro of twenty-one.
The spleen protruded, and the protruding part was ligated by a silver
wire, one-half of the organ sloughing off; the patient recovered. Sir
Astley Cooper mentions a curious case, in which, after vomiting, during
which the spleen was torn from its attachments, this organ produced a
swelling in the groin which was supposed to be a hernia. The vomiting
continued, and at the end of a week the woman died; it was then found
that the spleen had been turned half round on its axis, and detached
from the diaphragm; it had become enlarged; the twist interrupted the
return of the blood. Portal speaks of a rupture of the spleen simply
from engorgement. There was no history of a fall, contusion, or other
injury. Tait describes a case of rupture of the spleen in a woman who,
in attempting to avoid her husband's kick, fell on the edge of the
table. There were no signs of external violence, but she died the third
day afterward. The abdomen was found full of blood, and the spleen and
peritoneal covering was ruptured for three inches.

Splenectomy, excision of the spleen, has been performed a number of
times, with varying results, but is more successful when performed for
injury than when for disease. Ashhurst has tabulated a total of 109
operations, 27 having been for traumatic causes, and all but five
having terminated successfully; of 82 operations for disease, only 32
recovered. Vulpius has collected 117 cases of splenectomy, with a
death-rate of 50 per cent. If, however, from these cases we deduct
those suffering with leukocythemia and lardaceous spleen, in which the
operation should not be performed, the mortality in the remaining 85
cases is reduced to 33 per cent. Terrier speaks of splenectomy for
torsion or twisting of the pedicle, and such is mentioned by Sir Astley
Cooper, who has found records of only four such cases.  Conklin reports
a successful case of splenectomy for malarial spleen, and in reviewing
the subject he says that the records of the past decade in operations
for simple hypertrophy, including malaria, show 20 recoveries and eight
deaths. He also adds that extirpation in cases of floating or displaced
spleen was attended with brilliant results. Zuccarelli is accredited
with reporting two cases of splenectomy for malarial spleen, both of
which recovered early. He gives a table of splenectomies performed in
Italy, in which there were nine cases of movable spleen, with two
deaths; eight cases of simple hypertrophy, with three deaths; 12 cases
of malarial spleen, with three deaths; four cases of leukemia and
pseudoleukemia, with two deaths. In his experiments on rabbits it was
proved by Tizzoni, and in his experiments on dogs, by Crede, that an
individual could live without a spleen; but these observations were
only confirmatory of what had long been known, for, in 1867, Pean
successfully removed a spleen from a woman of twenty. Tricomi reports
eight cases in which he had extirpated the spleen for various morbid
conditions, with a fortunate issue in all but one. In one case he
ligated the splenic artery. In The Lancet there is an account of three
recent excisions of the spleen for injury at St. Thomas Hospital in
London, and it is added that they are among the first of this kind in
Great Britain.

Abnormalities of Size of the Spleen.--The spleen may be extremely
small. Storck mentions a spleen that barely weighed an ounce; Schenck
speaks of one in the last century that weighed as much as 20 pounds.
Frank describes a spleen that weighed 16 pounds; there is another
record of one weighing 15 pounds. Elliot mentions a spleen weighing 11
pounds; Burrows one, 11 pounds; Blasius, four pounds; Osiander, nine
pounds; Blanchard, 31 pounds; Richardson, 3 1/2 pounds; and Hare, 93
ounces.

The thoracic duct, although so much protected by its anatomical
position, under exceptional circumstances has been ruptured or wounded.
Kirchner has collected 17 cases of this nature, two of which were due
to contusions of the chest, one each to a puncture, a cut, and a
shot-wound, and three to erosion from suppuration. In the remaining
cases the account fails to assign a definite cause. Chylothorax, or
chylous ascites, is generally a result of this injury. Krabbel mentions
a patient who was run over by an empty coal car, and who died on the
fifth day from suffocation due to an effusion into the right pleural
cavity. On postmortem examination it was found that the effusion was
chyle, the thoracic duct being torn just opposite the 9th dorsal
vertebra, which had been transversely fractured. In one of Kirchner's
cases a girl of nine had been violently pushed against a window-sill,
striking the front of her chest in front of the 3d rib. She suffered
from pleural effusion, which, on aspiration, proved to be chyle. She
ultimately recovered her health. In 1891 Eyer reported a case of
rupture of the thoracic duct, causing death on the thirty-eighth day.
The young man had been caught between a railroad car and an engine, and
no bones were broken.

Manley reports a case of rupture of the thoracic duct in a man of
thirty-five, who was struck by the pole of a brewery wagon; he was
knocked down on his back, the wheel passing squarely over his abdomen.
There was subsequent bulging low down in the right iliac fossa, caused
by the presence of a fluid, which chemic and microscopic examination
proved was chyle. From five to eight ounces a day of this fluid were
discharged, until the tenth day, when the bulging was opened and
drained. On the fifteenth day the wound was healed and the man left the
hospital quite restored to health.

Keen has reported four instances of accidental injury to the thoracic
duct, near its termination at the base of the left side of the neck;
the wounding was in the course of removals for deep-seated growths in
this region. Three of the cases recovered, having sustained no
detriment from the injury to the thoracic duct. One died; but the fatal
influence was not specially connected with the wound of the duct.

Possibly the boldest operation in the history of surgery is that for
ligation of the abdominal aorta for inguinal aneurysm. It was first
practiced by Sir Astley Cooper in 1817, and has since been performed
several times with a uniformly fatal result, although Monteiro's
patient survived until the tenth day, and there is a record in which
ligature of the abdominal aorta did not cause death until the eleventh
day. Loreta of Bologna is accredited with operating on December 18,
1885, for the relief of a sailor who was suffering from an abdominal
aneurysm caused by a blow. An incision was made from the ensiform
cartilage to the umbilicus, the aneurysm exposed, and its cavity filled
up with two meters of silver-plated wire. Twenty days after no evidence
of pulsation remained in the sac, and three months later the sailor was
well and able to resume his duties.

Ligation of the common iliac artery, which, in a case of gunshot
injury, was first practiced by Gibson of Philadelphia in 1812, is,
happily, not always fatal. Of 82 cases collected by Ashhurst, 23
terminated successfully.

Foreign bodies loose in the abdominal cavity are sometimes voided at
stool, or may suppurate externally. Fabricius Hildanus gives us a
history of a person wounded with a sword-thrust into the abdomen, the
point breaking off. The sword remained one year in the belly and was
voided at stool. Erichsen mentions an instance in which a cedar
lead-pencil stayed for eight months in the abdominal cavity. Desgranges
gives a case of a fish-spine in the abdominal cavity, and ten years
afterward it ulcerated through an abscess in the abdominal wall.
Keetley speaks of a man who was shot when a boy; at the time of the
accident the boy had a small spelling-book in his pocket. It was not
until adult life that from an abscess of the groin was expelled what
remained of the spelling-book that had been driven into the abdomen
during boyhood. Kyle speaks of the removal of a corn-straw 33 inches in
length by an incision ten inches long, at a point about equidistant
from the umbilicus to the anterior spinous process of the right ilium.

There are several instances on record of tolerance of foreign bodies in
the skin and muscles of the back for an extended period. Gay speaks of
a curious case in which the point of a sheath-knife remained in the
back of an individual for nine years. Bush reported to Sir Astley
Cooper the history of a man who, as he supposed, received a wound in
the back by canister shot while serving on a Tartar privateer in 1779.
There was no ship-surgeon on board, and in about a month the wound
healed without surgical assistance. The man suffered little
inconvenience and performed his duties as a seaman, and was impressed
into the Royal Navy. In August, 1810, he complained of pain in the
lumbar region. He was submitted to an examination, and a cicatrix of
this region was noticed, and an extraneous body about 1/2 inch under
the integument was felt. An incision was made down it, and a rusty
blade of a seaman's clasp-knife extracted from near the 3d lumbar
vertebra. The man had carried this knife for thirty years. The wound
healed in a few days and there was no more inconvenience.

Fracture of the lower part of the spine is not always fatal, and
notwithstanding the lay-idea that a broken back means certain death,
patients with well-authenticated cases of vertebral fracture have
recovered. Warren records the case of a woman of sixty who, while
carrying a clothes-basket, made a misstep and fell 14 feet, the basket
of wet clothes striking the right shoulder, chest, and neck. There was
fracture of the 4th dorsal vertebra at the transverse processes. By
seizing the spinous process it could be bent backward and forward, with
the peculiar crepitus of fractured bone. The clavicle was fractured two
inches from the acromial end, and the sternal end was driven high up
into the muscles of the neck. The arm and hand were paralyzed, and the
woman suffered great dyspnea. There was at first a grave emphysematous
condition due to the laceration of several broken ribs. There was also
suffusion and ecchymosis about the neck and shoulder. Although
complicated with tertiary syphilis, the woman made a fair recovery, and
eight weeks later she walked into a doctor's office. Many similar and
equally wonderful injuries to the spine are on record.

The results sometimes following the operation of laminectomy for
fracture of the vertebrae are often marvelous. One of the most
successful on record is that reported by Dundore. The patient was a
single man who lived in Mahanoy, Pa., and was admitted to the State
Hospital for Injured Persons, Ashland, Pa., June 17, 1889, suffering
from a partial dislocation of the 9th dorsal vertebra.  The report is
as follows--"He had been a laborer in the mines, and while working was
injured March 18, 1889, by a fall of top rock, and from this date to
that of his admission had been under the care of a local physician
without any sign of improvement. At the time of his admission he
weighed but 98 pounds, his weight previous to the injury being 145. He
exhibited entire loss of motion in the lower extremities, with the
exception of very slight movement in the toes of the left foot;
sensation was almost nil up to the hips, above which it was normal; he
had complete retention of urine, with a severe cystitis. His tongue was
heavily coated, the bowels constipated, and there was marked anorexia,
with considerable anemia. His temperature varied from 99 degrees to 100
degrees in the morning, and from 101 degrees to 103 degrees in the
evening. The time which had elapsed since the accident precluded any
attempt at reduction, and his anemic condition would not warrant a more
radical method.

"He was put on light, nourishing diet, iron and strychnin were given
internally, and electricity was applied to the lower extremities every
other day; the cystitis was treated by irrigating the bladder each day
with Thiersch's solution. By August his appetite and general condition
were much improved, and his weight had increased to 125 pounds, his
temperature being 99 degrees or less each morning, and seldom as high
as 100 degrees at night. The cystitis had entirely disappeared, and he
was able, with some effort, to pass his urine without the aid of a
catheter. Sensation in both extremities had slightly improved, and he
was able to slightly move the toes of the right foot. This being his
condition, an operation was proposed as the only means of further and
permanent improvement, and to this he eagerly consented, and,
accordingly, on the 25th of August, the 9th dorsal vertebra was
trephined.

"The cord was found to be compressed and greatly congested, but there
was no evidence of laceration. The laminae and spinous processes of the
8th and 9th dorsal vertebrae were cut away, thus relieving all pressure
on the cord; the wound was drained and sutured, and a plaster-of-Paris
jacket applied, a hole being cut out over the wound for the purpose of
changing the dressing when necessary. By September 1st union was
perfect, and for the next month the patient remained in excellent
condition, but without any sign of improvement as to sensation and
motion. Early in October he was able to slightly move both legs, and
had full control of urination; from this time on his paralysis rapidly
improved; the battery was applied daily, with massage morning and
evening; and in November the plaster-of-Paris jacket was removed, and
he propelled himself about the ward in a rolling chair, and shortly
after was able to get about slowly on crutches. He was discharged
December 23d, and when I saw him six months later he walked very well
and without effort; he carried a cane, but this seemed more from habit
than from necessity. At present date he weighs 150 pounds, and drives a
huckster wagon for a living, showing very little loss of motion in his
lower extremities."

Although few cases show such wonderful improvement as this one,
statistics prove that the results of this operation are sometimes most
advantageous. Thorburn collects statistics of 50 operations from 1814
to 1885, undertaken for relief of injuries of the spinal cord. Lloyd
has compiled what is possibly the most extensive collection of cases of
spinal surgery, his cases including operations for both disease and
injury. White has collected 37 cases of recent date; and Chipault
reports two cases, and collected 33 cases. Quite a tribute to the
modern treatment by antisepsis is shown in the results of laminectomy.
Of his non-antiseptic cases Lloyd reports a mortality of 65 per cent;
those surviving the operation are distributed as follows: Cured, one;
partially cured, seven; unknown, two; no improvement, five. Of those
cases operated upon under modern antiseptic principles, the mortality
was 50 per cent; those surviving were distributed as follows: Cured,
four; partially cured, 15; no improvement, 11. The mortality in White's
cases, which were all done under antiseptic precautions, was 38 per
cent. Of those surviving, there were six complete recoveries, six with
benefit, and 11 without marked benefit. Pyle collects 52 cases of
spinal disease and injury, in which laminectomy was performed. All the
cases were operated upon since 1890. Of the 52 cases there were 15
deaths (a mortality of 29.4 per cent), 26 recoveries with benefit, and
five recoveries in which the ultimate result has not been observed. It
must be mentioned that several of the fatal cases reported were those
of cervical fracture, which is by far the most fatal variety.

Injury to the spinal cord does not necessarily cause immediate death.
Mills and O'Hara, both of Philadelphia, have recorded instances of
recovery after penetrating wound of the spinal marrow. Eve reports
three cases of gunshot wound in which the balls lodged in the vertebral
canal, two of the patients recovering. He adds some remarks on the
division of the spinal cord without immediate death.

Ford mentions a gunshot wound of the spinal cord, the patient living
ten days; after death the ball was found in the ascending aorta. Henley
speaks of a mulatto of twenty-four who was stabbed in the back with a
knife. The blade entered the body of the 6th dorsal vertebra, and was
so firmly embedded that the patient could be raised entirely clear of
the bed by the knife alone. An ultimate recovery ensued.

Although the word hernia can be construed to mean the protrusion of any
viscus from its natural cavity through normal or artificial openings in
the surrounding structures, the usual meaning of the word is protrusion
of the abdominal contents through the parietes--what is commonly spoken
of as rupture.  Hernia may be congenital or acquired, or may be single
or multiple--as many as five having been seen in one individual.  More
than two-thirds of cases of rupture suffer from inguinal hernia In the
oblique form of inguinal hernia the abdominal contents descend along
the inguinal canal to the outer side of the epigastric artery, and
enter the scrotum in the male, and the labium majus in the female. In
this form of hernia the size of the sac is sometimes enormous, the
accompanying illustration showing extreme cases of both scrotal and
labial hernia.  Umbilical hernia may be classed under three heads:
congenital, infantile, and adult. Congenital umbilical hernia occurs
most frequently in children, and is brought about by the failure of the
abdominal walls to close. When of large size it may contain not only
the intestines, but various other organs, such as the spleen, liver,
etc. In some monsters all the abdominal contents are contained in the
hernia. Infantile umbilical hernia is common, and appears after the
separation of the umbilical cord; it is caused by the yielding of the
cicatrix in this situation.  It never reaches a large size, and shows a
tendency to spontaneous cure. Adult umbilical hernia rarely commences
in infancy. It is most commonly seen in persons with pendulous bellies,
and is sometimes of enormous size, in addition to the ordinary
abdominal contents, containing even the stomach and uterus. A few years
since there was a man in Philadelphia past middle age, the victim of
adult umbilical hernia so pendulous that while walking he had to
support it with his arms and hands.  It was said that this hernia did
not enlarge until after his service as a soldier in the late war.

Abbott recites the case of an Irish woman of thirty-five who applied to
know if she was pregnant. No history of a hernia could be elicited. No
pregnancy existed, but there was found a ventral hernia of the
abdominal viscera through an opening which extended the entire length
of the linea alba, and which was four inches wide in the middle of the
abdomen.

Pim saw a colored woman of twenty-four who, on December 29, 1858, was
delivered normally of her first child, and who died in bed at 3 A.M. on
February 12, 1859. The postmortem showed a tumor from the ensiform
cartilage to the symphysis pubis, which contained the omentum, liver
(left lobe), small intestines, and colon. It rested upon the abdominal
muscles of the right side. The pelvic viscera were normally placed and
there was no inguinal nor femoral hernia.

Hulke reports a case remarkable for the immense size of the rupture
which protruded from a spot weakened by a former abscess.  There was a
partial absence of the peritoneal sac, and the obstruction readily
yielded to a clyster and laxative. The rupture had a transverse
diameter of 14 1/2 inches, with a vertical diameter of 11 1/2 inches.
The opening was in the abdominal walls outside of the internal inguinal
ring. The writhings of the intestines were very conspicuous through the
walls of the pouch.

Dade reports a case of prodigious umbilical hernia. The patient was a
widow of fifty-eight, a native of Ireland. Her family history was good,
and she had never borne any children. The present dimensions of the
tumor, which for fifteen years had been accompanied with pain, and had
progressively increased in size, are as follows: Circumference at the
base, 19 1/2 inches; circumference at the extremity, 11 1/4 inches;
distance of extremity from abdominal wall, 12 3/4 inches. Inspection
showed a large lobulated tumor protruding from the abdominal wall at
the umbilicus. The veins covering it were prominent and distended.  The
circulation of the skin was defective, giving it a blue appearance.
Vermicular contractions of the small intestines could be seen at the
distance of ten feet. The tumor was soft and velvety to the touch, and
could only partially be reduced.  Borborygmus could be easily heard. On
percussion the note over the bulk was tympanitic, and dull at the base.
The distal extremity contained a portion of the small intestine instead
of the colon, which Wood considered the most frequent occupant. The
umbilicus was completely obliterated. Dade believed that this hernia
was caused by the weakening of the abdominal walls from a blow, and
considered that the protrusion came from an aperture near the umbilicus
and not through it, in this manner differing from congenital umbilical
hernia.

A peculiar form of hernia is spontaneous rupture of the abdominal
walls, which, however, is very rare. There is an account of such a case
in a woman of seventy-two living in Pittsburg, who, after a spasmodic
cough, had a spontaneous rupture of the parietes. The rent was four
inches in length and extended along the linea alba, and through it
protruded a mass of omentum about the size of a child's head. It was
successfully treated and the woman recovered. Wallace reports a case of
spontaneous rupture of the abdominal wall, following a fit of coughing.
The skin was torn and a large coil of ileum protruded, uncovered by
peritoneum.  After protracted exposure of the bowel it was replaced,
the rent was closed, and the patient recovered.



CHAPTER XIII.

SURGICAL ANOMALIES OF THE GENITO-URINARY SYSTEM.

Wounds of the kidney may be very severe without causing death, and even
one entire kidney may be lost without interfering with the functions of
life. Marvand, the Surgeon-Major of an Algerian regiment, reports the
case of a young Arab woman who had been severely injured in the right
lumbar region by a weapon called a "yataghan," an instrument which has
only one cutting edge. On withdrawing this instrument the right kidney
was extruded, became strangulated between the lips of the wound, and
caused considerable hemorrhage. A ligature was put around the base of
the organ, and after some weeks the mass separated. The patient
continued in good health the whole time, and her urinary secretion was
normal. She was discharged in two months completely recovered. Price
mentions the case of a groom who was kicked over the kidney by a horse,
and eighteen months later died of dropsy.  Postmortem examination
showed traces of a line of rupture through the substance of the gland;
the preparation was deposited in St.  George's Hospital Museum in
London. The case is singular in that this man, with granular
degeneration of the kidney, recovered from so extensive a lesion, and,
moreover, that he remained in perfect health for over a year with his
kidney in a state of destructive disease. Borthwick mentions a dragoon
of thirty who was stabbed by a sword-thrust on the left side under the
short rib, the sword penetrating the pelvis and wounding the kidney.
There was no hemorrhage from the external wound, nor pain in the
spermatic cord or testicle. Under expectant treatment the man
recovered. Castellanos mentions a case of recovery from punctured wound
of the kidney by a knife that penetrated the tubular and cortical
substance, and entered the pelvis of the organ. The case was peculiar
in the absence of two symptoms, viz., the escape of urine from the
wound, and retraction of the corresponding testicle. Dusenbury reports
the case of a corporal in the army who was wounded on April 6, 1865,
the bullet entering both the liver and kidney. Though there was injury
to both these important organs, there was no impairment of the
patient's health, and he recovered.

Bryant reports four cases of wound of the kidney, with recovery.  All
of these cases were probably extraperitoneal lacerations or ruptures.
Cock found a curious anomaly in a necropsy on the body of a boy of
eighteen, who had died after a fall from some height.  There was a
compound, transverse rupture of the left kidney, which was twice as
large as usual, the ureter also being of abnormal size. Further search
showed that the right kidney was rudimentary, and had no vein or artery.

Ward mentions a case of ruptured kidney, caused by a fall of seven
feet, the man recovering after appropriate treatment.  Vernon reports a
case of serious injury to the kidney, resulting in recovery in nine
weeks. The patient fell 40 feet, landing on some rubbish and old iron,
and received a wound measuring six inches over the right iliac crest,
through which the lower end of the right kidney protruded; a piece of
the kidney was lost. The case was remarkable because of the slight
amount of hemorrhage.

Nephrorrhaphy is an operation in which a movable or floating kidney is
fixed by suture through its capsule, including a portion of
kidney-substance, and then through the adjacent lumbar fascia and
muscles. The ultimate results of this operation have been most
successful.

Nephrolithotomy is an operation for the removal of stone from the
kidney. The operation may be a very difficult one, owing to the
adhesions and thickening of all the perinephric tissues, or to the
small size or remote location of the stone.

There was a recent exhibition in London, in which were shown the
results of a number of recent operations on the kidney. There was
one-half of a kidney that had been removed on account of a
rapidly-growing sarcoma from a young man of nineteen, who had known of
the tumor for six months; there was a good recovery, and the man was
quite well in eighteen months afterward. Another specimen was a right
kidney removed at St. Bartholomew's Hospital. It was much dilated, and
only a small amount of the kidney-substance remained. A calculus
blocked the ureter at its commencement. The patient was a woman of
thirty-one, and made a good recovery. From the Middlesex Hospital was a
kidney containing a uric acid calculus which was successfully removed
from a man of thirty-five. From the Cancer Hospital at Brompton there
were two kidneys which had been removed from a man and a woman
respectively, both of whom made a good recovery. From the King's
College Hospital there was a kidney with its pelvis enlarged and
occupied by a large calculus, and containing little secreting
substance, which was removed from a man of forty-nine, who recovered.
These are only a few of the examples of this most interesting
collection. Large calculi of the kidney are mentioned in Chapter XV.

Rupture of the ureter is a very rare injury. Poland has collected the
histories of four cases, one of which ended in recovery after the
evacuation by puncture, at intervals, of about two gallons of fluid
resembling urine. The other cases terminated in death during the first,
fourth, and tenth weeks respectively.  Peritonitis was apparently not
present in any of the cases, the urinary extravasation having occurred
into the cellular tissue behind the peritoneum.

There are a few recorded cases of uncomplicated wounds of the ureters.
The only well authenticated case in which the ureter alone was divided
is the historic injury of the Archbishop of Paris, who was wounded
during the Revolution of 1848, by a ball entering the upper part of the
lumbar region close to the spine.  Unsuccessful attempts were made to
extract the ball, and as there was no urine in the bladder, but a
quantity escaping from the wound, a diagnosis of divided ureter was
made. The Archbishop died in eighteen hours, and the autopsy showed
that the ball had fractured the transverse process of the 3d lumbar
vertebra, and divided the cauda equina just below its origin; it had
then changed direction and passed up toward the left kidney, dividing
the ureter near the pelvis, and finally lodged in the psoas muscle.

It occasionally happens that the ureter is wounded in the removal of
uterine, ovarian, or other abdominal tumors. In such event, if it is
impossible to transplant to the bladder, the divided or torn end should
be brought to the surface of the loin or vagina, and sutured there. In
cases of malignant growth, the ureter has been purposely divided and
transplanted into the bladder.  Penrose, assisted by Baldy, has
performed this operation after excision of an inch of the left ureter
for carcinomatous involvement. The distal end of the ureter was
ligated, and the proximal end implanted in the bladder according to Van
Hook's method, which consists in tying the lowered end of the ureter,
then making a slit into it, and invaginating the upper end into the
lower through this slit. A perfect cure followed. Similar cases have
been reported by Kelly, Krug, and Bache Emmet. Reed reports a most
interesting series in which he has successfully transplanted ureters
into the rectum.

Ureterovaginal fistulae following total extirpation of the uterus,
opening of pelvic abscesses, or ulcerations from foreign bodies, are
repaired by an operation termed by Bazy of Paris ureterocystoneostomy,
and suggested by him as a substitute for nephrectomy in those cases in
which the renal organs are unaffected. In the repair of such a case
after a vaginal hysterectomy Mayo reports a successful reimplantation
of the ureter into the bladder.

Stricture of the ureter is also a very rare occurrence except as a
result of compression of abdominal or pelvic new growths.  Watson has,
however, reported two cases of stricture, in both of which a ureter was
nearly or quite obliterated by a dense mass of connective tissue. In
one case there was a history of the passage of a renal calculus years
previously. In both instances the condition was associated with
pyonephrosis. Watson has collected the reports of four other cases from
medical literature.

A remarkable procedure recently developed by gynecologists,
particularly by Kelly of Baltimore, is catheterization and sounding of
the ureters. McClellan records a case of penetration of the ureter by
the careless use of a catheter.

Injuries of the Bladder.--Rupture of the bladder may result from
violence without any external wound (such as a fall or kick) applied to
the abdomen. Jones reports a fatal case of rupture of the bladder by a
horse falling on its rider. In this case there was but little
extravasation of urine, as the vesical aperture was closed by omentum
and bowel. Assmuth reports two cases of rupture of the bladder from
muscular action. Morris cites the history of a case in which the
bladder was twice ruptured: the first time by an injury, and the second
time by the giving way of the cicatrix. The patient was a man of
thirty-six who received a blow in the abdomen during a fight in a
public house on June 6, 1879. At the hospital his condition was
diagnosed and treated expectantly, but he recovered perfectly and left
the hospital July 10, 1879. He was readmitted on August 4, 1886, over
seven years later, with symptoms of rupture of the bladder, and died on
the 6th. The postmortem showed a cicatrix of the bladder which had
given way and caused the patient's death.

Rupture of the bladder is only likely to happen when the organ is
distended, as when empty it sinks behind the pubic arch and is thus
protected from external injury. The rupture usually occurs on the
posterior wall, involving the peritoneal coat and allowing
extravasation of urine into the peritoneal cavity, a condition that is
almost inevitably fatal unless an operation is performed.  Bartels
collected the data of 98 such cases, only four recovering. When the
rent is confined to the anterior wall of the bladder the urine escapes
into the pelvic tissues, and the prognosis is much more favorable.
Bartels collected 54 such cases, 12 terminating favorably. When
celiotomy is performed for ruptured bladder, in a manner suggested by
the elder Gross, the mortality is much less. Ashhurst collected the
reports of 28 cases thus treated, ten of which recovered--a mortality
of 64.2 per cent. Ashhurst remarks that he has seen an extraperitoneal
rupture of the anterior wall of the bladder caused by improper use of
instruments, in the case of retention of urine due to the presence of a
tight urethral stricture.

There are a few cases on record in which the bladder has been ruptured
by distention from the accumulation of urine, but the accident is a
rare one, the urethra generally giving way first.  Coats reports two
cases of uncomplicated rupture of the bladder.  In neither case was a
history of injury obtainable. The first patient was a maniac; the
second had been intoxicated previous to his admission to the hospital,
with symptoms of acute peritonitis. The diagnosis was not made. The
first patient died in five days and the second in two days after the
onset of the illness. At the autopsies the rent was found to be in both
instances in the posterior wall of the bladder a short distance from
the fundus; the peritoneum was not inflamed, and there was absolutely
no inflammatory reaction in the vesical wound. From the statistics of
Ferraton and Rivington it seems that rupture of the bladder is more
common in intoxicated persons than in others--a fact that is probably
explained by a tendency to over-distention of the bladder which
alcoholic liquors bring about. The liquor imbibed increases the amount
of urine, and the state of blunted consciousness makes the call to
empty the bladder less appreciated. The intoxicated person is also
liable to falls, and is not so likely to protect himself in falling as
a sober person.

Gunshot Wounds of the Bladder.--Jackson relates the remarkable recovery
of a private in the 17th Tennessee Regiment who was shot in the pelvis
at the battle of Mill Springs or Fishing Creek, Ky.  He was left
supposedly mortally wounded on the field, but was eventually picked up,
and before receiving any treatment hauled 164 miles, over mountainous
roads in the midst of winter and in a wagon without springs. His urine
and excretions passed out through the wounds for several weeks and
several pieces of bone came away. The two openings eventually healed,
but for twenty-two months he passed pieces of bone by the natural
channels.

Eve records the case of a private in the Fifth Tennessee Cavalry who
was shot in the right gluteal region, the bullet penetrating the
bladder and making its exit through the pubis. He rode 30 miles, during
which the urine passed through the wound. Urine was afterward voided
through the left pubic opening, and spicules of bone were discharged
for two years afterward; ultimate recovery ensued.

Barkesdale relates the history of the case of a Confederate soldier who
was shot at Fredericksburg in the median line of the body, 1 1/2 inches
above the symphysis, the wound of exit being in the median line at the
back, 1/2 inch lower down. Urine escaped from both wounds and through
the urethra. There were no bad symptoms, and the wounds healed in four
weeks.

The bladder is not always injured by penetration of the abdominal wall,
but may be wounded by penetration through the anus or vagina, or even
by an instrument entering the buttocks and passing through the smaller
sacrosciatic notch. Camper records the case of a sailor who fell from a
mast and struck upon some fragments of wood, one of which entered the
anus and penetrated the bladder, the result being a rectovesical
fistula. About a year later the man consulted Camper, who
unsuccessfully attempted to extract the piece of wood; but by incising
the fistula it was found that two calculi had formed about the wooden
pieces, and when these were extracted the patient recovered. Perrin
gives the history of a man of forty who, while adjusting curtains, fell
and struck an overturned chair; one of the chair-legs penetrated the
anus. Its extraction was followed by a gush of urine, and for several
days the man suffered from incontinence of urine and feces. By the
tenth day he was passing urine from the urethra, and on the
twenty-fifth day there was a complete cicatrix of the parts; fifteen
days later he suffered from an attack of retention of urine lasting
five days; this was completely relieved after the expulsion of a small
piece of trouser-cloth which had been pushed into the bladder at the
time of the accident. Post reports the case of a young man who, in
jumping over a broomstick, was impaled upon it, the stick entering the
anus without causing any external wound, and penetrating the bladder,
thus allowing the escape of urine through the anus. A peculiar sequela
was that the man suffered from a calculus, the nucleus of which was a
piece of the seat of his pantaloons which the stick had carried in.

Couper reports a fatal case of stab-wound of the buttocks, in which the
knife passed through the lesser sacrosciatic notch and entered the
bladder close to the trigone. The patient was a man of twenty-three, a
seaman, and in a quarrel had been stabbed in the buttocks with a long
sailor's knife, with resultant symptoms of peritonitis which proved
fatal. At the autopsy it was found that the knife had passed through
the gluteal muscles and divided part of the great sacrosciatic
ligament. It then passed through the small sacrosciatic notch,
completely dividing the pudic artery and nerve, and one vein, each end
being closed by a clot.  The knife entered the bladder close to the
trigone, making an opening large enough to admit the index finger.
There were well-marked evidences of peritonitis and cellulitis.

Old-time surgeons had considerable difficulty in extracting arrow-heads
from persons who had received their injuries while on horseback. Conrad
Gesner records an ingenious device of an old surgeon who succeeded in
extracting an arrow which had resisted all previous attempts, by
placing the subject in the very position in which he was at the time of
reception of the wound.  The following noteworthy case shows that the
bladder may be penetrated by an arrow or bullet entering the buttocks
of a person on horseback. Forwood describes the removal of a vesical
calculus, the nucleus of which was an iron arrow-head, as follows:
"Sitimore, a wild Indian, Chief of the Kiowas, aged forty-two, applied
to me at Fort Sill, Indian Territory, August, 1869, with symptoms of
stone in the bladder. The following history was elicited: In the fall
of 1862 he led a band of Kiowas against the Pawnee Indians, and was
wounded in a fight near Fort Larned, Kansas. Being mounted and leaning
over his horse, a Pawnee, on foot and within a few paces, drove an
arrow deep into his right buttock. The stick was withdrawn by his
companions, but the iron point remained in his body. He passed bloody
urine immediately after the injury, but the wound soon healed, and in a
few weeks he was able to hunt the buffalo without inconvenience.  For
more than six years he continued at the head of his band, and traveled
on horseback, from camp to camp, over hundreds of miles every summer. A
long time after the injury he began to feel distress in micturating,
which steadily increased until he was forced to reveal this sacred
secret (as it is regarded by these Indians), and to apply for medical
aid. His urine had often stopped for hours, at which times he had
learned to obtain relief by elevating his hips, or lying in different
positions. The urine was loaded with blood and mucus and with a few pus
globules, and the introduction of a sound indicated a large, hard
calculus in the bladder. The Indians advised me approximately of the
depth to which the shaft had penetrated and the direction it took, and
judging from the situation of the cicatrix and all the circumstances it
was apparent that the arrow-head had passed through the glutei muscles
and the obturator foremen and entered the cavity of the bladder, where
it remained and formed the nucleus of a stone. Stone in the bladder is
extremely rare among the wild Indians, owing, no doubt, to their almost
exclusive meat diet and the very healthy condition of their digestive
organs, and this fact, in connection with the age of the patient and
the unobstructed condition of his urethra, went very far to sustain
this conclusion. On August 23d I removed the stone without difficulty
by the lateral operation through the perineum. The lobe of the prostate
was enlarged, which seemed to favor the extent of the incision beyond
what would otherwise have been safe. The perineum was deep and the
tuberosities of the ischii unnaturally approximated. The calculus of
the mixed ammoniaco-magnesian variety was egg-shaped, and weighed 19
drams.  The arrow-point was completely covered and imbedded near the
center of the stone. It was of iron, and had been originally about 2
1/2 inches long, by 7/8 inch at its widest part, somewhat reduced at
the point and edges by oxidation. The removal of the stone was
facilitated by the use of two pairs of forceps,--one with broad blades,
by which I succeeded in bringing the small end of the stone to the
opening in the prostate, while the other, long and narrow, seized and
held it until the former was withdrawn. In this way the forceps did not
occupy a part of the opening while the large end of the stone was
passing through it.  The capacity of the bladder was reduced, and its
inner walls were in a state of chronic inflammation. The patient
quickly recovered from the effects of the chloroform and felt great
relief, both in body and mind, after the operation, and up to the
eighth day did not present a single unfavorable symptom. The urine
began to pass by the natural channel by the third day, and continued
more or less until, on the seventh day, it had nearly ceased to flow at
the wound. But the restless spirit of the patient's friends could no
longer be restrained. Open hostility with the whites was expected to
begin at every moment, and they insisted on his removal. He needed
purgative medicine on the eighth day, which they refused to allow him
to take. They assumed entire charge of the case, and the following day
started with him to their camps 60 miles away. Nineteen days after he
is reported to have died; but his immediate relatives have since
assured me that his wound was well and that no trouble arose from it.
They described his symptoms as those of bilious remittent fever, a
severe epidemic of which was prevailing at the time, and from which
several white men and many Indians died in that vicinity." The calculus
was deposited in the Army Medical Museum at Washington, and is
represented in the accompanying photograph, showing a cross-section of
the calculus with the arrow-head in situ.

As quoted by Chelius, both Hennen and Cline relate cases in which men
have been shot through the skirts of the jacket, the ball penetrating
the abdomen above the tuberosity of the ischium, and entering the
bladder, and the men have afterward urinated pieces of clothing,
threads, etc., taken in by the ball. In similar cases the bullet itself
may remain in the bladder and cause the formation of a calculus about
itself as a nucleus, as in three cases mentioned by McGuire of
Richmond, or the remnants of cloth or spicules of bone may give rise to
similar formation. McGuire mentions the case of a man of twenty-three
who was wounded at the Battle of McDowell, May 8, 1862. The ball struck
him on the horizontal ramus of the left pubic bone, about an inch from
the symphysis, passed through the bladder and rectum, and came out just
below the right sacrosciatic notch, near the sacrum. The day after the
battle the man was sent to the general hospital at Staunton, Va., where
he remained under treatment for four months.  During the first month
urine passed freely through the wounds made by the entrance and exit of
the ball, and was generally mixed with pus and blood. Fecal matter was
frequently discharged through the posterior wound. Some time during the
third week he passed several small pieces of bone by the rectum. At the
end of the fifth week the wound of exit healed, and for the first time
after his injury urine was discharged through the urethra. The wound of
entrance gradually closed after five months, but opened again in a few
weeks and continued, at varying intervals, alternately closed and open
until September, 1865. At this time, on sounding the man, it was found
that he had stone; this was removed by lateral operation, and was found
to weigh 2 1/4 ounces, having for its nucleus a piece of bone about 1/2
inch long. Dougherty reports the operation of lithotomy, in which the
calculus removed was formed by incrustations about an iron bullet.

In cases in which there is a fistula of the bladder the subject may
live for some time, in some cases passing excrement through the
urethra, in others, urine by the anus. These cases seem to have been of
particular interest to the older writers, and we find the literature of
the last century full of examples.  Benivenius, Borellus, the
Ephemerides, Tulpius, Zacutus Lusitanus, and others speak of excrement
passing through the penis; and there are many cases of vaginal anus
recorded. Langlet cites an instance in which the intestine terminated
in the bladder. Arand mentions recovery after atresia of the anus with
passage of excrement from the vulva. Bartholinus, the Ephemerides,
Fothergill, de la Croix, Riedlin, Weber, and Zacutus Lusitanus mention
instances in which gas was passed by the penis and urethra. Camper
records such a case from ulcer of the neighboring or connecting
intestine; Frank, from cohesion and suppuration of the rectum;
Marcellus Donatus, from penetrating ulcer of the rectum; and Petit,
from communication of the rectum and bladder in which a cure was
effected by the continued use of the catheter for the evacuation of
urine.

Flatus through the vagina, vulva, and from the uterus is mentioned by
Bartholinus, the Ephemerides, Meckel, Mauriceau, Paullini, Riedlin,
Trnka, and many others in the older literature. Dickinson mentions a
Burmese male child, four years old, who had an imperforate anus and
urethra, but who passed feces and urine successfully through an opening
at the base of the glans penis. Dickinson eventually performed a
successful operation on this case. Modern literature has many similar
instances.

In the older literature it was not uncommon to find accounts of persons
passing worms from the bladder, no explanations being given to account
for their presence in this organ. Some of these cases were doubtless
instances of echinococcus, trichinae, or the result of rectovesical
fistula, but Riverius mentions an instance in which, after drinking
water containing worms, a person passed worms in the urine. In the old
Journal de physique de Rozier is an account of a man of forty-five who
enjoyed good health, but who periodically urinated small worms from the
bladder. They were described as being about 1 1/2 lines long, and
caused no inconvenience. There is also mentioned the case of a woman
who voided worms from the bladder. Tupper describes a curious case of a
woman of sixty-nine who complained of a severe, stinging pain that
completely overcame her after micturition. An ulceration of the neck of
the bladder was suspected, and the usual remedies were applied, but
without effect. An examination of the urine was negative. On
recommendation of her friends the patient, before going to bed, steeped
and drank a decoction of knot-grass. During the night she urinated
freely, and claimed that she had passed a worm about ten inches long
and of the size of a knitting-needle.  It exhibited motions like those
of a snake, and was quite lively, living five or six days in water. The
case seems quite unaccountable, but there is, of course, a possibility
that the animal had already been in the chamber, or that it was passed
by the bowel. A rectovaginal or vesical fistula could account for the
presence of this worm had it been voided from the bowel; nevertheless
the woman adhered to her statement that she had urinated the worm, and,
as confirmatory evidence, never complained of pain after passing the
animal.

Foreign bodies in the bladder, other than calculi (which will be spoken
of in Chapter XV), generally gain entrance through one of the natural
passages, as a rule being introduced, either in curiosity or for
perverted satisfaction, through the urethra.  Morand mentions an
instance in which a long wax taper was introduced into the bladder
through the urethra by a man. At the University Hospital, Philadelphia,
White has extracted, by median cystotomy, a long wax taper which had
been used in masturbation.  The cystoscopic examination in this case
was negative, and the man's statements were disbelieved, but the
operation was performed, and the taper was found curled up and covered
by mucus and folds of the bladder. It is not uncommon for needles,
hair-pins, and the like to form nuclei for incrustations. Gross found
three caudal vertebrae of a squirrel in the center of a vesical
calculus taken from the bladder of a man of thirty-five.  It was
afterward elicited that the patient had practiced urethral masturbation
with the tail of this animal. Morand relates the history of a man of
sixty-two who introduced a sprig of wheat into his urethra for a
supposed therapeutic purpose. It slipped into the bladder and there
formed the nucleus of a cluster calculus. Dayot reports a similar
formation from the introduction of the stem of a plant. Terrilon
describes the case of a man of fifty-four who introduced a pencil into
his urethra. The body rested fifteen days in this canal, and then
passed into the bladder. On the twenty-eighth day he had a chill, and
during two days made successive attempts to break the pencil. Following
each attempt he had a violent chill and intense evening fever. On the
thirty-third day Terrilon removed the pencil by operation.  Symptoms of
perivesical abscess were present, and seventeen days after the
operation, and fifty days after the introduction of the pencil, the
patient died. Caudmont mentions a man of twenty-six who introduced a
pencil-case into his urethra, from whence it passed into his bladder.
It rested about four years in this organ before violent symptoms
developed. Perforation of the bladder took place, and the patient died.
Poulet mentions the case of a man of seventy-eight, in whose bladder a
metallic sound was broken off. The fractured piece of sound, which
measured 17 cm.  in length, made its exit from the anus, and the
patient recovered. Wheeler reports the case of a man of twenty-one who
passed a button-hook into his anus, from whence it escaped into his
bladder. The hook, which was subsequently spontaneously passed,
measured 2 1/2 inches in length and 1/2 inch in diameter.

Among females, whose urethrae are short and dilatable, foreign bodies
are often found in the bladder, and it is quite common for smaller
articles of the toilet, such as hair-pins, to be introduced into the
bladder, and there form calculi. Whiteside describes a case in which a
foreign body introduced into the bladder was mistaken for pregnancy,
and giving rise to corresponding symptoms. The patient was a young girl
of seventeen who had several times missed her menstruation, and who was
considered pregnant. The abdomen was more developed than usual in a
young woman. The breasts were voluminous, and the nipples surrounded by
a somber areola. At certain periods after the cessation of
menstruation, she had incontinence of urine, and had also repeatedly
vomited. The urine was of high specific gravity, albuminous, alkaline,
and exhaled a disagreeable odor. In spite of the signs of pregnancy
already noted, palpitation and percussion did not show any augmentation
in the size of the uterus, but the introduction of a catheter into the
bladder showed the existence of a large calculus. Under chloroform the
calculus and its nucleus were disengaged, and proved to be the handle
of a tooth-brush, the exact size of which is represented in the
accompanying illustration. The handle was covered with calcareous
deposits, and was tightly fixed in the bladder. At first the young
woman would give no explanation for its presence, but afterward
explained that she had several times used this instrument for relief in
retention of urine, and one day it had fallen into the bladder. A short
time after the operation menstruation returned for the first time in
seven months, and was afterward normal. Bigelow reports the case of a
woman who habitually introduced hair-pins and common pins into her
bladder.  She acquired this mania after an attempt at dilatation of the
urethra in the relief of an obstinate case of strangury. Rode reports
the case of a woman who had introduced a hog's penis into her urethra.
It was removed by an incision into this canal, but the patient died in
five days of septicemia. There is a curious case quoted of a young
domestic of fourteen who was first seen suffering with pain in the
sides of the genital organs, retention of urine, and violent tenesmus.
She was examined by a midwife who found nothing, but on the following
day the patient felt it necessary to go to bed. Her general symptoms
persisted, and meanwhile the bladder became much distended. The patient
had made allusion to the loss of a hair-pin, a circumstance which
corresponded with the beginning of her trouble. Examination showed the
orifice of the urethra to be swollen and painful to the touch, and from
its canal a hair-pin 6.5 cm. long was extracted. The patient was unable
to urinate, and it was necessary to resort to catheterization. By
evening the general symptoms had disappeared, and the next day the
patient urinated as usual.

There are peculiar cases of hair in the bladder, in which all history
as to the method of entrance is denied, and which leave as the only
explanation the possibility that the bladder was in communication with
some dermoid cyst. Hamelin mentions a case of this nature. It is said
that all his life Sir William Elliot was annoyed by passing hairs in
urination. They would lodge in the urethra and cause constant
irritation. At his death a stone was taken from the bladder, covered
with scurf and hair. Hall relates the case of a woman of sixty, from
whose bladder, by dilatation of the urethra, was removed a bundle of
hairs two inches long, which, Hall says, without a doubt had grown from
the vesical walls.

Retention of Foreign Bodies in the Pelvis.--It is a peculiar fact that
foreign bodies which once gain entrance to the pelvis may be tolerated
in this location for many years. Baxter describes a man who suffered an
injury from a piece of white board which entered his pelvis, and
remained in position for sixteen and a half years; at this time a piece
of wood 7 1/2 inches long was discharged at stool, and the patient
recovered. Jones speaks of a case in which splinters of wood were
retained in the neighborhood of the rectum and vagina for sixteen
years, and spontaneously discharged. Barwell mentions a case in which a
gum elastic catheter that had been passed into the vagina for the
purpose of producing abortion became impacted in the pelvis for twenty
months, and was then removed.

Rupture of the Male Urethra.--The male urethra is occasionally ruptured
in violent coitus. Frank and the Philosophical Transactions are among
the older authorities mentioning this accident. In Frank's case there
was hemorrhage from the penis to the extent of five pounds. Colles
mentions a man of thirty-eight, prone to obesity, and who had been
married two months, who said that in sexual congress he had hurt
himself by pushing his penis against the pubic bone, and added that he
had a pain that felt as though something had broken in his organ. The
integuments of the penis became livid and swollen and were extremely
painful. His urine had to be drawn by a catheter, and by the fifth day
his condition was so bad that an incision was made into the tumor, and
pus, blood, urine, and air issued. The patient suffered intense rigors,
his abdomen became tympanitic, and he died.  Postmortem examination
revealed the presence of a ruptured urethra.

Watson relates an instance of coitus performed en postillon by a man
while drunk, with rupture of the urethra and fracture of the corpus
spongiosum only. Loughlin mentions a rupture of the corpus spongiosum
during coitus. Frank cites a curious case of hemorrhage from a fall
while the penis was erect. It is not unusual to find ruptured urethrae
following traumatism, and various explanations are given for it in the
standard works on surgery.

Fracture of the Penis.--A peculiar accident to the penis is fracture,
which sometimes occurs in coitus. This accident consists in the
laceration of the corpora cavernosa, followed by extensive
extravasation of blood into the erectile tissue. It has also occurred
from injury inflicted accidentally or maliciously, but always happening
when the organ was erect. An annoying sequel following this accident is
the tendency to curvature in erection, which is sometimes so marked as
to interfere with coitus, and even render the patient permanently
impotent.

There is an account of a laborer of twenty-seven who, in attempting to
micturate with his penis erect, pressed it downward with considerable
force and fractured the corpora cavernosa.  Veazie relates a case of
fracture of the corpora cavernosa occurring in coitus. During the act
the female suddenly withdrew, and the male, following, violently struck
the pubes, with the resultant injury. Recovery ensued. M'Clellan speaks
of removing the cavernous septum from a man of fifty-two, in whom this
part had become infiltrated with lime-salts and resembled a long,
narrow bone. When the penis was erect it was bent in the form of a
semicircular bow.

The Transactions of the South Carolina Medical Association contain an
account of a negro of sixty who had urethral stricture from gonorrhea
and who had been treated for fifteen years by caustics. The penis was
seven inches in circumference around the glans, and but little less
near the scrotum. The glans was riddled with holes, and numerous
fistulae existed on the inferior surface of the urethra, the meatus
being impermeable. So great was the weight and hypertrophy that
amputation was necessary.  John Hunter speaks of six strictures
existing in one urethra at one time; Lallemand of seven; Bolot of
eight; Ducamp of five; Boyer thought three could never exist together;
Leroy D'Etoilles found 11, and Rokitansky met with four.

Sundry Injuries to the Penis.--Fabricius Hildanus mentions a curious
case of paraphimosis caused by violent coitus with a virgin who had an
extremely narrow vagina. Joyce relates a history of a stout man who
awoke with a vigorous erection, and feeling much irritation, he
scratched himself violently. He soon bled copiously, his shirt and
underlying sheets and blankets being soaked through. On examination the
penis was found swollen, and on drawing back the foreskin a small jet
of blood spurted from a small rupture in the frenum. The authors have
knowledge of a case in which hemorrhage from the frenum proved fatal.
The patient, in a drunken wager, attempted to circumcise himself with a
piece of tin, and bled to death before medical aid could be summoned.
It sometimes happens that the virile member is amputated by an animal
bite. Paullini and Celliez mention amputation of the penis by a
dog-bite. Morgan describes a boy of thirteen who was feeding a donkey
which suddenly made a snap at him, unfortunately catching him by the
trousers and including the penis in one of the folds. By the violence
of the bite the boy was thrown to the ground, and his entire prepuce
was stripped off to the root as if it had been done by a knife. There
was little hemorrhage, and the prepuce was found in the trousers,
looking exactly like the finger of a glove. Morgan stated that this was
the third case of the kind of which he had knowledge. Bookey records a
case in which an artilleryman was seized by the penis by an infuriated
horse, and the two crura were pulled out entire.

Amputation of the penis is not always followed by loss of the sexual
power and instinct, but sometimes has the mental effect of temporarily
increasing the desire. Haslam reports the case of a man who slipped on
the greasy deck of a whaler, and falling forward with great violence
upon a large knife used to cut blubber, completely severed his penis,
beside inflicting a wound in the abdomen through which the intestines
protruded. After recovery there was a distinct increase of sexual
desire and frequent nocturnal emissions. In the same report there is
recorded the history of a man who had entirely lost his penis, but had
supplied himself with an ivory succedaneum. This fellow finally became
so libidinous that it was necessary to exclude him from the workhouse,
of which he was an inmate.

Norris gives an account of a private who received a gunshot wound of
the penis while it was partly erect. The wound was acquired at the
second battle of Fredericksburg. The ball entered near the center of
the glans penis, and taking a slightly oblique direction, it passed out
of the right side of the penis 1 1/2 inches beyond the glans; it then
entered the scrotum, and after striking the pelvis near the symphysis,
glanced off around the innominate bone, and finally made its exit two
inches above the anus. The after-effects of this injury were
incontinence of urine, and inability to assume the erect position.

Bookey cites the case of six wounds from one bullet with recovery. The
bullet entered the sole and emerged from the dorsum of the foot. It
then went through the right buttock and came out of the groin, only to
penetrate the dorsum of the penis and emerge at the upper part of the
glans. Rose speaks of a case in which a man had his clothes caught in
machinery, drawing in the external genital organs. The testicles were
found to be uninjured, but the penis was doubled out of sight and
embedded in the scrotum, from whence it was restored to its natural
position and the man recovered.

Nelaton describes a case of luxation of the penis in a lad of six who
fell from a cart. Nelaton found the missing member in the scrotum,
where it had been for nine days. He introduced Sir Astley Cooper's
instrument for tying deeply-seated arteries through a cutaneous tube,
and conducting the hook under the corporus cavernosum, seized this
crosswise, and by a to-and-fro movement succeeded in replacing the
organ.

Moldenhauer describes the case of a farmer of fifty-seven who was
injured in a runaway accident, a wheel passing over his body close to
the abdomen. The glans penis could not be recognized, since the penis
in toto had been torn from its sheath at the corona, and had slipped or
been driven into the inguinal region.  This author quotes Stromeyer's
case, which was that of a boy of four and a half years who was kicked
by a horse in the external genital region. The sheath was found empty
of the penis, which had been driven into the perineum.

Raven mentions a case of spontaneous retraction of the penis in a man
of twenty-seven. While in bed he felt a sensation of coldness in the
penis, and on examination he found the organ (a normal-sized one)
rapidly retracting or shrinking. He hastily summoned a physician, who
found that the penis had, in fact, almost disappeared, the glans being
just perceptible under the pubic arch, and the skin alone visible. The
next day the normal condition was restored, but the patient was weak
and nervous for several days after his fright. In a similar case,
mentioned by Ivanhoff, the penis of a peasant of twenty-three, a
married man, bodily disappeared, and was only captured by repeated
effort. The patient was six days under treatment, and he finally became
so distrustful of his virile member that, to be assured of its
constancy, he tied a string about it above the glans.

Injuries of the penis and testicles self-inflicted are grouped together
and discussed in Chapter XIV.

As a rule, spontaneous gangrene of the penis has its origin in some
intense fever. Partridge describes a man of forty who had been the
victim of typhus fever, and whose penis mortified and dried up,
becoming black and like the empty finger of a cast-off glove; in a few
days it dropped off. Boyer cites a case of edema of the prepuce,
noticed on the fifteenth day of the fever, and which was followed by
gangrene of the penis. Rostan mentions gangrene of the penis from
small-pox. Intermittent fever has been cited as a cause. Koehler
reports a fatal instance of gangrene of the penis, caused by a
prostatic abscess following gonorrhea. In this case there was
thrombosis of the pelvic veins. Hutchinson mentions a man who, thirty
years before, after six days' exposure on a raft, had lost both legs by
gangrene. At the age of sixty-six he was confined to bed by subacute
bronchitis, and during this period his whole penis became gangrenous
and sloughed off. This is quite unusual, as gangrene is usually
associated with fever; it is more than likely that the gangrene of the
leg was not connected with that of the penis, but that the latter was a
distinct after-result. Possibly the prolonged exposure at the time he
lost his legs produced permanent injury to the blood-vessels and nerves
of the penis. There is a case on record in which, in a man of
thirty-seven, gangrene of the penis followed delirium tremens, and was
attributed to alcoholism.  Quoted by Jacobson, Troisfontaines records a
case of gangrene of the skin and body of the penis in a young man, and
without any apparent cause. Schutz speaks of regeneration of the penis
after gangrenous destruction.

Gangrene of the penis does not necessarily hinder the performance of
marital functions. Chance mentions a man whose penis sloughed off,
leaving only a nipple-like remnant. However, he married four years
later, and always lived in harmony with his wife. At the time of his
death he was the father of a child, subsequent to whose birth his wife
had miscarried, and at the time of report she was daily expecting to be
again confined.

Willett relates the instance of a horseman of thirty-three who, after
using a combination of refuse oils to protect his horse from gnats, was
prompted to urinate, and, in so doing, accidentally touched his penis
with the mixture. Sloughing phagedena rapidly ensued, but under medical
treatment he eventually recovered.

Priapism is sometimes seen as a curious symptom of lesion of the spinal
cord. In such cases it is totally unconnected with any voluptuous
sensation and is only found accompanied by motor paralysis. It may
occur spontaneously immediately after accident involving the cord, and
is then probably due to undue excitement of the portion of the cord
below the lesion, which is deprived of the regulating influence of the
brain. Priapism may also develop spontaneously at a later period, and
is then due to central irritation from extravasation into the substance
of the cord, or to some reflex cause. It may also occur from simple
concussion, as shown by a case reported by Le Gros Clark. Pressure on
the cerebellum is supposed to account for cases of priapism observed in
executions and suicides by hanging. There is an instance recorded of an
Italian "castrate" who said he provoked sexual pleasure by partially
hanging himself. He accidentally ended his life in pursuance of this
peculiar habit. The facts were elicited by testimony at the inquest.

There are, however, in literature, records of long continued priapism
in which either the cause is due to excessive stimulation of the sexual
center or in which the cause is obscure or unknown. There may or may
not be accompanying voluptuous feelings. The older records contain
instances of continued infantile priapism caused by the constant
irritation of ascarides and also records of prolonged priapism
associated with intense agony and spasmodic cramps. Zacutus Lusitanus
speaks of a Viceroy of India who had a long attack of stubborn priapism
without any voluptuous feeling. Gross refers to prolonged priapism, and
remarks that the majority of cases seem to be due to excessive coitus.

Moore reports a case in a man of forty who had been married fifteen
years, and who suffered spasmodic contractions of the muscles of the
penis after an incomplete coitus. This pseudopriapism continued for
twenty-three days, during which time he had unsuccessfully resorted to
the application of cold, bleeding, and other treatment; but on the
twenty-sixth day, after the use of bladders filled with cold water,
there was a discharge from the urethra of a glairy mucus, similar in
nature to that in seminal debility. There was then complete relaxation
of the organ. During all this time the man slept very little, only
occasionally dozing. Donne describes an athletic laborer of twenty-five
who received a wound from a rifle-ball penetrating the cranial parietes
immediately in the posterior superior angle of the parietal bone, and a
few lines from the lambdoid suture.  The ball did not make egress, but
passed posteriorly downward.  Reaction was established on the third
day, but the inflammatory symptoms influenced the genitalia. Priapism
began on the fifth day, at which time the patient became affected with
a salacious appetite, and was rational upon every subject except that
pertaining to venery. He grew worse on the sixth day, and his medical
adviser was obliged to prohibit a female attendant.  Priapism
continued, but the man went into a soporose condition, with occasional
intervals of satyriasis. In this condition he survived nine days; there
was not the slightest abatement of the priapism until a few moments
before his death. Tripe relates the history of a seaman of twenty-five,
in perfect health, who, arriving from Calcutta on April 12, 1884,
lodged with a female until the 26th. At this time he experienced an
unusually fierce desire, with intense erection of the penis which, with
pain, lasted throughout the night. Though coitus was frequently
resorted to, these symptoms continued. He sought aid at the London
Hospital, but the priapism was persistent, and when he left, on May
10th, the penis formed an acute angle with the pubes, and he again had
free intercourse with the same female. At the time of leaving England
the penis made an angle of about 45 degrees with the pubes, and this
condition, he affirmed, lasted three months. On his return to England
his penis was flaccid, and his symptoms had disappeared.

Salzer presents an interesting paper on priapism which was quoted in
The Practitioner of London. Salzer describes one patient of forty-six
who awoke one morning with a strong erection that could not be reduced
by any means. Urine was voided by jerks and with difficulty, and only
when the subject was placed in the knee and elbow position. Despite all
treatment this condition continued for seven weeks. At this time the
patient's spleen was noticed to be enormously enlarged. The man died
about a year after the attack, but a necropsy was unfortunately
refused. Salzer, in discussing the theories of priapism, mentions eight
cases previously reported, and concludes, that such cases are
attributable to leukemia. Kremine believes that continued priapism is
produced by effusion of blood into the corpora cavernosa, which is
impeded on its return. He thinks it corresponds to bleeding at the nose
and rectum, which often occurs in perfectly healthy persons. Longuet
regards the condition of the blood in leukemia as the cause of such
priapism, and considers that the circulation of the blood is retarded
in the smaller vessels, while, owing to the great increase in the
number of white corpuscles, thrombi are formed. Neidhart and Matthias
conclude that the origin of this condition might be sought for in the
disturbance of the nerve-centers. After reviewing all these theories,
Salzer states that in his case the patient was previously healthy and
never had suffered the slightest hemorrhage in any part, and he
therefore rejects the theory of extravasation. He is inclined to
suppose that the priapism was due to the stimulation of the nervi
erigentes, brought about either by anatomic change in the nerves
themselves, or by pressure upon them by enlarged lumbar glands, an
associate condition of leukemia.

Burchard reports a most interesting case of prolonged priapism in an
English gentleman of fifty-three. When he was called to see the man on
July 15th he found him suffering with intense pain in the penis, and in
a state of extreme exhaustion after an erection which had lasted five
hours uninterruptedly, during the whole of which time the organ was in
a state of violent and continuous spasm. The paroxysm was controlled by
3/4 grain morphin and 1/50 grain atropin. Five hours later, after a
troubled sleep, there was another erection, which was again relieved by
hypodermic medication. During the day he had two other paroxysms, one
lasting forty-five minutes; and another, three hours later, lasting
eighteen minutes. Both these were controlled by morphin.  There was no
loss of semen, but after the paroxysms a small quantity of glairy mucus
escaped from the meatus. The rigidity was remarkable, simulating the
spasms of tetanus. No language could adequately describe the suffering
of the patient. Burchard elicited the history that the man had suffered
from nocturnal emissions and erotic dreams of the most lascivious
nature, sometimes having three in one night. During the day he would
have eight or ten erections, unaccompanied by any voluptuous emotions.
In these there would rarely be any emission, but occasionally a small
mucous discharge. This state of affairs had continued three years up to
the time Burchard saw him, and, chagrined by pain and his malady, the
patient had become despondent. After a course of careful treatment, in
which diet, sponging, application of ice-bags, and ergot were features,
this unfortunate man recovered.

Bruce mentions the case of an Irishman of fifty-five who, without
apparent cause, was affected with a painful priapism which lasted six
weeks, and did not subside even under chloroform. Booth mentions a case
of priapism in a married seaman of fifty-five, due to local
inflammation about the muscles, constricting the bulb of the penis. The
affection lasted five weeks, and was extremely painful. There was a
similar case of priapism which lasted for three weeks, and was
associated with hydrocele in a man of forty-eight.

Injuries of the testicle and scrotum may be productive of most serious
issue. It is a well-known surgical fact that a major degree of shock
accompanies a contusion of this portion of the body. In fact, Chevers
states that the sensitiveness of the testicles is so well known in
India, that there are cases on record in which premeditated murder has
been effected by Cossiah women, by violently squeezing the testicles of
their husbands. He also mentions another case in which, in frustrating
an attempt at rape, death was caused in a similar manner. Stalkartt
describes the case of a young man who, after drinking to excess with
his paramour, was either unable, or indifferent in gratifying her
sexual desire. The woman became so enraged that she seized the scrotum
and wrenched it from its attachments, exposing the testicles. The left
testicle was completely denuded, and was hanging by the vas deferens
and the spermatic vessels. There was little hemorrhage, and the wound
was healed by granulation.

Avulsion of the male external genitalia is not always accompanied by
serious consequences, and even in some cases the sexual power is
preserved. Knoll described a case in 1781, occurring in a peasant of
thirty-six who fell from a horse under the wheels of a carriage. He was
first caught in the revolving wheels by his apron, which drew him up
until his breeches were entangled, and finally his genitals were torn
off. Not feeling much pain at the time, he mounted his horse and went
to his house. On examination it was found that the injury was
accompanied with considerable hemorrhage. The wound extended from the
superior part of the pubes almost to the anus; the canal of the urethra
was torn away, and the penis up to the neck of the bladder. There was
no vestige of either the right scrotum or testicle. The left testicle
was hanging by its cord, enveloped in its tunica vaginalis. The cord
was swollen and resembled a penis stripped of its integument. The
prostate was considerably contused. After two months of suffering the
patient recovered, being able to evacuate his urine through a fistulous
opening that had formed. In ten weeks cicatrization was perfect. In his
"Memoirs of the Campaign of 1811," Larrey describes a soldier who,
while standing with his legs apart, was struck from behind by a bullet.
The margin of the sphincter and, the skin of the perineum, the bulbous
portion of the urethra, some of the skin of the scrotum, and the right
testicle were destroyed. The spermatic cord was divided close to the
skin, and the skin of the penis and prepuce was torn. The soldier was
left as dead on the field, but after four months' treatment he
recovered.

Madden mentions a man of fifty who fell under the feet of a pair of
horses, and suffered avulsion of the testicles through the scrotum. The
organs were mangled, the spermatic cord was torn and hung over the
anus, and the penis was lacerated from the frenum down. The man lost
his testicles, but otherwise completely recovered. Brugh reports an
instance of injury to the genitalia in a boy of eighteen who was caught
in a threshing-machine. The skin of the penis and scrotum, and the
tissue from the pubes and inguinal region were torn from the body.
Cicatrization and recovery were complete. Brigham cites an analogous
case in a youth of seventeen who was similarly caught in threshing
machinery. The skin of the penis and the scrotum was entirely torn
away; both sphincters of the anus were lacerated, and the perineum was
divested of its skin for a space 2 1/2 inches wide.  Recovery ensued,
leaving a penis which measured, when flaccid, three inches long and 1
1/2 inches in diameter.

There is a case reported of a man who had his testicles caught in
machinery while ginning cotton. The skin of the penis was stripped off
to its root, the scrotum torn off from its base, and the testicles were
contused and lacerated, and yet good recovery ensued. A peculiarity of
this case was the persistent erection of the penis when cold was not
applied.

Gibbs mentions a case in which the entire scrotum and the perineum,
together with an entire testicle and its cord attached, and nearly all
the integument of the penis were torn off, yet the patient recovered
with preservation of sexual powers. The patient was a negro of
twenty-two who, while adjusting a belt, had his coat (closely buttoned)
caught in the shafting, and his clothes and external genitals torn off.
On examination it was found that the whole scrotum was wrenched off,
and also the skin and cellular tissue, from 2 1/2 inches above the
spine of the pubes down to the edge of the sphincter ani, including all
the breadth of the perineum, together with the left testicle with five
inches of its cord attached, and all the integument and cellular
covering of the penis except a rim nearly half an inch wide at the
extremity and continuous with the mucous membrane of the prepuce. The
right testicle was hanging by its denuded cord, and was apparently
covered only by the tunica vaginalis as high up as the abdominal ring,
where the elastic feeling of the intestines was distinctly perceptible.
There was not more than half an ounce of blood lost. The raw surface
was dressed, the gap in the perineum brought together, and the patient
made complete recovery, with preservation of his sexual powers. Other
cases of injuries to the external genital organs (self-inflicted) will
be found in the next chapter.

The preservation of the sexual power after injuries of this kind is not
uncommon. There is a case reported of a man whose testicles were
completely torn away, and the perineal urethra so much injured that
micturition took place through the wound. After a tedious process the
wound healed and the man was discharged, but he returned in ten days
with gonorrhea, stating that he had neither lost sexual desire nor
power of satisfaction. Robbins mentions a man of thirty-eight who, in
1874, had his left testicle removed. In the following year his right
testicle became affected and was also removed. The patient stated that
since the removal of the second gland he had regular sexual desire and
coitus, apparently not differing from that in which he indulged before
castration. For a few months previous to the time of report the cord on
the left side, which had not been completely extirpated, became
extremely painful and was also removed.

Atrophy of the testicle may follow venereal excess, and according to
Larrey, deep wounds of the neck may produce the same result, with the
loss of the features of virility. Guthrie mentions a case of
spontaneous absorption of the testicle. According to Larrey, on the
return of the French Army from the Egyptian expedition the soldiers
complained of atrophy and disappearance of the testicle, without any
venereal affection. The testicle would lose its sensibility, become
soft, and gradually diminish in size. One testicle at a time was
attacked, and when both were involved the patient was deprived of the
power of procreation, of which he was apprised by the lack of desire
and laxity of the penis. In this peculiar condition the general health
seemed to fail, and the subjects occasionally became mentally deranged.
Atrophy of the testicles has been known to follow an attack of mumps.

In his description of the diseases of Barbadoes Hendy mentions several
peculiar cases under his observation in which the scrotum sloughed,
leaving the testicles denuded. Alix and Richter mention a singular
modification of rheumatic inflammation of the testicle, in which the
affection flitted from one testicle to the other, and alternated with
rheumatic pains elsewhere.

There is a case of retraction of the testicle reported in a young
soldier of twenty-one who, when first seen, complained of a swelling in
the right groin. He stated that while riding bareback his horse
suddenly plunged and threw him on the withers. He at once felt a
sickening pain in the groin and became so ill that he had to dismount.
On inspection an oval tumor was seen in the groin, tender to the touch
and showing no impulse on coughing.  The left testicle was in its usual
position, but the right was absent. The patient stated positively that
both testicles were in situ before the accident. An attempt at
reduction was made, but the pain was so severe that manipulation could
not be endured. A warm bath and laudanum were ordered, but
unfortunately, as the patient at stool gave a sudden bend to the left,
his testicle slipped up into the abdomen and was completely lost to
palpation.  Orchitis threatened, but the symptoms subsided; the patient
was kept under observation for some weeks, and then as a tentative
measure, discharged to duty. Shortly afterward he returned, saying that
he was ill, and that while lifting a sack of corn his testicle came
partly down, causing him great pain. At the time of report his left
testicle was in position, but the right could not be felt. The scrotum
on that side had retracted until it had almost disappeared; the right
external ring was very patent, and the finger could be passed up in the
inguinal canal; there was no impulse on coughing and no tendency to
hernia.

A unique case of ectopia of the testicle in a man of twenty-four is
given by Popoff. The scrotum was normally developed, and the right
testicle in situ. The left half of the scrotum was empty, and at the
root of the penis there was a swelling the size of a walnut, covered
with normal skin, and containing an oval body about four-fifths the
size of the testicle, but softer in constituency. The patient claimed
that this swelling had been present since childhood. His sexual power
had been normal, but for the past six months he had been impotent. In
childhood the patient had a small inguinal hernia, and Popoff thought
this caused the displacement of the testicle.

A somewhat similar case occurred in the Hotel-Dieu, Paris.  Through the
agency of compression one of the testes was forced along the corpus
cavernosum under the skin as far as the glans penis. It was easily
reduced, and at a subsequent autopsy it was found that it had not been
separated from the cord. Gluiteras a cites a parallel case of
dislocation of the testicle into the penis. It was the result of
traumatism--a fall upon the wheel of a cart. It was reduced under
anesthesia, after two incisions had been made, the adhesions broken up,
and the shrunken sac enlarged by stretching.

Rupture of the spermatic arteries and veins has caused sudden death.
Schleiser is accredited with describing an instance in which a healthy
man was engaged in a fray in the dark, and, suddenly crying out, fell
into convulsions and died in five minutes. On examination the only
injury found was the rupture of both spermatic arteries at the internal
ring, produced by a violent pull on the scrotum and testicles by one of
his antagonists. Shock was evidently a strong factor in this case.
Fabricius Hildanus gives a case of impotency due to lesions of the
spermatic vessels following a burn. There is an old record of an aged
man who, on marrying, found that he had erections but no ejaculations.
He died of ague, and at the autopsy it was found that the verumontanum
was hard and of the size of a walnut and that the ejaculatory ducts
contained calculi about the size and shape of peas.

Hydrocele is a condition in which there is an abnormal quantity of
fluid in the tunica vaginalis. It is generally caused by traumatism,
violent muscular efforts, or straining, and is much more frequent in
tropic countries than elsewhere. It sometimes attains an enormous size.
Leigh mentions a hydrocele weighing 120 pounds, and there are records
of hydroceles weighing 40 and 60 pounds. Larrey speaks of a sarcocele
in the coverings of the testicle which weighed 100 pounds. Mursinna
describes a hydrocele which measured 27 inches in its longest and 17 in
its transverse axis.

Tedford gives a curious case of separation of the ovary in a woman of
twenty-eight. After suffering from invagination of the bowel and
inflammation of the ovarian tissue, an ovary was discharged through an
opening in the sigmoid flexure, and thence expelled from the anus.

In discussing injuries of the vagina, the first to be mentioned will be
a remarkable case reported by Curran. The subject was an Irish girl of
twenty. While carrying a bundle of clothes that prevented her from
seeing objects in front of her, she started to pass over a stile, just
opposite to which a goat was lying. The woman wore no underclothing,
and in the ascent her body was partially exposed, and, while in this
enforced attitude, the goat, frightened by her approach, suddenly
started up, and in so doing thrust his horn forcibly into her anus and
about two or three inches up her rectum. The horn then passed through
the bowel and its coverings, just above the hymen, and was then
withdrawn as she flinched and fell back. The resultant wound included
the lower part of the vagina and rectum, the sphincter and, the
fourchet, and perineum. Hemorrhage was profuse, and the wound caused
excruciating pain. The subject fainted on the spot from hemorrhage and
shock. Her modesty forbade her summoning medical aid for three days,
during which time the wound was undergoing most primitive treatment.
After suturing, cicatrization followed without delay.

Trompert mentions a case of rupture of the vagina by the horn of a
bull. There is a case recorded in the Pennsylvania Hospital Reports of
a girl of nineteen who jumped out of a second-story window. On reaching
the ground, her foot turned under her as she fell. The high heel of a
French boot was driven through the perineum one inch from the median
line, midway between the anus and the posterior commissure of the labia
majora. The wound extended into the vagina above the external opening,
in which the heel, now separated from the boot, projected, and whence
it was removed without difficulty. This wound was the only injury
sustained by the fall.

Beckett records a case of impalement in a woman of forty-five who,
while attempting to obtain water from a hogshead, fell with one limb
inside the cistern, striking a projecting stave three inches wide and
1/2 inch thick. The external labia were divided, the left crus of the
clitoris separated, the nymphae lacerated, and the vaginal wall
penetrated to the extent of five inches; the patient recovered by the
fourth week.

Homans reports recovery from extensive wounds acquired by a negress who
fell from a roof, striking astride an upright barrel.  There was a
wound of the perineum, and penetration of the posterior wall of the
vagina, with complete separation of the soft parts from the symphysis
pubis, and extrusion of the bladder.

Howe reports a case of impalement with recovery in a girl of fifteen
who slid down a hay-stack, striking a hay-hook which penetrated her
perineum and passed into her body, emerging two inches below the
umbilicus and one inch to the right of the median line.

Injuries of the vagina may be so extensive as to allow protrusion of
the intestines, and some horrible cases of this nature are recorded. In
The Lancet for 1873 there is reported a murder or suicide of this
description. The woman was found with a wound in the vagina, through
which the intestines, with clean-cut ends, protruded. Over 7 1/2 feet
of the intestines had been cut off in three pieces. The cuts were all
clean and carefully separated from the mesentery. The woman survived
her injuries a whole week, finally succumbing to loss of blood and
peritonitis. Her husband was tried for murder, but was acquitted by a
Glasgow jury. Taylor mentions similar cases of two women murdered in
Edinburgh some years since, the wounds having been produced by razor
slashes in the vagina. Taylor remarks that this crime seems to be quite
common in Scotland. Starkey reports an instance in which the body of an
old colored woman was found, with evidences of vomiting, and her
clothing stained with blood that had evidently come from her vagina. A
postmortem showed the abdominal cavity to be full of blood; at Douglas'
culdesac there was a tear large enough to admit a man's hand, through
which protruded a portion of the omentum; this was at first taken for
the membranes of an abortion. There were distinct signs of acute
peritonitis. After investigation it was proved that a drunken
glass-blower had been seen leaving her house with his hand and arm
stained with blood.  In his drunken frenzy this man had thrust his hand
into the vagina, and through the junction of its posterior wall with
the uterus, up into the abdominal cavity, and grasped the uterus,
trying to drag it out. Outside of obstetric practice the injury is
quite a rare one.

There is a case of death from a ruptured clitoris reported by
Gutteridge. The woman was kicked while in a stooping position and
succumbed to a profuse hemorrhage, estimated to be between three and
four pounds, and proceeding from a rupture of the clitoris.

Discharge of Vaginal Parietes.--Longhi describes the case of a woman of
twenty-seven, an epileptic, with metritis and copious catamenia twice a
month. She was immoderately addicted to drink and sexual indulgence,
and in February, 1835, her menses ceased.  On May 8th she was admitted
to the hospital with a severe epileptic convulsion, and until the 18th
remained in a febrile condition, with abdominal tenderness, etc. On the
21st, while straining as if to discharge the contents of the rectum,
she felt a voluminous body pass through the vagina, and fancied it was
the expected fetus. After washing this mass it was found to be a
portion of the vaginal parietes and the fleshy body of the neck of the
uterus. The woman believed she had miscarried, and still persisted in
refusing medicine. Cicatrization was somewhat delayed; immediately on
leaving the hospital she returned to her old habits, but the pain and
hemorrhage attending copulation was so great that she had finally to
desist. The vagina, however, gradually yielding, ceased to interfere
with the gratification of her desires. Toward the end of June the
menses reappeared and flowed with the greatest regularity. The portions
discharged are preserved in the Milan Hospital.

The injuries received during coitus have been classified by Spaeth as
follows: Deep tears of the hymen with profuse hemorrhage; tears of the
clitoris and of the urethra (in cases of atresia hymenis);
vesicovaginal fistula; laceration of the vaginal fornices, posteriorly
or laterally; laceration of the septum of a duplex vagina; injuries
following coitus after perineorrhaphy. In the last century Plazzoni
reports a case of vaginal rupture occurring during coitus. Green of
Boston; Mann of Buffalo; Sinclair and Munro of Boston, all mention
lacerations occurring during coitus. There is an instance recorded of
extensive laceration of the vagina in a woman, the result of coitus
with a large dog. Haddon and Ross both mention cases of rupture of the
vagina in coitus; and Martin reports a similar case resulting in a
young girl's death. Spaeth speaks of a woman of thirty-one who, a few
days after marriage, felt violent pain in coitus, and four days later
she noticed that fecal matter escaped from the vagina during stool.
Examination showed that the columns of the posterior wall were torn
from their attachment, and that there was a rectovaginal fistula
admitting the little finger. Hofmokl cites an instance in which a
powerful young man, in coitus with a widow of fifty-eight, caused a
tear of her fornix, followed by violent hemorrhage. In another case by
the same author, coitus in a sitting posture produced a rupture of the
posterior fornix, involving the peritoneum; although the patient lost
much blood, she finally recovered. In a third instance, a young girl,
whose lover had violent connection with her while she was in an
exaggerated lithotomy position, suffered a large tear of the right
vaginal wall. Hofmokl also describes the case of a young girl with an
undeveloped vagina, absence of the uterus and adnexa, who during a
forcible and unsuccessful attempt at coitus, had her left labium majus
torn from the vaginal wall. The tear extended into the mons veneris and
down to the rectum, and the finger could be introduced into the vaginal
wound to the depth of two inches. The patient recovered in four weeks,
but was still anemic from the loss of blood.

Crandall cites instances in which hemorrhage, immediately after coitus
of the marriage-night, was so active as to almost cause death. One of
his patients was married three weeks previously, and was rapidly
becoming exhausted from a constant flowing which started immediately
after her first coitus. Examination showed this to be a case of active
intrauterine hemorrhage excited by coitus soon after the menstrual flow
had ceased and while the uterus and ovaries were highly congested. In
another case the patient commenced flooding while at the dinner table
in the Metropolitan Hotel in New York, and from the same cause an
almost fatal hemorrhage ensued. Hirst of Philadelphia has remarked that
brides have been found on their marital beds completely covered with
blood, and that the hemorrhage may have been so profuse as to soak
through the bed and fall on the floor. Lacerations of the urethra from
urethral coitus in instances of vaginal atresia or imperforate hymen
may also excite serious hemorrhage.

Foreign Bodies in the Vagina.--The elasticity of the vagina allows the
presence in this passage of the most voluminous foreign bodies. When we
consider the passage of a fetal head through the vagina the ordinary
foreign bodies, none of which ever approximate this size, seem quite
reasonable. Goblets, hair-pins, needles, bottles, beer glasses,
compasses, bobbins, pessaries, and many other articles have been found
in the vagina.  It is quite possible for a phosphatic incrustation to
be found about a foreign body tolerated in this location for some time.
Hubbauer speaks of a young girl of nineteen in whose vagina there was a
glass fixed by incrustations which held it solidly in place. It had
been there for six months and was only removed with great difficulty.
Holmes cites a peculiar case in which the neck of a bottle was found in
the vagina of a woman. One point of the glass had penetrated the
bladder and a calculus had formed on this as well as on the vaginal end.

When a foreign body remains in the vagina for a long time and if it is
composed of material other than glass, it becomes influenced by the
corrosive action of the vaginal secretion. For instance, Cloquet
removed a foreign body which was incrusted in the vagina, and found the
cork pessary which had formed its nucleus completely rotted. A similar
instrument found by Gosselin had remained in the vagina thirty-six
years, and was incrustated with calcareous salts. Metal is always
attacked by the vaginal secretions in the most marked manner. Cloquet
mentions that at an autopsy of a woman who had a pewter goblet in her
vagina, lead oxid was found in the gangrenous debris.

Long Retention of Pessaries, etc.--The length of time during which
pessaries may remain in the vagina is sometimes astonishing. The
accompanying illustration shows the phosphatic deposits and
incrustations around a pessary after a long sojourn in the vagina. The
specimen is in the Musee Dupoytren. Pinet mentions a pessary that
remained in situ for twenty-five years.  Gerould of Massilon, Ohio,
reports a case in which a pessary had been worn by a German woman of
eighty-four for more than fifty years. She had forgotten its existence
until reminded of it by irritation some years before death. It was
remarkable that when the pessary was removed it was found to have
largely retained its original wax covering. Hurxthal mentions the
removal of a pessary which had been in the pelvis for forty-one years.
Jackson speaks of a glove-pessary remaining in the vagina thirty-five
years.  Mackey reports the removal of a glass pessary after fifty-five
years' incarceration.

There is an account of a young girl addicted to onanism who died from
the presence of a pewter cup in her vagina; it had been there fourteen
months. Shame had led her to conceal her condition for all the period
during which she suffered pain in the hypogastrium, and diarrhea. She
had steadily refused examination.  Bazzanella of Innsbruck removed a
drinking glass from the vagina by means of a pair of small obstetric
forceps. The glass had been placed there ten years previously by the
woman's husband.  Szigethy reports the case of a woman of seventy-five
who, some thirty years before, introduced into her vagina a ball of
string previously dipped in wax. The ball was effectual in relieving a
prolapsed uterus, and was worn with so little discomfort that she
entirely forgot it until it was forced out of place by a violent
effort. The ball was seven inches in circumference, and covered with
mucus, but otherwise unchanged. Breisky is accredited with the report
of a case of a woman suffering with dysmenorrhea, in whose vagina was
found a cotton reel which had been introduced seven years before. The
woman made a good recovery. Pearse mentions a woman of thirty-six who
had suffered menorrhagia for ten days, and was in a state of great
prostration and suffering from strong colicky pains. On examination he
found a silk-bobbin about an inch from the entrance, which the patient
had introduced fourteen years before. She had already had attacks of
peritonitis and hemorrhage, and a urethrovaginal fistula was found. The
bobbin itself was black. This patient had been married twice, and had
been cared for by physicians, but the existence of a body 3/4 inch long
had never been noticed. Poulet quotes two curious cases: in one a
pregnant woman was examined by a doctor who diagnosticated
carcinomatous degeneration of the neck of the uterus. Capuron, who was
consulted relative to the case, did not believe that the state of the
woman's health warranted the diagnosis, and on further examination the
growth was found to have been a sponge which had previously been
introduced by the woman into the vagina. The other case, reported by
Guyon, exemplified another error in diagnosis. The patient was a woman
who suffered from continuous vaginal hemorrhage, and had been given
extensive treatment without success. Finally, when the woman was in
extreme exhaustion, an injection of vinegar-water was ordered, the use
of which was followed by the expulsion from the vagina of a live leech
of a species very abundant in the country. The hemorrhage immediately
ceased and health returned.

There is a record of a woman of twenty-eight who was suddenly surprised
by some one entering her chamber at the moment she was introducing a
cedar pencil into her vagina. With the purpose of covering up her act
and dissembling the woman sat down, and the shank of the wood was
pushed through the posterior wall of the vagina into the peritoneal
cavity. The intestine was, without doubt, pierced in two of its curves,
which was demonstrated later by an autopsy. A plastic exudation had
evidently agglutinated the intestine at the points of penetration, and
prevented an immediate fatal issue. Erichsen practiced extraction eight
months after the accident, and a pencil 5 1/2 inches long, having a
strong fecal odor, was brought out. The patient died the fourth day
after the operation, from peritonitis, and an autopsy showed the
perforation and agglutination of the two intestinal curvatures.
Getchell relates the description of a calculus in the vagina, formed
about a hair-pin as a nucleus. It is reported that a country girl came
to the Hotel-Dieu to consult Dupoytren, and stated that several years
before she had been violated by some soldiers, who had introduced an
unknown foreign body into her vagina, which she never could extract.
Dupuytren found this to be a small metallic pot, two inches in
diameter, with its concavity toward the uterus. It contained a solid
black substance of a most fetid odor.

Foreign bodies are generally introduced in the uterus either
accidentally in vaginal applications, or for the purpose of producing
abortion. Zuhmeister describes a case of a woman who shortly after the
first manifestations of pregnancy used a twig of a tree to penetrate
the matrix. She thrust it so strongly into the uterus that the wall was
perforated, and the twig became planted in the region of the kidneys.
Although six inches long and of the volume of a goose feather, this
branch remained five months in the pelvis without causing any
particular inconvenience, and was finally discharged by the rectum.
Brignatelli mentions the case of a woman who, in culpable practices,
introduced the stalk of a reed into her uterus. She suffered no
inconvenience until the next menstrual epoch which was accompanied by
violent pains. She presented the appearance of one in the pains of
labor. The matrix had augmented in volume, and the orifice of the
uterine cervix was closed, but there was hypertrophy as if in the
second or third month of pregnancy.  After examination a piece of reed
three cm. long was extracted from the uterus, its external face being
incrusted with hard calcareous material. Meschede of Schwetz, Germany,
mentions death from a hair-pin in the uterine cavity.

Crouzit was called to see a young girl who had attempted criminal
abortion by a darning-needle. When he arrived a fetus of about three
months had already been expelled, and had been wounded by the
instrument. It was impossible to remove the needle, and the placenta
was not expelled for two days. Eleven days afterward the girl commenced
to have pains in the inguinal region, and by the thirty-fifth day an
elevation was formed, and the pains increased in violence. On the
seventy-ninth day a needle six inches long was expelled from the
swelling in the groin, and the patient recovered. Lisfranc extracted
from the uterus of a woman who supposed herself to be pregnant at the
third month, a fragment of a large gum-elastic sound which during
illicit maneuvers had broken off within five cm. of its extremity, and
penetrated the organ. Lisfranc found there was not the slightest sign
of pregnancy, despite the woman's belief that she was with child.



CHAPTER XIV.

MISCELLANEOUS SURGICAL ANOMALIES.

Marvelous Recoveries from Multiple Injuries.--There are injuries so
numerous or so great in extent, and so marvelous in their recovery,
that they are worthy of record in a section by themselves. They are
found particularly in military surgery. In the Medical and
Philosophical Commentaries for 1779 is the report of the case of a
lieutenant who was wounded through the lungs, liver, and stomach, and
in whose armpit lodged a ball. It was said that when the wound in his
back was injected, the fluid would immediately be coughed up from his
lungs. Food would pass through the wound of the stomach. The man was
greatly prostrated, but after eleven months of convalescence he
recovered. In the brutal capture of Fort Griswold, Connecticut, in
1781, in which the brave occupants were massacred by the British,
Lieutenant Avery had an eye shot out, his skull fractured, the
brain-substance scattering on the ground, was stabbed in the side, and
left for dead; yet he recovered and lived to narrate the horrors of the
day forty years after.

A French invalid-artillery soldier, from his injuries and a peculiar
mask he used to hide them, was known as "L'homme a la tete de cire."
The Lancet gives his history briefly as follows: During the
Franco-Prussian War, he was horribly wounded by the bursting of a
Prussian shell. His whole face, including his two eyes, were literally
blown away, some scanty remnants of the osseous and muscular systems,
and the skull covered with hair being left. His wounds healed, giving
him such a hideous and ghastly appearance that he was virtually
ostracized from the sight of his fellows. For his relief a dentist by
the name of Delalain constructed a mask which included a false palate
and a set of false teeth. This apparatus was so perfect that the
functions of respiration and mastication were almost completely
restored to their former condition, and the man was able to speak
distinctly, and even to play the flute. His sense of smell also
returned. He wore two false eyes simply to fill up the cavities of the
orbits, for the parts representing the eyes were closed.  The mask was
so well-adapted to what remained of the real face, that it was
considered by all one of the finest specimens of the prothetic art that
could be devised. This soldier, whose name was Moreau, was living and
in perfect health at the time of the report, his bizarre face, without
expression, and his sobriquet, as mentioned, making him an object of
great curiosity. He wore the Cross of Honor, and nothing delighted him
more than to talk about the war. To augment his meager pension he sold
a pamphlet containing in detail an account of his injuries and a
description of the skilfully devised apparatus by which his declining
life was made endurable. A somewhat similar case is mentioned on page
585.

A most remarkable case of a soldier suffering numerous and almost
incredible injuries and recovering and pursuing his vocation with
undampened ardor is that of Jacques Roellinger, Company B, 47th New
York Volunteers. He appeared before a pension board in New York, June
29, 1865, with the following history: In 1862 he suffered a sabre-cut
across the quadriceps extensor of the left thigh, and a sabre-thrust
between the bones of the forearm at the middle third. Soon afterward at
Williamsburg, Va., he was shot in the thigh, the ball passing through
the middle third external to the femur. At Fort Wagner, 1863, he had a
sword-cut, severing the spinal muscles and overlying tissue for a
distance of six inches.  Subsequently he was captured by guerillas in
Missouri and tortured by burning splinters of wood, the cicatrices of
which he exhibited; he escaped to Florida, where he was struck by a
fragment of an exploding shell, which passed from without inward,
behind the hamstring on the right leg, and remained embedded and could
be plainly felt. When struck he fell and was fired on by the retiring
enemy. A ball entered between the 6th and 7th ribs just beneath the
apex of the heart, traversed the lungs and issued at the right 9th rib.
He fired his revolver on reception of this shot, and was soon
bayonetted by his own comrades by mistake, this wound also penetrating
the body. He showed a depressed triangular cicatrix on the margin of
the epigastrium.  If the scars are at all indicative, the bayonet must
have passed through the left lobe of the liver and border of the
diaphragm.  Finally he was struck by a pistol-ball at the lower angle
of the left lower jaw, this bullet issuing on the other side of the
neck. As exemplary of the easy manner in which he bore his many
injuries during a somewhat protracted convalescence, it may be added
that he amused his comrades by blowing jets of water through the
apertures on both sides of his neck. Beside the foregoing injuries he
received many minor ones, which he did not deem worthy of record or
remembrance. The greatest disability he suffered at the time of
applying for a pension resulted from an ankylosed knee. Not satisfied
with his experience in our war, he stated to the pension examiners that
he was on his way to join Garibaldi's army. This case is marvelous when
we consider the proximity of several of the wounds to a vital part; the
slightest deviation of position would surely have resulted in a fatal
issue for this apparently charmed life. The following table shows the
man's injuries in the order of their reception:--

(1) Sabre-cut across the quadriceps femoris of right leg, dividing the
tendinous and muscular structures.

(2) Sabre-thrust between the bones in the middle third of the right
forearm.

(3) Shot in the right thigh, the ball passing through the middle third.

(4) A sword-cut across the spinal muscles covering the lower dorsal
vertebrae.

(5) Tortured by guerillas in Indian fashion by having burning splinters
of wood applied to the surface of his right thorax.

(6) An exploded shell passed through the hamstring muscles of the right
thigh and embedded itself in the ligamentous tissues of the internal
condyle of the femur.

(7) Shot by a ball between the 6th and 7th ribs of the left side.

(8) Bayonetted through the body, the steel passing through the left
lobe of the liver and penetrating the posterior border of the diaphragm.

(9) Pistol-ball shot through the sternocleido muscle of one side of the
neck, emerging through the corresponding muscle of the other side of
the neck.

(10) Sabre-thrust between the bones of the left forearm.

(11) Pistol-shot through the left pectoralis major and left deltoid
muscles.

(12) Deep cut dividing the commissure between the left thumb and
forefinger down to the carpal bones.

Somewhat analogous to the foregoing is a case reported in 1834 by
McCosh from Calcutta. The patient was a native who had been dreadfully
butchered in the Chooar campaign. One of his hands was cut off above
the wrist. The remaining stump was nearly amputated by a second blow. A
third blow penetrated the shoulder-joint.  Beside these and several
other slashes, he had a cut across the abdomen extending from the
umbilicus to the spine. This cut divided the parietes and severed one
of the coats of the colon.  The intestines escaped and lay by his side.
He was then left on the ground as dead. On arrival at the hospital his
wounds were dressed and he speedily convalesced, but the injured colon
ruptured and an artificial anus was formed and part of the feces were
discharged through the wound. This man was subsequently seen at
Midnapore healthy and lusty although his body was bent to one side in
consequence of a large cicatrix; a small portion of the feces
occasionally passed through the open wound.

There is an account of a private soldier, aged twenty-seven, who
suffered a gunshot wound of the skull, causing compound fracture of the
cranium, and who also received compound fractures of both bones of the
leg. He did not present himself for treatment until ten days later. At
this time the head-injury caused him no inconvenience, but it was
necessary to amputate the leg and remove the necrosed bones from the
cranial wounds; the patient recovered.

Recovery After Injuries by Machinery, with Multiple Fractures,
etc.--Persons accidentally caught in some portions of powerful
machinery usually suffer several major injuries, any one of which might
have been fatal, yet there are marvelous instances of recovery after
wounds of this nature. Phares records the case of a boy of nine who,
while playing in the saw-gate of a cotton-press, was struck by the
lever in revolution, the blow fracturing both bones of the leg about
the middle. At the second revolution his shoulder was crushed; the
third passed over him, and the fourth, with maximum momentum struck his
head, carrying away a large part of the integument, including one
eyebrow, portions of the skull, membranes, and brain-substance. A piece
of cranial bone was found sticking in the lever, and there were stains
of brain on all the 24 posts around the circumference of the hole.
Possibly from 1 1/2 to two ounces of cerebral substance were lost. A
physician was called, but thinking the case hopeless he declined to
offer surgical interference. Undaunted, the father of the injured lad
straightened the leg, adjusted the various fractures, and administered
calomel and salts. The boy progressively recovered, and in a few weeks
his shoulder and legs were well. About this time a loosened fragment of
the skull was removed almost the size and shape of a dessert spoon,
with the handle attached, leaving a circular opening directly over the
eye as large as a Mexican dollar, through which cerebral pulsation was
visible. A peculiar feature of this case was that the boy never lost
consciousness, and while one of his playmates ran for assistance he got
out of the hole himself, and moved to a spot ten feet distant before
any help arrived, and even then he declined proffered aid from a man he
disliked. This boy stated that he remembered each revolution of the
lever and the individual injuries that each inflicted. Three years
after his injury he was in every respect well. Fraser mentions an
instance of a boy of fifteen who was caught in the crank of a
balance-wheel in a shingle-mill, and was taken up insensible. His skull
was fractured at the parietal eminence and the pericranium stripped
off, leaving a bloody tumor near the base of the fracture about two
inches in diameter. The right humerus was fractured at the external
condyle; there was a fracture of the coronoid process of the ulna, and
a backward dislocation at the elbow. The annular ligament was ruptured,
and the radius was separated from the ulna. On the left side there was
a fracture of the anatomic neck of the humerus, and a dislocation
downward. The boy was trephined, and the comminuted fragments removed;
in about six weeks recovery was nearly complete. Gibson reports the
history of a girl of eight who was caught by her clothing in a
perpendicular shaft in motion, and carried around at a rate of 150 or
200 times a minute until the machinery could be stopped.  Although she
was found in a state of shock, she was anesthetized, in order that
immediate attention could be given to her injuries, which were found to
be as follows:--

(1) An oblique fracture of the middle third of the right femur.

(2) A transverse fracture of the middle third of the left femur.

(3) A slightly comminuted transverse fracture of the middle third of
the left tibia and fibula.

(4) A transverse fracture of the lower third of the right humerus.

(5) A fracture of the lower third of the right radius.

(6) A partial radiocarpal dislocation.

(7) Considerable injuries of the soft parts at the seats of fracture,
and contusions and abrasions all over the body.

During convalescence the little patient suffered an attack of measles,
but after careful treatment it was found by the seventy-eighth day that
she had recovered without bony deformity, and that there was bony union
in all the fractures. There was slight tilting upward in the left
femur, in which the fracture had been transverse, but there was no
perceptible shortening.

Hulke describes a silver-polisher of thirty-six who, while standing
near a machine, had his sleeve caught by a rapidly-turning wheel, which
drew him in and whirled him round and round, his legs striking against
the ceiling and floor of the room. It was thought the wheel had made 50
revolutions before the machinery was stopped. After his removal it was
found that his left humerus was fractured at its lower third, and
apparently comminuted. There was no pulse in the wrist in either the
radial or ulnar arteries, but there was pulsation in the brachial as
low as the ecchymosed swelling. Those parts of the hand and fingers
supplied by the median and radial nerves were insensible. The right
humerus was broken at the middle, the end of the upper fragment
piercing the triceps, and almost protruding through the skin. One or
more of the middle ribs on the right side were broken near the angle,
and there was a large transverse rent in the quadriceps extensor.
Despite this terrible accident the man made a perfect recovery, with
the single exception of limitation of flexion in the left elbow-joint.

Dewey details a description of a girl of six who was carried around the
upright shaft of a flour mill in which her clothes became entangled.
Some part of the body struck the bags or stones with each revolution.
She sustained a fracture of the left humerus near the insertion of the
deltoid, a fracture of the middle third of the left femur, a compound
fracture of the left femur in the upper third, with protrusion of the
upper fragment and considerable venous hemorrhage, and fracture of the
right tibia and fibula at the upper third. When taken from the shafting
the child was in a moribund state, with scarcely perceptible pulse, and
all the accompanying symptoms of shock. Her injuries were dressed, the
fractures reduced, and starch bandages applied; in about six weeks
there was perfect union, the right leg being slightly shortened. Six
months later she was playing about, with only a slight halt in her gait.

Miscellaneous Multiple Fractures.--Westmoreland speaks of a man who was
pressed between two cars, and sustained a fracture of both collar-bones
and of the sternum; in addition, six or eight ribs were fractured,
driven into and lacerating the lung. The heart was displaced. In spite
of these terrible injuries, the man was rational when picked up, and
lived nearly half a day. In comment on this case Battey mentions an
instance in which a mill-sawyer was run over by 20 or 30 logs, which
produced innumerable fractures of his body, constituting him a surgical
curiosity. He afterward completely recovered, and, as a consequence of
his miraculous escape, became a soothsayer in his region. West reports
a remarkable recovery after a compound fracture of the femur, fracture
of the jaw, and of the radius, and possibly injury to the base of the
skull, and injury to the spine.

There is on record an account of a woman of forty-three who, by
muscular action in lifting a stone, fractured her pubes, external to
the spine, on the left side. Not realizing her injury she continued
hard work all that day, but fell exhausted on the next.  She recovered
in about a month, and was able to walk as well as ever.

Vinnedge reports recovery after concussion of the brain and extreme
shock, associated with fracture of the left femur, and comminuted
fractures of the left tibia and fibula.

Tufnell mentions recovery after compound comminuted fracture of the
leg, with simple fracture of both collar-bones, and dislocation of the
thumb. Nankivell speaks of a remarkable recovery in an individual who
suffered compound comminuted fracture of both legs, and fracture of the
skull. It was found necessary to amputate the right thigh and left leg.
Erichsen effected recovery by rest alone, in an individual whose ribs
and both clavicles were fractured by being squeezed.

Gilman records recovery after injuries consisting of fracture of the
frontal bone near the junction with the right parietal; fracture of the
right radius and ulna at the middle third and at the wrist; and
compound fracture of the left radius and ulna, 1 1/4 inches above the
wrist. Boulting reports a case of an individual who suffered compound
fractures of the skull and humerus, together with extensive laceration
of the thigh and chest, and yet recovered.

Barwell mentions recovery after amputation of the shoulder-joint, in an
individual who had suffered fracture of the base of the skull, fracture
of the jaw, and compound fracture of the right humerus. There was high
delirium followed by imbecility in this case. Bonnet reports a case of
fracture of both thighs, two right ribs, luxation of the clavicle, and
accidental club-foot with tenotomy, with good recovery from all the
complications. Beach speaks of an individual who suffered fracture of
both thighs, and compound comminuted fracture of the tibia, fibula, and
tarsal bones into the ankle-joint, necessitating amputation of the leg.
The patient not only survived the operation, but recovered with good
union in both thighs. As illustrative of the numerous fractures a
person may sustain at one time, the London Medical Gazette mentions an
injury to a girl of fourteen, which resulted in 31 fractures.

Remarkable Falls.--In this connection it is of interest to note from
how great a height a person may fall without sustaining serious injury.
A remarkable fall of a miner down 100 meters of shaft (about 333 feet)
without being killed is recorded by M.  Reumeaux in the Bulletin de
l'Industrie Minerale. Working with his brother in a gallery which
issued on the shaft, he forgot the direction in which he was pushing a
truck; so it went over, and he after it, falling into some mud with
about three inches of water. As stated in Nature, he seems neither to
have struck any of the wood debris, nor the sides of the shaft, and he
showed no contusions when he was helped out by his brother after about
ten minutes. He could not, however, recall any of his impressions
during the fall. The velocity on reaching the bottom would be about 140
feet, and time of fall 4.12 seconds; but it is thought he must have
taken longer. It appears strange that he should have escaped simple
suffocation and loss of consciousness during a time sufficient for the
water to have drowned him.

While intoxicated Private Gough of the 42d Royal Highlanders attempted
to escape from the castle at Edinburgh. He fell almost perpendicularly
170 feet, fracturing the right frontal sinus, the left clavicle, tibia,
and fibula. In five months he had so far recovered as to be put on duty
again, and he served as an efficient soldier. There is an account of
recovery after a fall of 192 feet, from a cliff in County Antrim,
Ireland. Manzini mentions a man who fell from the dome of the Invalides
in Paris, without sustaining any serious accident, and there is a
record from Madrid of a much higher fall than this without serious
consequence. In 1792 a bricklayer fell from the fourth story of a high
house in Paris, landing with his feet on the dirt and his body on
stone. He bled from the nose, and lost consciousness for about
forty-five minutes; he was carried to the Hotel-Dieu where it was found
that he had considerable difficulty in breathing; the regions about the
external malleoli were contused and swollen, but by the eighth day the
patient had recovered. In the recent reparation of the Hotel Raleigh in
Washington, D.C., a man fell from the top of the building, which is
above the average height, fracturing several ribs and rupturing his
lung. He was taken to the Emergency Hospital where he was put to bed,
and persistent treatment for shock was pursued; little hope of the
man's recovery was entertained. His friends were told of his apparently
hopeless condition. There were no external signs of the injury with the
exception of the emphysema following rupture of the lung. Respiration
was limited and thoracic movement diminished by adhesive straps and a
binder; under careful treatment the man recovered.

Kartulus mentions an English boy of eight who, on June 1, 1879, while
playing on the terrace in the third story of a house in Alexandria, in
attempting to fly a kite in company with an Arab servant, slipped and
fell 71 feet to a granite pavement below. He was picked up conscious,
but both legs were fractured about the middle. He had so far recovered
by the 24th of July that he could hobble about on crutches. On the 15th
of November of the same year he was seen by Kartulus racing across the
playground with some other boys; as he came in third in the race he had
evidently lost little of his agility. Parrott reports the history of a
man of fifty, weighing 196 pounds, who fell 110 feet from the steeple
of a church. In his descent he broke a scaffold pole in two, and fell
through the wooden roof of an engine-house below, breaking several
planks and two strong joists, and landing upon some sacks of cement
inside the house. When picked up he was unconscious, but regained his
senses in a short time, and it was found that his injuries were not
serious. The left metacarpal bones were dislocated from the carpal
bones, the left tibia was fractured, and there were contusions about
the back and hips. Twelve days later he left for home with his leg in
plaster. Farber and McCassy report a case in which a man fell 50 feet
perpendicularly through an elevator shaft, fracturing the skull. Pieces
of bone at the superior angle of the occipital bone were removed,
leaving the aura exposed for a space one by four inches. The man was
unconscious for four days, but entirely recovered in eighteen days,
with only a slightly subnormal hearing as an after-effect of his fall.

For many years there have been persons who have given exhibitions of
high jumps, either landing in a net or in the water. Some of these
hazardous individuals do not hesitate to dive from enormous heights,
being satisfied to strike head first or to turn a somersault in their
descent. Nearly all the noted bridges in this country have had their
"divers." The death of Odlum in his attempt to jump from Brooklyn
bridge is well known. Since then it has been claimed that the feat has
been accomplished without any serious injury. It is reported that on
June 20, 1896, a youth of nineteen made a headlong dive from the top of
the Eads bridge at St. Louis, Mo., a distance of 125 feet. He is said
to have swum 250 feet to a waiting tug, and was taken on board without
having been hurt.

Probably the most interesting exhibition of this kind that was ever
seen was at the Royal Aquarium, London, in the summer of 1895. A part
of the regular nightly performance at this Hall, which is familiar on
account of its immensity, was the jump of an individual from the
rafters of the large arched roof into a tank of water about 15 by 20
feet, and from eight to ten feet deep, sunken in the floor of the hall.
Another performer, dressed in his ordinary street clothes, was tied up
in a bag and jumped about two-thirds of this height into the same tank,
breaking open the bag and undressing himself before coming to the
surface. In the same performance a female acrobat made a backward dive
from the topmost point of the building into a net stretched about ten
feet above the floor. Nearly every large acrobatic entertainment has
one of these individuals who seem to experience no difficulty in
duplicating their feats night after night.

It is a common belief that people falling from great heights die in the
act of descent. An interview with the sailor who fell from the
top-gallant of an East Indiaman, a height of 120 feet, into the water,
elicited the fact that during the descent in the air, sensation
entirely disappeared, but returned in a slight degree when he reached
the water, but he was still unable to strike out when rising to the
surface. By personal observation this man stated that he believed that
if he had struck a hard substance his death would have been painless,
as he was sure that he was entirely insensible during the fall.

A writer in the Pall Mall Gazette, in speaking of the accidents which
had happened in connection with the Forth Bridge, tells of a man who
trusted himself to work at the height of 120 feet above the waters of
the Firth, simply grasping a rope. His hands became numb with cold, his
grasp relaxed, and he fell backward down into the water, but was
brought out alive. In another instance a spanner fell a distance of 300
feet, knocked off a man's cap, and broke its way through a four-inch
plank. Again, another spanner fell from a great height, actually
tearing off a man's clothes, from his waistcoat to his ankle, but
leaving him uninjured. On another occasion a staging with a number of
workmen thereon gave way. Two of the men were killed outright by
striking some portion of the work in their descent; two others fell
clear of the girders, and were rescued from the Firth little worse for
their great fall.

Resistance of Children to Injuries.--It is a remarkable fact that young
children, whose bones, cartilages, and tissues are remarkably elastic,
are sometimes able to sustain the passage over their bodies of vehicles
of great weight without apparent injury. There is a record early in
this century of a child of five who was run over across the epigastrium
by a heavy two-wheeled cart, but recovered without any bad symptoms.
The treatment in this case is quite interesting, and was as follows:
venesection to faintness, castor oil in infusion of senna until there
was a free evacuation of the bowels, 12 leeches to the abdomen and
spine, and a saline mixture every two hours! Such depleting
therapeutics would in themselves seem almost sufficient to provoke a
fatal issue, and were given in good faith as the means of effecting a
recovery in such a case. In a similar instances a wagon weighing 1200
pounds passed over a child of five, with no apparent injury other than
a bruise near the ear made by the wheel.

Infant-vitality is sometimes quite remarkable, a newly-born child
sometimes surviving extreme exposure and major injuries. There was a
remarkable instance of this kind brought to light in the Mullings vs.
Mullings divorce-case, recorded in The Lancet. It appeared that Mrs.
Mullings, a few hours after her confinement at Torquay, packed her
newly-born infant boy in a portmanteau, and started for London. She had
telegraphed Dr. J. S. Tulloch to meet her at Paddington, where he found
his patient apparently in good condition, and not weak, as he expected
in a woman shortly to be confined. On the way to her apartments, which
had been provided by Dr. Tulloch, Mrs. Mullings remarked to the Doctor
that she had already borne her child. Dr. Tulloch was greatly
surprised, and immediately inquired what she had done with the baby.
She replied that it was in a box on top of the cab. When the box was
opened the child was found alive. The Lancet comments on the remarkable
fact that, shortly after confinement, a woman can travel six or seven
hours in a railroad train, and her newly-born babe conveyed the same
distance in a portmanteau, without apparent injury, and without
attracting attention.

Booth reports a remarkable case of vitality of a newly-born child which
came under his observation in October, 1894. An illegitimate child,
abandoned by its mother, was left at the bottom of a cesspool vault;
she claimed that ten hours before Booth's visit it had been
accidentally dropped during an attempt to micturate. The infant lived
despite the following facts: Its delivery from an ignorant,
inexperienced, unattended negress; its cord not tied; its fall of 12
feet down the pit; its ten hours' exposure in the cesspool; its
smothering by foul air, also by a heavy covering of rags, paper, and
straw; its pounding by three bricks which fell in directly from eight
feet above (some loose bricks were accidentally dislodged from the
sides of the vault, in the maneuvers to extricate the infant); its
lowered temperature previous to the application of hot bottles,
blankets, and the administration of cardiac stimulants. Booth adds that
the morning after its discovery the child appeared perfectly well, and
some two months afterward was brought into court as evidence in the
case. A remarkable case of infant vitality is given on page 117.

Operations in the Young and Old.--It might be of interest to mention
that such a major operation as ovariotomy has been successfully
performed in an infant. In a paper on infant ovariotomy, several
instances of this nature are mentioned.  Roemer successfully performed
ovariotomy on a child one year and eight months old; Swartz, on a child
of four; Barker, on a child of four; Knowsley Thornton, on a child of
seven, and Spencer Wells Cupples, and Chenoweth, on children of eight.
Rein performed ovariotomy on a girl of six, suffering from a
multilocular cyst of the left ovary. He expresses his belief that
childhood and infancy are favorable to laparotomy.

Kidd removed a dermoid from a child of two years and eleven months;
Hooks performed the same operation on a child of thirty months. Chiene
extirpated an ovary from a child of three; Neville duplicated this
operation in a child one month younger; and Alcock performed ovariotomy
on a child of three.

Successful ovariotomies are infrequent in the extremely aged.  Bennett
mentions an instance in a woman of seventy-five, and Davies records a
similar instance. Borsini and Terrier cite instances of successful
ovariotomy in patients of seventy-seven.  Carmichael performed the
operation at seventy-four. Owens mentions it at eighty; and Homans at
eighty-two years and four months. Dewees records a successful case of
ovariotomy in a woman over sixty-seven; McNutt reports a successful
instance in a patient of sixty-seven years and six months; the tumor
weighed 60 pounds, and there were extensive adhesions. Maury removed a
monocystic ovarian tumor from a woman of seventy-four, his patient
recovering. Pippingskold mentions an ovariotomy at eighty. Terrier
describes double ovariotomy for fibromata in a woman of seventy-seven.
Aron speaks of an operation for pilous dermoid of the ovary in a woman
of seventy-five. Shepherd reports a case of recurrent proliferous cyst
in a woman of sixty-three, on whom successful ovariotomy was performed
twice within nine months. Wells mentions an ovarian cyst in a woman of
sixty-five, from which 72 pints of fluid were removed.

Hawkins describes the case of a musician, M. Rochard, who at the age of
one hundred and seven was successfully operated on for strangulated
hernia of upward of thirty hours' duration. The wound healed by first
intention, and the man was well in two weeks. Fowler operated
successfully for strangulated umbilical hernia on a patient of
sixty-eight.

Repeated Operations.--Franzolini speaks of a woman of fifty on whom he
performed six celiotomies between June, 1879, and April, 1887. The
first operation was for fibrocystic disease of the uterus. Since the
last operation the woman had had remarkably good health, and there was
every indication that well-merited recovery had been effected. The
Ephemerides contains an account of a case in which cystotomy was
repeated four times, and there is another record of this operation
having been done five times on a man. Instances of repeated Cesarean
section are mentioned on page 130.

Before leaving this subject, we mention a marvelous operation performed
by Billroth on a married woman of twenty-nine, after her sixth
pregnancy. This noted operator performed, synchronously, double
ovariotomy and resections of portions of the bladder and ileum, for a
large medullary carcinomatous growth of the ovary, with surrounding
involvement. Menstruation returned three months after the operation,
and in fifteen months the patient was in good health in every way, with
no apparent danger of recurrence of the disease.

Self-performed Surgical Operations.--There have been instances in which
surgeons and even laymen have performed considerable operations upon
themselves. On the battlefield men have amputated one of their own
limbs that had been shattered. In such cases there would be little
pain, and premeditation would not be brought into play in the same
degree as in the case of M. Clever de Maldigny, a surgeon in the Royal
Guards of France, who successfully performed a lithotomy on himself
before a mirror. He says that after the operation was completed the
urine flowed in abundance; he dressed the wound with lint dipped in an
emollient solution, and, being perfectly relieved from pain, fell into
a sound sleep. On the following day, M. Maldigny says, he was as
tranquil and cheerful as if he had never been a sufferer. A Dutch
blacksmith and a German cooper each performed lithotomy on themselves
for the intense pain caused by a stone in the bladder.  Tulpius,
Walther, and the Ephemerides each report an instance of self-performed
cystotomy.

The following case is probably the only instance in which the patient,
suffering from vesical calculus, tried to crush and break the stone
himself. J. B., a retired draper, born in 1828, while a youth of
seventeen, sustained a fracture of the leg, rupture of the urethra, and
laceration of the perineum, by a fall down a well, landing astride an
iron bar. A permanent perineal fistula was established, but the patient
was averse to any operative remedial measure. In the year 1852 he
became aware of the presence of a calculus, but not until 1872 did he
ask for medical assistance. He explained that he had introduced a
chisel through his perineal fistula to the stone, and attempted to
comminute it himself and thus remove it, and by so doing had removed
about an ounce of the calculus. The physician started home for his
forceps, but during the interval, while walking about in great pain,
the man was relieved by the stone bursting through the perineum,
falling to the floor, and breaking in two.  Including the ounce already
chiselled off, the stone weighed 14 1/2 ounces, and was 10 5/8 inches
in its long circumference. B.  recovered and lived to December, 1883,
still believing that he had another piece of stone in his bladder.

In Holden's "Landmarks" we are told that the operation of dividing the
Achilles tendon was first performed by an unfortunate upon himself, by
means of a razor. According to Patterson, the late Mr. Symes told of a
patient in North Scotland who, for incipient hip-disease, had the
cautery applied at the Edinburgh Infirmary with resultant great relief.
After returning home to the country he experienced considerable pain,
and despite his vigorous efforts he was unable to induce any of the men
to use the cautery upon him; they termed it "barbarous treatment." In
desperation and fully believing in the efficacy of this treatment as
the best means of permanently alleviating his pain, the crippled
Scotchman heated a poker and applied the cautery himself.

We have already mentioned the marvelous instances of Cesarean sections
self-performed, and in the literature of obstetric operations many of
the minor type have been done by the patient herself. In the foregoing
cases it is to be understood that the operations have been performed
solely from the inability to secure surgical assistance or from the
incapacity to endure the pain any longer. These operations were not the
self-mutilations of maniacs, but were performed by rational persons,
driven to desperation by pain.

Possibly the most remarkable instances of extensive loss of blood, with
recoveries, are to be found in the older records of venesection. The
chronicles of excessive bleeding in the olden days are well known to
everybody. Perhaps no similar practice was so universally indulged in.
Both in sickness and in health, depletion was indicated, and it is no
exaggeration to say that about the hospital rooms at times the floors
were covered with blood. The reckless way in which venesection was
resorted to, led to its disuse, until to-day it has so vanished from
medical practice that even its benefits are overlooked, and depletion
is brought about in some other manner. Turning to the older writers, we
find Burton describing a patient from whom he took 122 ounces of blood
in four days. Dover speaks of the removal of 111 and 190 ounces; Galen,
of six pounds; and Haen, of 114 ounces. Taylor relates the history of a
case of asphyxia in which he produced a successful issue by extracting
one gallon of blood from his patient during twelve hours. Lucas speaks
of 50 venesections being practiced during one pregnancy. Van der Wiel
performed venesection 49 times during a single pregnancy. Balmes
mentions a case in which 500 venesections were performed in twenty-five
years. Laugier mentions 300 venesections in twenty-six months.
Osiander speaks of 8000 ounces of blood being taken away in thirty-five
years. Pechlin reports 155 venesections in one person in sixteen years,
and there is a record of 1020 repeated venesections.

The loss of blood through spontaneous hemorrhage is sometimes
remarkable. Fabricius Hildanus reports the loss of 27 pounds of blood
in a few days; and there is an older record of 40 pounds being lost in
four days. Horstius, Fabricius Hildanus, and Schenck, all record
instances of death from hemorrhage of the gums. Tulpius speaks of
hemoptysis lasting chronically for thirty years, and there is a similar
record of forty years' duration in the Ephemerides. Chapman gives
several instances of extreme hemorrhage from epistaxis. He remarks that
Bartholinus has recorded the loss of 48 pounds of blood from the nose;
and Rhodius, 18 pounds in thirty-six hours. The Ephemerides contains an
account of epistaxis without cessation for six weeks. Another writer in
an old journal speaks of 75 pounds of blood from epistaxis in ten days.
Chapman also mentions a case in which, by intestinal hemorrhage, eight
gallons of blood were lost in a fortnight, the patient recovering. In
another case a pint of blood was lost daily for fourteen days, with
recovery. The loss of eight quarts in three days caused death in
another case; and Chapman, again, refers to the loss of three gallons
of blood from the bowel in twenty-four hours. In the case of
Michelotti, recorded in the Transactions of the Royal Society, a young
man suffering from enlargement of the spleen vomited 12 pounds of blood
in two hours, and recovered.

In hemorrhoidal hemorrhages, Lieutaud speaks of six quarts being lost
in two days; Hoffman, of 20 pounds in less than twenty-four hours, and
Panaroli, of the loss of one pint daily for two years.

Arrow-Wounds.--According to Otis the illustrious Baron Percy was wont
to declare that military surgery had its origin in the treatment of
wounds inflicted by darts and arrows; he used to quote Book XI of the
Iliad in behalf of his belief, and to cite the cases of the patients of
Chiron and Machaon, Menelaus and Philoctetes, and Eurypiles, treated by
Patroclus; he was even tempted to believe with Sextus that the name
iatros, medicus, was derived from ios, which in the older times
signified "sagitta," and that the earliest function of our professional
ancestors was the extraction of arrows and darts. An instrument called
beluleum was invented during the long Peloponnesian War, over four
hundred years before the Christian era. It was a rude
extracting-forceps, and was used by Hippocrates in the many campaigns
in which he served. His immediate successor, Diocles, invented a
complicated instrument for extracting foreign bodies, called
graphiscos, which consisted of a canula with hooks. Otis states that it
was not until the wars of Augustus that Heras of Cappadocia designed
the famous duck-bill forceps which, with every conceivable
modification, has continued in use until our time. Celsus instructs
that in extracting arrow-heads the entrance-wound should be dilated,
the barb of the arrow-head crushed by strong pliers, or protected
between the edges of a split reed, and thus withdrawn without
laceration of the soft parts. According to the same authority, Paulus
Aegineta also treated fully of wounds by arrow-heads, and described a
method used in his time to remove firmly-impacted arrows. Albucasius
and others of the Arabian school did little or nothing toward aiding
our knowledge of the means of extracting foreign bodies. After the
fourteenth century the attention of surgeons was directed to wounds
from projectiles impelled by gunpowder. In the sixteenth century arrows
were still considerably used in warfare, and we find Pare a delineating
the treatment of this class of injuries with the sovereign good sense
that characterized his writings. As the use of firearms became
prevalent the literature of wounds from arrows became meager, and the
report of an instance in the present day is very rare.

Bill has collected statistics and thoroughly discussed this subject,
remarking upon the rapidity with which American Indians discharge their
arrows, and states that it is exceptional to meet with only a single
wound. It is commonly believed that the Indian tribes make use of
poisoned arrows, but from the reports of Bill and others, this must be
a very rare custom. Ashhurst states that he was informed by Dr. Schell,
who was stationed for some time at Fort Laramie, that it is the
universal custom to dip the arrows in blood, which is allowed to dry on
them; it is not, therefore, improbable that septic material may thus be
inoculated through a wound.

Many savage tribes still make use of the poisonous arrow. The Dyak uses
a sumpitan, or blow-tube, which is about seven feet long, and having a
bore of about half an inch. Through this he blows his long, thin dart,
anointed on the head with some vegetable poison. Braidwood speaks of
the physiologic action of Dajaksch, an arrow-poison used in Borneo.
Arnott has made observations relative to a substance produced near
Aden, which is said to be used by the Somalies to poison their arrows.
Messer of the British Navy has made inquiries into the reputed
poisonous nature of the arrows of the South Sea Islanders.

Otis has collected reports of arrow-wounds from surgical cases
occurring in the U. S. Army. Of the multiple arrow-wounds, six out of
the seven cases were fatal. In five in which the cranial cavity was
wounded, four patients perished. There were two remarkable instances of
recovery after penetration of the pleural cavity by arrows. The great
fatality of arrow-wounds of the abdomen is well known, and, according
to Bill, the Indians always aim at the umbilicus; when fighting
Indians, the Mexicans are accustomed to envelop the abdomen, as the
most vulnerable part, in many folds of a blanket.

Of the arrow-wounds reported, nine were fatal, with one exception, in
which the lesion implicated the soft parts only.  The regions injured
were the scalp, face, and neck, in three instances; the parietes of the
chest in six; the long muscles of the back in two; the abdominal
muscles in two; the hip or buttocks in three; the testis in one; the
shoulder or arm in 13; forearm or hand in six; the thigh or leg in
seven.

The force with which arrows are projected by Indians is so great that
it has been estimated that the initial velocity nearly equals that of a
musket-ball. At a short distance an arrow will perforate the larger
bones without comminuting them, causing a slight fissure only, and
resembling the effect of a pistol-ball fired through a window-glass a
few yards off.

Among extraordinary cases of recovery from arrow-wounds, several of the
most striking will be recorded. Tremaine mentions a sergeant of
thirty-four who, in a fray with some hostile Indians, received seven
arrow-wounds: two on the anterior surface of the right arm; one in the
right axilla; one on the right side of the chest near the axillary
border; two on the posterior surface of the left arm near the
elbow-joint, and one on the left temple. On June 1st he was admitted to
the Post Hospital at Fort Dodge, Kan.  The wound on the right arm near
the deltoid discharged, and there was slight exfoliation of the
humerus. The patient was treated with simple dressings, and was
returned to duty in July, 1870.

Goddard mentions an arrow-wound by which the body was transfixed.  The
patient was a cutler's helper at Fort Rice, Dakota Territory.  He was
accidentally wounded in February, 1868, by an arrow which entered the
back three inches to the right of the 5th lumbar vertebra, and emerged
about two inches to the right of the ensiform cartilage. During the
following evening the patient lost about eight ounces of blood
externally, with a small amount internally. He was confined to his bed
some two weeks, suffering from circumscribed peritonitis with
irritative fever. In four weeks he was walking about, and by July 1st
was actively employed. The arrow was deposited in the Army Medical
Museum.

Muller gives a report of an arrow-wound of the lung which was
productive of pleurisy but which was followed by recovery. Kugler
recites the description of the case of an arrow-wound of the thorax,
complicated by frightful dyspnea and blood in the pleural cavity and in
the bronchi, with recovery.

Smart extracted a hoop-iron arrow-head, 1 3/4 inches long and 1/2 inch
in breadth, from the brain of a private, about a month after its
entrance. About a dram of pus followed the exit of the arrow-head.
After the operation the right side was observed to be paralyzed, and
the man could not remember his name. He continued in a varying
condition for a month, but died on May 13, 1866, fifty-two days after
the injury. At the postmortem it was found that the brain-tissue, to
the extent of 3/4 inch around the track of the arrow as a center, was
softened and disorganized. The track itself was filled with thick pus
which extended into the ventricles.

Peabody reports a most remarkable case of recovery from multiple
arrow-wounds. In a skirmish with some Indians on June 3, 1863, the
patient had been wounded by eight distinct arrows which entered
different parts of the body. They were all extracted with the exception
of one, which had entered at the outer and lower margin of the right
scapula, and had passed inward and upward through the upper lobe of the
right lung or trachea. The hemorrhage at this time was so great that
all hope was abandoned.  The patient, however, rallied, but continued
to experience great pain on swallowing, and occasionally spat blood. In
July, 1866, more than three years after the injury, he called on Dr.
Peabody to undergo an examination with a view of applying for a
pension, stating that his health was affected from the presence of an
arrow-head. He was much emaciated, and expressed himself as tired of
life. Upon probing through a small fistulous opening just above the
superior end of the sternum, the point of the arrow was found resting
against the bone, about 1 1/2 inches below, the head lying against the
trachea and esophagus, with the carotid artery, jugular vein, and
nerves overlying. After some little difficulty the point of the arrow
was raised above the sternum, and it was extracted without the loss of
an ounce of blood. The edge grazed against the sheath of the innominate
artery during the operation. The missile measured an inch at the base,
and was four inches long. The health of the patient underwent
remarkable improvement immediately after the operation.

Serious Insect-stings.--Although in this country the stings of insects
are seldom productive of serious consequences, in the tropic climates
death not unfrequently results from them. Wounds inflicted by large
spiders, centipedes, tarantulae, and scorpions have proved fatal. Even
in our country deaths, preceded by gangrene, have sometimes followed
the bite of a mosquito or a bee, the location of the bite and the
idiosyncrasy of the individual probably influencing the fatal issue. In
some cases, possibly, some vegetable poison is introduced with the
sting.  Hulse, U.S.N., reports the case of a man who was bitten on the
penis by a spider, and who subsequently exhibited violent symptoms
simulating spinal meningitis, but ultimately recovered.  Kunst mentions
a man of thirty-six who received several bee-stings while taking some
honey from a tree, fell from the tree unconscious, and for some time
afterward exhibited signs of cerebral congestion. Chaumeton mentions a
young man who did not perceive a wasp in a glass of sweet wine, and
swallowed the insect. He was stung in the throat, followed by such
intense inflammation that the man died asphyxiated in the presence of
his friends, who could do nothing to relieve him. In connection with
this case there is mentioned an English agriculturist who saved the
life of one of his friends who had inadvertently swallowed a wasp with
a glass of beer. Alarming symptoms manifested themselves at the moment
of the sting. The farmer made a kind of paste from a solution of common
salt in as little water as possible, which he gave to the young man,
and, after several swallows of the potion, the symptoms disappeared as
if by enchantment. There is a recent account from Bridgeport, Conn., of
a woman who, while eating a pear, swallowed a hornet that had alighted
on the fruit. In going down the throat the insect stung her on the
tonsil. Great pain and inflammation followed, and in a short time there
was complete deprivation of the power of speech.

Mease relates the case of a corpulent farmer who, in July, 1835, was
stung upon the temple by a common bee. He walked to a fence a short
distance away, thence to his house, 20 yards distant, lay down, and
expired in ten minutes. A second case, which occurred in June, 1811, is
also mentioned by Mease. A vigorous man was stung in the septum of the
nose by a bee. Supported by a friend he walked to his house, a few
steps distant, and lay down. He rose immediately to go to the well,
stepped a few paces, fell, and expired. It was thirty minutes from the
time of the accident to the man's death. A third case is reported by
the same author from Kentucky. A man of thirty-five was stung on the
right superior palpebrum, and died in twenty minutes. Mease reports a
fourth ease from Connecticut, in which a man of twenty-six was stung by
a bee on the tip of the nose. He recovered after treatment with
ten-grain doses of Dover's Powder, and persistent application of
plantain leaves. A fifth case was that of a farmer in Pennsylvania who
was stung in the left side of the throat by a wasp which he had
swallowed in drinking cider. Notwithstanding medical treatment, death
ensued twenty-seven hours afterward. A sixth case, which occurred in
October, 1834, is given by the same author. A middle-aged man was stung
by a yellow wasp on the middle finger of the right hand, and died in
less than twenty minutes after having received his wound. A seventh
case was that of a New York farmer who, while hoeing, was bitten on the
foot by a spider. Notwithstanding medical treatment, principally
bleeding, the man soon expired.

Desbrest mentions the sting of a bee above the eyebrow followed by
death. Zacutus saw a bee-sting which was followed by gangrene.
Delaistre mentions death from a hornet-sting in the palate.  Nivison
relates the case of a farmer of fifty who was stung in the neck by a
bee. The usual swelling and discoloration did not follow, but
notwithstanding vigorous medical treatment the man died in six days.
Thompson relates three cases of bee-sting, in all of which death
supervened within fifteen minutes,--one in a farmer of fifty-eight who
was stung in the neck below the right ear; a second in an inn-keeper of
fifty who was stung in the neck, and a third of a woman of sixty-four
who was stung on the left brow. "Chirurgus" recalls the details of a
case of a wasp-sting in the middle finger of the right hand of a man of
forty, depriving him of all sense and of muscular power. Ten minutes
after receiving it he was unconscious, his heart-beats were feeble, and
his pulse only perceptible.

Syphilis from a Flea-bite.--Jonathan Hutchinson, in the October, 1895,
number of his unique and valuable Archives of Surgery, reports a
primary lesion of most unusual origin. An elderly member of the
profession presented himself entirely covered with an evident
syphilitic eruption, which rapidly disappeared under the use of
mercury. The only interest about the case was the question as to how
the disease had been acquired. The doctor was evidently anxious to give
all the information in his power, but was positive that he had never
been exposed to any sexual risk, and as he had retired from practice,
no possibility of infection in that manner existed. He willingly
stripped, and a careful examination of his entire body surface revealed
no trace of lesion whatever on the genitals, or at any point, except a
dusky spot on one leg, which looked like the remains of a boil. This,
the doctor stated, had been due to a small sore, the dates of the
appearance and duration of which were found to fit exactly with those
of a primary lesion. There had also been some enlargement of the
femoral glands. He had never thought of the sore in this connection,
but remembered most distinctly that it followed a flea-bite in an
omnibus, and had been caused, as he supposed, by his scratching the
place, though he could not understand why it lasted so long. Mr.
Hutchinson concludes that all the evidence tends to show that the
disease had probably been communicated from the blood of an infected
person through the bite of the insect. It thus appears that even the
proverbially trivial fleabite may at times prove a serious injury.

Snake-bites.--A writer in an Indian paper asserts that the traditional
immunity of Indian snake-charmers is due to the fact that having been
accidentally bitten by poisonous serpents or insects more than once,
and having survived the first attack, they are subsequently immune. His
assertion is based on personal acquaintance with Madari Yogis and
Fakirs, and an actual experiment made with a Mohammedan Fakir who was
immune to the bites of scorpions provided by the writer. The animals
were from five to seven inches long and had lobster-like claws. Each
bite drew blood, but the Fakir was none the worse.

The venom of poisonous snakes may be considered the most typical of
animal poisons, being unrivaled in the fatality and rapidity of its
action. Fortunately in our country there are few snake-bites, but in
the tropic countries, particularly India, the mortality from this cause
is frightful. Not only are there numerous serpents in that country, but
the natives are lightly dressed and unshod, thus being exposed to the
bites of the reptiles. It is estimated by capable authorities that the
deaths in India each year from snake-bites exceed 20,000. It is stated
that there were 2893 human beings killed by tigers, leopards, hyenas,
and panthers in India during the year 1894, and in the same year the
same species of beasts, aided by snakes, killed 97,371 head of cattle.
The number of human lives destroyed by snakes in India in 1894 was
21,538. The number of wild beasts killed in the same year was 13,447,
and the number of snakes killed was 102,210.

Yarrow of Washington, who has been a close student of this subject, has
found in this country no less than 27 species of poisonous snakes,
belonging to four genera. The first genus is the Crotalus, or
rattlesnake proper; the second is the Caudisona, or ground-rattlesnake;
the third is the Ancistrodon, or moccasin, one of the species of which
is a water-snake; and the fourth is the Elaps, or harlequin snake.
There is some dispute over the exact degree of the toxic qualities of
the venom of the Heloderma suspectum, or Gila monster. In India the
cobra is the most deadly snake. It grows to the length of 5 1/2 feet,
and is most active at night. The Ophiophagus, or hooded cobra, is one
of the largest of venomous snakes, sometimes attaining a length of 15
feet; it is both powerful, active, and aggressive. The common snakes of
the deadly variety in the United States are the rattlesnake, the
"copperhead," and the moccasin; and it is from the bites of one of
these varieties that the great majority of reported deaths are caused.
But in looking over medical literature one is struck with the scarcity
of reports of fatal snake-bites. This is most likely attributable to
the fact that, except a few army-surgeons, physicians rarely see the
cases. The natural abode of the serpents is in the wild and uninhabited
regions.

The venom is delivered to the victim through the medium of a long fang
which is connected with a gland in which the poison is stored. The
supply may be readily exhausted; for a time the bite would then be
harmless. Contrary to the general impression, snake-venom when
swallowed is a deadly poison, as proved by the experiments of Fayrer,
Mitchell, and Reichert. Death is most likely caused by paralysis of the
vital centers through the circulation. In this country the wounds
invariably are on the extremities, while in India the cobra sometimes
strikes on the shoulder or neck.

If called on to describe accurately the symptoms of snake-venom
poisoning, few medical men could respond correctly. In most cases the
wound is painful, sometimes exaggerated by the mental condition, which
is wrought up to a pitch rarely seen in other equally fatal injuries.
It is often difficult to discern the exact point of puncture, so minute
is it. There is swelling due to effusion of blood, active inflammation,
and increasing pain.  If the poison has gained full entrance into the
system, in a short time the swelling extends, vesicles soon form, and
the disorganization of the tissues is so rapid that gangrene is liable
to intervene before the fatal issue. The patient becomes prostrated
immediately after the infliction of the wound, and his condition
strongly indicates the use of stimulants, even if the medical attendant
were unfamiliar with the history of the snake-bite. There may be a
slight delirium; the expression becomes anxious, the pulse rapid and
feeble, the respiration labored, and the patient complains of a sense
of suffocation.  Coma follows, and the respirations become slower and
slower until death results. If the patient lives long enough, the
discoloration of the extremity and the swelling may spread to the neck,
chest and back. Loss of speech after snake-bite is discussed in Chapter
XVII, under the head of Aphasia.

A peculiar complication is a distressing inflammation of the mouth of
individuals that have sucked the wounds containing venom. This custom
is still quite common, and is preferred by the laity to the surer and
much wiser method of immediate cauterization by fire. There is a
curious case reported of a young man who was bitten on the ankle by a
viper; he had not sucked the wound, but he presented such an enormous
swelling of the tongue as to be almost provocative of a fatal issue. In
this case the lingual swelling was a local effect of the general
constitutional disturbance.

Cases of Snake-bite.--The following case illustrative of the tenacity
of virulence of snake-venom was reported by Mr. Temple, Chief Justice
of Honduras, and quoted by a London authority.  While working at some
wood-cutting a man was struck on a heavy boot by a snake, which he
killed with an axe. He imagined that he had been efficiently protected
by the boot, and he thought little of the incident. Shortly afterward
he began to feel ill, sank into a stupor, and succumbed. His boots were
sold after his death, as they were quite well made and a luxury in that
country.  In a few hours the purchaser of the boots was a corpse, and
every one attributed his death to apoplexy or some similar cause. The
boots were again sold, and the next unfortunate owner died in an
equally short time. It was then thought wise to examine the boots, and
in one of them was found, firmly embedded, the fang of the serpent. It
was supposed that in pulling on the boots each of the subsequent owners
had scratched himself and became fatally inoculated with the venom,
which was unsuspected and not combated. The case is so strange as to
appear hypothetic, but the authority seems reliable.

The following are three cases of snake-bite reported by surgeons of the
United States Army, two followed by recovery, and the other by death:
Middleton mentions a private in the Fourth Cavalry, aged twenty-nine,
who was bitten by a rattlesnake at Fort Concho, Texas, June 27, 1866.
The bite opened the phalangeal joint of the left thumb, causing violent
inflammation, and resulted in the destruction of the joint. Three years
afterward the joint swelled and became extremely painful, and it was
necessary to amputate the thumb. Campbell reports the case of a private
of the Thirteenth Infantry who was bitten in the throat by a large
rattlesnake. The wound was immediately sucked by a comrade, and the man
reported at the Post Hospital, at Camp Cooke, Montana, three hours
after the accident. The only noticeable appearance was a slightly wild
look about the eyes, although the man did not seem to be the least
alarmed. The region of the wound was hard and somewhat painful,
probably from having been bruised by the teeth of the man who sucked
the wound; it remained so for about three hours. The throat was bound
up in rancid olive oil (the only kind at hand) and no internal remedy
was administered. There were no other bad consequences, and the patient
soon returned to duty.

Le Carpentier sends the report of a fatal case of rattlesnake-bite: A
private, aged thirty-seven, remarkable for the singularity of his
conduct, was known in his Company as a snake-charmer, as he had many
times, without injury, handled poisonous snakes. On the morning of July
13, 1869, he was detailed as guard with the herd at Fort Cummings, New
Mexico, when, in the presence of the herders, he succeeded in catching
a rattlesnake and proving his power as a sorcerer. The performance
being over and the snake killed, he caught sight of another of the same
class, and tried to duplicate his previous feat; but his dexterity
failed, and he was bitten in the middle finger of the right hand. He
was immediately admitted to the Post Hospital, complaining only of a
little pain, such as might follow the sting of a bee or wasp. A
ligature was applied above the wound; the two injuries made by the
fangs were enlarged by a bistoury; ammonia and the actual cautery were
applied; large doses of whiskey were repeated frequently, the
constitution of the patient being broken and poor. Vomiting soon came
on but was stopped without trouble, and there were doubts from the
beginning as to his recovery. The swelling of the hand and arm
gradually increased, showing the particular livid and yellowish tint
following the bites of poisonous snakes. A blister was applied to the
bitten finger, tincture of iodin used, and two ounces of whiskey given
every two hours until inebriety was induced. The pulse, which was very
much reduced at first, gained gradually under the influence of
stimulants; two grains of opium were given at night, the patient slept
well, and on the next day complained only of numbness in the arm. The
swelling had extended as far as the shoulder-joint, and the blood,
which was very fluid, was incessantly running from the wound. Carbolic
acid and cerate were applied to the arm, with stimulants internally. On
the 15th his condition was good, the swelling had somewhat augmented,
there was not so much lividity, but the yellowish hue had increased. On
the 16th the man complained of pain in the neck, on the side of the
affected limb, but his general condition was good. Examining his
genitals, an iron ring 3/4 inch in diameter was discovered, imbedded in
the soft tissues of the penis, constricting it to such a degree as to
have produced enormous enlargement of the parts. Upon inquiry it seemed
that the ring had been kept on the parts very long, as a means of
preservation of chastity; but under the influence of the snake's venom
the swelling had increased, and the patient having much trouble in
passing water was obliged to complain. The ring was filed off with some
difficulty. Gangrene destroyed the extremity of the bitten finger. From
this date until the 30th the man's condition improved somewhat. The
progress of the gangrene was stopped, and the injured finger was
disarticulated at the metacarpal articulation. Anesthesia was readily
obtained, but the appearance of the second stage was hardly
perceptible. Le Carpentier was called early on the next morning, the
patient having been observed to be sinking; there was stertorous
respiration, the pulse was weak and slow, and the man was only partly
conscious. Electricity was applied to the spine, and brandy and
potassium bromid were given, but death occurred about noon. A necropsy
was made one hour after death. There was general softening of the
tissues, particularly on the affected side. The blood was black and
very fluid,--not coagulable. The ventricles of the brain were filled
with a large amount of serum; the brain was somewhat congested. The
lungs were healthy, with the exception of a few crude tubercles of
recent formation on the left side. The right ventricle of the heart was
empty, and the left filled with dark blood, which had coagulated. The
liver and kidneys were healthy, and the gall-bladder very much
distended with bile. The intestines presented a few livid patches on
the outside.

Hydrophobia.--The bite of an enraged animal is always of great danger
to man, and death has followed a wound inflicted by domestic animals or
even fowls; a human bite has also caused a fatal issue. Rabies is
frequently observed in herbivorous animals, such as the ox, cow, or
sheep, but is most commonly found in the carnivore, such as the dog,
wolf, fox, jackal, hyena, and cat and other members of the feline
tribe. Fox reports several cases of death from symptoms resembling
those of hydrophobia in persons who were bitten by skunks. Swine,
birds, and even domestic poultry have caused hydrophobia by their
bites.  Le Cat speaks of the bite of an enraged duck causing death, and
Thiermeyer mentions death shortly following the bite of a goose, as
well as death in three days from a chicken-bite. Camerarius describes a
case of epilepsy which he attributed to a horse-bite.  Among the older
writers speaking of death following the bite of an enraged man, are van
Meek'ren, Wolff, Zacutus Lusitanus, and Glandorp. The Ephemerides
contains an account of hydrophobia caused by a human bite. Jones
reports a case of syphilitic inoculation from a human bite on the hand.

Hydrophobia may not necessarily be from a bite; a previously-existing
wound may be inoculated by the saliva alone, conveyed by licking.
Pliny, and some subsequent writers, attributed rabies to a worm under
the animal's tongue which they called "lytta." There is said to be a
superstition in India that, shortly after being bitten by a mad dog,
the victim conceives pups in his belly; at about three months these
move rapidly up and down the patient's intestines, and being mad like
their progenitor, they bite and bark incessantly, until they finally
kill the unfortunate victim. The natives of Nepaul firmly believe this
theory. All sorts of curious remedies have been suggested for the cure
of hydrophobia. Crabs-claws, Spanish fly, and dragon roots, given three
mornings before the new or full moon, was suggested as a specific by
Sir Robert Gordon. Theodore De Vaux remarks that the person bitten
should immediately pluck the feathers from the breech of an old cock
and apply them bare to the bites. If the dog was mad the cock was
supposed to swell and die. If the dog was not mad the cock would not
swell; in either case the person so treated was immune. Mad-stones, as
well as snake-stones, are believed in by some persons at the present
day.  According to Curran, at one time in Ireland the fear of
hydrophobia was so great that any person supposed to be suffering from
it could be legally smothered.

According to French statistics, hydrophobia is an extremely fatal
disease, although the proportion of people bitten and escaping without
infection is overwhelmingly greater than those who acquire the disease.
The mortality of genuine hydrophobia is from 30 to 80 per cent,
influenced by efficient and early cauterization and scientific
treatment. There is little doubt that many of the cases reported as
hydrophobia are merely examples of general systemic infection from a
local focus of sepsis, made possible by some primitive and uncleanly
treatment of the original wound. There is much superstition relative to
hydrophobia; the majority of wounds seen are filled with the hair of
the dog, soot, ham-fat, and also with particles of decayed food and
saliva from the mouth of some person who has practiced sucking the
wound.

Ordinarily, the period of incubation of hydrophobia in man is before
the end of the second month, although rarely cases are seen as many as
six months from the reception of the bite. The first symptoms of the
disease are melancholia, insomnia, loss of appetite, and occasionally
shooting pains, radiating from the wound. There may be severe pain at
the back of the head and in the neck. Difficulty in swallowing soon
becomes a marked symptom.  The speech assumes a sobbing tone, and
occasionally the expression of the face is wild and haggard. As regards
the crucial diagnostic test of a glass of water, the following account
of a patient's attempt to drink is given by Curtis and quoted by
Warren: "A glass of water was offered the patient, which he refused to
take, saying that he could not stand so much as that, but would take it
from a teaspoon. On taking the water from the spoon he evinced some
discomfort and agitation, but continued to raise the spoon. As it came
within a foot of his lips, he gagged and began to gasp violently, his
features worked, and his head shook. He finally almost tossed the water
into his mouth, losing the greater part of it, and staggered about the
room gasping and groaning. At this moment the respirations seemed
wholly costal, and were performed with great effort, the elbows being
jerked upward with every inspiration. The paroxysm lasted about half a
minute. The act of swallowing did not appear to cause distress, for he
could go through the motions of deglutition without any trouble. The
approach of liquid toward the mouth would, however, cause distress." It
is to be remarked that the spasm affects the mechanism of the
respiratory apparatus, the muscles of mastication and deglutition being
only secondarily contracted.

Pasteur discovered that the virulence of the virus of rabies could be
attenuated in passing it through different species of animals, and also
that inoculation of this attenuated virus had a decided prophylactic
effect on the disease; hence, by cutting the spinal cord of inoculated
animals into fragments a few centimeters long, and drying them, an
emulsion could be made containing the virus. The patients are first
inoculated with a cord fourteen days old, and the inoculation is
repeated for nine days, each time with a cord one day fresher. The
intensive method consists in omitting the weakest cords and giving the
inoculations at shorter intervals. As a curious coincidence, Pliny and
Pasteur, the ancient and modern, both discuss the particular virulence
of saliva during fasting.

There is much discussion over the extent of injury a shark-bite can
produce. In fact some persons deny the reliability of any of the
so-called cases of shark-bites. Ensor reports an interesting case
occurring at Port Elizabeth, South Africa. While bathing, an expert
swimmer felt a sharp pain in the thigh, and before he could cry out,
felt a horrid crunch and was dragged below the surface of the water. He
struggled for a minute, was twisted about, shaken, and then set free,
and by a supreme effort, reached the landing stairs of the jetty,
where, to his surprise, he found that a monstrous shark had bitten his
leg off. The leg had been seized obliquely, and the teeth had gone
across the joints, wounding the condyles of the femur. There were three
marks on the left side showing where the fish had first caught him. The
amputation was completed at once, and the man recovered.  Macgrigor
reports the case of a man at a fishery, near Manaar, who was bitten by
a shark. The upper jaw of the animal was fixed in the left side of the
belly, forming a semicircular wound of which a point one inch to the
left of the umbilicus was the upper boundary, and the lower part of the
upper third of the thigh, the lower boundary. The abdominal and lumbar
muscles were divided and turned up, exposing the colon in its passage
across the belly.  Several convolutions of the small intestines were
also laid bare, as were also the three lowest ribs. The gluteal muscles
were lacerated and torn, the tendons about the trochanter divided,
laying the bone bare, and the vastus externus and part of the rectus of
the thigh were cut across. The wound was 19 inches in length and four
or five inches in breadth. When Dr. Kennedy first saw the patient he
had been carried in a boat and then in a palanquin for over five miles,
and at this time, three hours after the reception of the wound, Kennedy
freed the abdominal cavity of salt water and blood, thoroughly cleansed
the wound of the hair and the clots, and closed it with adhesive
strips. By the sixteenth day the abdominal wound had perfectly closed,
the lacerations granulated healthily, and the man did well. Boyle
reports recovery from extensive lacerated wounds from the bite of a
shark. Both arms were amputated as a consequence of the injuries.
Fayrer mentions shark-bites in the Hooghley.

Leprosy from a Fish-bite.--Ashmead records the curious case of a man
that had lived many years in a leprous country, and while dressing a
fish had received a wound of the thumb from the fin of the fish.
Swelling of the arm followed, and soon after bullae upon the chest,
head, and face. In a few months the blotches left from this eruption
became leprous tubercles, and other well-marked signs of the malady
followed. The author asked if in this case we have to do with a latent
leprosy which was evoked by the wound, or if it were a case of
inoculation from the fish?

Cutliffe records recovery after amputation at the elbow-joint, as a
consequence of an alligator-bite nine days before admission to the
hospital. The patient exhibited a compound comminuted fracture of the
right radius and ulna in their lower thirds, compound comminuted
fractures of the bones of the carpus and metacarpus, with great
laceration of the soft parts, laying bare the wrist-joint, besides
several penetrating wounds of the arm and fore-arm. Mourray gives some
notes on a case of crocodile-bite with removal of a large portion of
omentum. Sircar speaks of recovery from a crocodile-bite. Dudgeon
reports two cases of animal-bites, both fatal, one by a bear, and the
other by a camel. There is mention of a compound dislocation of the
wrist-joint from a horse-bite. Fayrer speaks of a wolf-bite of the
forearm, followed by necrosis and hemorrhage, necessitating ligature of
the brachial artery and subsequent excision of the elbow-joint.

Injuries from Lightning.--The subject of lightning-stroke, with its
diverse range of injuries, is of considerable interest, and, though not
uncommon, the matter is surrounded by a veil of superstition and
mystery. It is well known that instantaneous or temporary
unconsciousness may result from lightning-stroke.  Sometimes
superficial or deep burns may be the sole result, and again paralysis
of the general nerves, such as those of sensation and motion, may be
occasioned. For many years the therapeutic effect of a lightning-stroke
has been believed to be a possibility, and numerous instances are on
record. The object of this article will be to record a sufficient
number of cases of lightning-stroke to enable the reader to judge of
its various effects, and form his own opinion of the good or evil of
the injury. It must be mentioned here that half a century ago Le Conte
wrote a most extensive article on this subject, which, to the present
time, has hardly been improved upon.

The first cases to be recorded are those in which there has been
complete and rapid recovery from lightning-stroke. Crawford mentions a
woman who, while sitting in front of her fireplace on the first floor
of a two-story frame building, heard a crash about her, and realized
that the house had been struck by lightning. The lightning had torn all
the weather-boarding off the house, and had also followed a spouting
which terminated in a wooden trough in a pig-sty, ten feet back of the
house, and killed a pig. Another branch of the fluid passed through the
inside of the building and, running along the upper floor to directly
over where Mrs. F. was sitting, passed through the floor and descended
upon the top of her left shoulder. Her left arm was lying across her
abdomen at the time, the points of the fingers resting on the crests of
the ilium. There was a rent in the dress at the top of the shoulder,
and a red line half an inch wide running from thence along the inside
of the arm and fore-arm. In some places there was complete vesication,
and on its palmer surface the hand lying on the abdomen was completely
denuded. The abdomen, for a space of four inches in length and eight
inches in breadth, was also blistered. The fluid then passed from the
fingers to the crest of the ilium, and down the outside of the leg,
bursting open the shoes, and passing then through the floor.  Again a
red line half an inch wide could be traced from the ilium to the toes.
The clothing was not scorched, but only slightly rent at the point of
the shoulder and where the fingers rested.  This woman was neither
knocked off her chair nor stunned, and she felt no shock at the time.
After ordinary treatment for her burns she made rapid and complete
recovery.

Halton reports the history of a case of a woman of sixty-five who,
about thirty-five minutes before he saw her, had been struck by
lightning. While she was sitting in an outbuilding a stroke of
lightning struck and shattered a tree about a foot distant. Then,
leaving the tree about seven feet from the ground, it penetrated the
wall of the building, which was of unplastered frame, and struck Mrs.
P. on the back of the head, at a point where her hair was done up in a
knot and fastened by two ordinary hair-pins. The hair was much
scorched, and under the knot the skin of the scalp was severely burned.
The fluid crossed, burning her right ear, in which was a gold ear-ring,
and then passed over her throat and down the left sternum, leaving a
burn three inches wide, covered by a blister. There was another burn,
12 inches long and three inches wide, passing from just above the crest
of the ilium forward and downward to the symphysis pubis. The next burn
began at the patella of the right knee, extending to the bottom of the
heel, upon reaching which it wound around the inner side of the leg.
About four inches below the knee a sound strip of cuticle, about 1 1/2
inches, was left intact. The lightning passed off the heel of the foot,
bursting open the heel of a strongly sewed gaiter-boot. The woman was
rendered unconscious but subsequently recovered.

A remarkable feature of a lightning-stroke is the fact that it very
often strips the affected part of its raiment, as in the previous case
in which the shoe was burst open. In a discussion before the Clinical
Society of London, October 24 1879, there were several instances
mentioned in which clothes had been stripped off by lightning. In one
case mentioned by Sir James Paget, the clothes were wet and the man's
skin was reeking with perspiration. In its course the lightning
traveled down the clothes, tearing them posteriorly, and completely
stripping the patient. The boots were split up behind and the laces
torn out.  This patient, however, made a good recovery. Beatson
mentions an instance in which an explosion of a shell completely tore
off the left leg of a sergeant instructor, midway between the knee and
ankle. It was found that the foot and lower third of the leg had been
completely denuded of a boot and woolen stocking, without any apparent
abrasion or injury to the skin. The stocking was found in the battery
and the boot struck a person some distance off. The stocking was much
torn, and the boot had the heel missing, and in one part the sole was
separated from the upper.  The laces in the upper holes were broken but
were still present in the lower holes. The explanation offered in this
case is similar to that in analogous cases of lightning-stroke, that
is, that the gas generated by the explosion found its way between the
limb and the stocking and boot and stripped them off.

There is a curious collection of relics, consisting of the clothes of a
man struck by lightning, artistically hung in a glass case in the
Museum of the Royal College of Surgeons, London, and the history of the
injury, of which these remnants are the result, is given by Professor
Stewart, the curator, as follows: At half past four on June 8, 1878,
James Orman and others were at work near Snave, in Romney Marsh, about
eight miles from Ashford. The men were engaged in lopping willows, when
the violence of the rain compelled them to take refuge under a hedge.
Three of the men entered a shed near by, but Orman remained by the
willow, close to the window of the shed. Scarcely were the three inside
when a lightning-stroke entered the door, crossed the shed, and passed
out the window, which it blew before it into the field. The men noticed
that the tree under which Orman stood was stripped of its bark. Their
companion's boots stood close to the foot of the tree, while the man
himself lay almost perfectly naked a few yards further on, calling for
help.  When they left him a few moments previously, he was completely
clad in a cotton shirt, cotton jacket, flannel vest, and cotton
trousers, secured at the waist with leather straps and buckles.  Orman
also wore a pair of stout hobnail boots, and had a watch and chain.
After the lightning-stroke, however, all he had on him was the left arm
of his flannel vest. The field was strewn for some distance with
fragments of the unfortunate man's clothing.  Orman was thrown down,
his eyebrows burned off, and his whiskers and beard much scorched. His
chest was covered with superficial burns, and he had sustained a
fracture of the leg. His strong boots were torn from his feet, and his
watch had a hole burned right through it, as if a soldering iron had
been used. The watch-chain was almost completely destroyed, only a few
links remaining. Together with some fused coins, these were found close
by, and are deposited in a closed box in the Museum. According to
Orman's account of the affair, he first felt a violent blow on the
chest and shoulders, and then he was involved in a blinding light and
hurled into the air. He said he never lost consciousness; but when at
the hospital he seemed very deaf and stupid. He was discharged
perfectly cured twenty weeks after the occurrence. The scientific
explanation of this amazing escape from this most eccentric vagary of
the electric fluid is given,--the fact that the wet condition of the
man's clothing increased its power of conduction, and in this way saved
his life. It is said that the electric current passed down the side of
Orman's body, causing everywhere a sudden production of steam, which by
its expansion tore the clothing off and hurled it away.  It is a
curious fact that where the flannel covered the man's skin the burns
were merely superficial, whereas in those parts touched by the cotton
trousers they were very much deeper. This case is also quoted and
described by Dr. Wilks.

There was a curious case of lightning-stroke reported at Cole Harbor,
Halifax. A diver, while at work far under the surface of the water, was
seriously injured by the transmission of a lightning-stroke, which
first struck the communicating air pump to which the diver was
attached. The man was brought to the surface insensible, but he
afterward recovered.

Permanent Effect of Lightning on the Nervous System.--MacDonald
mentions a woman of seventy-eight who, some forty-two years previous,
while ironing a cap with an Italian iron, was stunned by an extremely
vivid flash of lightning and fell back unconscious into a chair. On
regaining consciousness she found that the cap which she had left on
the table, remote from the iron, was reduced to cinders. Her clothes
were not burned nor were there any marks on the skin. After the stroke
she felt a creeping sensation and numbness, particularly in the arm
which was next to the table. She stated positively that in consequence
of this feeling she could predict with the greatest certainty when the
atmosphere was highly charged with electricity, as the numbness
increased on these occasions. The woman averred that shortly before or
during a thunder storm she always became nauseated. MacDonald offers as
a physiologic explanation of this case that probably the impression
produced forty-two years before implicated the right brachial plexus
and the afferent branches of the pneumogastric, and to some degree the
vomiting center in the medulla; hence, when the atmosphere was highly
charged with electricity the structures affected became more readily
impressed. Camby relates the case of a neuropathic woman of
thirty-eight, two of whose children were killed by lightning in her
presence. She herself was unconscious for four days, and when she
recovered consciousness, she was found to be hemiplegic and
hemianesthetic on the left side. She fully recovered in three weeks.
Two years later, during a thunder storm, when there was no evidence of
a lightning-stroke, she had a second attack, and three years later a
third attack under similar circumstances.

There are some ocular injuries from lightning on record. In these cases
the lesions have consisted of detachment of the retina, optic atrophy,
cataract, hemorrhages into the retina, and rupture of the choroid,
paralysis of the oculomotor muscles, and paralysis of the optic nerve.
According to Buller of Montreal, such injuries may arise from the
mechanic violence sustained by the patient rather than by the thermal
or chemic action of the current. Buller describes a case of
lightning-stroke in which the external ocular muscles, the crystalline
lens, and the optic nerve were involved. Godfrey reports the case of
Daniel Brown, a seaman on H.M.S. Cambrian. While at sea on February 21,
1799, he was struck both dumb and blind by a lightning-stroke. There
was evidently paralysis of the optic nerve and of the oculomotor
muscles; and the muscles of the glottis were also in some manner
deprived of motion.

That an amputation can be perfectly performed by a lightning-stroke is
exemplified in the case of Sycyanko of Cracow, Poland. The patient was
a boy of twelve, whose right knee was ankylosed. While riding in a
field in a violent storm, a loud peal of thunder caused the horse to
run away, and the child fell stunned to the ground. On coming to his
senses the boy found that his right leg was missing, the parts having
been divided at the upper end of the tibia. The wound was perfectly
round and the patella and femur were intact. There were other signs of
burns about the body, but the boy recovered. Some days after the injury
the missing leg was found near the place where he was first thrown from
the horse.

The therapeutic effect of lightning-stroke is verified by a number of
cases, a few of which will be given. Tilesius mentions a peculiar case
which was extensively quoted in London. Two brothers, one of whom was
deaf, were struck by lightning. It was found that the inner part of the
right ear near the tragus and anti-helix of one of the individuals was
scratched, and on the following day his hearing returned. Olmstead
quotes the history of a man in Carteret County, N.C., who was seized
with a paralytic affection of the face and eyes, and was quite unable
to close his lids. While in his bedroom, he was struck senseless by
lightning, and did not recover until the next day, when it was found
that the paralysis had disappeared, and during the fourteen years which
he afterward lived his affection never returned.  There is a record of
a young collier in the north of England who lost his sight by an
explosion of gunpowder, utterly destroying the right eye and fracturing
the frontal bone. The vision of the left eye was lost without any
serious damage to the organ, and this was attributed to shock. On
returning from Ettingshall in a severe thunder storm, he remarked to
his brother that he had seen light through his spectacles, and had
immediately afterward experienced a piercing sensation which had passed
through the eye to the back of the head. The pain was brief, and he was
then able to see objects distinctly. From this occasion he steadily
improved until he was able to walk about without a guide.

Le Conte mentions the case of a negress who was struck by lightning
August 19, 1842, on a plantation in Georgia. For years before the
reception of the shock her health had been very bad, and she seemed to
be suffering from a progressive emaciation and feebleness akin to
chlorosis. The difficulty had probably followed a protracted
amenorrhea, subsequent to labor and a retained placenta In the course
of a week she had recovered from the effects of lightning and soon
experienced complete restoration to health; and for two years had been
a remarkably healthy and vigorous laborer. Le Conte quotes five similar
cases, and mentions one in which a lightning-shock to a woman of
twenty-nine produced amenorrhea, whereas she had previously suffered
from profuse menstruation, and also mentions another case of a woman of
seventy who was struck unconscious; the catamenial discharge which had
ceased twenty years before, was now permanently reestablished, and the
shrunken mammae again resumed their full contour.

A peculiar feature or superstition as to lightning-stroke is its
photographic properties. In this connection Stricker of Frankfort
quotes the case of Raspail of a man of twenty-two who, while climbing a
tree to a bird's nest, was struck by lightning, and afterward showed
upon his breast a picture of the tree, with the nest upon one of its
branches. Although in the majority of cases the photographs resembled
trees, there was one case in which it resembled a horse-shoe; another,
a cow; a third, a piece of furniture; a fourth, the whole surrounding
landscape. This theory of lightning-photographs of neighboring objects
on the skin has probably arisen from the resemblance of the burns due
to the ramifications of the blood-vessels as conductors, or to peculiar
electric movements which can be demonstrated by positive charges on
lycopodium powder.

A lightning-stroke does not exhaust its force on a few individuals or
objects, but sometimes produces serious manifestations over a large
area, or on a great number of people.  It is said that a church in the
village of Chateauneuf, in the Department of the Lower Alps, in France,
was struck by three successive lightning strokes on July 11, 1819,
during the installation of a new pastor. The company were all thrown
down, nine were killed and 82 wounded. The priest, who was celebrating
mass, was not affected, it is believed, on account of his silken robe
acting as an insulator. Bryant of Charlestown, Mass., has communicated
the particulars of a stroke of lightning on June 20, 1829, which
shocked several hundred persons. The effect of this discharge was felt
over an area of 172,500 square feet with nearly the same degree of
intensity. Happily, there was no permanent injury recorded. Le Conte
reports that a person may be killed when some distance--even as far as
20 miles away from the storm--by what Lord Mahon calls the "returning
stroke."

Skin-grafting is a subject which has long been more or less familiar to
medical men, but which has only recently been developed to a
practically successful operation. The older surgeons knew that it was
possible to reunite a resected nose or an amputated finger, and in
Hunter's time tooth-replantation was quite well known. Smellie has
recorded an instance in which, after avulsion of a nipple in suckling,
restitution was effected.  It is not alone to the skin that grafting is
applicable; it is used in the cornea, nerves, muscles, bones, tendons,
and teeth.  Wolfer has been successful in transplanting the mucous
membranes of frogs, rabbits, and pigeons to a portion of mucous
membrane previously occupied by cicatricial tissue, and was the first
to show that on mucous surfaces, mucous membrane remains mucous
membrane, but when transplanted to skin, it becomes skin.  Attempts
have been made to transplant a button of clear cornea of a dog, rabbit,
or cat to the cornea of a human being, opaque as the result of
ophthalmia, and von Hippel has devised a special method of doing this.
Recently Fuchs has reported his experience in cornea-grafting in
sections, as a substitute for von Hippel's method, in parenchymatous
keratitis and corneal staphyloma, and though not eminently successful
himself, he considers the operation worthy of trial in cases that are
without help, and doomed to blindness.

John Hunter was the first to perform the implantation of teeth; and
Younger the first to transplant the teeth of man in the jaws of man;
the initial operation should be called replantation, as it was merely
the replacement of a tooth in a socket from which it had accidentally
or intentionally been removed. Hunter drilled a hole in a cock's comb
and inserted a tooth, and held it by a ligature. Younger drilled a hole
in a man's jaw and implanted a tooth, and proved that it was not
necessary to use a fresh tooth.  Ottolengni mentions the case of a man
who was struck by a ruffian and had his two central incisors knocked
out. He searched for them, washed them in warm water, carefully washed
the teeth-sockets, and gently placed the teeth back in their position,
where they remained firmly attached. At the time of report, six years
after the accident, they were still firmly in position. Pettyjohn
reports a successful case of tooth-replantation in his young daughter
of two, who fell on the cellar stairs, completely excising the central
incisors. The alveolar process of the right jaw was fractured, and the
gum lacerated to the entire length of the root. The teeth were placed
in a tepid normal saline solution, and the child chloroformed, narcosis
being induced in sleep; the gums were cleaned antiseptically, and 3 1/2
hours afterward the child had the teeth firmly in place. They had been
out of the mouth fully an hour.  Four weeks afterward they were as firm
as ever. By their experiments Gluck and Magnus prove that there is a
return of activity after transplantation of muscle. After excision of
malignant tumors of muscles, Helferich of Munich, and Lange of New
York, have filled the gap left by the excision of the muscle affected
by the tumor with transplanted muscles from dogs. Gluck has induced
reproduction of lost tendons by grafting them with cat-gut, and
according to Ashhurst, Peyrot has filled the gaps in retracted tendons
by transplanting tendons, taken in one case from a dog, and in another
from a cat.

Nerve-grafting, as a supplementary operation to neurectomy, has been
practiced, and Gersung has transplanted the nerves of lower animals to
the nerve stumps of man.

Bone-grafting is quite frequently practiced, portions from a recently
amputated limb, or portions removed from living animals, or bone-chips,
may be used. Senn proposed decalcified bone-plates to be used to fill
in the gaps. Shifting of the bone has been done, e.g., by dividing a
strip of the hard palate covered with its soft parts, parallel to the
fissure in cleft palate, but leaving unsevered the bony attachments in
front, and partially fracturing the pedicle, drawing the bony flaps
together with sutures; or, when forming a new nose, by turning down
with the skin and periosteum the outer table of the frontal bone, split
off with a chisel, after cutting around the part to be removed.
Trueheart reports a case of partial excision of the clavicle,
successfully followed by the grafting of periosteal and osseous
material taken from a dog. Robson and Hayes of Rochester, N.Y., have
successfully supplemented excision of spina bifida by the
transplantation of a strip of periosteum from a rabbit. Poncet hastened
a cure in a case of necrosis with partial destruction of the periosteum
by inserting grafts taken from the bones of a dead infant and from a
kid. Ricketts speaks of bone-grafting and the use of ivory, and remarks
that Poncet of Lyons restored a tibia in nine months by grafting to the
superior articular surface.  Recently amalgam fillings have been used
in bone-cavities to supplant grafting.

In destructive injuries of the skin, various materials were formerly
used in grafting, none of which, however, have produced the same good
effect as the use of skin by the Thiersch Method, which will be
described later.

Rodgers, U.S.N., reports the case of a white man of thirty-eight who
suffered from gangrene of the skin of the buttocks caused by sitting in
a pan of caustic potash. When seen the man was intoxicated, and there
was a gangrenous patch four by six inches on his buttocks. Rodgers used
grafts from the under wing of a young fowl, as suggested by Redard,
with good result. Vanmeter of Colorado describes a boy of fourteen with
a severe extensive burn; a portion beneath the chin and lower jaw, and
the right arm from the elbow to the fingers, formed a granulating
surface which would not heal, and grafting was resorted to. The
neck-grafts were supplied by the skin of the father and brother, but
the arm-grafts were taken from two young puppies of the Mexican
hairless breed, whose soft, white, hairless skin seemed to offer itself
for the purpose with good prospect of a successful result.  The outcome
was all that could be desired. The puppy-grafts took faster and proved
themselves to be superior to the skin-grafts.  There is a case reported
in which the skin of a greyhound seven days old, taken from the
abdominal wall and even from the tail, was used with most satisfactory
results in grafting an extensive ulcer following a burn on the left leg
of a boy of ten. Masterman has grafted with the inner membrane of a
hen's egg, and a Mexican surgeon, Altramirano, used the gills of a cock.

Fowler of Brooklyn has grafted with the skin from the back and abdomen
of a large frog. The patient was a colored boy of sixteen, who was
extensively burned by a kerosene lamp. The burns were on the legs,
thighs, buttocks, and right ankle, and the estimated area of burnt
surface was 247.95 square inches. The frog skin was transferred to the
left buttocks, and on the right buttocks eight long strips of white
skin were transferred after the manner of Thiersch. A strip of human
skin was placed in one section over the frog skin, but became necrotic
in four days, not being attached to the granulating surface. The man
was discharged cured in six months. The frog skin was soft, pliable,
and of a reddish hue, while the human white skin was firm and rapidly
becoming pigmented. Leale cites the successful use of common warts in a
case of grafting on a man of twenty who was burned on the foot by a
stream of molten metal. Leale remarks that as common warts of the skin
are collections of vascular papillae, admitting of separation without
injury to their exceptionally thick layer of epidermis, they are
probably better for the purposes of skin-grafting than ordinary skin of
less vitality or vascularity. Ricketts has succeeded in grafting the
skin of a frog to that of a tortoise, and also grafting frog skin to
human skin. Ricketts remarks that the prepuce of a boy is remarkably
good material for grafting. Sponge-grafts are often used to hasten
cicatrization of integumental wounds. There is recorded an instance in
which the breast of a crow and the back of a rat were grafted together
and grew fast. The crow dragged the rat along, and the two did not seem
to care to part company.

Relative to skin-grafting proper, Bartens succeeded in grafting the
skin of a dead man of seventy on a boy of fourteen. Symonds reports
cases of skin-grafting of large flaps from amputated limbs, and says
this method is particularly available in large hospitals where they
have amputations and grafts on the same day.  Martin has shown that,
after many hours of exposure in the open air at a temperature of nearly
32 degrees F., grafts could be successfully applied, but in such
temperatures as 82 degrees F., exposure of from six to seven hours
destroyed their vitality, so that if kept cool, the limb of a healthy
individual amputated for some accident, may be utilized for grafting
purposes.

Reverdin originated the procedure of epidermic grafting. Small grafts
the size of a pin-head doing quite as well as large ones.
Unfortunately but little diminution of the cicatricial contraction is
effected by Reverdin's method. Thiersch contends that healing of a
granulated surface results first from a conversion of the soft,
vascular granulation-papillae, by contraction of some of their elements
into young connective-tissue cells, into "dry, cicatricial papillae,"
actually approximating the surrounding tissues, thus diminishing the
area to be covered by epidermis; and, secondly, by the covering of
these papillae by epidermic cells. Thiersch therefore recommends that
for the prevention of cicatricial contraction, the grafting be
performed with large strips of skin.

Harte gives illustrations of a case of extensive skin-grafting on the
thigh from six inches above the great trochanter well over the median
line anteriorly and over the buttock. This extent is shown in Figure
228, taken five months after the accident, when the granulations had
grown over the edge about an inch. Figure 229 shows the surface of the
wound, six and one-half months after the accident and three months
after the applications of numerous skin-grafts.

Cases of self-mutilation may be divided into three classes:--those in
which the injuries are inflicted in a moment of temporary insanity from
hallucinations or melancholia; with suicidal intent; and in religious
frenzy or emotion.  Self-mutilation is seen in the lower animals, and
Kennedy, in mentioning the case of a hydrocephalic child who ate off
its entire under lip, speaks also of a dog, of cats, and of a lioness
who ate off their tails. Kennedy mentions the habit in young children
of biting the finger-nails as an evidence of infantile trend toward
self-mutilation. In the same discussion Collins states that he knew of
an instance in India in which a horse lay down, deliberately exposing
his anus, and allowing the crows to pick and eat his whole rectum. In
temporary insanity, in fury, or in grief, the lower animals have been
noticed by naturalists to mutilate themselves.

Self-mutilation in man is almost invariably the result of meditation
over the generative function, and the great majority of cases of this
nature are avulsions or amputations of some parts of the genitalia. The
older records are full of such instances. Benivenius, Blanchard,
Knackstedt, and Schenck cite cases. Smetius mentions castration which
was effected by using the finger-nails, and there is an old record in
which a man avulsed his own genitals. Scott mentions an instance in
which a man amputated his genitals and recovered without subsequent
symptoms. Gockelius speaks of self-castration in a ruptured man, and
Golding, Guyon, Louis, Laugier, the Ephemerides, Alix, Marstral, and
others, record instances of self-castration. In his Essays Montaigne
mentions an instance of complete castration performed by the individual
himself.

Thiersch mentions a case of a man who circumcised himself when
eighteen. He married in 1870, and upon being told that he was a father
he slit up the hypogastrium from the symphysis pubis to the umbilicus,
so that the omentum protruded; he said his object was to obtain a view
of the interior. Although the knife was dirty and blunt, the wound
healed after the removal of the extruding omentum. A year later he laid
open one side of the scrotum. The prolapsed testicle was replaced, and
the wound healed without serious effect. He again laid open his abdomen
in 1880, the wound again healing notwithstanding the prolapse of the
omentum. In May of the same year he removed the right testicle, and
sewed the wound up himself. Four days later the left was treated the
same way. The spermatic cord however escaped, and a hematoma, the size
of a child's head, formed on account of which he had to go to the
hospital. This man acted under an uncontrollable impulse to mutilate
himself, and claimed that until he castrated himself he had no peace of
mind.

There is a similar report in an Italian journal which was quoted in
London. It described a student at law, of delicate complexion, who at
the age of fourteen gave himself up to masturbation. He continually
studied until the age of nineteen, when he fell into a state of
dulness, and complained that his head felt as if compressed by a circle
of fire. He said that a voice kept muttering to him that his generative
organs were abnormally deformed or the seat of disease. After that, he
imagined that he heard a cry of "amputation! amputation!" Driven by
this hallucination, he made his first attempt at self-mutilation ten
days later. He was placed in an Asylum at Astino where, though closely
watched, he took advantage of the first opportunity and cut off
two-thirds of his penis, when the delirium subsided. Camp describes a
stout German of thirty-five who, while suffering from delirium tremens,
fancied that his enemies were trying to steal his genitals, and seizing
a sharp knife he amputated his penis close to the pubes. He threw the
severed organ violently at his imaginary pursuers. The hemorrhage was
profuse, but ceased spontaneously by the formation of coagulum over the
mouth of the divided vessels. The wound was quite healed in six weeks,
and he was discharged from the hospital, rational and apparently
content with his surgical feat.

Richards reports the case of a Brahman boy of sixteen who had
contracted syphilis, and convinced, no doubt, that "nocit empta dolore
voluptus," he had taken effective means of avoiding injury in the
future by completely amputating his penis at the root.  Some days after
his admission to the hospital he asked to be castrated, stating that he
intended to become an ascetic, and the loss of his testes as well as of
his penis appeared to him to be an imperative condition to the
attainment of that happy consummation. Chevers mentions a somewhat
similar case occurring in India.

Sands speaks of a single man of thirty who amputated his penis.  He
gave an incomplete history of syphilis. After connection with a woman
he became a confirmed syphilophobe and greatly depressed.  While
laboring under the hallucination that he was possessed of two bodies he
tied a string around the penis and amputated the organ one inch below
the glans. On loosening the string, three hours afterward, to enable
him to urinate, he lost three pints of blood, but he eventually
recovered. In the Pennsylvania Hospital Reports there is an account of
a married man who, after drinking several weeks, developed mania a
potu, and was found in his room covered with blood. His penis was
completely cut off near the pubes, and the skin of the scrotum was so
freely incised that the testicles were entirely denuded, but not
injured. A small silver cap was made to cover the sensitive urethra on
a line with the abdominal wall.

There is a record of a tall, powerfully-built Russian peasant of
twenty-nine, of morose disposition, who on April 3d, while reading his
favorite book, without uttering a cry, suddenly and with a single pull
tore away his scrotum together with his testes. He then arose from the
bank where he had been sitting, and quietly handed the avulsed parts to
his mother who was sitting near by, saying to her: "Take that; I do not
want it any more." To all questions from his relatives he asked pardon
and exemption from blame, but gave no reason for his act. This patient
made a good recovery at the hospital. Alexeef, another Russian, speaks
of a similar injury occurring during an attack of delirium tremens.

Black details the history of a young man of nineteen who went to his
bath-room and deliberately placing his scrotum on the edge of the tub
he cut it crossways down to the wood. He besought Black to remove his
testicle, and as the spermatic cord was cut and much injured, and
hemorrhage could only be arrested by ligature, the testicle was
removed. The reason assigned for this act of mutilation was that he had
so frequent nocturnal emissions that he became greatly disgusted and
depressed in spirit thereby. He had practiced self-abuse for two years
and ascribed his emissions to this cause. Although his act was that of
a maniac, the man was perfectly rational. Since the injury he had had
normal and frequent emissions and erections.

Orwin mentions the case of a laborer of forty who, in a fit of remorse
after being several days with a prostitute, atoned for his
unfaithfulness to his wife by opening his scrotum and cutting away his
left testicle with a pocket knife. The missing organ was found about
six yards away covered with dirt. At the time of infliction of this
injury the man was calm and perfectly rational. Warrington relates the
strange case of Isaac Brooks, an unmarried farmer of twenty-nine, who
was found December 5, 1879, with extensive mutilations of the scrotum;
he said that he had been attacked and injured by three men. He swore to
the identity of two out of the three, and these were transported to ten
years' penal servitude. On February 13, 1881, he was again found with
mutilation of the external genitals, and again said he had been set
upon by four men who had inflicted his injury, but as he wished it kept
quiet he asked that there be no prosecution. Just before his death on
December 31, 1881, he confessed that he had perjured himself, and that
the mutilations were self-performed.  He was not aware of any morbid
ideas as to his sexual organs, and although he had an attack of
gonorrhea ten years before he seemed to worry very little over it.
There is an account of a Scotch boy who wished to lead a "holy life,"
and on two occasions sought the late Mr. Liston's skilful aid in
pursuance of this idea. He returned for a third time, having himself
unsuccessfully performed castration.

A case of self-mutilation by a soldier who was confined in the
guard-house for drunkenness is related by Beck. The man borrowed a
knife from a comrade and cut off the whole external genital apparatus,
remarking as he flung the parts into a corner: "Any----fool can cut his
throat, but it takes a soldier to cut his privates off!" Under
treatment he recovered, and then he regretted his action.

Sinclair describes an Irishman of twenty-five who, maniacal from
intemperance, first cut off one testicle with a wire nail, and then the
second with a trouser-buckle. Not satisfied with the extent of his
injuries he drove a nail into his temple, first through the skin by
striking it with his hand, and then by butting it against the
wall,--the latter maneuver causing his death.

There is on record the history of an insane medical student in Dublin
who extirpated both eyes and threw them on the grass. He was in a state
of acute mania, and the explanation offered was that as a "grinder"
before examination he had been diligently studying the surgery of the
eye, and particularly that relating to enucleation. Another Dublin case
quoted by the same authority was that of a young girl who, upon being
arrested and committed to a police-cell in a state of furious
drunkenness, tore out both her eyes. In such cases, as a rule, the
finger-nails are the only instrument used. There is a French case also
quoted of a woman of thirty-nine who had borne children in rapid
succession. While suckling a child three months old she became much
excited, and even fanatical, in reading the Bible. Coming to the
passage, "If thy right eye offend thee, pluck it out, etc.," she was so
impressed with the necessity of obeying the divine injunction that she
enucleated her eye with a meat-hook. There is mentioned the case of a
young woman who cut off her right hand and cast it into the fire, and
attempted to enucleate her eyes, and also to hold her remaining hand in
the fire. Haslam reports the history of a female who mutilated herself
by grinding glass between her teeth.

Channing gives an account of the case of Helen Miller, a German Jewess
of thirty, who was admitted to the Asylum for Insane Criminals at
Auburn, N.Y., in October, 1872, and readmitted in June, 1875, suffering
from simulation of hematemesis. On September 25th she cut her left
wrist and right hand; in three weeks she became again "discouraged"
because she was refused opium, and again cut her arms below the elbows,
cleanly severing the skin and fascia, and completely hacking the
muscles in every direction. Six weeks later she repeated the latter
feat over the seat of the recently healed cicatrices. The right arm
healed, but the left showed erysipelatous inflammation, culminating in
edema, which affected the glottis to such an extent that tracheotomy
was performed to save her life. Five weeks after convalescence, during
which her conduct was exemplary, she again cut her arms in the same
place. In the following April, for the merest trifle, she again
repeated the mutilation, but this time leaving pieces of glass in the
wounds. Six months later she inflicted a wound seven inches in length,
in which she inserted 30 pieces of glass, seven long splinters, and
five shoe-nails. In June, 1877, she cut herself for the last time. The
following articles were taken from her arms and preserved: Ninety-four
pieces of glass, 34 splinters, two tacks, five shoe-nails, one pin, and
one needle, besides other things which were lost,--making altogether
about 150 articles.

"Needle-girls," etc.--A peculiar type of self-mutilation is the habit
sometimes seen in hysteric persons of piercing their flesh with
numerous needles or pins. Herbolt of Copenhagen tells of a young Jewess
from whose body, in the course of eighteen months, were extracted 217
needles. Sometime after 100 more came from a tumor on the shoulder. As
all the symptoms in this case were abdominal, it was supposed that
during an epileptic seizure this girl had swallowed the needles; but as
she was of an hysteric nature it seems more likely they had entered the
body through the skin. There is an instance in which 132 needles were
extracted from a young lady's person. Caen describes a woman of
twenty-six, while in prison awaiting trial, succeeding in committing
suicide by introducing about 30 pins and needles in the chest region,
over the heart. Her method was to gently introduce them, and then to
press them deeper with a prayer-book. An autopsy showed that some of
the pins had reached the lungs, some were in the mediastinum, on the
back part of the right auricle; the descending vena cave was
perforated, the anterior portion of the left ventricle was transfixed
by a needle, and several of the articles were found in the liver.
Andrews removed 300 needles from the body of an insane female. The
Lancet records an account of a suicide by the penetration of a
darning-needle in the epigastrium. There were nine punctures in this
region, and in the last the needle was left in situ and fixed by
worsted. In 1851 the same journal spoke of an instance in which 30 pins
were removed from the limbs of a servant girl. It was said that while
hanging clothes, with her mouth full of pins, she was slapped on the
shoulder, causing her to start and swallow the pins. There is another
report of a woman who swallowed great numbers of pins. On her death one
pound and nine ounces of pins were found in her stomach and duodenum.
There are individuals known as "human pin-cushions," who publicly
introduce pins and needles into their bodies for gain's sake.

The wanderings of pins and needles in the body are quite well known.
Schenck records the finding of a swallowed pin in the liver. Haller
mentions one that made its way to the hand. Silvy speaks of a case in
which a quantity of swallowed pins escaped through the muscles, the
bladder, and vagina; there is another record in which the pins escaped
many years afterward from the thigh. The Philosophical Transactions
contain a record of the escape of a pin from the skin of the arm after
it had entered by the mouth. Gooch, Ruysch, Purmann, and Hoffman speak
of needle-wanderings. Stephenson gives an account of a pin which was
finally voided by the bladder after forty-two years' sojourn in a
lady's body. On November 15, 1802, the celebrated Dr. Lettsom spoke of
an old lady who sat on a needle while riding in a hackney coach; it
passed from the injured leg to the other one, whence it was extracted.
Deckers tells of a gentleman who was wounded in the right
hypochondrium, the ball being taken thirty years afterward from the
knee. Borellus gives an account of a thorn entering the digit and
passing out of the body by the anus.

Strange as it may seem, a prick of a pin not entering a vital center or
organ has been the indirect cause of death. Augenius writes of a tailor
who died in consequence of a prick of a needle between the nail and
flesh of the end of the thumb. Amatus Lusitanus mentions a similar
instance in an old woman, although, from the symptoms given, the direct
cause was probably tetanus.  In modern times Cunninghame, Boring, and
Hobart mention instances in which death has followed the prick of a
pin: in Boring's case the death occurred on the fifth day.

Manufacture of Crippled Beggars.--Knowing the sympathy of the world in
general for a cripple, in some countries low in the moral scale,
voluntary mutilation is sometimes practiced by those who prefer begging
to toiling. In the same manner artificial monstrosities have been
manufactured solely for gain's sake. We quite often read of these
instances in lay-journals, but it is seldom that a case comes under the
immediate observation of a thoroughly scientific mind. There is,
however, on record a remarkable instance accredited to Jamieson of
Shanghai who presented to the Royal College of Surgeons a pair of feet
with the following history: Some months previously a Chinese beggar had
excited much pity and made a good business by showing the mutilated
stumps of his legs, and the feet that had belonged to them slung about
his neck. While one day scrambling out of the way of a constable who
had forbidden this gruesome spectacle, he was knocked down by a
carriage in the streets of Shanghai, and was taken to the hospital,
where he was questioned about the accident which deprived him of his
feet. After selling the medical attendant his feet he admitted that he
had purposely performed the amputations himself, starting about a year
previously. He had fastened cords about his ankles, drawing them as
tightly as he could bear them, and increasing the pressure every two or
three days. For a fortnight his pain was extreme, but when the bones
were bared his pains ceased. At the end of a month and a half he was
able to entirely remove his feet by partly snapping and partly cutting
the dry bone. Such cases appear to be quite common in China, and by
investigation many parallels could elsewhere be found.

The Chinese custom of foot-binding is a curious instance of
self-mutilation. In a paper quoted in the Philadelphia Medical Times,
January 31, 1880, a most minute account of the modus operandi, the
duration, and the suffering attendant on this process are given.
Strapping of the foot by means of tight bandages requires a period of
two or three years' continuance before the desired effect is produced.
There is a varying degree of pain, which is most severe during the
first year and gradually diminishes after the binding of all the joints
is completed.  During the binding the girl at night lies across the
bed, putting her legs on the edge of the bed-stead in such a manner as
to make pressure under the knees, thus benumbing the parts below and
avoiding the major degree of pain. In this position, swinging their
legs backward and forward, the poor Chinese girls pass many a weary
night. During this period the feet are unbound once a month only. The
operation is begun by placing the end of a long, narrow bandage on the
inside of the instep and carrying it over the four smaller toes,
securing them under the foot. After several turns the bandage is
reversed so as to compress the foot longitudinally. The young girl is
then left for a month, and when the bandage is removed the foot is
often found gangrenous and ulcerated, one or two toes not infrequently
being lost. If the foot is thus bound for two years it becomes
virtually dead and painless. By this time the calf disappears from lack
of exercise, the bones are attenuated, and all the parts are dry and
shrivelled. In after-life the leg frequently regains its muscles and
adipose tissue, but the foot always remains small. The binding process
is said to exert a markedly depressing influence upon the emotional
character of the subject, which lasts through life, and is very
characteristic.

To show how minute some of the feet of the Chinese women are, Figure I
of the accompanying plate, taken from a paper by Kenthughes on the
"Feet of Chinese Ladies" is from a photograph of a shoe that measured
only 3 1/4 inches anteroposteriorly. The foot which it was intended to
fill must have been smaller still, for the bandage would take up a
certain amount of space. Figure II is a reproduction of a photograph of
a foot measuring 5 1/2 inches anteroposteriorly, the wrinkled
appearance of the skin being due to prolonged immersion in spirit. This
photograph shows well the characteristics of the Chinese foot--the
prominent and vertically placed heel, which is raised generally about
an inch from the level of the great toe; the sharp artificial cavus,
produced by the altered position of the os calcis, and the downward
deflection of the foot in front of the mediotarsal joint; the straight
and downward pointing great toe, and the infolding of the smaller toes
underneath the great toe. In Figure III we have a photograph of the
skeleton of a Chinese lady's foot about five inches in anteroposterior
diameter. The mesial axis of the os calcis is almost directly vertical,
with a slight forward inclination, forming a right angle with the bones
in front of the mediotarsal joint. The upper three-quarters of the
anterior articular surface of the calcis is not in contact with the
cuboid, the latter being depressed obliquely forward and downward, the
lower portion of the posterior facet on the cuboid articulating with a
new surface on the under portion of the bone.  The general shape of the
bone closely resembles that of a normal one--a marked contrast to its
wasted condition and tapering extremity in paralytic calcaneus.
Extension and flexion at the ankle are only limited by the shortness of
the ligaments; there is no opposition from the conformation of the
bones. The astragalus is almost of normal shape; the trochlea is
slightly prolonged anteriorly, especially on the inner side, from
contact with the tibial articular surface. The cartilage on the exposed
posterior portion of the trochlea seems healthy. The head of the
astragalus is very prominent on the outer side, the scaphoid being
depressed downward and inward away from it. The anterior articular
surface is prolonged in the direction of the displaced scaphoid. The
scaphoid, in addition to its displacement, is much compressed on the
planter surface, being little more than one-half the width of the
dorsal surface. The cuboid is displaced obliquely downward and forward,
so that the upper part of the posterior articular surface is not in
contact with the calcis.

A professional leg-breaker is described in the Weekly Medical Review of
St. Louis, April, 1890. This person's name was E. L.  Landers, and he
was accredited with earning his living by breaking or pretending to
break his leg in order to collect damages for the supposed injury.
Moreover, this individual had but one leg, and was compelled to use
crutches. At the time of report he had succeeded in obtaining damages
in Wichita, Kansas, for a supposed fracture. The Review quotes a
newspaper account of this operation as follows.--

"According to the Wichita Dispatch he represented himself as a
telegraph operator who was to have charge of the postal telegraph
office in that city as soon as the line reached there. He remained
about town for a month until he found an inviting piece of defective
sidewalk, suitable for his purpose, when he stuck his crutch through
the hole and fell screaming to the ground, declaring that he had broken
his leg. He was carried to a hospital, and after a week's time, during
which he negotiated a compromise with the city authorities and
collected $1000 damages, a confederate, claiming to be his nephew,
appeared and took the wounded man away on a stretcher, saying that he
was going to St.  Louis. Before the train was fairly out of Wichita,
Landers was laughing and boasting over his successful scheme to beat
the town. The Wichita story is in exact accord with the artistic
methods of a one-legged sharper who about 1878 stuck his crutch through
a coal-hole here, and, falling heels over head, claimed to have
sustained injuries for which he succeeded in collecting something like
$1500 from the city. He is described as a fine-looking fellow, well
dressed, and wearing a silk hat. He lost one leg in a railroad
accident, and having collected a good round sum in damages for it,
adopted the profession of leg-breaking in order to earn a livelihood.
He probably argued that as he had made more money in that line than in
any other he was especially fitted by natural talents to achieve
distinction in this direction. But as it would be rather awkward to
lose his remaining leg altogether he modified the idea and contents
himself with collecting the smaller amounts which ordinary fractures of
the hip-joint entitle such an expert 'fine worker' to receive.

"He first appeared here in 1874 and succeeded, it is alleged, in
beating the Life Association of America. After remaining for some time
in the hospital he was removed on a stretcher to an Illinois village,
from which point the negotiations for damages were conducted by
correspondence, until finally a point of agreement was reached and an
agent of the company was sent to pay him the money. This being
accomplished the agent returned to the depot to take the train back to
St. Louis when he was surprised to see the supposed sufferer stumping
around on his crutches on the depot platform, laughing and jesting over
the ease with which he had beaten the corporation.

"He afterward fell off a Wabash train at Edwardsville and claimed to
have sustained serious injuries, but in this case the company's
attorneys beat him and proved him to be an impostor. In 1879 he
stumbled into the telegraph office at the Union Depot here, when Henry
C. Mahoney, the superintendent, catching sight of him, put him out,
with the curt remark that he didn't want him to stick that crutch into
a cuspidor and fall down, as it was too expensive a performance for the
company to stand. He beat the Missouri Pacific and several other
railroads and municipalities at different times, it is claimed, and
manages to get enough at each successful venture to carry him along for
a year or eighteen months, by which time the memory of his trick fades
out of the public mind, when he again bobs up serenely."

Anomalous Suicides.--The literature on suicide affords many instances
of self-mutilations and ingenious modes of producing death. In the
Dublin Medical Press for 1854 there is an extraordinary case of
suicide, in which the patient thrust a red-hot poker into his abdomen
and subsequently pulled it out, detaching portions of the omentum and
32 inches of the colon.  Another suicide in Great Britain swallowed a
red-hot poker. In commenting on suicides, in 1835, Arntzenius speaks of
an ambitious Frenchman who was desirous of leaving the world in a
distinguished manner, and who attached himself to a rocket of enormous
size which he had built for the purpose, and setting fire to it, ended
his life. On September 28, 1895, according to the Gaulois and the New
York Herald (Paris edition) of that date, there was admitted to the
Hopital St. Louis a clerk, aged twenty-five, whom family troubles had
rendered desperate and who had determined to seek death as a relief
from his misery.  Reviewing the various methods of committing suicide
he found none to his taste, and resolved on something new. Being
familiar with the constituents of explosives, he resolved to convert
his body into a bomb, load it with explosives, and thus blow himself to
pieces. He procured some powdered sulphur and potassium chlorate, and
placing each in a separate wafer he swallowed both with the aid of
water. He then lay down on his bed, dressed in his best clothes,
expecting that as soon as the two explosive materials came into contact
he would burst like a bomb and his troubles would be over. Instead of
the anticipated result the most violent collicky pains ensued, which
finally became so great that he had to summon his neighbors, who took
him to the hospital, where, after vigorous application with the
stomach-pump, it was hoped that his life would be saved. Sankey
mentions an epileptic who was found dead in his bed in the Oxford
County Asylum; the man had accomplished his end by placing a round
pebble in each nostril, and thoroughly impacting in his throat a strip
of flannel done up in a roll. In his "Institutes of Surgery" Sir
Charles Bell remarks that his predecessor at the Middlesex Hospital
entered into a conversation with his barber over an attempt at suicide
in the neighborhood, during which the surgeon called the "would-be
suicide" a fool, explaining to the barber how clumsy his attempts had
been at the same time giving him an extempore lecture on the anatomic
construction of the neck, and showing him how a successful suicide in
this region should be performed. At the close of the conversation the
unfortunate barber retired into the back area of his shop, and
following minutely the surgeon's directions, cut his throat in such a
manner that there was no hope of saving him. It is supposed that one
could commit suicide by completely gilding or varnishing the body, thus
eliminating the excretory functions of the skin. There is an old story
of an infant who was gilded to appear at a Papal ceremony who died
shortly afterward from the suppression of the skin-function. The fact
is one well established among animals, but after a full series of
actual experiments, Tecontjeff of St.  Petersburg concludes that in
this respect man differs from animals. This authority states that in
man no tangible risk is entailed by this process, at least for any
length of time required for therapeutic purposes. "Tarred and
feathered" persons rarely die of the coating of tar they receive. For
other instances of peculiar forms of suicide reference may be made to
numerous volumes on this subject, prominent among which is that by
Brierre de Boismont, which, though somewhat old, has always been found
trustworthy, and also to the chapters on this subject written by
various authors on medical jurisprudence.

Religious and Ceremonial Mutilations.--Turning now to the subject of
self-mutilation and self-destruction from the peculiar customs or
religious beliefs of people, we find pages of information at our
disposal. It is not only among the savage or uncivilized tribes that
such ideas have prevailed, but from the earliest times they have had
their influence upon educated minds. In the East, particularly in
India, the doctrines of Buddhism, that the soul should be without fear,
that it could not be destroyed, and that the flesh was only its
resting-place, the soul several times being reincarnated, brought about
great indifference to bodily injuries and death. In the history of the
Brahmans there was a sect of philosophers called the Gymnosophists, who
had the extremest indifference to life. To them incarnation was a
positive fact, and death was simply a change of residence. One of these
philosophers, Calanus, was burned in the presence of Alexander; and,
according to Plutarch, three centuries later another Gymnosophist named
Jarmenochegra, was similarly burned before Augustus. Since this time,
according to Brierre de Boismont, the suicides from indifference to
life in this mystic country are counted by the thousands. Penetrating
Japan the same sentiment, according to report, made it common in the
earlier history of that country to see ships on its coasts, filled with
fanatics who, by voluntary dismantling, submerged the vessels little by
little, the whole multitude sinking into the sea while chanting praises
to their idols. The same doctrines produced the same result in China.
According to Brucker it is well known that among the 500 philosophers
of the college of Confucius, there were many who disdained to survive
the loss of their books (burned by order of the savage Emperor
Chi-Koung-ti), and throwing themselves into the sea, they disappeared
under the waves. According to Brierre de Boismont, voluntary mutilation
or death was very rare among the Chaldeans, the Persians, or the
Hebrews, their precepts being different from those mentioned. The
Hebrews in particular had an aversion to self-murder, and during a
period in their history of 4000 years there were only eight or ten
suicides recorded. Josephus shows what a marked influence on suicides
the invasion of the Romans among the Hebrews had.

In Africa, as in India, there were Gymnosophists. In Egypt Sesostris,
the grandest king of the country, having lost his eyesight in his old
age, calmly and deliberately killed himself.  About the time of Mark
Anthony and Cleopatra, particularly after the battle of Actium, suicide
was in great favor in Egypt. In fact a great number of persons formed
an academy called The Synapothanoumenes, who had for their object the
idea of dying together. In Western Europe, as shown in the ceremonies
of the Druids, we find among the Celts a propensity for suicide and an
indifference to self-torture. The Gauls were similarly minded,
believing in the dogma of immortality and eternal repose. They thought
little of bodily cares and ills. In Greece and Rome there was always an
apology for suicide and death in the books of the philosophers. "Nil
igitur mors est, ad nos neque pertinet hilum; quando quidem natura
animi mortalis habetur!" cries Lucretius.  With the advent of
Christianity, condemning as it did the barbarous customs of
self-mutilation and self-murder, these practices seem to disappear
gradually; but stoicism and indifference to pain were exhibited in
martyrdom. Toward the middle ages, when fanaticism was at its height
and the mental malady of demoniacal possession was prevalent, there was
something of a reversion to the old customs. In the East the Juggernaut
procession was still in vogue, but this was suppressed by civilized
authorities; outside of a few minor customs still prevalent among our
own people we must to-day look to the savage tribes for the
perpetuation of such practices.

In an excellent article on the evolution of ceremonial institutions
Herbert Spencer mentions the Fuegians, Veddahs, Andamanese, Dyaks,
Todas, Gonds, Santals, Bodos, and Dhimals, Mishmis, Kamchadales, and
Snake Indians, as among people who form societies to practice simple
mutilations in slight forms.  Mutilations in somewhat graver forms, but
still in moderation, are practiced by the Tasmanians, Tamaese, the
people of New Guinea, Karens, Nagas, Ostiaks, Eskimos, Chinooks,
Comanches, and Chippewas. What might be called mixed or compound
mutilations are practiced by the New Zealanders, East Africans, Kondes,
Kukas, and Calmucks. Among those practising simple but severe
mutilations are the New Caledonians, the Bushmen, and some indigenous
Australians. Those tribes having for their customs the practice of
compound major mutilations are the Fiji Islanders, Sandwich Islanders,
Tahitians, Tongans, Samoans, Javanese, Sumatrans, natives of Malagasy,
Hottentots, Damaras, Bechuanas, Kaffirs, the Congo people, the Coast
Negroes, Inland Negroes, Dahomeans, Ashantees, Fulahs, Abyssinians,
Arabs, and Dakotas.  Spencer has evidently made a most extensive and
comprehensive study of this subject, and his paper is a most valuable
contribution to the subject. In the preparation of this section we have
frequently quoted from it.

The practice of self-bleeding has its origin in other mutilations,
although the Aztecs shed human blood in the worship of the sun. The
Samoiedes have a custom of drinking the blood of warm animals. Those of
the Fijians who were cannibals drank the warm blood of their victims.
Among the Amaponda Kaffirs there are horrible accounts of kindred
savage customs. Spencer quotes:--"It is usual for the ruling chief on
his accession to be washed in the blood of a near relative, generally a
brother, who is put to death for the occasion." During a Samoan
marriage-ceremony the friends of the bride "took up stones and beat
themselves until their heads were bruised and bleeding." In Australia a
novitiate at the ceremony of manhood drank a mouthful of blood from the
veins of the warrior who was to be his sponsor.

At the death of their kings the Lacedemonians met in large numbers and
tore the flesh from their foreheads with pins and needles. It is said
that when Odin was near his death he ordered himself to be marked with
a spear; and Niort, one of his successors, followed the example of his
predecessor. Shakespeare speaks of "such as boast and show their
scars." In the olden times it was not uncommon for a noble soldier to
make public exhibition of his scars with the greatest pride; in fact,
on the battlefield they invited the reception of superficial
disfiguring injuries, and to-day some students of the learned
universities of Germany seem prouder of the possession of scars
received in a duel of honor than in awards for scholastic attainments.

Lichtenstein tells of priests among the Bechuanas who made long cuts
from the thigh to the knee of each warrior who slew an enemy in battle.
Among some tribes of the Kaffirs a kindred custom was practiced; and
among the Damaras, for every wild animal a young man destroyed his
father made four incisions on the front of his son's body. Speaking of
certain Congo people, Tuckey says that they scar themselves principally
with the idea of rendering themselves agreeable to the women of their
tribe. Among the Itzaex Indians of Yucatan, a race with particularly
handsome features, some are marked with scarred lines, inflicted as
signs of courage.

Cosmetic Mutilations.--In modern times there have been individuals
expert in removing facial deformities, and by operations of various
kinds producing pleasing dimples or other artificial signs of beauty.
We have seen an apparatus advertised to be worn on the nose during the
night for the purpose of correcting a disagreeable contour of this
organ. A medical description of the artificial manufacture of dimples
is as follows:--"The modus operandi was to make a puncture in the skin
where the dimple was required, which would not be noticed when healed,
and, with a very delicate instrument, remove a portion of the muscle.
Inflammation was then excited in the skin over the subcutaneous pit,
and in a few days the wound, if such it may be called, was healed, and
a charming dimple was the result." It is quite possible that some of
our modern operators have overstepped the bounds of necessity, and
performed unjustifiable plastic operations to satisfy the vanity of
their patients.

Dobrizhoffer says of the Abipones that boys of seven pierce their
little arms in imitation of their parents. Among some of the indigenous
Australians it is quite customary for ridged and linear scars to be
self-inflicted. In Tanna the people produce elevated scars on the arms
and chests. Bancroft recites that family-marks of this nature existed
among the Cuebas of Central America, refusal being tantamount to
rebellion. Schomburgk tells that among the Arawaks, after a Mariquawi
dance, so great is their zeal for honorable scars, the blood will run
down their swollen calves, and strips of skin and muscle hang from the
mangled limbs. Similar practices rendered it necessary for the United
States Government to stop some of the ceremonial dances of the Indians
under their surveillance.

A peculiar custom among savages is the amputation of a finger as a
sacrifice to a deity. In the tribe of the Dakotas the relatives of a
dead chief pacified his spirit by amputating a finger. In a similar
way, during his initiation, the young Mandan warrior, "holding up the
little finger of his left hand to the Great Spirit," ... "expresses his
willingness to give it as a sacrifice, and he lays it on the dried
buffalo skull, when another chops it off near the hand with a blow of
the hatchet." According to Mariner the natives of Tonga cut off a
portion of the little finger as a sacrifice to the gods for the
recovery of a superior sick relative. The Australians have a custom of
cutting off the last joint of the little finger of females as a token
of submission to powerful beings alive and dead. A Hottentot widow who
marries a second time must have the distal joint of her little finger
cut off; another joint is removed each time she remarries.

Among the mutilations submitted to on the death of a king or chief in
the Sandwich Islands, Cook mentions in his "Voyages" the custom of
knocking out from one to four front teeth.

Among the Australian tribes the age of virility and the transition into
manhood is celebrated by ceremonial customs, in which the novices are
subjected to minor mutilations. A sharp bone is used for lancing their
gums, while the throw-stick is used for knocking out a tooth.
Sometimes, in addition to this crude dentistry, the youth is required
to submit to cruel gashes cut upon his back and shoulders, and should
he flinch or utter any cry of pain he is always thereafter classed with
women.  Haygarth writes of a semi-domesticated Australian who said one
day, with a look of importance, that he must go away for a few days, as
he had grown to man's estate, and it was high time he had his teeth
knocked out. It is an obligatory rite among various African tribes to
lose two or more of their front teeth. A tradition among certain
Peruvians was that the Conqueror Huayna Coapae made a law that they and
their descendants should have three front teeth pulled out in each jaw.
Cieza speaks of another tradition requiring the extraction of the teeth
of children by their fathers as a very acceptable service to their
gods. The Damaras knock out a wedge-shaped gap between two of their
front teeth; and the natives of Sierra Leone file or chip their teeth
after the same fashion.

Depilatory customs are very ancient, and although minor in extent are
still to be considered under the heading of mutilations. The giving of
hair to the dead as a custom, has been perpetuated through many tribes
and nations. In Euripides we find Electra admonishing Helen for sparing
her locks, and thereby defrauding the dead. Alexander the Great shaved
his locks in mourning for his friend, Hephaestion, and it was supposed
that his death was hastened by the sun's heat on his bare head after
his hat blew off at Babylon. Both the Dakota Indians and the Caribs
maintain the custom of sacrificing hair to the dead. In Peru the custom
was varied by pulling out eyelashes and eyebrows and presenting them to
the sun, the hills, etc. It is said this custom is still in
continuance. When Clovis was visited by the Bishop of Toulouse he gave
him a hair from his beard and was imitated by his followers. In the
Arthurian legends we find "Then went Arthur to Caerleon; and thither
came messages from King Ryons who said, 'even kings have done me
homage, and with their beards I have trimmed a mantle. Send me now thy
beard, for there lacks yet one to the finishing of the mantle.'" The
association between short hair and slavery arose from the custom of
taking hair from the slain. It existed among the Greeks and Romans, and
was well known among the indigenous tribes of this continent. Among the
Shoshones he who took the most scalps gained the most glory.

In speaking of the prisoners of the Chicimecs Bancroft says they were
often scalped while yet alive, and the bloody trophies placed on the
heads of their tormentors. In this manner we readily see that long hair
among the indigenous tribes and various Orientals, Ottomans, Greeks,
Franks, Goths, etc., was considered a sign of respect and honor. The
respect and preservation of the Chinese queue is well known in the
present day. Wishing to divide their brother's kingdom, Clothair and
Childebert consulted whether to cut off the hair of their nephews, the
rightful successors, so as to reduce them to the rank of subjects, or
to kill them. The gods of various people, especially the greater gods,
were distinguished by their long beards and flowing locks. In all
pictures Thor and Samson were both given long hair, and the belief in
strength and honor from long hair is proverbial. Hercules is always
pictured with curls.  According to Goldzhier, long locks of hair and a
long beard are mythologic attributes of the sun. The sun's rays are
compared to long locks or hairs on the face of the sun. When the sun
sets and leaves his place to the darkness, or when the powerful summer
sun is succeeded by the weak rays of the winter sun, then Samson's long
locks, through which alone his strength remains, are cut off by the
treachery of his deceitful concubine Delilah (the languishing,
according to the meaning of the name). The beaming Apollo was,
moreover, called the "Unshaven;" and Minos cannot conquer the solar
hero, Nisos, until the latter loses his golden hair. In Arabic
"Shams-on" means the sun, and Samson had seven locks of hair, the
number of the planetary bodies. In view of the foregoing facts it seems
quite possible that the majority of depilatory processes on the scalp
originated in sun-worship, and through various phases and changes in
religions were perpetuated to the Middle Ages. Charles Martel sent
Pepin, his son, to Luithprand, king of the Lombards, that he might cut
his first locks, and by this ceremony hold for the future the place of
his illustrious father. To make peace with Alaric, Clovis became his
adopted son by offering his beard to be cut. Among the Caribs the hair
constituted their chief pride, and it was considered unequivocal proof
of the sincerity of their sorrow, when on the death of a relative they
cut their hair short. Among the Hebrews shaving of the head was a
funeral rite, and among the Greeks and Romans the hair was cut short in
mourning, either for a relative or for a celebrated personage.
According to Krehl the Arabs also had such customs. Spencer mentions
that during an eruption in Hawaii, "King Kamahameha cut off part of his
own hair" ... "and threw it into the torrent (of lava)."

The Tonga regarded the pubic hairs as under the special care of the
devil, and with great ceremony made haste to remove them. The female
inhabitants of some portions of the coast of Guinea remove the pubic
hairs as fast as they appear. A curious custom of Mohammedan ladies
after marriage is to rid themselves of the hirsute appendages of the
pubes. Depilatory ointments are employed, consisting of equal parts of
slaked lime and arsenic made into a paste with rose-water. It is said
that this important ceremony is not essential in virgins. One of the
ceremonies of assuming the toga virilis among the indigenous
Australians consists in submitting to having each particular hair
plucked singly from the body, the candidate being required not to
display evidences of pain during the operation. Formerly the Japanese
women at marriage blackened their teeth and shaved or pulled out their
eyebrows.

The custom of boring the ear is very old, mention of it being made in
Exodus xxi., 5 and 6, in which we find that if a Hebrew servant served
for six years, his freedom was optional, but if he plainly said that he
loved his master, and his wife and children, and did not desire to
leave their house, the master should bring him before the judges; and
according to the passage in Exodus, "he shall also bring him to the
door or unto the doorpost, and his master shall bore his ear through
with an awl; and he shall serve him forever." All the Burmese, says
Sangermano, without exception, have the custom of boring their ears.
The days when the operations were performed were kept as festivals. The
ludicrous custom of piercing the ears for the wearing of ornaments,
typical of savagery and found in all indigenous African tribes, is
universally prevalent among our own people.

The extremists in this custom are the Botocudos, who represent the most
cruel and ferocious of the Brazilian tribes, and who especially cherish
a love for cannibalism. They have a fondness for disfiguring themselves
by inserting in the lower parts of their ears and in their under lips
variously shaped pieces of wood ornaments called peleles, causing
enormous protrusion of the under lip and a repulsive wide mouth, as
shown in Figure 230.

Tattooing is a peculiar custom originating in various ways. The
materials used are vermilion, indigo, carbon, or gunpowder. At one time
this custom was used in the East to indicate caste and citizenship.
Both sexes of the Sandwich Islanders have a peculiar tattooed mark
indicative of their tribe or district. Among the Uapes, one tribe, the
Tucanoes, have three vertical blue lines.  Among other people tattooed
marks indicated servility, and Boyle says the Kyans, Pakatans, and
Kermowits alone, among the Borneo people, practised tattooing, and adds
that these races are the least esteemed for bravery. Of the Fijians the
women alone are tattooed, possibly as a method of adornment.

The tattooing of the people of Otaheite, seen by Cook, was surmised by
him to have a religious significance, as it presented in many instances
"squares, circles, crescents, and ill-designed representations of men
and dogs." Every one of these people was tattooed upon reaching
majority. According to Carl Bock, among the Dyaks of Borneo all of the
married women were tattooed on the hands and feet, and sometimes on the
thighs. The decoration is one of the privileges of matrimony, and is
not permitted to unmarried girls. Andrew Lang says of the Australian
tribes that the Wingong or the Totem of each man is indicated by a
tattooed representation of it on his flesh. The celebrated American
traveler, Carpenter, remarks that on his visit to a great prison in
Burmah, which contains more than 3000 men, he saw 6000 tattooed legs.
The origin of the custom he was unable to find out, but in Burmah
tattooing was a sign of manhood, and professional tattooers go about
with books of designs, each design warding off some danger. Bourke
quotes that among the Apaches-Yumas of Arizona the married women are
distinguished by several blue lines running from the lower lip to the
chin; and he remarks that when a young woman of this tribe is anxious
to become a mother she tattoos the figure of a child on her forehead.
After they marry Mojave girls tattoo the chin with vertical blue lines;
and when an Eskimo wife has her face tattooed with lamp-black she is
regarded as a matron in society.  The Polynesians have carried this
dermal art to an extent which is unequaled by any other people, and it
is universally practiced among them. Quoted by Burke, Sullivan states
that the custom of tattooing continued in England and Ireland down to
the seventh century. This was the tattooing with the woad. Fletcher
remarks that at one time, about the famous shrine of Our Lady of
Loretto, were seen professional tattooers, who for a small sum of money
would produce a design commemorative of the pilgrim's visit to the
shrine. A like profitable industry is pursued in Jerusalem.

Universal tattooing in some of the Eastern countries is used as a means
of criminal punishment, the survival of the persecuted individual being
immaterial to the torturers, as he would be branded for life and
ostracized if he recovered. Illustrative of this O'Connell tells of a
case in Hebra's clinic. The patient, a man five feet nine inches in
height, was completely tattooed from head to foot with all sorts of
devices, such as elephants, birds, lions, etc., and across his
forehead, dragons. Not a square of even a quarter inch had been exempt
from the process. According to his tale this man had been a leader of a
band of Greek robbers, organized to invade Chinese Tartary, and,
together with an American and a Spaniard, was ordered by the ruler of
the invaded province to be branded in this manner as a criminal. It
took three months' continuous work to carry out this sentence, during
which his comrades succumbed to the terrible agonies.  During the
entire day for this extended period indigo was pricked in this
unfortunate man's skin. Accounts such as this have been appropriated by
exhibitionists, who have caused themselves to be tattooed merely for
mercenary purposes. The accompanying illustration represents the
appearance of a "tattooed man" who exhibited himself. He claimed that
his tattooing was done by electricity. The design showing on his back
is a copy of a picture of the Virgin Mary surrounded by 31 angels.

The custom of tattooing the arms, chest, or back is quite prevalent,
and particularly among sailors and soldiers. The sequences of this
custom are sometimes quite serious. Syphilis has been frequently
contracted in this manner, and Maury and Dulles have collected 15 cases
of syphilis acquired in tattooing.  Cheinisse reports the case of a
young blacksmith who had the emblems of his trade tattooed upon his
right forearm. At the end of forty days small, red, scaly elevations
appeared at five different points in the tattooed area. These broke
down and formed ulcers. When examined these ulcers presented the
peculiarities of chancres, and there was upon the body of the patient a
well-marked syphilitic roseola. It was ascertained that during the
tattooing the operator had moistened the ink with his own saliva.

Hutchinson exhibited drawings and photographs showing the condition of
the arms of two boys suffering from tuberculosis of the skin, who had
been inoculated in the process of tattooing.  The tattooing was done by
the brother of one of the lads who was in the last stages of phthisis,
and who used his own saliva to mix the pigment. The cases were under
the care of Murray of Tottenham, by whom they had been previously
reported. Williams has reported the case of a militiamen of seventeen
who, three days after an extensive tattooing of the left forearm,
complained of pain, swelling, and tenderness of the left wrist. A day
later acute left-sided pneumonia developed, but rapidly subsided. The
left shoulder, knee, and ankle were successively involved in the
inflammation, and a cardiac bruit developed. Finally chorea developed
as a complication, limited for a time to the left side, but shortly
spreading to the right, where rheumatic inflammation was attacking the
joints. The last, however, quickly subsided, leaving a general, though
mild chorea and a permanently damaged heart.

Infibulation of the male and female external genital organs for the
prevention of sexual congress is a very ancient custom. The Romans
infibulated their singers to prevent coitus, and consequent change in
the voice, and pursued the same practice with their actors and dancers.
According to Celsus, Mercurialis, and others, the gladiators were
infibulated to guard against the loss of vigor by sexual excesses. In
an old Italian work there is a figure of an infibulated musician--a
little bronze statue representing a lean individual tortured or
deformed by carrying an enormous ring through the end of the penis. In
one of his pleasantries Martial says of these infibulated singers that
they sometimes break their rings and fail to place them back--"et cujus
refibulavit turgidum faber peruem." Heinsius considers Agamemnon
cautious when he left Demodocus near Clytemnestra, as he remarks that
Demodocus was infibulated. For such purposes as the foregoing
infibulation offered a more humane method than castration.

Infibulation by a ring in the prepuce was used to prevent premature
copulation, and was in time to be removed, but in some cases its
function was the preservation of perpetual chastity.  Among some of the
religious mendicants in India there were some who were condemned to a
life of chastity, and, in the hotter climates, where nudity was the
custom, these persons traveled about exposing an enormous preputial
ring, which was looked upon with adoration by devout women. It is said
these holy persons were in some places so venerated that people came on
their knees, and bowing below the ring, asked forgiveness--possibly for
sexual excesses.

Rhodius mentions the usage of infibulation in antiquity, and Fabricius
d'Aquapendente remarks that infibulation was usually practiced in
females for the preservation of chastity. No Roman maiden was able to
preserve her virginity during participation in the celebrations in the
Temples of Venus, the debauches of Venus and Mars, etc., wherein vice
was authorized by divine injunction; for this reason the lips of the
vagina were closed by rings of iron, copper, or silver, so joined as to
hinder coitus, but not prevent evacuation. Different sized rings were
used for those of different ages. Although this device provided against
the coitus, the maiden was not free from the assaults of the Lesbians.
During the Middle Ages, in place of infibulation, chastity-girdles were
used, and in the Italian girdles, such as the one exhibited in the
Musee Cluny in Paris, both the anus and vulva were protected by a steel
covering perforated for the evacuations. In the Orient, particularly in
India and Persia, according to old travelers, the labia were sewed
together, allowing but a small opening for excretions. Buffon and Brown
mention infibulation in Abyssinia, the parts being separated by a
bistoury at the time of marriage. In Circassia the women were protected
by a copper girdle or a corset of hide and skin which, according to
custom, only the husband could undo. Peney speaks of infibulation for
the preservation of chastity, as observed by him in the Soudan. Among
the Nubians this operation was performed at about the age of eight with
great ceremony, and when the time for marriage approached the vulva had
to be opened by incision. Sir Richard Buxton, a distinguished traveler,
also speaks of infibulation, and, according to him, at the time of the
marriage ceremony the male tries to prove his manhood by using only
Nature's method and weapon to consummate the marriage, but if he failed
he was allowed artificial aid to effect entrance. Sir Samuel Baker is
accredited in The Lancet with giving an account in Latin text of the
modus operandi of a practice among the Nubian women of removing the
clitoris and nymphae in the young girl, and abrading the adjacent walls
of the external labia so that they would adhere and leave only a
urethral aperture.

This ancient custom of infibulation is occasionally seen at the present
day in civilized countries, and some cases of infibulation from
jealousy are on record. There is mentioned, as from the Leicester
Assizes, the trial of George Baggerly for execution of a villainous
design on his wife. In jealousy he "had sewed up her private parts."
Recently, before the New York Academy of Medicine, Collier reported a
case of pregnancy in a woman presenting nympha-infibulation. The
patient sought the physician's advice in the summer of 1894, while
suffering from uterine disease, and being five weeks pregnant. She was
a German woman of twenty-eight, had been married several years, and was
the mother of several children. Collier examined her and observed two
holes in the nymphae. When he asked her concerning these, she
reluctantly told him that she had been compelled by her husband to wear
a lock in this region. Her mother, prior to their marriage, sent her
over to the care of her future husband (he having left Germany some
months before). On her arrival he perforated the labia minora, causing
her to be ill several weeks; after she had sufficiently recovered he
put on a padlock, and for many years he had practiced the habit of
locking her up after each intercourse. Strange to relate, no physician,
except Collier, had ever inquired about the openings. In this
connection the celebrated Harvey mentions a mare with infibulated
genitals, but these did not prevent successful labor.

Occasionally infibulation has been used as a means of preventing
masturbation. De la Fontaine has mentioned this fact, and there is a
case in this country in which acute dementia from masturbation was
cured by infibulation. In this instance the prepuce was perforated in
two opposite places by a trocar, and two pewter sounds (No. 2) were
introduced into the wounds and twisted like rings. On the eleventh day
one of the rings was removed, and a fresh one introduced in a new
place. A cure was effected in eight weeks. There is recent mention made
of a method of preventing masturbation by a cage fastened over the
genitals by straps and locks. In cases of children the key was to be
kept by the parents, but in adults to be put in some part of the house
remote from the sleeping apartment, the theory being that the desire
would leave before the key could be obtained.

Among some peoples the urethra was slit up as a means of preventing
conception, making a meatus near the base of the penis. Herodotus
remarks that the women of a certain portion of Egypt stood up while
they urinated, while the men squatted.  Investigation has shown that
the women were obliged to stand up on account of elongated nymphae and
labia, while the men sought a sitting posture on account of the
termination of the urethra being on the inferior side of the base of
the penis, artificially formed there in order to prevent conception. In
the Australian Medical Gazette, May, 1883, there is an account of some
of the methods of the Central Australians of preventing conception. One
was to make an opening into the male urethra just anterior to the
scrotum, and another was to slit up the entire urethra so far as to
make but a single canal from the scrotum to the glans penis.  Bourke
quotes Palmer in mentioning that it is a custom to split the urethra of
the male of the Kalkadoon tribe, near Cloncurry, Queensland, Australia
Mayer of Vienna describes an operation of perforation of the penis
among the Malays; and Jagor and Micklucho-Maclay report similar customs
among the Dyaks and other natives of Borneo, Java, and Phillipine
Islands.

Circumcision is a rite of great antiquity. The Bible furnishes frequent
records of this subject, and the bas-reliefs on some of the old
Egyptian ruins represent circumcised children. Labat has found traces
of circumcision and excision of nymphae in mummies.  Herodotus remarks
that the Egyptians practiced circumcision rather as a sanitary measure
than as a rite. Voltaire stated that the Hebrews borrowed circumcision
from the Egyptians; but the Jews claimed that the Phoenicians borrowed
this rite from the Israelites.

Spencer and others say that in the early history of the Christian
religion, St. Paul and his Disciples did not believe in circumcision,
while St. Peter and his followers practiced it.  Spencer mentions that
the Abyssinians take a phallic trophy by circumcision from the enemy's
dead body. In his "History of Circumcision," Remondino says that among
the modern Berbers it is not unusual for a warrior to exhibit virile
members of persons he has slain; he also says that, according to
Bergman, the Israelites practiced preputial mutilations; David brought
200 prepuces of the Philistines to Saul. Circumcision is practiced in
nearly every portion of the world, and by various races, sometimes
being a civil as well as a religious custom. Its use in surgery is too
well known to be discussed here. It might be mentioned, however, that
Rake of Trinidad, has performed circumcision 16 times, usually for
phimosis due to leprous tuberculation of the prepuce. Circumcision, as
practiced on the clitoris in the female, is mentioned on page 308.

Ceremonial Ovariotomy.--In the writings of Strabonius and Alexander ab
Alexandro, allusion is made to the liberties taken with the bodies of
females by the ancient Egyptians and Lydians.  Knott says that ablation
of the ovaries is a time-honored custom in India, and that he had the
opportunity of physically examining some of the women who had been
operated on in early life. At twenty-five he found them strong and
muscular, their mammary glands wholly undeveloped, and the normal
growth of pubic hairs absent. The pubic arch was narrow, and the
vaginal orifice practically obliterated. The menses had never appeared,
and there seemed to be no sexual desire. Micklucho-Maclay found that
one of the most primitive of all existing races--the New
Hollanders--practiced ovariotomy for the utilitarian purpose of
creating a supply of prostitutes, without the danger of burdening the
population by unnecessary increase. MacGillibray found a native
ovariotomized female at Cape York who had been subjected to the
operation because, having been born dumb, she would be prevented from
bearing dumb children,--a wise, though primitive, method of preventing
social dependents.

Castration has long been practiced, either for the production of
eunuchs, or castrata, through vengeance or jealousy, for excessive
cupidity, as a punishment for crime, in fanaticism, in ignorance, and
as a surgical therapeutic measure (recently, for the relief of
hypertrophied prostate). The custom is essentially Oriental in origin,
and was particularly used in polygamous countries, where the mission of
eunuchs was to guard the females of the harem. They were generally
large, stout men, and were noted for their vigorous health. The history
of eunuchism is lost in antiquity. The ancient Book of Job speaks of
eunuchs, and they were in vogue before the time of Semiramis; the King
of Lydia, Andramytis, is said to have sanctioned castration of both
male and female for social reasons. Negro eunuchs were common among the
Romans. All the great emperors and conquerors had their eunuchs.
Alexander the Great had his celebrated eunuch, Bagoas, and Nero, his
Sporus, etc. Chevers says that the manufacture of eunuchs still takes
place in the cities of Delhi, Lucknow, and Rajpootana. So skilful are
the traveling eunuch-makers that their mortality is a small fraction of
one per cent. Their method of operation is to encircle the external
genital organs with a tight ligature, and then sweep them off at one
stroke. He also remarks that those who retain their penises are of but
little value or trusted. He divided the Indian eunuchs into three
classes: those born so, those with a penis but no testicles, and those
minus both testicles and penis. Curran describes the traveling
eunuch-makers in Central India, and remarks upon the absence of death
after the operation, and invites the attention of gynecologists and
operators to the successful, though crude, methods used. Curran says
that, except those who are degraded by practices of sexual perversions,
these individuals are vigorous bodily, shrewd, and sagacious, thus
proving the ancient descriptions of them.

Jamieson recites a description of the barbarous methods of making
eunuchs in China. The operators follow a trade of eunuch-making, and
keep it in their families from generation to generation; they receive
the monetary equivalent of about $8.64 for the operation.  The patient
is grasped in a semi-prone position by an assistant, while two others
hold the legs. After excision the wounded parts are bathed three times
with a hot decoction of pepper-pods, the wound is covered with paper
soaked in cold water, and bandages applied. Supported by two men the
patient is kept walking for two or three hours and then tied down. For
three days he is allowed nothing to drink, and is not allowed to pass
his urine, the urethra being filled with a pewter plug. It generally
takes about one hundred days for the wound to heal, and two per cent of
the cases are fatal. There is nocturnal incontinence of urine for a
long time after the operation.

Examples of castration because of excessive cupidity, etc.,--a most
unwarranted operation,--are quite rare and are usually found among
ecclesiastics. The author of "Faustin, or le Siecle Philosophique,"
remarked that there were more than 4000 castrated individuals among the
ecclesiastics and others of Italy. The virtuous Pope Clement XIV
forbade this practice, and describes it as a terrible abuse; but in
spite of the declaration of the Pope the cities of Italy, for some
time, still continued to contain great numbers of these victims. In
France an article was inserted into the penal code providing severe
punishment for such mutilations. Fortunately castration for the
production of "castrata," or tenor singers, has almost fallen into
disuse.  Among the ancient Egyptians and Persians amputation of the
virile member was inflicted for certain crimes of the nature of rape.

Castration as a religious rite has played a considerable role.  With
all their might the Emperors Constantine and Justinian opposed the
delirious religion of the priests of Cybele, and rendered their offence
equivalent to homicide. At the annual festivals of the Phrygian Goddess
Amma (Agdistis) it was the custom of young men to make eunuchs of
themselves with sharp shells, and a similar rite was recorded among
Phoenicians.  Brinton names severe self-mutilators of this nature among
the ancient Mexican priests. Some of the Hottentots and indigenous
Australians enforced semicastration about the age of eight or nine.

The Skoptzies, religious castrators in Russia, are possibly the most
famous of the people of this description. The Russian government has
condemned members of this heresy to hard labor in Siberia, but has been
unable to extinguish the sect. Pelikan, Privy Counsel of the
government, has exhaustively considered this subject. Articles have
appeared in Le Progres Medical, December.  1876. and there is an
account in the St. Louis Clinical Record, 1877-78. The name Skoptzy
means "the castrated," and they call themselves the "White Doves." They
arose about 1757 from the Khlish or flagellants. Paul I caused
Sseliwanow, the true founder, to return from Siberia, and after seeing
him had him confined in an insane asylum. After an interview, Alexander
I transferred him to a hospital. Later the Councillor of State,
Jelansky, converted by Sseliwanow, set the man free and soon the
Skoptzies were all through Russia and even at the Court. The principal
argument of these people is the nonconformity of orthodox believers,
especially the priests, to the doctrines professed, and they contrast
the lax morals of these persons with the chaste lives, the abstinence
from liquor, and the continual fasts of the "White Doves." For the
purpose of convincing novices of the Scriptural foundation of their
rites and belief they are referred to Matthew xix., 12: "and there be
eunuchs which have made themselves for the kingdom of Heaven's sake,"
etc.; and Mark ix., 43-47; Luke xxiii., 29: "blessed are the barren,"
etc., and others of this nature. As to the operation itself, pain is
represented as voluntary martyrdom, and persecution as the struggle of
the spirit of darkness with that of light. They got persons to join the
order by monetary offers. Another method was to take into service young
boys, who soon became lost to society, and lied with effrontery and
obstinacy. They had secret methods of communicating with one another,
and exhibited a passion for riches, a fact that possibly accounts for
their extended influence. The most perfect were those "worthy of
mounting the white horse," the "bearers of the Imperial seal," who were
deprived of the testicles, penis, and scrotum. The operation of
castration among these people was performed at one stroke or at two
different times, in the former case one cicatrix being left, and in the
latter two. The greater number--those who had submitted to the "first
purification," conferring upon them the "lesser seal"--had lost
testicles and scrotum. These people are said to have lost the "keys of
hell," but to retain the "key of the abyss" (female genitals). As
instruments of excision the hot iron, pieces of glass, old wire,
sharpened bone, and old razors are used. Only nine fatal cases
resulting from the operation are known. At St. Petersburg Liprandi knew
a rich Skoptzy who constantly kept girls--mostly Germans--for his own
gratification, soon after having entered into the "first purification."
Few of them were able to remain with him over a year, and they always
returned to their homes with health irretrievably lost. Women members
of the order do not have their ovaries removed, but mutilation is
practiced upon the external genitals, the mammae, and nipples. The
first ablation is obtained by applying fire or caustics to the nipples,
the second by amputation of the breasts, one or both, the third by
diverse gashes, chiefly across the breast, and the fourth by resection
of the nymphae or of the nymphae and clitoris, and the superior major
labia, the cicatrices of which would deform the vulva. Figure 232
represents the appearance of the external genital organs of a male
Skoptzy after mutilation; Figure 233 those of a female.

Battey speaks of Skoptzies in Roumania who numbered at the time of
report 533 persons. They came from Russia and practiced the same
ceremonies as the heretics there.



CHAPTER XV.

ANOMALOUS TYPES AND INSTANCES OF DISEASE.

Tumors.--In discussing tumors and similar growths no attempt will be
made to describe in detail the various types. Only the anomalous
instances or examples, curious for their size and extent of
involvement, will be mentioned. It would be a difficult matter to
decide which was the largest tumor ever reported. In reviewing
literature so many enormous growths are recorded that but few can be
given here. Some of the large cystic formations have already been
mentioned; these are among the largest tumors.  Scrotal tumors are
recorded that weighed over 200 pounds; and a limb affected with
elephantiasis may attain an astonishing size.  Delamater is accredited
with a report of a tumor that weighed 275 pounds, the patient only
weighing 100 pounds at death. Benign tumors will be considered first.

Pure adenoma of the breast is a rare growth. Gross was able to collect
but 18 examples; but closely allied to this condition is what is known
as diffuse hypertrophy of the breast. In some parts of the world,
particularly in India and Africa, long, dependent breasts are signs of
beauty. On the other hand we learn from Juvenal and Martial that, like
ourselves, the Greeks detested pendant and bulky breasts, the signs of
beauty being elevation, smallness, and regularity of contour. In the
Grecian images of Venus the breasts are never pictured as engorged or
enlarged. The celebrated traveler Chardin says that the Circassian and
Georgian women have the most beautiful breasts in the world; in fact
the Georgians are so jealous of the regular contour and wide interval
of separation of their breasts that they refuse to nourish their
children in the natural manner.

The amount of hypertrophy which is sometimes seen in the mammae is
extraordinary. Borellus remarks that he knew of a woman of ordinary
size, each of whose mammae weighed about 30 pounds, and she supported
them in bags hung about her neck. Durston reports a case of sudden
onset of hypertrophy of the breast causing death.  At the postmortem it
was found that the left breast weighed 64 pounds and the right 40
pounds. Boyer successfully removed two breasts at an interval of
twenty-six days between the two operations. The mass excised was
one-third of the total body-weight.

Schaeffer speaks of hypertrophied mammae in a girl of fourteen, the
right breast weighing 3900 grams (136 1/2 oz.) and the right 3500 grams
(122 1/2 oz.). Hamilton reports a case of hypertrophied glands in a
woman of thirty-two, which, within the short space of a year, reached
the combined weight of 52 pounds.  They were successfully excised.
Velpeau, Billroth, and Labarracque have reported instances of the
removal of enormously hypertrophied mammae. In 1886 Speth of Munich
described a hypertrophy of the right breast which increased after every
pregnancy. At the age of twenty-six the woman had been five times
pregnant in the space of a little over five years, and at this time the
right breast hung down to the anterior superior spine of the ilium. It
weighed 20 pounds, and its greatest circumference was 25 inches. There
was no milk in this breast, although the left was in perfect lactation.
This case was one of pure hypertrophy and not an example of
fibro-adenoma, as illustrated by Billroth. Warren figures a case of
diffused hypertrophy of the breast which was operated on by Porter. The
right breast in its largest circumference measured 38 inches and from
the chest-wall to the nipple was 17 inches long, the circumference at
the base being 23 inches; the largest circumference of the left breast
was 28 inches; its length from the chest-wall to the nipple was 14
inches, and its circumference at the base 23 inches. The skin was
edematous and thickened. Throughout both breasts were to be felt
hardened movable masses, the size of oranges. Microscopic examination
showed the growth to be a diffused intracanalicular fibroma. A peculiar
case was presented before the Faculty at Montpellier. The patient was a
young girl of fifteen and a half years. After a cold bath, just as the
menses were appearing, it was found that the breasts were rapidly
increasing in size; she was subsequently obliged to leave service on
account of their increased size, and finally the deformity was so great
as to compel her to keep from the public view. The circumference of the
right breast was 94 cm. and of the left 105 cm.; the pedicle of the
former measured 67 cm. and of the latter 69 cm.; only the slightest
vestige of a nipple remained. Removal was advocated, as applications of
iodin had failed; but she would not consent to operation. For eight
years the hypertrophy remained constant, but, despite this fact, she
found a husband. After marriage the breasts diminished, but she was
unable to suckle either of her three children, the breasts becoming
turgid but never lactescent.  The hypertrophy diminished to such a
degree that, at the age of thirty-two, when again pregnant, the
circumference of the right breast was only 27 cm. and of the left 33
cm. Even thus reduced the breasts descended almost to the navel. When
the woman was not pregnant they were still less voluminous and seemed
to consist of an immense mass of wrinkled, flaccid skin, traversed by
enormous dilated and varicose blood-vessels, the mammary glands
themselves being almost entirely absent.

Diffuse hypertrophy of the breast is occasionally seen in the male
subject. In one case reported from the Westminster Hospital in London,
a man of sixty, after a violent fall on the chest, suffered enormous
enlargement of the mammae, and afterward atrophy of the testicle and
loss of sexual desire.

The names goiter, struma, and bronchocele are applied indiscriminately
to all tumors of the thyroid gland; there are, however, several
distinct varieties among them that are true adenoma, which, therefore,
deserves a place here. According to Warren, Wolfler gives the following
classification of thyroid tumors: 1. Hypertrophy of the thyroid gland,
which is a comparatively rare disease; 2. Fetal adenoma, which is a
formation of gland tissue from the remains of fetal structures in the
gland; 3. Gelatinous or interacinous adenoma, which consists in an
enlargement of the acini by an accumulation of colloid material, and an
increase in the interacinous tissue by a growth of round cells. It is
this latter form in which cysts are frequently found. The accompanying
illustration pictures an extreme ease of cystic goiter shown by Warren.
A strange feature of tumors of the thyroid is that pressure-atrophy and
flattening of the trachea do not take place in proportion to the size
of the tumor. A small tumor of the middle lobe of the gland, not larger
that a hen's egg, will do more damage to the trachea than will a large
tumor, such as that shown by Senn, after Bruns. When a tumor has
attained this size, pressure-symptoms are often relieved by the weight
of the tumor making traction away from the trachea. Goiter is endemic
in some countries, particularly in Switzerland and Austria, and appears
particularly at the age of childhood or of puberty. Some communities in
this country using water containing an excess of calcium salt show
distinct evidences of endemic goiter. Extirpation of the thyroid gland
has in recent years been successfully practiced. Warren has extirpated
one lobe of the thyroid after preliminary ligation of the common
carotid on the same side. Green practiced rapid removal of the tumor
and ligated the bleeding vessels later. Rose tied each vessel before
cutting, proceeding slowly. Senn remarks that in 1878 he witnessed one
of Rose's operations which lasted for four hours. Although the operatic
technic of removal of the thyroid gland for tumor has been greatly
perfected by Billroth, Lucke, Julliard, Reverdin, Socin, Kocher, and
others, the current opinion at the present day seems to be that
complete extirpation of the thyroid gland, except for malignant
disease, is unjustifiable. Partial extirpation of the thyroid gland is
still practiced; and Wolfler has revived the operation of ligating the
thyroid arteries in the treatment of tumors of the thyroid gland.

Fibromata.--One of the commonest seats of fibroma is the skin.
Multiple fibromata of the skin sometimes occur in enormous numbers and
cover the whole surface of the body; they are often accompanied by
pendulous tumors of enormous size. Virchow called such tumors fibroma
molluscum. Figure 237 represents a case of multiple fibromata of the
skin shown by Octerlony. Pode mentions a somewhat similar case in a man
of fifty-six, under the care of Thom. The man was pale and emaciated,
with anxious expression, complaining of a tumor which he described as a
"wishing-mark." On examination he was found to be covered with a number
of small tumors, ranging in size from that of a small orange to that of
a pin's head; from the thoracic wall over the lower true ribs of the
right side was situated a large pendulous tumor, which hung down as far
as the upper third of the thigh. He said that it had always been as
long as this, but had lately become thicker, and two months previously
the skin over the lower part of the tumor had ulcerated. This large
tumor was successfully removed; it consisted of fibrous tissue, with
large veins running in its substance. The excised mass weighed 51
pounds. The patient made an early recovery.

Keloids are fibromata of the true skin, which may develop spontaneously
or in a scar. Although the distinction of true and false keloid has
been made, it is generally discarded. According to Hebra a true typical
keloid is found once in every 2000 cases of skin-disease. It is,
however, particularly the false keloid, or keloid arising from
cicatrices, with which we have mostly to deal. This tumor may arise
from a scar in any portion of the body, and at any age. There seems to
be a disposition in certain families and individuals to
keloid-formations, and among negroes keloids are quite common, and
often of remarkable size and conformation. The form of injury causing
the cicatrix is no factor in the production of keloid, the sting of an
insect, the prick of a needle, and even the wearing of ear-rings having
been frequent causes of keloid-formations among the negro race.
Collins describes a negress of ninety, born of African parents, who
exhibited multiple keloids produced by diverse injuries. At fourteen
she was burned over her breasts by running against a shovelful of hot
coals, and several months later small tumors appeared, which never
suppurated. When a young girl a tumor was removed from the front of her
neck by operation, and cicatricial tumors then spread like a band
encircling one-half her neck.  There were keloids over her scapulae,
which followed the application of blisters. On her back, over, and
following the direction of the ribs, were growths attributed to the
wounds caused by a flogging. This case was quite remarkable for the
predisposition shown to keloid at an early age, and the variety of
factors in causation.

About 1867 Duhring had under his observation at the Philadelphia
Hospital a negro whose neck was encircled by enormous keloids, which,
although black, otherwise resembled tomatoes. A photograph of this
remarkable case was published in Philadelphia in 1870.

A lipoma is a tumor consisting of adipose tissue. When there is much
fibrous tissue in the tumor it is much firmer, and is known as a
fibro-lipoma. Brander describes a young native of Manchuria, North
China, from whom he removed a fibro-lipoma weighing 50 pounds. The
growth had progressively enlarged for eleven years, and at the time of
extirpation hung as an enormous mass from beneath the left scapula. In
operating the tumor had to be swung on a beam. The hemorrhage was
slight and the patient was discharged in five days.

The true lipoma must be distinguished from diffuse accumulations of fat
in different parts of the body in the same way that fibroma is
distinguished from elephantiasis. Circumscribed lipoma appears as a
lobulated soft tumor, more or less movable, lying beneath the skin. It
sometimes reaches enormous size and assumes the shape of a pendulous
tumor.

Diffuse lipoma, occurring in the neck, often gives the patient a
grotesque and peculiar appearance. It is generally found in men
addicted to the use of alcohol, and occurs between thirty-five and
forty-five years of age; in no case has general obesity been described.
In one of Madelung's cases a large lobe extended downward over the
clavicle. The growth has been found between the larynx and the pharynx.
Black reports a remarkable case of fatty tumor in a child one year and
five months old which filled the whole abdominal cavity, weighing nine
pounds and two ounces.  Chipault mentions a case of lipoma of the
parietal region, observed by Rotter. This monstrous growth was three
feet three inches long, descending to the knees. It had its origin in
the left parietal region, and was covered by the skin of the whole left
side of the face and forehead. The left ear was plainly visible in the
upper third of the growth.

Chondroma, or enchondroma, is a cartilaginous tumor occurring
principally where cartilage is normally found, but sometimes in regions
containing no cartilage. Enchondroma may be composed of osteoid tissue,
such as is found in the ossifying callous between the bone and the
periosteum, and, according to Virchow, then takes the name of
osteochondroma. Virchow has divided chondromata into two forms--those
which he calls ecchondromata, which grow from cartilage, and those that
grow independently from cartilage, or the enchondromata, which latter
are in the great majority.  Enchondroma is often found on the long
bones, and very frequently upon the bones of the hands or on the
metatarsal bones.

Figure 244 represents an enchondroma of the thumb. Multiple
enchondromata are most peculiar, and may attain enormous sizes.
Whittaker describes a farmer of forty who exhibited peculiar tumors of
the fingers, which he calls multiple osteoecchondromata. His family
history was negative. He stated that at an early age he received a
stroke of lightning, which rendered him unconscious for some time. He
knows of nothing else that could be in possible relation with his
present condition.  Nine months after this accident there was noticed
an enlargement of the middle joint of the little finger, and about the
same time an enlargement on the middle finger. Gradually all the joints
of the right hand became involved. The enlargement increased so that at
the age of twelve they were of the size of walnuts, and at this time
the patient began to notice the same process developing in the left
hand. The growths continued to develop, new nodules appearing, until
the fingers presented the appearance of nodulated potatoes.

One of the most frequent of the fibro-cartilaginous tumors is the
"mixed cartilaginous" tumor of Paget, which grows in the interstitial
tissues of the parotid gland, and sometimes attains enormous size.
Matas presented the photograph of a negress having an enormous fibroma
growing from the left parotid region; and there is a photograph of a
similar case in the Mutter Museum of the College of Physicians,
Philadelphia.

The hyaline enchondroma is of slow growth, but may at times assume
immense proportions, as is shown in the accompanying illustration,
given by Warren, of a patient in whom the growth was in the scapula.

In 1824 there is quoted the description of a peculiar growth which,
though not definitely described, may be spoken of here. It was an
enormous encysted tumor, springing from the clavicle of a Veronese
nobleman. Contrary to general expectations it was successfully removed
by Portalupi, a surgeon of Venice. It weighed 57 pounds, being 20 1/2
inches long and 30 inches in circumference. It is said this tumor
followed the reception of a wound.

Among the benign bone tumors are exostoses--homologous outgrowths
differing from hypertrophies, as they only involve a limited part of
the circumference. When developmental, originating in childhood, the
outgrowths may be found on any part of the skeleton, and upon many and
generally symmetric parts at the same time, as is shown in Figure 248.

Barwell had a case of a girl with 38 exostoses. Erichsen mentions a
young man of twenty-one with 15 groups of symmetric exostoses in
various portions of the body; they were spongy or cancellous in nature.

Hartmann shows two cases of multiple exostoses, both in males, and
universally distributed over the body.

Macland of the French navy describes an affection of the bones of the
face known as anakhre or goundron (gros-nez). It is so common that
about one per cent of the natives of certain villages on the Ivory
Coast, West Africa, are subject to it. As a rule the earliest symptoms
in childhood are: more or less persistent headache, particularly
frontal, sanguineous and purulent discharge from the nostrils, and the
formation of symmetric swellings the size of an almond in the region of
the nasal processes of the superior maxilla. The cartilage does not
seem to be involved, and, although it is not so stated, the nasal duct
appears to remain intact.

The headache and discharge continue for a year, and the swelling
continually increases through life, although the symptoms gradually
disappear, the skin not becoming involved, and no pain being present.
It has been noticed in young chimpanzees. The illustration represents a
man of forty who suffered from the disease since puberty. Pressure on
the eyeball had started and the native said he expected that in two
years he would lose his sight. Figure 251 shows an analogous condition,
called by Hutchinson symmetric osteomata of the nasal processes of the
maxilla. His patient was a native of Great Britain.

Among neuromata, multiple neurofibroma is of considerable interest,
chiefly for the extent of general involvement.  According to Senn,
Heusinger records the case of a sailor of twenty-three in whom all the
nerves were affected by numerous nodular enlargements. Not a nerve in
the entire body was found normal. The enlargement was caused by
increase in the connective tissue, the axis-cylinders being normal. In
this case there was neither pain nor tenderness.

Prudden reports the case of a girl of twenty-five who, during
convalescence from variola, became paraplegic, and during this time
multiple neuromata appeared. At the postmortem more than a thousand
tumors were found affecting not only the peripheral branches and the
sympathetic, but also the cranial nerves and the pneumogastric. Under
the microscope these tumors showed an increase in the interfascicular
as well as perivascular fibers, but the nerve-fibers were not increased
in size or number.  Virchow collected 30 cases of multiple
neurofibromata. In one case he found 500, in another from 800 to 1000
tumors.

Plexiform neuroma is always congenital, and is found most frequently in
the temporal region, the neck, and the sides of the face, but almost
any part of the body may be affected. Christot reports two cases in
which the tumors were located upon the cheek and the neck. Czerny
observed a case in which the tumor involved the lumbar plexus. Quoted
by Senn, Campbell de Morgan met with a plexiform neuroma of the
musculo-spiral nerve and its branches.  The patient was a young lady,
and the tumor, which was not painful, had undergone myxomatous
degeneration.

Neuroma of the vulva is a pathologic curiosity. Simpson reports a case
in which the tumor was a painful nodule situated near the urinary
meatus. Kennedy mentions an instance in which the tumor appeared as
extremely tender tubercles.

Tietze describes a woman of twenty-seven who exhibited a marked type of
plexiform neurofibroma. The growth was simply excised and recovery was
promptly effected.

Carcinomatous growths, if left to themselves, make formidable
devastations of the parts which they affect. Warren pictures a case of
noli-me-tangere, a destructive type of epithelial carcinoma. The
patient suffered no enlargement of the lymphatic glands. The same
absence of glandular involvement was observed in another individual, in
whom there was extensive ulceration. The disease had in this case
originated in the scar of a gunshot wound received during the Civil
War, and had destroyed the side of the nose, the eye, the ear, the
cheek, including the corresponding half of the upper and lower lips.

Harlan reports a most extraordinary epithelioma of the orbit in a boy
of about five years. It followed enucleation, and attained the size
depicted in a few months.

Sarcomata, if allowed full progress, may attain great size. Plate 10
shows an enormous sarcoma of the buttocks in an adult negro.  Fascial
sarcomata are often seen of immense size. Senn shows a tumor of this
variety which was situated between the scapulae.

Schwimmer records a curious case of universal small sarcomata over the
whole body of a teacher of the age of twenty-one, in the Hungarian
lowlands. The author called the disease sarcomata pigmentosum diffusum
multiplex.

The bones are a common seat of sarcomatous growths, the tumor in this
instance being called osteosarcoma. It may affect any bone, but rarely
involves an articulation; at times it skips the joint and goes to the
neighboring bone.

A case of nasal sarcoma is shown by Moore. The tumor was located in the
nasal septum, and caused a frightful deformity. In this case pain was
absent, the sense of smell was lost, and the sight of the right eye
impaired. Moore attempted to remove the tumor, but in consequence of
some interference of respiration the patient died on the table.

Tiffany reports several interesting instances of sarcoma, one in a
white female of nineteen following a contusion of tibia. The growth had
all the clinical history of an osteosarcoma of the tibia, and was
amputated and photographed after removal. In another case, in a white
male of thirty, the same author successfully performed a hip-amputation
for a large sarcoma of the left femur. The removed member was sent
entire to the Army Medical Museum at Washington.

The fatality and incurability of malignant growths has done much to
stimulate daring and marvelous operations in surgery. The utter
hopelessness of the case justifies almost any means of relief, and many
of the visceral operations, resections of functional organs, and
extraordinary amputations that were never dreamed of in the early
history of medicine are to-day not only feasible and justifiable, but
even peremptorily demanded.

Varicose veins sometimes become so enlarged and distorted as to
simulate the appearance of one varicose tumor. Adams describes a
curious case of congenital dilatation of the arteries and veins in the
right lower limb, accompanied by an anastomosis with the interior of
the os calcis. The affected thigh exceeded the other in size by
one-third, all the veins being immensely swelled and distorted. The
arteries were also distorted and could be felt pulsating all over the
limb. The patient died at thirty from rupture of the aneurysm.

Abbe shows a peculiar aneurysmal varix of the finger in a boy of nine.
When a babe the patient had, on the dorsum of the little finger, a
small nevus, which was quiescent for many years. He received a deep cut
at the base of the thumb, and immediately after this accident the nevus
began to enlarge rapidly. But for the local aneurysmal thrill at the
point of the scar the condition would have been diagnosed as angioma,
but as a bruit could be heard over the entire mass it was called an
aneurysmal varix, because it was believed there was a connection
between a rather large artery and a vein close to the mass. There is a
curious case reported of cirsoid tumor of the ear of a boy of thirteen.
Figure 259 shows the appearance before and after operation.

Jessop records a remarkable case of multiple aneurysm. This case was
particularly interesting as it was accompanied by a postmortem
examination. Pye-Smith reports an extremely interesting case in which
death occurred from traumatic aneurysm of an aberrant subclavian
artery. The patient fell from a height of 28 feet, lost consciousness
for a few minutes, but soon recovered it. There was no evidence of any
fracture, but the man suffered greatly from dyspnea, pain between the
shoulders, and collapse. The breath-sounds on auscultation and the
difficulty in swallowing led to the belief that one of the bronchi was
blocked by the pressure of a hematoma. Dyspnea continued to increase,
and eighteen days after admission the man was in great distress, very
little air entering the chest. He had no pulse at the right wrist, and
Pye-Smith was unable to feel either the temporal or carotid beats on
the right side, although these vessels were felt pulsating on the left
side. Laryngotomy was done with the hope of removing a foreign body,
but the man died on the tenth day. A postmortem examination disclosed
the existence of an aberrant right subclavian artery in the posterior
mediastinum, and this was the seat of a traumatic aneurysm that had
ruptured into the esophagus.

Relative to the size of an aneurysm, Warren reported a case of the
abdominal aorta which commenced at the origin of the celiac axis and
passed on to the surfaces of the psoas and iliac muscles, descending to
the middle of the thigh The total length of the aneurysm was 19 inches,
and it measured 18 inches in circumference.

A peculiar sequence of an aortic aneurysm is perforation of the sternum
or rib. Webb mentions an Irish woman who died of aneurysm of the aorta,
which had perforated the sternum, the orifice being plugged by a large
clot. He quotes 17 similar cases which he has collected as occurring
from 1749 to 1874, and notes that one of the patients lived seven weeks
after the rupture of the aneurysmal sac.

Large Uterine Tumors.--Before the meeting of the American Medical
Association held in Washington, D.C., 1891, McIntyre a reported a case
of great interest. The patient, a woman of thirty-eight, five feet 5
1/2 inches in height, coarse, with masculine features, having hair on
her upper lip and chin, and weighing 199 1/2 pounds, was found in a
poor-house in Trenton, Missouri, on November 26, 1890, suffering from a
colossal growth of the abdomen. The accompanying illustration is from a
photograph which was taken at the time of the first interview. The
measurements made at the time were as follows: circumference at the
largest part, just below the umbilicus, 50 inches; circumference just
below the mammae, 35 inches; from the xiphoid cartilage to the
symphysis pubis, 32 inches, not including the appendum, which is shown
in the picture. Percussion suggested a fluid within a sac.  The uterus
was drawn up to the extent of from 12 to 14 inches.  The woman walked
with great difficulty and with a waddling gait, bending far backward
the better to keep "the center of gravity within the base," and to
enable her to sustain the enormous weight of the abdomen. She was
compelled to pass her urine while standing. Attempts had been made six
and two years before to tap this woman, but only a few drops of blood
followed several thrusts of a large trocar. A diagnosis was made of
multilocular ovarian cyst or edematous myoma of the uterus, and on the
morning of December 7, 1890, an operation was performed. An incision 14
inches in length was first made in the linea alba, below the umbilicus,
and afterward extended up to the xiphoid cartilage.  The hemorrhage
from the abdominal wall was very free, and the enormously distended
vessels required the application of a large number of pressure-forceps.
Adhesions were found almost everywhere the most difficult to manage
being those of the liver and diaphragm. The broad ligaments and
Fallopian tubes were ligated on either side, the tumor turned out, the
thick, heavy pedicle transfixed and ligated, and the enormous growth
cut away.  After operation the woman was immediately placed on platform
scales, and it was found that she had lost 93 1/2 pounds.
Unfortunately the patient developed symptoms of septicemia and died on
the fifth day. In looking over the literature on this subject McIntyre
found no mention of any solid tumor of this size having been removed.
On April 18, 1881, Keith, late of Edinburgh, now of London,
successfully removed an edematous myoma, together with the uterus,
which was 42 pounds in weight. In a recent work Tait remarks that the
largest uterine myoma which he ever removed weighed 68 pounds, and adds
that it grew after the menopause.  McIntyre believes that his tumor,
weighing 93 1/2 pounds, is the largest yet reported. Eastman reports
the removal of a fibroid tumor of the uterus weighing 60 pounds. The
patient recovered from the operation.

It is quite possible for a fibrocyst of the uterus to attain an
enormous size, equaling the ovarian cysts. Stockard describes an
instance of this nature in a negress of fifty, the mother of several
children. About twelve years before a cyst in the right iliac region
was tapped. The woman presented the following appearance: The navel
hung below her knees, and the skin near the umbilicus resembled that of
an elephant. The abdomen in its largest circumference measured 68
inches, and 27 inches from the ensiform cartilage to the umbilicus. The
umbilicus was five inches in diameter and three inches in length. Eight
gallons and seven pints of fluid were removed by tapping, much
remaining. The whole tumor weighed 135 pounds. Death from exhaustion
followed on the sixth day after the tapping.

Ovarian cysts, of which by far the greater number are of the glandular
variety, form extremely large tumors; ovarian dropsies of enormous
dimensions are recorded repeatedly throughout medical literature. Among
the older writers Ford mentions an instance of ovarian dropsy from
which, by repeated operations, 2786 pints of water were drawn.
Martineau describes a remarkable case of twenty-five years' duration,
in which 80 paracenteses were performed and 6630 pints of fluid were
withdrawn. In one year alone 495 pints were withdrawn. Tozzetti
mentions an ovarian tumor weighing 150 pounds. Morand speaks of an
ovarian cyst from which, in ten months, 427 pounds of fluid were
withdrawn. There are old records of tubal cysts weighing over 100
pounds. Normand speaks of an ovary degenerating into a scirrhous mass
weighing 55 pounds. Among recent operations Briddon describes the
removal of an ovarian cyst which weighed 152 pounds, death resulting.
Helmuth mentions an ovarian cyst from which, in 12 tappings, 559 pounds
of fluid were withdrawn. Delivery was effected by instrumental aid. The
tumor of 70 pounds was removed and death followed. McGillicuddy
mentions a case of ovarian cyst containing 132 pounds of fluid. The
patient was a woman of twenty-eight whose abdomen at the umbilicus
measured 69 inches in circumference and 47 inches from the sternum to
the pubes. Before the operation the great tumor hung down as far as the
knees, the abdominal wall chafing the thighs. Figure 263 shows the
appearance of a large ovarian cyst weighing 149 pounds. The emaciation
of the subject is particularly noticeable. Reifsnyder describes a
native Chinese woman affected with an ovarian tumor seen at the
Margaret Williamson Hospital at Shanghai. She was four feet eight
inches in height, and twenty-five years of age.  The tumor had been
growing for six years until the circumference at the umbilicus measured
five feet 7 3/4 inches; 88 quarts of fluid were drawn off and the woman
recovered. In the College of Physicians, Philadelphia, there are
photographs of this case, with an inscription saying that the patient
was a young Chinese woman who measured but four feet eight inches in
height, while her girth was increased by an ovarian cyst to five feet 9
1/8 inches. The tumor was removed and weighed 182 1/2 pounds; it
contained 22 gallons of fluid. Figure 265 shows the appearance of the
woman two months after the operation, when the girth was reduced to
normal. Stone performed ovariotomy on a girl of fifteen, removing a
tumor weighing 81 1/2 pounds. Ranney speaks of the successful removal
of a unilocular tumor weighing 95 pounds; and Wall tells of a death
after removal of an ovarian tumor of the same weight. Rodenstein
portrays the appearance of a patient of forty-five after death from an
enormous glandular ovarian cystoma. The tumor was three feet high,
covered the breasts, extended to the knees, and weighed 146 pounds.
Kelly speaks of a cyst weighing 116 pounds; Keith one of 89 1/2 pounds;
Gregory, 80 pounds; Boerstler, 65 pounds; Bixby, 70 pounds; and Alston
a tumor of 70 pounds removed in the second operation of ovariotomy.

Dayot reports the removal of an enormous ovarian cyst from a girl of
seventeen. The tumor had been present three years, but the patient and
her family refused an operation until the size of the tumor alarmed
them. Its largest circumference was five feet 11 inches. The distance
from the xiphoid to the symphysis pubis was three feet. The tumor was
covered with veins the size of the little finger. The apex of the heart
was pushed to the 3d interspace and the umbilicus had disappeared.
There were 65 quarts of a thick, brown fluid in the tumor. The patient
recovered in twenty-five days.

Cullingworth of St. Thomas Hospital, London, successfully removed from
a girl of sixteen an ovarian cyst weighing over 80 pounds.  The patient
was admitted to the hospital April 30, 1895. She gave a history of a
single menstruation, which took place in March or April, 1893, and said
that in the latter month she noticed that she was growing large. She
was tapped at Christmas, 1893, when a large quantity of fluid was
removed, and again in February, 1894, and a third time in May, 1894,
but without useful results. For the previous six months she had been
almost entirely bedridden because of the great size of the tumor. There
were no symptoms referring to the bladder and rectum. At the time she
entered the hospital she was much emaciated, the eyes were sunken, and
her cheeks had a livid hue. The chest was thin and the lower ribs were
everted; dulness began at the lower border of the 3d cartilage, and the
apex-beat was best felt in the third space.  Liver-dulness began at the
4th rib cartilage in the nipple line.  The abdomen was enormously
distended, and covered by large veins running from below upward to the
thorax. About 3 1/2 inches above the umbilicus there was a sulcus with
its convexity downward.  There was dulness over the whole abdomen,
except at the sides parallel with the lumbar spines, and a resonant
band over the stomach. The greatest girth was 54 1/2 inches. By vaginal
examination the cervix was found to be pulled up and obliterated; the
anterior vaginal wall was bulged downward by the tumor. On May 3d
abdominal section was performed. An incision eight inches long was made
in the mid-line of the abdomen. A cystic tumor, formed of small cysts
in its upper part and of somewhat larger ones in the lower part, was
revealed. It was adherent to the abdominal wall, liver, spleen, and
omentum. The adhesions were separated and the cyst tapped with a large
trocar, and then the septa between the cysts were broken down with the
fingers. The pedicle was rather small and was tied in the usual way,
and the tumor was removed. Its seat of origin was the left ovary. The
right ovary and the uterus were healthy, but poorly developed.  The
tumor weighed between 80 and 90 pounds,--the patient having weighed 170
pounds on the night before the operation and 79 1/2 pounds a week after
the operation. Alarming symptoms of collapse were present during the
night after the operation, but the patient responded to stimulation by
hypodermic injections of 1/20 grain of strychnin and of brandy, and
after the first twenty-four hours the recovery was uninterrupted.
Cullingworth thinks that the most interesting points in the case are:
the age of the patient, the enormous size of the tumor, and the advice
given by the surgeon who first attended the patient (insisting that no
operation should be performed). This case shows anew the uselessness of
tapping ovarian cysts.

In the records of enormous dropsies much material of interest is to be
found, and a few of the most interesting cases on record will be cited.
In the older times, when the knowledge of the etiology and pathology of
dropsies was obscure, we find the records of the most extraordinary
cases. Before the Royal Society, in 1746, Glass of Oxford read the
report of a case of preternatural size of the abdomen, and stated that
the dropsy was due to the absence of one kidney. The circumference of
the abdomen was six feet four inches, and the distance from the xiphoid
to the os pubis measured four feet 1/2 inch. In this remarkable case 30
gallons of fluid were drawn off from the abdomen after death.
Bartholinus mentions a dropsy of 120 pounds; and Gockelius one of 180
pounds; there is recorded an instance of a dropsy of 149 pounds. There
is an old record of a woman of fifty who had suffered from ascites for
thirty years. She had been punctured 154 times, and each time about 20
pints were drawn off. During each of two pregnancies she was punctured
three or four times; one of her children was still living. It has been
said that there was a case in Paris of a person who was punctured 300
times for ascites. Scott reports a case of ascites in which 928 pints
of water were drawn off in 24 successive tappings, from February, 1777,
to May, 1778. Quoted by Hufeland, Van Wy mentions 1256 pounds of fluid
being drawn from the abdomen of a woman in five years. Kaltschmid
describes a case of ascites in which, in 12 paracenteses, 500 pounds of
fluid were removed. In 1721 Morand reported two cases of ascites in one
of which, by the means of 57 paracenteses, 970 pounds of fluid were
drawn off in twenty-two months. In the other case 1708 pounds of fluid
issued in ten months. There is a record of 484 pounds of "pus" being
discharged during a dropsy.

The Philosophical Transactions contain the account of a case of
hydronephrosis in which there were 240 pounds of water in the sac.
There are several cases on record in which ovarian dropsies have
weighed over 100 pounds; and Blanchard mentions a uterine dropsy of 80
pounds.

The Ephemerides contains an account of a case of hydrocephalus in which
there were 24 pounds of fluid, and similar cases have been noted.

Elliotson reports what he calls the largest quantity of pus from the
liver on record. His patient was a man of thirty-eight, a victim of
hydatid disease of the liver, from whom he withdrew one gallon of
offensive material.

Lieutaud cites a case, reported by Blanchard, in which, in a case of
hydatid disease, the stomach contained 90 pounds of fluid.

Ankylosis of the articulations, a rare and curious anomaly, has been
seen in the human fetus by Richaud, Joulin, Bird, and Becourt.
Ankylosis of all the joints, with muscular atrophy, gives rise to a
condition that has been popularly termed "ossified man." A case of this
nature is described, the patient being a raftsman, aged seventeen, who
suffered with inflammatory symptoms of the right great toe, which were
followed in the next ten years by progressive involvement of all the
joints of the extremities, and of the vertebrae and temporo-maxillary
articulations, with accompanying signs of acute articular rheumatism.
At the age of thirty-one the pains had subsided, leaving him completely
disabled. All the joints except the fingers and toes had become
ankylosed, and from nonusage the muscles had atrophied. There were no
dislocations, anesthesia, or bedsores, and the viscera were normal;
there were apparently no gouty deposits, as an examination of the urine
was negative.

J. R. Bass, the well-known "ossified man" of the dime museums, has been
examined by many physicians, and was quite intelligent and cheerful in
spite of his complete ankylosis. Figure 269 represents his appearance
in 1887.

Percy speaks of a man named Simoore, born in 1752, who at the age of
fifteen was afflicted with ankylosis of all the joints, and at
different angles He was unable to move even his jaw, and his teeth had
to be extracted in order to supply him with nourishment. Even his ribs
were ankylosed; his chest puffed up, and the breathing was entirely
abdominal. In spite of his infirmities, after his pains had ceased he
lived a comparatively comfortable life. His digestion was good, and his
excretory functions were sufficient. The urine always showed
phosphates, and never the slightest sign of free phosphoric acid. He
still retained his sexual feeling, and occasionally had erections. This
man died in 1802 at the age of fifty, asphyxia being the precursor of
death. His skeleton was deposited in the Museum of the ecole de
Medecine de Paris. In the same Museum there was another similar
skeleton, but in this subject there was motion of the head upon the
first vertebra, the lower jaw was intact, and the clavicle, arms, and
some of the digits of the right hand were movable.

An ossified man has been recently found and exhibited to the Paris
Academy of Medicine. He is a Roumanian Jew of thirty who began to
ossify twelve years ago, first up the right side of his back, then down
the left side. He has hardened now to the nape of the neck, his head is
turned to the left, and the jaws are ankylosed. He can still move his
arms and legs a little with great difficulty.

Akin to the foregoing condition is what is known as petrifaction or
ossification of portions of the living human body other than the
articulations. Of the older writers Hellwigius, Horstius, and Schurig
speak of petrifaction of the arm. In the Philosophical Transactions
there was a case recorded in which the muscles and ligaments were so
extensively converted into bone that all the joints were fixed, even
including the vertebrae, head, and lower jaw. In a short time this man
was, as it were, one single bone from his head to his knees, the only
joints movable being the right wrist and knee. For over a century there
has been in the Trinity College at Dublin the skeleton of a man who
died about 20 miles from the city of Cork. The muscles about the
scapula, and the dorsum of the ilium (the glutei) were converted into
great masses of bone, equal to the original muscles in thickness and
bulk. Half of the muscles of the hips and thighs were converted into
bone, and for a long time this specimen was the leading curiosity of
the Dublin Museum. In the Isle of Man, some years ago, there was a case
of ossification which continued progressively for many years. Before
death this man was reduced to almost a solid mass of bony substance.
With the exception of one or two toes his entire frame was solidified.
He was buried in Kirk Andreas Churchyard, and his grave was strictly
guarded against medical men by his friends, but the body was finally
secured and taken to Dublin by Dr. McCartney.

Calculi.--In reviewing the statistics of vesical calculi, the strangest
anomalies in their size and weight have been noticed.  Among the older
writers the largest weights have been found. Le Cat speaks of a
calculus weighing over three pounds, and Morand is accredited with
having seen a calculus which weighed six pounds. In his statistics in
1883 Cross collected reports on 704 stones, and remarked that only nine
of these weighed above four ounces, and only two above six, and that
with the last two the patient succumbed. Of those removed successfully
Harmer of Norwich reports one of 15 ounces; Kline, one of 13 ounces 30
grains; Mayo of Winchester, 14 ounces two drams; Cheselden, 12 ounces;
and Pare in 1570 removed a calculus weighing nine ounces.  Sir Astley
Cooper remarks that the largest stone he ever saw weighed four ounces,
and that the patient died within four hours after its removal. Before
the Royal Society of London in 1684 Birch reported an account of a
calculus weighing five ounces.  Fabricius Hildanus mentions calculi
weighing 20 and 21 ounces; Camper, 13 ounces; Foschini, 19 ounces six
drams; Garmannus, 25 ounces; Greenfield, 19 ounces; Heberden, 32
ounces; Wrisberg, 20 ounces; Launai, 51 ounces; Lemery, 27 ounces;
Paget, in Kuhn's Journal, 27 ounces (from a woman); Pauli, 19 ounces;
Rudolphi, 28 ounces; Tozzetti, 39 ounces; Threpland, 35 ounces; and
there is a record of a calculus weighing over six pounds. There is
preserved in Trinity College, Cambridge, a stone weighing 34 ounces
taken from the bladder of the wife of Thomas Raisin, by Gutteridge, a
surgeon of Norwich. This stone was afterward sent to King Charles II
for inspection. In his "Journey to Paris" Dr. Lister said that he saw a
stone which weighed 51 ounces; it had been taken from one of the
religious brothers in June, 1690, and placed in the Hopital de la
Charite. It was said that the monk died after the operation. There is a
record of a calculus taken from the bladder of an individual living in
Aberdeen. This stone weighed two pounds, three ounces, and six drams.
In the Hunterian Museum in London there is a stone weighing 44 ounces,
and measuring 16 inches in circumference. By suprapubic operation
Duguise removed a stone weighing 31 ounces from a patient who survived
six days.  A Belgian surgeon by the name of Uytterhoeven, by the
suprapubic method extracted a concretion weighing two pounds and
measuring 6 1/2 inches long and four wide. Frere Come performed a high
operation on a patient who died the next day after the removal of a
24-ounce calculus. Verduc mentions a calculus weighing three pounds
three ounces. It was said that a vesical calculus was seen in a dead
boy at St. Edmund's which was as large as the head of a new-born child.
It has been remarked that Thomas Adams, Lord Mayor of London, who died
at the age of eighty-two, had in his bladder at the time of his death a
stone which filled the whole cavity, and which was grooved from the
ureters to the urethral opening, thus allowing the passage of urine.
Recent records of large calculi are offered: by Holmes, 25 ounces;
Hunter, 25 ounces; Cayley, 29 ounces; Humphrys, 33 ounces; Eve, 44
ounces; and Janeway, 51 ounces. Kirby has collected reports ol a number
of large vesical calculi.

Barton speaks of stone in the bladder in very young children.  There is
a record of a stone at one month, and another at three years. Todd
describes a stone in the bladder of a child of sixteen months. May
removed an enormous stone from a young girl, which had its nucleus in a
brass penholder over three inches long.

Multiple Vesical Calculi.--Usually the bladder contains a single
calculus, but in a few instances a large number of stones have been
found to coexist. According to Ashhurst, the most remarkable case on
record is that of the aged Chief Justice Marshal, from whose bladder
Dr. Physick of Philadelphia is said to have successfully removed by
lateral lithotomy more than 1000 calculi.  Macgregor mentions a case in
which 520 small calculi coexisted with a large one weighing 51 ounces.
There is an old record of 32 stones having been removed from a man of
eighty-one, a native of Dantzic, 16 of which were as large as a
pigeon's egg. Kelly speaks of 228 calculi in the bladder of a man of
seventy-three, 12 being removed before death. The largest weighed 111
grains.  Goodrich took 96 small stones from the bladder of a lad. Among
the older records of numerous calculi Burnett mentions 70; Desault,
over 200; the Ephemerides, 120; Weickman, over 100; Fabricius Hildanus,
2000 in two years; and there is a remarkable case of 10,000 in all
issuing from a young girl. Greenhow mentions 60 stones removed from the
bladder. An older issue of The Lancet contains an account of lithotrity
performed on the same patient 48 times.

Occasionally the calculi are discharged spontaneously. Trioen mentions
the issue of a calculus through a perineal aperture, and there are many
similar cases on record. There is an old record of a stone weighing
five ounces being passed by the penis. Schenck mentions a calculus
perforating the bladder and lodging in the groin. Simmons reports a
case in which a calculus passed through a fistulous sore in the loins
without any concomitant passage of urine through the same passage.
Vosberg mentions a calculus in a patent urachus; and calculi have
occasionally been known to pass from the umbilicus. Gourges mentions
the spontaneous excretion of a five-ounce calculus; and Thompson speaks
of the discharge of two calculi of enormous size.

Of the extravesical calculi some are true calculi, while others are
simply the result of calcareous or osseous degeneration.  Renal and
biliary calculi are too common to need mention here.  There are some
extraordinary calculi taken from a patient at St.  Bartholomew's
Hospital and deposited in the museum of that institution. The patient
was a man of thirty-eight. In the right kidney were found a calculus
weighing 36 1/2 ounces, about 1000 small calculi, and a quantity of
calcareous dust. In the left kidney there was a calculus weighing 9 3/4
ounces, besides a quantity of calcareous dust. The calculi in this case
consisted chiefly of phosphate of magnesium and ammonium. Cordier of
Kansas City, Mo., successfully removed a renal calculus weighing over
three ounces from a woman of forty-two. The accompanying illustration
shows the actual size of the calculus.

At the University College Hospital, London, there are exhibited 485
gall-stones that were found postmortem in a gall-bladder.  Vanzetti
reports the removal of a preputial calculus weighing 224 grams.
Phillipe mentions the removal of a calculus weighing 50 grams from the
prepuce of an Arab boy of seven. Croft gives an account of some
preputial calculi removed from two natives of the Solomon Islands by an
emigrant medical officer in Fiji. In one case 22 small stones were
removed, and in the other a single calculus weighing one ounce 110
grains. Congenital phimosis is said to be very common among the natives
of Solomon Islands.

In September, 1695, Bernard removed two stones from the meatus
urinarius of a man, after a lodgment of twenty years. Block mentions a
similar case, in which the lodgment had lasted twenty-eight years.
Walton speaks of a urethral calculus gradually increasing in size for
fifty years. Ashburn shows what he considers the largest calculus ever
removed from the urethra.  It was 2 1/8 inches long, and 1 1/4 inches
in diameter; it was white on the outside, very hard, and was shaped and
looked much like a potato. Its dry weight was 660 grains. At one end
was a polished surface that corresponded with a similar surface on a
smaller stone that lay against it; the latter calculus was shaped like
a lima bean, and weighed 60 grains. Hunt speaks of eight calculi
removed from the urethra of a boy of five. Herman and the Ephemerides
mention cases of calculi in the seminal vesicles.

Calcareous degeneration is seen in the ovary, and Peterman speaks of a
stone in the ovary. Uterine calculi are described by Cuevas and Harlow;
the latter mentions that the calculus he saw was egg-shaped. There is
an old chronicle of a stone taken from the womb of a woman near Trent,
Somersetshire, at Easter, 1666, that weighed four ounces. The
Ephemerides speaks of a calculus coming away with the menstrual fluid.

Stones in the heart are mentioned by medical writers, and it is said
that two stones as large as almonds were found in the heart of the Earl
of Balcarres.

Morand speaks of a calculus ejected from the mouth by a woman.

An old record says that stones in the brain sometimes are the cause of
convulsions. D'Hericourt reports the case of a girl who died after six
months' suffering, whose pineal gland was found petrified, and the
incredible size of a chicken's egg. Blasius, Diemerbroeck, and the
Ephemerides, speak of stones in the location of the pineal gland.

Salivary calculi are well known; they may lodge in any of the buccal
ducts. There is a record of the case of a man of thirty-seven who
suffered great pain and profuse salivation. It was found that he had a
stone as large as a pigeon's egg under his tongue.

Umbilical calculi are sometimes seen, and Deani reports such a case.
There is a French record of a case of exstrophy of the umbilicus,
attended with abnormal concretions.

Aetius, Marcellus Donatus, Scaliger, and Schenck mention calculi of the
eyelids.

There are some extraordinary cases of retention and suppression of
urine on record. Actual retention of urine, that is, urinary secretion
passed into the bladder, but retention in the latter viscus by
inanition, stricture, or other obstruction, naturally cannot continue
any great length of time without mechanically rupturing the vesical
walls; but suppression of urine or absolute anuria may last an
astonishingly extended period. Of the cases of retention of urine,
Fereol mentions that of a man of forty-nine who suffered absolute
retention of urine for eight days, caused by the obstruction of a uric
acid calculus. Cunyghame reports a ease of mechanic obstruction of the
flow of urine for eleven days. Trapenard speaks of retention of urine
for seven days.  Among the older writers Bartholinus mentions ischuria
lasting fourteen days; Cornarius, fourteen days; Rhoclius, fifteen
days; the Ephemerides, ten, eleven, and twelve days. Croom notes a case
of retention of urine from laceration of the vagina during first
coitus. Foucard reports a case of retention of urine in a young girl of
nineteen, due to accumulation of the menstrual fluid behind an
imperforate hymen.

The accumulation of urine in cases of ischuria is sometimes quite
excessive. De Vilde speaks of 16 pints being drawn off. Mazoni cites a
case in which 15 pounds of urine were retained; and Wilson mentions 16
pounds of urine being drawn off. Frank reports instances in which both
12 and 30 pounds of urine were evacuated.  There is a record at the
beginning of this century in which it is stated that 31 pounds of urine
were evacuated in a case of ischuria.

Following some toxic or thermic disturbance, or in diseased kidneys,
suppression of urine is quite frequently noticed. The older writers
report some remarkable instances: Haller mentions a case lasting
twenty-two weeks; Domonceau, six months; and Marcellus Donatus, six
months.

Whitelaw describes a boy of eight who, after an attack of scarlet
fever, did not pass a single drop of urine from December 7th to
December 20th when two ounces issued, after vesication over the
kidneys. On January 2d two ounces more were evacuated, and no more was
passed until the bowel acted regularly. On January 5th a whole pint of
urine passed; after that the kidneys acted normally and the boy
recovered. It would be no exaggeration to state that this case lasted
from December 5th to January 5th, for the evacuations during this
period were so slight as to be hardly worthy of mention.

Lemery reports observation of a monk who during eight years vomited
periodically instead of urinating in a natural way. Five hours before
vomiting he experienced a strong pain in the kidneys. The vomitus was
of dark-red color, and had the odor of urine. He ate little, but drank
wine copiously, and stated that the vomiting was salutary to him, as he
suffered more when he missed it.

Bryce records a case of anuria of seventeen days' standing.  Butler
speaks of an individual with a single kidney who suffered suppression
of urine for thirteen days, caused by occlusion of the ureter by an
inspissated thrombus. Dubuc observed a case of anuria which continued
for seventeen days before the fatal issue.  Fontaine reports a case of
suppression of urine for twenty-five days. Nunneley showed the kidneys
of a woman who did not secrete any urine for a period of twelve days,
and during this time she had not exhibited any of the usual symptoms of
uremia. Peebles mentions a case of suspension of the functions of the
kidneys more than once for five weeks, the patient exhibiting neither
coma, stupor, nor vomiting. Oke speaks of total suppression of urine
during seven days, with complete recovery; and Paxon mentions a case in
a child that recovered after five days' suppression. Russell reports a
case of complete obstructive suppression for twenty days followed by
complete recovery. Scott and Shroff mention recovery after nine days'
suppression.

The most persistent constipation may exist for weeks, or even months,
with fair health. The fact seemed to be a subject of much interest to
the older writers. De Cabalis mentions constipation lasting
thirty-seven days; Caldani, sixty-five days; Lecheverel, thirty-four
days; and Pomma, eight months; Sylvaticus, thirty months; Baillie,
fifteen weeks; Blanchard, six weeks; Smetius, five mouths; Trioen,
three months; Devilliers, two years; and Gignony, seven years. Riverius
mentions death following constipation of one month, and says that the
intestines were completely filled. Moosman mentions death from the same
cause in sixty days. Frank speaks of constipation from intestinal
obstructions lasting for three weeks, and Manget mentions a similar
case lasting three months.

Early in the century Revolat reported in Marseilles an observation of
an eminently nervous subject addicted to frequent abuse as regards
diet, who had not had the slightest evacuation from the bowel for six
months. A cure was effected in this case by tonics, temperance,
regulation of the diet, etc. In Tome xv of the Commentaries of Leipzig
there is an account of a man who always had his stercoral evacuations
on Wednesdays, and who suffered no evil consequences from this
abnormality. This state of affairs had existed from childhood, and, as
the evacuations were abundant and connected, no morbific change or
malformation seemed present. The other excretions were slightly in
excess of the ordinary amount. There are many cases of constipation on
record lasting longer than this, but none with the same periodicity and
without change in the excrement. Tommassini records the history of a
man of thirty, living an ordinary life, who became each year more
constipated. Between the ages of twenty and twenty-four the evacuations
were gradually reduced to one in eight or ten days, and at the age of
twenty-six, to one every twenty-two days. His leanness increased in
proportion to his constipation, and at thirty his appetite was so good
that he ate as much as two men. His thirst was intense, but he secreted
urine natural in quantity and quality. Nothing seemed to benefit him,
and purgatives only augmented his trouble. His feces came in small,
hard balls. His tongue was always in good condition, the abdomen not
enlarged, the pulse and temperature normal.

Emily Plumley was born on June 11,1850, with an imperforate anus, and
lived one hundred and two days without an evacuation. During the whole
period there was little nausea and occasional regurgitation of the
mother's milk, due to over-feeding. Cripps mentions a man of forty-two
with stricture of the rectum, who suffered complete intestinal
obstruction for two months, during which time he vomited only once or
twice. His appetite was good, but he avoided solid food. He recovered
after the performance of proctotomy.

Fleck reports the case of a Dutchman who, during the last two years, by
some peculiar innervation of the intestine, had only five or six bowel
movements a year. In the intervals the patient passed small quantities
of hard feces once in eight or ten days, but the amount was so small
that they constituted no more than the feces of one meal. Two or three
days before the principal evacuation began the patient became ill and
felt uncomfortable in the back; after sharp attacks of colic he would
pass hard and large quantities of offensive feces. He would then feel
better for two or three hours, when there would be a repetition of the
symptoms, and so on until he had four or five motions that day.  The
following day he would have a slight diarrhea and then the bowels would
return to the former condition. The principal fecal accumulations were
in the ascending and transverse colon and not only could be felt but
seen through the abdominal wall. The patient was well nourished and had
tried every remedy without success. Finally he went to Marienbad where
he drank freely of the waters and took the baths until the bowel
movements occurred once in two or three days.

There is a record of a man who stated that for two years he had not
passed his stool by the anus, but that at six o'clock each evening he
voided feces by the mouth. His statement was corroborated by
observation. At times the evacuation took place without effort, but was
occasionally attended with slight pain in the esophagus and slight
convulsions. Several hours before the evacuation the abdomen was hard
and distended, which appearance vanished in the evening. In this case
there was a history of an injury in the upper iliac region.

The first accurate ideas in reference to elephantiasis arabum are given
by Rhazes, Haly-Abas, and Avicenna, and it is possibly on this account
that the disease received the name elephantiasis arabum. The disease
was afterward noticed by Forestus, Mercurialis, Kaempfer, Ludoff, and
others. In 1719 Prosper Alpinus wrote of it in Egypt, and the medical
officers of the French army that invaded Egypt became familiar with it;
since then the disease has been well known.

Alard relates as a case of elephantiasis that of a lady of Berlin,
mentioned in the Ephemerides of 1694, who had an abdominal tumor the
lower part of which reached to the knees. In this case the tumor was
situated in the skin and no vestige of disease was found in the
abdominal cavity and no sensible alteration had taken place in the
veins. Delpech quotes a similar case of elephantiasis in the walls of
the abdomen in a young woman of twenty-four, born at Toulouse.

Lymphedema, or elephantiasis arabum, is a condition in which, in the
substance of a limb or a part, there is diffused dilatation of the
lymphatics, with lymphostasis. Such a condition results when there is
obstruction of so large a number of the ducts converging to the root of
the extremity or part that but little relief through collateral trunks
is possible. The affected part becomes swollen and hardened, and
sometimes attains an enormous size. It is neither reducible by position
nor pressure. There is a corresponding dilatation and multiplication of
the blood-vessels with the connective-tissue hypertrophy. The muscles
waste, the skin becomes coarse and hypertrophied. The swollen limb
presents immense lobulated masses, heaped up at different parts,
separated from one another by deep sulci, which are especially marked
at the flexures of the joints. Although elephantiasis is met with in
all climates, it is more common in the tropics, and its occurrence has
been repeatedly demonstrated in these localities to be dependent on the
presence in the lymphatics of the filaria sanguinis hominis. The
accompanying illustration shows the condition of the limb of a girl of
twenty-one, the subject of lymphedema, five years after the inception
of the disease. The changes in the limb were as yet moderate. The
photograph from which the cut was made was taken in 1875 At the present
time (seventeen years later) the case presents the typical condition of
the worst form of elephantiasis. Repeated attacks of lymphangitis have
occurred during this period, each producing an aggravation of the
previous condition. The leg below the knee has become enormously
deformed by the production of the elephantoid masses; the outer side of
the thigh remains healthy, but the skin of the inner side has developed
so as to form a very large and pendant lobulated mass.  A similar
condition has begun to develop in the other leg, which is row about in
the condition of the first, as shown in the figure. Figure 273
represents this disease in its most aggravated form, a condition rarely
observed in this country. As an example of the change in the weight of
a person after the inception of this disease, we cite a case reported
by Griffiths. The patient was a woman of fifty-two who, five years
previous, weighed 148 pounds. The elephantoid change was below the
waist, yet at the time of report the woman weighed 387 pounds. There
was little thickening of the skin. The circumference of the calf was 28
inches; of the thigh, 38 inches; and of the abdomen, 80 inches; while
that of the arm was only 15 inches.

The condition commonly known as "Barbadoes leg" is a form of
elephantiasis deriving its name from its relative frequency in
Barbadoes.

Figure 275 represents a well-known exhibitionist who, from all
appearances, is suffering from an elephantoid hypertrophy of the lower
extremities, due to a lymphedema. Quite a number of similar
exhibitionists have been shown in recent years, the most celebrated of
whom was Falmy Mills, one of whose feet alone was extensively involved,
and was perhaps the largest foot ever seen.

Elephantiasis seldom attacks the upper extremities. Of the older cases
Rayer reports four collected by Alard. In one case the hard and
permanent swelling of the arm occurred after the application of a
blister; in another the arm increased so that it weighed more than 200
Genoese pounds, 40 of which consisted of serum. The swellings of the
arm and forearm resembled a distended bladder.  The arteries, veins,
and nerves had not undergone any alteration, but the lymphatics were
very much dilated and loaded with lymph.

The third case was from Fabricius Hildanus, and the fourth from Hendy.
Figure 276 represents a remarkable elephantoid change in the hand of an
elderly German woman. Unfortunately there is no medical description of
the case on record, but the photograph is deemed worthy of reproduction.

Terry describes a French mulatto girl of eleven whose left hand was
enormously increased in weight and consistency, the chief enlargement
being in the middle finger, which was 6 1/2 inches long, and 5 1/2
inches about the nail, and 8 1/2 around the base of the finger. The
index finger was two inches thick and four inches long, twisted and
drawn, while the other fingers were dwarfed. The elephantiasis in this
case slowly and gradually increased in size until the hand weighed 3
1/2 pounds. The skin of the affected finger, contrary to the general
appearance of a part affected with elephantiasis, was of normal color,
smooth, shiny, showed no sensibility, and the muscles had undergone
fatty degeneration. It was successfully amputated in August, 1894. The
accompanying illustration shows a dorsal view of the affected hand.

Magalhaes of Rio Janeiro reports a very interesting case of
elephantiasis of the scalp, representing dermatolysis, in which the
fold of hypertrophied skin fell over the face like the hide of an
elephant, somewhat similar in appearance to the "elephant-man." Figure
279 represents a somewhat similar hypertrophic condition of the scalp
and face reported in the Photographic Review of Medicine and Surgery,
1870.

Elephantiasis of the face sometimes only attacks it on one side.  Such
a case was reported by Alard, in which the elephantiasis seems to have
been complicated with eczema of the ear. Willier, also quoted by Alard,
describes a remarkable case of elephantiasis of the face. After a
debauch this patient experienced violent pain in the left cheek below
the zygomatic arch; this soon extended under the chin, and the
submaxillary glands enlarged and became painful; the face swelled and
became erythematous, and the patient experienced nausea and slight
chills. At the end of six months there was another attack, after which
the patient perceived that the face continued puffed. This attack was
followed by several others, the face growing larger and larger. In
similar cases tumefaction assumes enormous proportions, and Schenck
speaks of a man whose head exceeded that of an ox in size, the lower
part of the face being entirely covered with the nose, which had to be
raised to enable its unhappy owner to breathe.

Rayer cites two instances in which elephantiasis of the breast enlarged
these organs to such a degree that they hung to the knees. Salmuth
speaks of a woman whose breasts increased to such a size that they hung
down to her knees. At the same time she had in both axillae glandular
tumors as large as the head of a fetus.  Borellus also quotes the case
of a woman whose breasts became so large that it was necessary to
support them by straps, which passed over the shoulders and neck.

Elephantiasis is occasionally seen in the genital regions of the
female, but more often in the scrotum of the male, in which location it
produces enormous tumors, which sometimes reach to the ground and
become so heavy as to prevent locomotion. This condition is curious in
the fact that these immense tumors have been successfully removed, the
testicles and penis, which had long since ceased to be distinguished,
saved, and their function restored. Alibert mentions a patient who was
operated upon by Clot-Bey, whose scrotum when removed weighed 110
pounds; the man had two children after the disease had continued for
thirteen years, but before it had obtained its monstrous development--a
proof that the functions of the testicles had not been affected by the
disease.

There are several old accounts of scrotal tumors which have evidently
been elephantoid in conformation. In the Ephemerides in 1692 there was
mentioned a tumor of the scrotum weighing 200 pounds. In the West
Indies it was reported that rats have been known to feed on these
enormous tumors, while the deserted subjects lay in a most helpless
condition. Larrey mentioned a case of elephantiasis of the scrotum in
which the tumor weighed over 200 pounds. Sir Astley Cooper removed a
tumor of 56 pounds weight from a Chinese laborer. It extended from
beneath the umbilicus to the anterior border of the anus; it had begun
in the prepuce ten years previously. Clot-Bey removed an elephantoid
tumor of the scrotum weighing 80 pounds, performing castration at the
same time. Alleyne reports a case of elephantiasis, in which he
successfully removed a tumor of the integuments of the scrotum and
penis weighing 134 pounds.

Bicet mentions a curious instance of elephantiasis of the penis and
scrotum which had existed for five years. The subject was in great
mental misery and alarm at his unsightly condition. The parts of
generation were completely buried in the huge mass. An operation was
performed in which all of the diseased structures that had totally
unmanned him were removed, the true organs of generation escaping
inviolate. Thebaud mentions a tumor of the scrotum, the result of
elephantiasis, which weighed 63 1/2 pounds. The weight was ascertained
by placing the tumor on the scales, and directing the patient to squat
over them without resting any weight of the body on the scales. This
man could readily feel his penis, although his surgeons could not do
so.  The bladder was under perfect control, the urine flowing over a
channel on the exterior of the scrotum, extending 18 inches from the
meatus. Despite his infirmity this patient had perfect sexual desire,
and occasional erections and emissions. A very interesting operation
was performed with a good recovery.

Partridge reports an enormous scrotal tumor which was removed from a
Hindoo of fifty-five, with subsequent recovery of the subject. The
tumor weighed 111 1/2 pounds. The ingenious technic of this operation
is well worth perusal by those interested.  Goodman successfully
removed an elephantiasis of the scrotum from a native Fiji of
forty-five. The tumor weighed 42 pounds, without taking into
consideration the weight of the fluid which escaped in abundance during
the operation and also after the operation, but before it was weighed.
Van Buren and Keyes mention a tumor of the scrotum of this nature
weighing 165 pounds. Quoted by Russell, Hendy describes the case of a
negro who had successive attacks of glandular swelling of the scrotum,
until finally the scrotum was two feet long and six feet in
circumference. It is mentioned that mortification of the part caused
this patient's ultimate death.

Figure 281 is taken from a photograph loaned to the authors by Dr.
James Thorington. The patient was a native of Fiji, and was
successfully operated on, with preservation of the testes. The tumor,
on removal, weighed 120 pounds.

W. R. Browne, Surgeon-General, reports from the Madras General Hospital
an operation on a patient of thirty-five with elephantoid scrotum of
six years' duration. The proportions of the scrotum were as follows:
Horizontally the circumference was six feet 6 1/2 inches, and
vertically the circumference was six feet ten inches. The penis was
wholly hidden, and the urine passed from an opening two feet 5 1/2
inches from the pubis. The man had complete control of his bladder, but
was unable to walk.  The operation for removal occupied one hour and
twenty minutes, and the tumor removed weighed 124 3/4 pounds. Little
blood was lost on account of an elastic cord tied about the neck of the
tumor, and secured by successful removal of a scrotal tumor weighing 56
pounds.

Fenger describes a case of the foregoing nature in a German of
twenty-three, a resident of Chicago. The growth had commenced eight
years previously, and had progressively increased. There was no pain or
active inflammation, and although the patient had to have especially
constructed trousers he never ceased his occupation as a driver. The
scrotum was represented by a hairless tumor weighing 22 pounds, and
hanging one inch below the knees.  No testicles or penis could be made
out. Fenger removed the tumor, and the man was greatly improved in
health. There was still swelling of the inguinal glands on both sides,
but otherwise the operation was very successful. The man's mental
condition also greatly improved. Fenger also calls especial attention
to the importance of preserving the penis and testes in the operation,
as although these parts may apparently be obliterated their functions
are undisturbed.

The statistics of this major operation show a surprisingly small
mortality. Fayrer operated on 28 patients with 22 recoveries and six
deaths, one from shock and five from pyemia The same surgeon collected
193 cases, and found the general mortality to be 18 per cent. According
to Ashhurst, Turner, who practiced as a medical missionary in the
Samoan Islands, claims to have operated 136 times with only two deaths.
McLeod, Fayrer's successor in India, reported 129 cases with 23 deaths.

Early in this century Rayer described a case of elephantiasis in a boy
of seventeen who, after several attacks of erysipelas, showed marked
diminution of the elephantoid change; the fact shows the antagonism of
the streptococcus erysipelatis to hypertrophic and malignant processes.

Acromegaly is a term introduced by Marie, and signifies large
extremities. It is characterized by an abnormally large development of
the extremities and of the features of the face,--the bony as well as
the soft parts. In a well-marked case the hands and feet are greatly
enlarged, but not otherwise deformed, and the normal functions are not
disturbed. The hypertrophy involves all the tissues, giving a curious
spade-like appearance to the hands. The feet are similarly enlarged,
although the big toe may be relatively much larger. The nails also
become broad and large. The face increases in volume and becomes
elongated, in consequence of the hypertrophy of the superior and
inferior maxillary bones. The latter often projects beyond the upper
teeth. The teeth become separated, and the soft parts increase in size.
The nose is large and broad, and the skin of the eyelids and ears is
enormously hypertrophied. The tongue is greatly hypertrophied. The
disease is of long duration, and late in the history the bones of the
spine and thorax may acquire great deformity. As we know little of the
influences and sources governing nutrition, the pathology and etiology
of acromegaly are obscure. Marie regards the disease as a systemic
dystrophy analogous to myxedema, due to a morbid condition of the
pituitary body, just as myxedema is due to disease of the thyroid. In
several of the cases reported the squint and optic atrophy and the
amblyopia have pointed to the pituitary body as the seat of a new
growth of hypertrophy. Pershing shows a case of this nature.  The
enlargement of the face and extremities was characteristic, and the
cerebral and ocular symptoms pointed to the pituitary body as the seat
of the lesion. Unverricht, Thomas, and Ransom report cases in which the
ocular lesions, indicative of pituitary trouble, were quite prominent.
Of 22 cases collected by Tamburini 19 showed some change in the
pituitary body, and in the remaining three cases either the diagnosis
was uncertain or the disease was of very short duration. Linsmayer
reported a case in which there was a softened adenoma in the pituitary
body, and the thymus was absent.

Hersman reports an interesting case of progressive enlargement of the
hands in a clergyman of fifty. Since youth he had suffered with pains
in the joints. About three years before the time of report he noticed
enlargement of the phalangeal joint of the third finger of the right
hand. A short time later the whole hand became gradually involved and
the skin assumed a darker hue.  Sensation and temperature remained
normal in both hands; acromegaly was excluded on account of the absence
of similar changes elsewhere. Hersman remarks that the change was
probably due to increase in growth of the fibrous elements of the
subcutaneous lesions about the tendons, caused by rheumatic poison.
Figure 283 shows the palmer and dorsal surfaces of both hands.

Chiromegaly is a term that has been applied by Charcot and Brissaud to
the pseudoacromegaly that sometimes occurs in syringomyelia. Most of
the cases that have been reported as a combination of these two
diseases are now thought to be only a syringomyelia. A recent case is
reported by Marie. In this connection it is interesting to notice a
case of what might be called acute symptomatic transitory
pseudoacromegaly, reported by Potovski: In an insane woman, and without
ascertainable cause, there appeared an enlargement of the ankles,
wrists, and shoulders, and later of the muscles, with superficial
trophic disturbances that gradually disappeared. The author excludes
syphilis, tuberculosis, rheumatism, gout, hemophilia, etc., and
considers it to have been a trophic affection of cerebral origin.
Cases of pneumonia osteoarthropathy simulating acromegaly have been
reported by Korn and Murray.

Megalocephaly, or as it was called by Virchow, leontiasis ossea, is due
to a hypertrophic process in the bones of the cranium. The cases
studied by Virchow were diffuse hyperostoses of the cranium. Starr
describes what he supposes to be a case of this disease, and proposes
the title megalocephaly as preferable to Virchow's term, because the
soft parts are also included in the hypertrophic process. A woman of
fifty-two, married but having no children, and of negative family
history, six years before the time of report showed the first symptoms
of the affection, which began with formication in the finger-tips. This
gradually extended to the shoulders, and was attended with some
uncertainty of tactile sense and clumsiness of movement, but actual
anesthesia had never been demonstrated. This numbness had not invaded
the trunk or lower extremities, although there was slight uncertainty
in the gait. There had been a slowly progressing enlargement of the
head, face, and neck, affecting the bone, skin, and subcutaneous
tissues, the first to the greatest degree.  The circumference of the
neck was 16 inches; the horizontal circumference of the head was 24
inches; from ear to ear, over the vertex, 16 inches; and from the root
of the nose to the occipital protuberance, 16 inches. The cervical
vertebrae were involved, and the woman had lost five inches in height.
It may be mentioned here that Brissaud and Meige noticed the same loss
in height, only more pronounced, in a case of gigantism, the loss being
more than 15 inches. In Starr's case the tongue was normal and there
was no swelling of the thyroid.

Cretinism is an endemic disease among mountainous people who drink
largely of lime water, and is characterized by a condition of physical,
physiologic, and mental degeneracy and nondevelopment, and possibly
goiter. The subjects of this disease seldom reach five feet in height,
and usually not more than four.  The word cretin is derived from the
Latin creatura. They are found all over the world. In Switzerland it is
estimated that in some cantons there is one cretin to every 25
inhabitants. In Styria, the Tyrol, and along the Rhine cretins are
quite common, and not long since cases existed in Derbyshire. These
creatures have been allowed to marry and generate, and thus extend
their species. In "Le Medicin de Campagne," Balzac has given a vivid
picture of the awe and respect in which they were held and the way in
which they were allowed to propagate. Speaking of the endemic cretins,
Beaupre says: "I see a head of unusual form and size, a squat and
bloated figure, a stupid look, bleared, hollow, and heavy eyes, thick,
projecting eyelids, and a flat nose. His face is of a leaden hue, his
skin dirty, flabby, covered with tetters, and his thick tongue hangs
down over his moist, livid lips; his mouth, always open and full of
saliva, shows teeth going to decay. His chest is narrow, his back
curved, his breath asthmatic, his limbs short, misshapen, without
power. The knees are thick and inclined inward, the feet flat. The
large head droops listlessly on the breast; the abdomen is like a bag."
The cretin is generally deaf and dumb, or only able to give a hoarse
cry. He is indifferent to heat and cold, and even to the most revolting
odors. The general opinion has always been that the sexual desire and
genital organs are fully developed.

A quotation under our observation credits Colonel Sykes with the
following statistics of cretinism, which show how in some locations it
may be a decided factor of population. In December, 1845, in a
population of 2,558,349 souls (the locality not mentioned), there were
18,462 people with simple goiter. Of the cretins without goiter there
were 2089. Of cretins with goiter there were 3909; and cretins in which
goiter was not stated 962, making a total of 6960. Of these 2185 had
mere animal instincts; 3531 possessed very small intellectual
faculties; 196 were almost without any; 1048 not classified. Of this
number 2483 were born of healthy and sane fathers; 2285 from healthy
mothers; 961 from goitrous fathers; 1267 from goitrous mothers; 49 from
cretin fathers; 41 from cretin mothers; 106 from cretin fathers with
goiter; 66 from cretin mothers with goiter; 438 fathers and 405 mothers
were not specified.

Sporadic cretinism, or congenital myzedema, is characterized by a
congenital absence of the thyroid, diminutiveness of size, thickness of
neck, shortness of arms and legs, prominence of the abdomen, large size
of the face, thickness of the lips, large and protruding tongue, and
imbecility or idiocy. It is popularly believed that coitus during
intoxication is the cause of this condition. Osler was able to collect
11 or 12 cases in this country. The diagnosis is all-important, as the
treatment by the thyroid extract produces the most noteworthy results.
There are several remarkable recoveries on record, but possibly the
most wonderful is the case of J. P. West of Bellaire, Ohio, the
portraits of which are reproduced in Plate 11. At seventeen months the
child presented the typical appearance of a sporadic cretin. The
astonishing results of six months' treatment with thyroid extract are
shown in the second figure. After a year's treatment the child presents
the appearance of a healthy and well-nourished little girl.

Myxedema proper is a constitutional condition due to the loss of the
function of the thyroid gland. The disease was first described by Sir
William Gull as a cretinoid change, and later by William Ord of London,
who suggested the name. It is characterized clinically by a
myxedematous condition of the subcutaneous tissues and mental failure,
and anatomically by atrophy of the thyroid gland. The symptoms of
myxedema, as given by Ord, are marked increase in the general bulk of
the body, a firm, inelastic swelling of the skin, which does not pit on
pressure; dryness and roughness which tend, with swelling, to
obliterate the lines of expression in the face; imperfect nutrition of
the hair; local tumefaction of the skin and subcutaneous tissues,
particularly in the supraclavicular region.  The physiognomy is
remarkably altered; the features are coarse and broad, the lips thick,
the nostrils broad and thick, and the mouth enlarged. There is a
striking slowness of thought and of movement; the memory fails, and
conditions leading to incipient dementia intervene. The functions of
the thoracic and abdominal organs seem to be normal, and death is
generally due to some intercurrent disease, possibly tuberculosis. A
condition akin to myxedema occurs after operative removal of the
thyroid gland.

In a most interesting lecture Brissaud shows the intimate relation
between myxedema, endemic cretinism, sporadic cretinism, or
myxedematous idiocy, and infantilism. He considers that they are all
dependent upon an inherited or acquired deficiency or disease of the
thyroid gland, and he presents cases illustrating each affection.
Figure 285 shows a case of myxedema, one of myxedema in a case of
arrested development--a transition case between myxedema of the adult
and sporadic cretinism--and a typical case of sporadic cretinism.

Cagots are an outcast race or clan of dwarfs in the region of the
Pyrenees, and formerly in Brittany, whose existence has been a
scientific problem since the sixteenth century, at which period they
were known as Cagots, Gahets, Gafets, Agotacs, in France; Agotes or
Gafos, in Spain; and Cacous, in Lower Brittany. Cagot meant the dog of
a Goth; they were of supposed Gothic origin by some, and of Tartar
origin by others. These people were formerly supposed to have been the
descendants of lepers, or to have been the victims of leprosy
themselves. From the descriptions there is a decided difference between
the Cagots and the cretins. In a recent issue of Cosmos a writer
describes Cagots as follows:--

"They inhabit the valley of the Ribas in the northwestern part of the
Spanish province now called Gerona. They never exceed 51 1/2 inches in
height, and have short, ill-formed legs, great bellies, small eyes,
flat noses, and pale, unwholesome complexions. They are usually stupid,
often to the verge of idiocy, and much subject to goiter and scrofulous
affections. The chief town of the Ribas Valley is Ribas, a place of
1500 inhabitants, about 800 feet above sea-level. The mountains rise
about the town to a height of from 6000 to 8000 feet, and command an
amazingly beautiful panorama of mountain, plain, and river, with
Spanish cities visible upon the one side and French upon the other. The
region is rich, both agriculturally and minerally, and is famous for
its medicinal springs. In this paradise dwell the dwarfs, perhaps as
degraded a race of men and women as may be found in any civilized
community. They are almost without education, and inhabit wretched huts
when they have any shelter. The most intelligent are employed as
shepherds, and in summer they live for months at an elevation of more
than 6000 feet without shelter. Here they see no human creature save
some of their own kind, often idiots, who are sent up every fifteen or
twenty days with a supply of food.

"It is said that formal marriage is almost unknown among them.  The
women in some instances are employed in the village of Ribas as nurses
for children, and as such are found tender and faithful. Before
communication throughout the region was as easy as it is now, it was
thought lucky to have one of these dwarfs in a family, and the dwarfs
were hired out and even sold to be used in beggary in neighboring
cities. There are somewhat similar dwarfs in other valleys of the
Pyrenees, but the number is decreasing, and those of the Ribas Valley
are reduced to a few individuals."

Hiccough is a symptom due to intermittent, sudden contraction of the
diaphragm. Obstinate cases are most peculiar, and sometimes exhaust the
physician's skill. Symes divides these cases into four groups:--

(1) Inflammatory, seen particularly in inflammatory diseases of the
viscera or abdominal membranes, and in severe cases of typhoid fever.

(2) Irritative, as in direct stimulus of the diaphragm in swallowing
some very hot substance; local disease of the esophagus near the
diaphragm, and in many conditions of gastric and intestinal disorder,
more particularly those associated with flatus.

(3) Specific or idiopathic, in which there are no evident causes
present; it is sometimes seen in cases of nephritis and diabetes.

(4) Neurotic, in which the primary cause is in the nervous
system,--hysteria, epilepsy, shock, or cerebral tumors.

The obstinacy of continued hiccough has long been discussed.  Osler
calls to mind that in Plato's "Symposium" the physician, Eryximachus,
recommended to Aristophanes, who had hiccough from eating too much,
either to hold his breath or to gargle with a little water; but if it
still continued, "tickle your nose with something and sneeze, and if
you sneeze once or twice even the most violent hiccough is sure to go."
The attack must have been a severe one, as it is stated subsequently
that the hiccough did not disappear until Aristophanes had excited the
sneezing.

Among the older medical writers Weber speaks of singultus lasting for
five days; Tulpius, for twelve days; Eller and Schenck, for three
months; Taranget, for eight months; and Bartholinus, for four years.

At the present day it is not uncommon to read in the newspapers
accounts of prolonged hiccoughing. These cases are not mythical, and
are paralleled by a number of instances in reliable medical literature.
The cause is not always discernible, and cases sometimes resist all
treatment.

Holston reports a case of chronic singultus of seven years' standing.
It had followed an attack of whooping-cough, and was finally cured
apparently by the administration of strychnin.  Cowan speaks of a
shoemaker of twenty-two who experienced an attack of constant singultus
for a week, and then intermittent attacks for six years. Cowan also
mentions instances of prolonged hiccough related by Heberden, Good,
Hoffman, and Wartmouth.  Barrett is accredited with reporting a case of
persistent hiccough in a man of thirty-five. Rowland speaks of a man of
thirty-five who hiccoughed for twelve years. The paroxysms were almost
constant, and occurred once or twice a minute during the hours when the
man was not sleeping. There was no noise with the cough. There is
another case related in the same journal of a man who died on the
fourth day of an attack of singultus, probably due to abscess of the
diaphragm, which no remedy would relieve.  Moore records a case of a
child, injured when young, who hiccoughed until about twenty years of
age (the age at the time of report). Foot mentions a lad of fifteen
who, except when asleep, hiccoughed incessantly for twenty-two weeks,
and who suffered two similar, but less severe, attacks in the summer of
1879, and again in 1880. The disease was supposed to be due to the
habit of pressing the chest against the desk when at school.  Dexter
reports a case of long-continued singultus in an Irish girl of
eighteen, ascribed to habitual masturbation. There was no intermission
in the paroxysm, which increased in force until general convulsions
ensued. The patient said that the paroxysm could be stopped by firm
pressure on the upper part of the external genital organs. Dexter
applied firm pressure on her clitoris, and the convulsions subsided,
and the patient fell asleep. They could be excited by firm pressure on
the lower vertebrae. Corson speaks of a man of fifty-seven who, after
exposure to cold, suffered exhausting hiccough for nine days; and also
records the case of an Irish servant who suffered hiccough for four
months; the cause was ascribed to fright. Stevenson cites a fatal
instance of hiccough in a stone-mason of forty-four who suffered
continuously from May 14th to May 28th. The only remedy that seemed to
have any effect in this case was castor-oil in strong purgative doses.

Willard speaks of a man of thirty-four who began to hiccough after an
attack of pneumonia, and continued for eighty-six hours.  The treatment
consisted of the application of belladonna and cantharides plasters,
bismuth, and lime-water, camphor, and salts of white hellebore inhaled
through the nose in finest powder. Two other cases are mentioned by the
same author. Gapper describes the case of a young man who was seized
with loud and distressing hiccough that never ceased for a minute
during eighty hours. Two ounces of laudanum were administered in the
three days without any decided effect, producing only slight languor.

Ranney reports the case of an unmarried woman of forty-four who
suffered from paroxysms of hiccough that persisted for four years. A
peculiarity of this attack was that it invariably followed movements of
the upper extremities. Tenderness and hyperesthesia over the spinous
processes of the 4th, 5th, and 6th cervical vertebrae led to the
application of the thermocautery, which, in conjunction with the
administration of ergot and bromide, was attended with marked benefit,
though not by complete cure. Barlow mentions a man with a rheumatic
affection of the shoulder who hiccoughed when he moved his joints.
Barlow also recites a case of hiccough which was caused by pressure on
the cicatrix of a wound in the left hand.

Beilby reports a peculiar case in a girl of seventeen who suffered an
anomalous affection of the respiratory muscle, producing a sound like a
cough, but shriller, almost resembling a howl. It was repeated every
five or six seconds during the whole of the waking moments, and
subsided during sleep. Under rest and free purgation the patient
recovered, but the paroxysms continued during prolonged intervals, and
in the last six years they only lasted from twenty-four to forty-eight
hours.

Parker reports four rebellious cases of singultus successfully treated
by dry cups applied to the abdomen. In each case it was necessary to
repeat the operation after two hours, but recovery was then rapid.
Tatevosoff reports a brilliant cure in a patient with chronic chest
trouble, by the use of common snuff, enough being given several times
to induce lively sneezing. Griswold records a successful treatment of
one case in a man of fifty, occurring after a debauch, by the
administration of glonoin, 1/150 of a grain every three hours.
Heidenhain records a very severe and prolonged case caused, as shown
later at the operation and postmortem examination, by carcinoma of the
pancreas. The spasms were greatly relieved by cocain administered by
the mouth, as much as 15 grains being given in twelve hours. Laborde
and Lepine report the case of a young girl who was relieved of an
obstinate case of hiccough lasting four days by traction on her tongue.
After the tongue had been held out of the mouth for a few minutes the
hiccoughs ceased. Laborde referred to two cases of a similar character
reported by Viand.

Anomalous Sneezing.--In the olden times sneezing was considered a good
omen, and was regarded as a sacred sign by nearly all of the ancient
peoples. This feeling of reverence was already ancient in the days of
Homer. Aristotle inquired into the nature and origin of the
superstition, somewhat profanely wondering why sneezing had been
deified rather than coughing. The Greeks traced the origin of the
sacred regard for sneezing to the days of Prometheus, who blessed his
man of clay when he sneezed.  According to Seguin the rabbinical
account says that only through Jacob's struggle with the angel did
sneezing cease to be an act fatal to man. Not only in Greece and Rome
was sneezing revered, but also by races in Asia and Africa, and even by
the Mexicans of remote times. Xenophon speaks of the reverence as to
sneezing, in the court of the King of Persia. In Mesopotamia and some
of the African towns the populace rejoiced when the monarch sneezed. In
the present day we frequently hear "God bless you" addressed to persons
who have just sneezed, a perpetuation of a custom quite universal in
the time of Gregory the Great, in whose time, at a certain season, the
air was filled with an unwholesome vapor or malaria which so affected
the people that those who sneezed were at once stricken with
death-agonies. In this strait the pontiff is said to have devised a
form of prayer to be uttered when the paroxysm was seen to be coming
on, and which, it was hoped, would avert the stroke of the death-angel.

There are some curious cases of anomalous sneezing on record, some of
which are possibly due to affections akin to our present "hay fever,"
while others are due to causes beyond our comprehension. The
Ephemerides records a paroxysm of continual sneezing lasting thirty
days. Bonet, Lancisi, Fabricius Hildanus, and other older observers
speak of sneezing to death. Morgagni mentions death from congestion of
the vasa cerebri caused by sneezing. The Ephemerides records an
instance of prolonged sneezing which was distinctly hereditary.

Ellison makes an inquiry for treatment of a case of sneezing in a white
child of ten. The sneezing started without apparent cause and would
continue 20 or 30 times, or until the child was exhausted, and then
stop for a half or one minute, only to relapse again. Beilby speaks of
a boy of thirteen who suffered constant sneezing (from one to six times
a minute) for one month.  Only during sleep was there any relief. The
patient recovered under treatment consisting of active leeching,
purgation, and blisters applied behind the ear, together with the
application of olive oil to the nostrils.

Lee reports a remarkable case of yawning followed by sneezing in a girl
of fifteen who, just before, had a tooth removed without difficulty.
Half an hour afterward yawning began and continued for five weeks
continuously. There was no pain, no illness, and she seemed amused at
her condition. There was no derangement of the sexual or other organs
and no account of an hysteric spasm.  Potassium bromid and belladonna
were administered for a few days with negative results, when the
attacks of yawning suddenly turned to sneezing. One paroxysm followed
another with scarcely an interval for speech. She was chloroformed once
and the sneezing ceased, but was more violent on recovery therefrom.
Ammonium bromid in half-drachm doses, with rest in bed for psychologic
reasons, checked the sneezing. Woakes presented a paper on what he
designated "ear-sneezing," due to the caking of cerumen in one ear.
Irritation of the auricular branch of the vagus was produced, whence an
impression was propagated to the lungs through the pulmonary branches
of the vagus. Yawning was caused through implication of the third
division of the 5th nerve, sneezing following from reflex implication
of the spinal nerves of respiration, the lungs being full of air at the
time of yawning. Woakes also speaks of "ear-giddiness" and offers a new
associate symptom--superficial congestion of the hands and forearm.

A case of anomalous sneezing immediately prior to sexual intercourse is
mentioned on page 511.

Hemophilia is an hereditary, constitutional fault, characterized by a
tendency to uncontrollable bleeding, either spontaneous or from slight
wounds. It is sometimes associated with a form of arthritis (Ogler).
This hemorrhagic diathesis has been known for many years; and the fact
that there were some persons who showed a peculiar tendency to bleed
after wounds of a trifling nature is recorded in some of the earliest
medical literature. Only recently, however, through the writings of
Buel, Otto, Hay, Coates, and others, has the hereditary nature of the
malady and its curious mode of transmission through the female line
been known. As a rule the mother of a hemophile is not a "bleeder"
herself, but is the daughter of one. The daughters of a hemophile,
though healthy and free from any tendency themselves, are almost
certain to transmit the disposition to the male offspring. The
condition generally appears after some slight injury in the first two
years of life; but must be distinguished from the hemorrhagic
affections of the new-born, which will be discussed later. The social
condition of the family does not alter the predisposition; the old Duke
of Albany was a "bleeder"; and bleeder families are numerous, healthy
looking, and have fine, soft skins.

The duration of this tendency, and its perpetuation in a family, is
remarkable. The Appleton-Swain family of Reading, Mass., has shown
examples for two centuries. Osler has been advised of instances already
occurring in the seventh generation. Kolster has investigated
hemophilia in women, and reports a case of bleeding in the daughter of
a hemophilic woman. He also analyzes 50 genealogic trees of hemophilic
families, and remarks that Nasse's law of transmission does not hold
true. In 14 cases the transmission was direct from the father to the
child, and in 11 cases it was direct from the mother to the infant.

The hemorrhagic symptoms of bleeders may be divided into external
bleedings, either spontaneous or traumatic; interstitial bleedings,
petechiae, and ecchymoses; and the joint-affections.  The external
bleedings are seldom spontaneous, and generally follow cuts, bruises,
scratches, and often result seriously. A minor operation on a hemophile
may end in death; so slight an operation as drawing a tooth has been
followed by the most disastrous consequences.

Armstrong, Blagden, and Roberts, have seen fatal hemorrhage after the
extraction of teeth. MacCormac observed five bleeders at St.  Thomas
Hospital, London, and remarks that one of these persons bled twelve
days after a tooth-extraction. Buchanan and Clay cite similar
instances. Cousins mentions an individual of hemorrhagic diathesis who
succumbed to extensive extravasation of blood at the base of the brain,
following a slight fall during an epileptic convulsion. Dunlape reports
a case of hemorrhagic diathesis, following suppression of the
catamenia, attended by vicarious hemorrhage from the gums, which
terminated fatally.  Erichsenf cites an instance of extravasation of
blood into the calf of the leg of an individual of hemophilic
tendencies. A cavity was opened, which extended from above the knee to
the heel; the clots were removed, and cautery applied to check the
bleeding. There was extension of the blood-cavity to the thigh, with
edema and incipient gangrene, necessitating amputation of the thigh,
with a fatal termination.

Mackenzie reports an instance of hemophilic purpura of the retina,
followed by death. Harkin gives an account of vicarious bleeding from
the under lip in a woman of thirty-eight. The hemorrhage occurred at
every meal and lasted ten minutes. There is no evidence that the woman
was of hemophilic descent.

Of 334 cases of bleeding in hemophilia collected by Grandidier, 169
were from the nose, 43 from the mouth, 15 from the stomach, 36 from the
bowels, 16 from the urethra, 17 from the lungs, and a few from the skin
of the head, eyelids, scrotum, navel, tongue, finger-tips, vulva, and
external ear. Osler remarks that Professor Agnew knew of a case of a
bleeder who had always bled from cuts and bruises above the neck, never
from those below. The joint-affections closely resemble acute
rheumatism. Bleeders do not necessarily die of their early bleedings,
some living to old age. Oliver Appleton, the first reported American
bleeder, died at an advanced age, owing to hemorrhage from a bed-sore
and from the urethra. Fortunately the functions of menstruation and
parturition are not seriously interfered with in hemophilia.
Menstruation is never so excessive as to be fatal. Grandidier states
that of 152 boy subjects 81 died before the termination of the seventh
year. Hemophilia is rarely fatal in the first year.

Of the hemorrhagic diseases of the new-born three are worthy of note.
In syphilis haemorrhagica neonatorum the child may be born healthy, or
just after birth there may appear extensive cutaneous extravasations
with bleeding from the mucous surfaces and from the navel; the child
may become deeply jaundiced. Postmortem examination shows extensive
extravasations into the internal viscera, and also organic syphilitic
lesions.

Winckel's disease, or epidemic hemoglobinuria, is a very fatal
affection, sometimes epidemic in lying-in institutions; it develops
about the fourth day after birth. The principal symptom is hematogenous
icterus with cyanosis,--the urine contains blood and blood-coloring
matter. Some cases have shown in a marked degree acute fatty
degeneration of the internal organs--Buhl's disease.

Apart from the common visceral hemorrhages, the results of injuries at
birth, bleeding from one or more of the surfaces is a not uncommon
event in the new-born, particularly in hospital-practice. According to
Osler Townsend reports 45 cases in 6700 deliveries, the hemorrhage
being both general and from the navel alone. Bleeding also occurs from
the bowels, stomach, and mouth, generally beginning in the first week,
but in rare instances it is delayed to the second or third. Out of 50
cases collected by Townsend 31 died and 19 recovered. The nature of the
disease is unknown, and postmortem examination reveals no pathologic
changes, although the general and not local nature of the affection,
its self-limited character, the presence of fever, and the greater
prevalence of the disease in hospitals, suggest an infectious origin
(Townsend). Kent a speaks of a new-born infant dying of spontaneous
hemorrhage from about the hips.

Infantile scurvy, or Barlow's disease, has lately attracted marked
attention, and is interesting for the numerous extravasations and
spontaneous hemorrhages which are associated with it. A most
interesting collection of specimens taken from the victims of Barlow's
disease were shown in London in 1895.

In an article on the successful preventive treatment of tetanus
neonatorum, or the "scourge of St. Kilda," of the new-born, Turner says
the first mention of trismus nascentium or tetanus neonatorum was made
by Rev. Kenneth Macaulay in 1764, after a visit to the island of St.
Kilda in 1758. This gentleman states that the infants of this island
give up nursing on the fourth or fifth day after birth; on the seventh
day their gums are so clinched together that it is impossible to get
anything down their throats; soon after this they are seized with
convulsive fits and die on the eighth day. So general was this trouble
on the island of St. Kilda that the mothers never thought of making any
preparation for the coming baby, and it was wrapped in a dirty piece of
blanket till the ninth or tenth day, when, if the child survived, the
affection of the mother asserted itself. This lax method of caring for
the infant, the neglect to dress the cord, and the unsanitary condition
of the dwellings, make it extremely probable that the infection was
through the umbilical cord. All cases in which treatment was properly
carried out by competent nurses have survived. This treatment consisted
in dressing the cord with iodoform powder and antiseptic wool, the
breast-feeding of the baby from the first, and the administration of
one-grain doses of potassium bromid at short intervals. The infant
death-rate on the island of St. Kilda has, consequently, been much
reduced. The author suggests the use of a new iodin-preparation called
loretin for dressing the cord. The powder is free from odor and is
nonpoisonous.

Human Parasites.--Worms in the human body are of interest on account of
the immense length some species attain, the anomalous symptoms which
they cause, or because of their anomalous location and issue. According
to modern writers the famous Viennese collection of helminths contains
chains of tenia saginata 24 feet long. The older reports, according to
which the taenia solium (i.e., generally the taenia saginata) grew to
such lengths as 40, 50, 60, and even as much as 800 yards, are
generally regarded as erroneous. The observers have apparently taken
the total of all the fragments of the worm or worms evacuated at any
time and added them, thus obtaining results so colossal that it would
be impossible for such an immense mass to be contained in any human
intestine.

The name solium has no relation to the Latin solus, or solium. It is
quite possible for a number of tapeworms to exist simultaneously in the
human body. Palm mentions the fact of four tapeworms existing in one
person; and Mongeal has made observations of a number of cases in which
several teniae existed simultaneously in the stomach. David speaks of
the expulsion of five teniae by the ingestion of a quantity of sweet
wine. Cobbold reports the case of four simultaneous tapeworms; and
Aguiel describes the case of a man of twenty-four who expelled a mass
weighing a kilogram, 34.5 meters long, consisting of several different
worms. Garfinkel mentions a case which has been extensively quoted, of
a peasant who voided 238 feet of tapeworms, 12 heads being found.
Laveran reports a case in which 23 teniae were expelled in the same
day. Greenhow mentions the occurrence of two teniae mediocanellata.

The size of a tapeworm in a small child is sometimes quite surprising.
Even the new-born have exhibited signs of teniae, and Haussmann has
discussed this subject. Armor speaks of a fully-matured tapeworm being
expelled from a child five days old.  Kennedy reports cases in which
tapeworms have been expelled from infants five, and five and one-half
months old. Heisberg gives an account of a tapeworm eight feet in
length which came from a child of two. Twiggs describes a case in which
a tapeworm 36 feet long was expelled from a child of four; and Fabre
mentions the expulsion of eight teniae from a child. Occasionally the
tapeworm is expelled from the mouth. Such cases are mentioned by Hitch
and Martel. White speaks of a tapeworm which was discharged from the
stomach after the use of an emetic. Lile mentions the removal of a
tapeworm which had been in the bowel twenty-four years.

The peculiar effects of a tapeworm are exaggerated appetite and thirst,
nausea, headaches, vertigo, ocular symptoms, cardiac palpitation, and
Mursinna has even observed a case of trismus, or lockjaw, due to taenia
solium. Fereol speaks of a case of vertigo, accompanied with epileptic
convulsions, which was caused by teniae. On the administration of
kousso three heads were expelled simultaneously. There is a record of
an instance of cardiac pulsation rising to 240 per minute, which ceased
upon the expulsion of a large tapeworm. It is quite possible for the
presence of a tapeworm to indirectly produce death. Garroway describes
a case in which death was apparently imminent from the presence of a
tapeworm. Kisel has recorded a fatal case of anemia, in a child of six,
dependent on teniae.

The number of ascarides or round-worms in one subject is sometimes
enormous. Victor speaks of 129 round-worms being discharged from a
child in the short space of five days. Pole mentions the expulsion of
441 lumbricoid worms in thirty-four days, and Fauconneau-Dufresne has
reported a most remarkable case in which 5000 ascarides were discharged
in less than three years, mostly by vomiting. The patient made an
ultimate recovery.

There are many instances in which the lumbricoid worms have pierced the
intestinal tract and made their way to other viscera, sometimes leading
to an anomalous exit. There are several cases on record in which the
lumbricoid worms have been found in the bladder. Pare speaks of a case
of this kind during a long illness; and there is mention of a man who
voided a worm half a yard long from his bladder after suppression of
urine. The Ephemerides contains a curious case in which a stone was
formed in the bladder, having for its nucleus a worm. Fontanelle
presented to the Royal Academy of Medicine of Paris several yards of
tapeworm passed from the urethra of a man of fifty-three. The following
is a quotation from the British Medical Journal: "I have at present a
patient passing in his urine a worm-like body, not unlike a tapeworm as
far as the segments and general appearance are concerned, the length of
each segment being about 1/4 inch, the breadth rather less; sometimes 1
1/2 segments are joined together. The worm is serrated on the one side,
each segment having 1 1/2 cusps. The urine pale, faintly acid at first,
within the last week became almost neutral. There was considerable
vesical irritation for the first week, with abundant mucus in the
urine, specific gravity was 1010; there were no albumin nor tube-casts
nor uric acid in the urinary sediments.  Later there were pus-cells and
abundant pus. Tenderness existed behind the prostate and along the
course of left ureter.  Temperature of patient oscillated from 97.5
degrees to 103.2 degrees F. There was no history at any time of
recto-vesical fistula. Can anyone suggest the name, etc., of this
helminth?"

Other cases of worms in the bladder are mentioned in Chapter XIII

Mitra speaks of the passage of round-worms through the umbilicus of an
adult; and there is a case mentioned in which round-worms about seven
inches long were voided from the navel of a young child. Borgeois
speaks of a lumbricoid worm found in the biliary passages, and another
in the air passages.

Turnbull has recorded two cases of perforation of the tympanic membrane
from lumbricoides. Dagan speaks of the issue of a lumbricoid from the
external auditory meatus. Laughton reports an instance of lumbricoid in
the nose. Rake speaks of asphyxia from a round-worm. Morland mentions
the ejection of numerous lumbricoid worms from the mouth.

Worms have been found in the heart; and it is quite possible that in
cases of trichinosis, specimens of the trichinae may be discovered
anywhere in the line of cardiac or lymphatic circulation. Quoted by
Fournier, Lapeyronnie has seen worms in the pericardial sac, and also
in the ventricle. There is an old record of a person dying of
intestinal worms, one of which was found in the left ventricle. Castro
and Vidal speak of worms in the aorta. Rake reports a case of sudden
death from round-worm; and Brown has noted a similar instance.

The echinococcus is a tiny cestode which is the factor in the
production of the well-known hydatid cysts which may be found in any
part of the body. Delafield and Prudden report the only instance of
multilocular echinococcus seen in this country. Their patient was a
German who had been in this country five years.  There are only about
100 of these cases on record, most of them being in Bavaria and
Switzerland.

The filaria sanguinis hominis is a small worm of the nematode species,
the adult form of which lives in the lymphatics, and either the adult
or the prematurely discharged ova (Manson) block the lymph-channels,
producing the conditions of hematochyluria, elephantiasis, and
lymph-scrotum. The Dracunculus medinensis or Guinea-worm is a
widely-spread parasite in parts of Africa and the West Indies.
According to Osler several cases have occurred in the United States.
Jarvis reports a case in a post-chaplain who had lived at Fortress
Monroe, Va., for thirty years. Van Harlingen's patient, a man of
forty-seven, had never lived out of Philadelphia, so that the worm must
be included among the parasites infesting this country.

In February, 1896, Henry of Philadelphia showed microscopic slides
containing blood which was infested with numbers of living and active
filaria embryos. The blood was taken from a colored woman at the
Woman's Hospital, who developed hematochyluria after labor. Henry
believed that the woman had contracted the disease during her residence
in the Southern States.

Curran gives quite an exhaustive article on the disease called in olden
times "eaten of worms,"--a most loathsome malady. Herod the Great, the
Emperor Galerius, and Philip II of Spain perished from it. In speaking
of the Emperor Galerius, Dean Milman, in his "History of Latin
Christianity," says, "a deep and fetid ulcer preyed on the lower parts
of his body and ate them away into a mass of living corruption."
Gibbon, in his "Decline and Fall," also says that "his (Galerius's)
death was caused by a very painful and lingering disorder. His body,
swelled by an intemperate course of life to an unwieldy corpulence, was
covered with ulcers and devoured by immense swarms of those insects who
have given their names to this most loathsome disease." It is also said
that the African Vandal King, the Arian Huneric, died of the disease.
Antiochus, surnamed the "Madman," was also afflicted with it; and
Josephus makes mention of it as afflicting the body of Herod the Great.
The so-called "King Pym" died of this "morbus pedicularis," but as
prejudice and passion militated against him during his life and after
his death, this fact is probably more rumor than verity. A case is
spoken of by Curran, which was seen by an army-surgeon in a very aged
woman in the remote parts of Ireland, and another in a female in a
dissecting-room in Dublin. The tissues were permeated with lice which
emerged through rents and fissures in the body.

Instances of the larvae of the estrus or the bot-fly in the skin are
not uncommon. In this country Allen removed such larvae from the skin
of the neck, head, and arm of a boy of twelve. Bethune, Delavigne,
Howship, Jacobs, Jannuzzi and others, report similar cases. These
flesh-flies are called creophilae, and the condition they produce is
called myiosis. According to Osler, in parts of Central America, the
eggs of a bot-fly, called the dermatobia, are not infrequently
deposited in the skin, and produce a swelling very like the ordinary
boil. Matas has described a case in which the estrus larvae were found
in the gluteal region.  Finlayson of Glasgow has recently reported an
interesting case in a physician who, after protracted constipation and
pain in the back and sides, passed large numbers of the larvae of the
flower-fly, anthomyia canicularis, and there are other instances of
myiosis interna from swallowing the larvae of the common house-fly.

There are forms of nasal disorder caused by larvae, which some native
surgeons in India regard as a chronic and malignant ulceration of the
mucous membranes of the nose and adjacent sinuses in the debilitated
and the scrofulous. Worms lodging in the cribriform plate of the
ethmoid feed on the soft tissues of that region. Eventually their
ravages destroy the olfactory nerves, with subsequent loss of the sense
of smell, and they finally eat away the bridge of the nose. The head of
the victim droops, and he complains of crawling of worms in the
interior of the nose. The eyelids swell so that the patient cannot see,
and a deformity arises which exceeds that produced by syphilis. Lyons
says that it is one of the most loathsome diseases that comes under the
observation of medical men. He describes the disease as "essentially a
scrofulous inflammation of the Schneiderian membrane, ... which finally
attacks the bones." Flies deposit their ova in the nasal discharges,
and from their infection maggots eventually arise. In Sanskrit peenash
signifies disease of the nose, and is the Indian term for the disease
caused by the deposition of larvae in the nose. It is supposed to be
more common in South America than in India.



CHAPTER XVI.

ANOMALOUS SKIN-DISEASES.

Ichthyosis is a disease of the skin characterized by a morbid
development of the papillae and thickening of the epidermic lamellae;
according as the skin is affected over a larger or smaller area, or
only the epithelial lining of the follicles, it is known as ichthyosis
diffusa, or ichthyosis follicularis. The hardened masses of epithelium
develop in excess, the epidermal layer loses in integrity, and the
surface becomes scaled like that of a fish. Ichthyosis may be
congenital, and over sixty years ago Steinhausen described a fetal
monster in the anatomic collection in Berlin, the whole surface of
whose body was covered with a thick layer of epidermis, the skin being
so thick as to form a covering like a coat-of-mail. According to Rayer
the celebrated "porcupine-man" who exhibited himself in England in 1710
was an example of a rare form of ichthyosis. This man's body, except
the face, the palms of the hands, and the soles of the feet, was
covered with small excrescences in the form of prickles. These
appendages were of a reddish-brown color, and so hard and elastic that
they rustled and made a noise when the hand was passed over their
surfaces. They appeared two months after birth and fell off every
winter, to reappear each summer. In other respects the man was in very
good health. He had six children, all of whom were covered with
excrescences like himself. The hands of one of these children has been
represented by Edwards in his "Gleanings of Natural History." A picture
of the hand of the father is shown in the fifty-ninth volume of the
Philosophical Transactions.

Pettigrew mentions a man with warty elongations encasing his whole
body. At the parts where friction occurred the points of the
elongations were worn off. This man was called "the biped armadillo."
His great grandfather was found by a whaler in a wild state in Davis's
Straits, and for four generations the male members of the family had
been so encased. The females had normal skins. All the members of the
well-known family of Lambert had the body covered with spines. Two
members, brothers, aged twenty-two and fourteen, were examined by
Geoffroy-Saint-Hilaire.  This thickening of the epidermis and hair was
the effect of some morbid predisposition which was transmitted from
father to son, the daughters not being affected. Five generations could
be reckoned which had been affected in the manner described.

The "porcupine-man" seen by Baker contracted small-pox, and his skin
was temporarily freed from the squamae, but these reappeared shortly
afterward. There are several older records of prickly men or
porcupine-men. Ascanius mentions a porcupine-man, as do Buffon and
Schreber. Autenreith speaks of a porcupine-man who was covered with
innumerable verrucae. Martin described a remarkable variety of
ichthyosis in which the skin was covered with strong hairs like the
bristles of a boar. When numerous and thick the scales sometimes
assumed a greenish-black hue. An example of this condition was the
individual who exhibited under the name of the "alligator-boy." Figure
286 represents an "alligator-boy" exhibited by C. T. Taylor. The skin
affected in this case resembled in color and consistency that of a
young alligator. It was remarked that his olfactory sense was intact.

The harlequin fetus, of which there are specimens in Guy's Hospital,
London Hospital, and the Royal College of Surgeons Museum, is the
result of ichthyosis congenita. According to Crocker either after the
removal of the vernix caseosa, which may be thick, or as the skin dries
it is noticeably red, smooth, shiny, and in the more severe cases
covered with actual plates.  In the harlequin fetus the whole surface
of the body is thickly covered with fatty epidermic plates, about 1/16
inch in thickness, which are broken up by horizontal and vertical
fissures, and arranged transversely to the surface of the body like a
loosely-built stone wall. After birth these fissures may extend down
into the corium, and on movement produce much pain.  The skin is so
stiff and contracted that the eyes cannot be completely opened or shut,
the lips are too stiff to permit of sucking, and are often inverted;
the nose and ears are atrophied, the toes are contracted and cramped,
and, if not born dead, the child soon dies from starvation and loss of
heat. When the disease is less severe the child may survive some time.
Crocker had a patient, a male child one month old, who survived three
months. Hallopeau and Elliot also report similar cases.

Contagious follicular keratosis is an extremely rare affection in which
there are peculiar, spine-like outgrowths, consisting in exudations of
the mouths of the sebaceous glands. Leloir and Vidal shorten the name
to acne cornee.

Erasmus Wilson speaks of it as ichthyosis sebacea cornea. H. G.  Brooke
describes a case in a girl of six. The first sign had been an eruption
of little black spots on the nape of the neck. These spots gradually
developed into papules, and the whole skin took on a dirty yellow
color. Soon afterward the same appearances occurred on both shoulders,
and, in the same order, spread gradually down the outer sides of the
arms--first black specks, then papules, and lastly pigmentation. The
black specks soon began to project, and comedo-like plugs and small,
spine-like growths were produced. Both the spines and plugs were very
hard and firmly-rooted. They resisted firm pressure with the forceps,
and when placed on sheets of paper rattled like scraps of metal.  A
direct history of contagion was traced from this case to others.

Mibelli describes an uncommon form of keratodermia (porokeratosis). The
patient was a man of twenty-one, and exhibited the following changes in
his skin: On the left side of the neck, beyond a few centimeters below
the lobe of the ear, there were about ten small warty patches,
irregularly scattered, yellowish-brown in color, irregular in outline,
and varying in size from a lentil to a half-franc piece, or rather
more. Similar patches were seen on other portions of the face. Patches
of varying size and form, sharply limited by a kind of small,
peripheral "dike," sinuous but uninterrupted, of a color varying from
red to whitish-red, dirty white, and to a hue but little different from
that of the healthy skin. Similar patches were seen on the right hand,
and again on the back of the right hand was a wide space, prolonged
upward in the form of a broad band on the posterior surface of the
forearm to just below the olecranon, where the skin was a little
smoother and thinner than the surrounding skin, and altogether bare of
hairs. The disease was noticed at the age of two, and gradually
progressed. The patient always enjoyed the most perfect health, but had
contracted syphilis three years before. A brother of the patient, aged
twenty-four, for sixteen years has had the same skin-affection as this
patient, on the back of the hand, and the sister and father had noticed
similar lesions.

Diffuse symmetric scleroderma, or hide-bound disease, is quite rare,
and presents itself in two phases: that of infiltration (more properly
called hypertrophy) and atrophy, caused by shrinkage. The whole body
may be involved, and each joint may be fixed as the skin over it
becomes rigid. The muscles may be implicated independently of the skin,
or simultaneously, and they give the resemblance of rigor mortis. The
whole skin is so hard as to suggest the idea of a frozen corpse,
without the coldness, the temperature being only slightly subnormal.
The skin can neither be pitted nor pinched. As Crocker has well put it,
when the face is affected it is gorgonized, so to speak, both to the
eye and to the touch. The mouth cannot be opened; the lids usually
escape, but if involved they are half closed, and in either case
immovable. The effect of the disease on the chest-walls is to seriously
interfere with the respiration and to flatten and almost obliterate the
breasts; as to the limbs, from the shortening of the distended skin the
joints are fixed in a more or less rigid position. The mucous membranes
may be affected, and the secretion of both sweat and sebum is
diminished in proportion to the degree of the affection, and may be
quite absent. The atrophic type of scleroderma is preceded by an edema,
and from pressure-atrophy of the fat and muscles the skin of the face
is strained over the bones; the lips are shortened, the gums shrink
from the teeth and lead to caries, and the nostrils are compressed. The
strained skin and the emotionless features (relieved only by
telangiectatic striae) give the countenance a ghastly, corpse-like
aspect. The etiology and pathology of this disease are quite obscure.
Happily the prognosis is good, as there is a tendency to spontaneous
recovery, although the convalescence may be extended.

Although regarded by many as a disease distinct from scleroderma,
morphea is best described as a circumscribed scleroderma, and presents
itself in two clinical aspects: patches and bands, the patches being
the more common.

Scleroderma neonatorum is an induration of the skin, congenital and
occurring soon after birth, and is invariably fatal. A disease somewhat
analogous is edema neonatorum, which is a subcutaneous edema with
induration affecting the new-born. If complete it is invariably fatal,
but in a few cases in which the process has been incomplete recovery
has occurred. Gerard reports recovery from a case of sclerema
neonatorum in an infant five weeks old, which seemed in perfect health
but for this skin-affection. The back presented a remarkable induration
which involved the entire dorsal aspect, including the deltoid regions,
the upper arms, the buttocks, and the thighs, down to and involving the
popliteal spaces. The edges of the indurated skin were sharply defined,
irregular, and map-like. The affected skin was stretched, but not
shiny, and exhibited a pink mottling; it could not be pinched between
the fingers; pressure produced no pitting, but rendered the surface
pale for a time. The induration upon the buttocks had been noticed
immediately after birth, and the region was at first of a deep pink
color. During the first nine days the trouble had extended to the
thighs, but only shortly before the examination had it attacked the
arms.  Inunctions of codliver oil were at first used, but with little
improvement. Blue ointment was substituted, and improvement commenced.
As the induration cleared up, outlying patches of the affected skin
were left surrounded by normal integument. No pitting could be produced
even after the tension of the skin had decreased during recovery. The
lowest rectal temperature was 98 degrees F. In a little more than four
months the skin became normal. The treatment with mercurial ointment
was stopped some time before recovery.

Possibly the most interesting of the examples of skin-anomaly was the
"elephant-man" of London. His real name was Merrick. He was born at
Leicester, and gave an elaborate account of shock experienced by his
mother shortly before his birth, when she was knocked down by an
elephant at a circus; to this circumstance he attributed his
unfortunate condition. He derived his name from a proboscis-like
projection of his nose and lips, together with a peculiar deformity of
the forehead. He was victimized by showmen during his early life, and
for a time was shown in Whitechapel Road, where his exhibition was
stopped by the police. He was afterward shown in Belgium, and was there
plundered of all his savings. The gruesome spectacle he presented
ostracized him from the pleasures of friendship and society, and
sometimes interfered with his travels. On one occasion a steamboat
captain refused to take him as a passenger. Treves exhibited him twice
before the Pathological Society of London. His affection was not
elephantiasis, but a complication of congenital hypertrophy of certain
bones and pachydermatocele and papilloma of the skin.  From his youth
he suffered from a disease of the left hip-joint.  The papillary masses
developed on the skin of the back, buttock, and occiput. In the right
pectoral and posterior aspect of the right axillary region, and over
the buttocks, the affected skin hung in heavy pendulous flaps. His left
arm was free from disease. His head grew so heavy that at length he had
great difficulty in holding it up. He slept in a sitting or crouching
position, with his hands clasped over his legs, and his head on his
knees. If he lay down flat, the heavy head showed a tendency to fall
back and produce a sense of suffocation. For a long time he was an
inmate of the London Hospital, where special quarters were provided for
him, and it was there that he was found dead, April 11, 1890; while in
bed his ponderous head had fallen backward and dislocated his neck.

Ainhum may be defined as a pathologic process, the ultimate result of
which is a spontaneous amputation of the little toe. It is confined
almost exclusively to negroes, chiefly males, and of African descent.
In Brazil it is called "ainham" or "quigila." "Ainham" literally means
to saw, and is doubtless a colloquial name derived from a supposed
slow, sawing process. The Hindoo name for it is "sukha pakla," meaning
dry suppuration.

In 1866 da Silva Lima of Bahia, at the Misericordia Hospital, gave the
first reports of this curious disease, and for quite a period it was
supposed to be confined to Brazilian territory.  Since then, however,
it has been reported from nearly every quarter of the globe. Relative
to its geographic distribution, Pyle states that da Silva Lima and
Seixas of Bahia have reported numerous cases in Brazil, as have
Figueredo, Pereira, Pirovano, Alpin, and Guimares. Toppin reports it in
Pernambuco. Mr. Milton reports a case from Cairo, and Dr. Creswell at
Suez, both in slaves. E. A. G. Doyle reports several cases at the
Fernando Hospital, Trinidad. Digby reports its prevalence on the west
coast of Africa, particularly among a race of negroes called Krumens.
Messum reports it in the South African Republic, and speaks of its
prevalence among the Kaffirs. Eyles reports it on the Gold Coast. It
has also been seen in Algiers and Madagascar.  Through the able efforts
of Her Majesty's surgeons in India the presence of ainhum has been
shown in India, and considerable investigation made as to its etiology,
pathologic histology, etc.  Wise at Dacca, Smyth and Crombie at
Calcutta, Henderson at Bombay, and Warden, Sen, Crawford, and Cooper in
other portions of Southern India have all rendered assistance in the
investigation of ainhum. In China a case has been seen, and British
surgeons speak of it as occurring in Ceylon. Von Winckler presents an
admirable report of 20 cases at Georgetown, British Guiana. Dr.
Potoppidan sends a report of a case in a negress on St. Thomas Island.
The disease has several times been observed in Polynesia.

Dr. Hornaday reports a case in a negress from North Carolina, and,
curious to relate, Horwitz of Philadelphia and Shepherd of Canada found
cases in negroes both of North Carolina antecedents.  Dr. James Evans
reports a case in a negro seventy-four years of age, at Darlington,
S.C. Dr. R. H. Days of Baton Rouge, La., had a case in a negress, and
Dr. J. L. Deslates, also of Louisiana, reports four cases in St. James
Parish. Pyle has seen a case in a negress aged fifty years, at the
Emergency Hospital in Washington.

So prevalent is the disease in India that Crawford found a case in
every 2500 surgical cases at the Indian hospitals. The absence of pain
or inconvenience in many instances doubtless keeps the number of cases
reported few, and again we must take into consideration the fact that
the class of persons afflicted with ainhum are seldom brought in
contact with medical men.

The disease usually affects the 5th phalanx at the interphalangeal
joint. Cases of the 4th and other phalanges have been reported. Cooper
speaks of a young Brahman who lost his left great toe by this process.
Crombie speaks of a simultaneous amputation of both fourth toes.
Potoppidan reports a similar case in a negress on St. Thomas Island.
Sen reports a case in a supernumerary digit in a child, whose father, a
Hindoo, lost a toe by ainhum. Eyles reports a case in a negro in whom
the second finger was affected. Mirault, at Angiers, speaks of a case
in which two fingers were lost in fifteen days, a fact which makes his
diagnosis dubious. Beranger-Ferraud has seen all the toes amputated,
and there is a wax model by Baretta, Paris, in the Army Medical Museum
at Washington, in which all the toes of the right foot have been
amputated, and the process is fast making progress at the middle third
of the leg.

Ainhum is much more common in males than in females; it is, in fact,
distinctly rare in the latter. Of von Winckler's 20 cases all were
males.

It may occur at any age, but is most common between thirty and
thirty-five. It has been reported in utero by Guyot, and was seen to
extend up to the thigh, a statement that is most likely fallacious.
However, there are well-authenticated cases in infants, and again in
persons over seventy years of age.

In some few cases the metatarso-phalangeal joint is affected; but no
case has been seen at the base of the ungual phalanx. The duration of
the disease is between two and four years, but Dr. Evans's case had
been in progress fifty years. It rarely runs its full course before a
year.

Ainhum begins as a small furrow or crack, such as soldiers often
experience, at the digito-plantar fold, seen first on the inner side.
This process of furrowing never advances in soldiers, and has been
given a name more expressive than elegant. In ainhum the toe will swell
in a few days, and a pain, burning or shooting in nature, may be
experienced in the foot and leg affected. Pain, however, is not
constant. There may be an erythematous eruption accompanying the
swelling. The furrow increases laterally and in depth, and meets on the
dorsal aspect of the toe, giving the toe the appearance of being
constricted by a piece of fine cord. As the furrow deepens the distal
end of the toe becomes ovoid, and soon an appearance as of a marble
attached to the toe by a fibrous pedicle presents itself. By this time
the swelling, if any, has subsided. The distal end of the toe bends
under the foot, and becomes twisted when walking, and causes
inconvenience, and, unfortunately, says Eyles, it is in this last stage
only that the Fanti presents himself. There is in the majority of cases
a small ulcer in or near the digito-plantar fold, which causes most of
the pain, particularly when pressed upon. This ulcer does not occur
early, and is not constant. The case under Pyle's observation showed no
ulceration, and was absolutely painless, the negress applying for
diagnosis rather than treatment. The furrow deepens until spontaneous
amputation takes place, which rarely occurs, the patient generally
hastening the process by his own operation, or by seeking surgical
treatment. A dry scab forms at the furrow, and when picked and repicked
constantly re-forms, being composed of horny desquamation or necrosis.

The histology of ainhum shows it to be a direct ingrowth of epithelium,
with a corresponding depression of surface due to a rapid hyperplasia
that pushes down and strangles the papillae, thus cutting off the blood
supply from the epithelial cells, causing them to undergo a horny
change.

The disease is not usually symmetric, as formerly stated, nor is it
simultaneous in different toes. There are no associated constitutional
symptoms, no tendency to similar morbid changes in other parts, and no
infiltration elsewhere. There is little or no edema with ainhum. In
ainhum there is, first, simple hypertrophy, then active hyperplasia The
papillae degenerate when deprived of blood supply, and become horny.
Meanwhile the pressure thus exerted on the nervi vasorum sets up
vascular changes which bring about epithelial changes in more distant
areas, the process advancing anteriorly, that is, in the direction of
the arteries.  This makes the cause, according to Eyles, an
inflammatory and trophic phenomenon due mainly to changes following
pressure on the vasomotor nerves.

Etiology.--The theories of the causation of ainhum are quite numerous.
The first cause is the admirable location for a furrow in the
digito-plantar fold, and the excellent situation of the furrow for the
entrance of sand or other particles to make the irritation constant,
thus causing chronic inflammatory changes, which are followed
subsequently by the changes peculiar to ainhum. The cause has been
ascribed to the practice of wearing rings on the toes; but von Winckler
says that in his locality (British Guinea) this practice is confined to
the coolie women, and in not one of his 20 cases had a ring been
previously worn on the toe; in fact all of the patients were males.
Digby says, however, that the Krumens, among whom the disease is
common, have long worn brass or copper rings on the fifth toe. Again
the natives of India, who are among those most frequently afflicted,
have no such custom.

Injury, such as stone-bruise, has been attributed as the initial cause,
and well-authenticated cases have been reported in which traumatism is
distinctly remembered; but Smyth, Weber, and several other observers
deny that habits, accidents, or work, are a feature in causation.

Von During reports a curious case which he calls sclerodactylia
annularis ainhumoides. The patient was a boy about twelve years old,
born in Erzeroum, brought for treatment for scabies, and not for the
affection about to be described. A very defective history led to the
belief that a similar affection had not been observed in the family.
When he was six years old it began on the terminal phalanges of the
middle fingers. A myxomatous swelling attacked the phalanges and
effected a complete absorption of the terminal phalanx. It did not
advance as far as gangrene or exfoliation of bone. At the time of
report the whole ten fingers were involved; the bones seemed to be
thickened, the soft parts being indurated or sclerosed. In the right
index finger a completely sclerosed ring passed around the middle
phalanx. The nails on the absorbed phalanges had become small and
considerably thickened plates. No analogous changes were found
elsewhere, and sensation was perfectly normal in the affected parts.
There were no signs whatever of a multiple neuritis nor of a leprous
condition.

There is a rare and curious condition known as "deciduous skin" or
keratolysis, in which the owners possess a skin, which, like that of a
serpent, is periodically cast off, that of the limbs coming off like
the finger of a glove. Preston of Canterbury, New Zealand, mentions the
case of a woman who had thus shed her skin every few weeks from the age
of seven or even earlier. The woman was sixty-seven years of age; the
skin in every part of the body came away in casts and cuticles which
separated entire and sometimes in one unbroken piece like a glove or
stocking. Before each paroxysm she had an associate symptom of malaise.
Even the skin of the nose and ears came off complete. None of the
patient's large family showed this idiosyncrasy, and she said that she
had been told by a medical man that it had been due to catching cold
after an attack of small-pox. Frank mentions a case in which there was
periodic and complete shedding of the cuticle and nails of the hands
and feet, which was repeated for thirty-three consecutive years on July
24th of each year, and between the hours of 3 P.M. and 9 P.M. The
patient remembered shedding for the first time while a child at play.
The paroxysms always commenced abruptly, constitutional febrile
symptoms were first experienced, and the skin became dry and hot. The
acute symptoms subsided in three or four hours and were entirely gone
in twelve hours, with the exception of the redness of the skin, which
did not disappear for thirty-six hours more. The patient had been
delirious during this period. The cuticle began to shed some time
between the third and twelfth day, in large sheets, as pictured in the
accompanying illustrations. The nails were shed in about four weeks
after the acute stage. Crocker had an instance of this nature in a man
with tylosis palmae, in which the skin was cast off every autumn, but
the process lasted two months. Lang observed a case in which the
fingers alone were affected.

There is a case of general and habitual desquamation of the skin in the
Ephemerides of 1686; and Newell records a case which recovered under
the use of Cheltenham water for several seasons.  Latham describes a
man of fifty who was first seized about ten years previously with a
singular kind of fever, and this returned many times afterward, even
twice in the course of the same year, attended with the same symptoms
and circumstances, and appearing to be brought on by obstructed
perspiration, in consequence of catching cold. Besides the common
febrile symptoms, upon the invasion of the disease his skin universally
itched, more especially at the joints, and the itching was followed by
many little red spots, with a small degree of swelling. Soon after this
his fingers became stiff; hard, and painful at the ends, and at the
roots of the nails. In about twenty-four hours the cuticle began to
separate from the cutis, and in ten or twelve days this separation was
general from head to foot, during which time he completely turned the
cuticle off from the wrists to the fingers' ends like a glove, and in
like manner on the legs to the toes, after which his nails shot
gradually from their roots, at first with exquisite pain, which abated
as the separation of the cuticle advanced, and the old nails were
generally thrown off by new ones in about six months. The cuticle rose
in the palms and soles like blisters, having, however, no fluid
beneath, and when it came off it left the underlying cutis exposed for
a few days.  Sometimes, upon catching cold, before quite free from
feverish symptoms, a second separation of the cuticle from the cutis
occurred, but it appeared so thin as to be like scurf, demonstrating
the quick renewal of the parts.

There is a similar case in the Philosophical Transactions in a miller
of thirty-five who was exposed to great heat and clouds of dust. On the
first cold a fever attacked him, and once or twice a year, chiefly in
the autumn, this again occurred, attended with a loosening and
detachment of the cuticle. The disorder began with violent fever,
attended with pains in the head, back, limbs, retching, vomiting, dry
skin, furred tongue, urgent thirst, constipation, and high-colored
urine. Usually the whole surface of the body then became yellow. It
afterward became florid like a rash, and then great uneasiness was felt
for several days, with general numbness and tingling; the urine then
began to deposit a thick sediment. About the third week from the first
attack the cuticle appeared elevated in many places, and in eight or
ten days afterward became so loose as to admit of its easy removal in
large flakes. The cuticle of the hands, from the wrists to the fingers'
ends, came off like a glove. The patient was never disposed to sweat,
and when it was attempted to force perspiration he grew worse; nor was
he much at ease until his urine deposited a sediment, after which he
felt little inconvenience but from the rigidity of the skin. The nails
were not detached as in the previous case.

It is quite natural that such cases as this should attract the
attention of the laity, and often find report in newspapers. The
following is a lay-report of a "snake-boy" in Shepardstown, Va.:--

"Jim Twyman, a colored boy living with his foster-parents ten miles
from this place, is a wonder. He is popularly known as the "snake-boy."
Mentally he is as bright as any child of his age, and he is popular
with his playmates, but his physical peculiarities are probably
unparalleled. His entire skin, except the face and hands, is covered
with the scales and markings of a snake. These exceptions are kept so
by the constant use of Castile soap, but on the balance of his body the
scales grow abundantly. The child sheds his skin every year. It causes
him no pain or illness. From the limbs it can be pulled in perfect
shape, but off the body it comes in pieces. His feet and hands are
always cold and clammy. He is an inordinate eater, sometimes spending
an hour at a meal, eating voraciously all the time, if permitted to do
so. After these gorgings he sometimes sleeps two days. There is a
strange suggestion of a snake in his face, and he can manipulate his
tongue, accompanied by hideous hisses, as viciously as a serpent."

Under the name of dermatitis exfoliativa neonatorum, Ritter has
described an eruption which he observed in the foundling asylum at
Prague, where nearly 300 cases occurred in ten years.  According to
Crocker it begins in the second or third week of life, and occasionally
as late as the fifth week, with diffuse and universal scaling, which
may be branny or in laminae like pityriasis rubra, and either dry or
with suffusion beneath the epidermis. Sometimes it presents flaccid
bullae like pemphigus foliaceus, and then there are crusts as well as
scales, with rhagades on the mouth, anus, etc.; there is a total
absence of fever or other general symptoms. About 50 per cent die of
marasmus and loss of heat, with or without diarrhea. In those who
recover the surface gradually becomes pale and the desquamation ceases.
Opinions differ regarding it, some considering it of septic origin,
while others believe it to be nothing but pemphigus foliaceus. Kaposi
regards it as an aggravation of the physiologic exfoliation of the
new-born. Elliott of New York reports two cases with a review of the
subject, but none have been reported in England. Cases on the Continent
have been described by Billard, von Baer, Caspary, those already
mentioned, and others.

The name epidemic exfoliative dermatitis has been given to an epidemic
skin-disease which made its appearance in 1891 in England; 425 cases
were collected in six institutions, besides sporadic cases in private
houses.

In 1895, in London, some photographs and sketches were exhibited that
were taken from several of the 163 cases which occurred in the
Paddington Infirmary and Workhouse, under the care of Dr. Savill, from
whose negatives they were prepared. They were arranged in order to
illustrate the successive stages of the disorder. The eruption starts
usually with discrete papules, often in stellate groups, and generally
arranged symmetrically when on the limbs. These become fused into
crimson, slightly raised maculae, which in severe cases become further
fused into red thickened patches, in which the papules can still be
felt and sometimes seen. Vesicles form, and exudation occurs in only
about one-third of the cases. Desquamation of the epidermis is the
invariable feature of all cases, and it usually commences between the
fourth and eighth days. In severe cases successive layers of the
epidermis are shed, in larger or smaller scales, throughout the whole
course of the malady. One-half of the epidermis shed from the hand of a
patient is exhibited in this collection.

Of sphaceloderma, or gangrene of the skin, probably the most
interesting is Raynaud's disease of symmetric gangrene, a vascular
disorder, which is seen in three grades of intensity: there is local
syncope, producing the condition known as dead-fingers or dead-toes,
and analogous to that produced by intense cold; and local asphyxia,
which usually follows local syncope, or may develop independently.
Chilblains are the mildest manifestation of this condition. The
fingers, toes, and ears, are the parts usually affected. In the most
extreme degree the parts are swollen, stiff, and livid, and the
capillary circulation is almost stagnant; this is local or symmetric
gangrene, the mildest form of which follows asphyxia. Small areas of
necrosis appear on the pads of the fingers and of the toes; also at the
edges of the ears and tip of the nose. Occasional symmetric patches
appear on the limbs and trunk, and in extensive cases terminate in
gangrene. Raynaud suggested that the local syncope was produced by
contraction of the vessels; the asphyxia is probably caused by a
dilatation of the capillaries and venules, with persistence of the
spasm of the arterioles. According to Osler two forms of congestion
occur, which may be seen in adjacent fingers, one of which may be
swollen, intensely red, and extremely hot; the other swollen, cyanotic,
and intensely cold. Sometimes all four extremities are involved, as in
Southey's case, in a girl of two and a half in whom the process began
on the calves, after a slight feverish attack, and then numerous
patches rapidly becoming gangrenous appeared on the backs of the legs,
thighs, buttocks, and upper arms, worse where there was pressure; the
child died thirty-two hours after the onset. The whole phenomenon may
be unilateral, as in Smith's case, quoted by Crocker,--in a girl of
three years in whom the left hand was cold and livid, while on the
right there was lividity, progressing to gangrene of the fingers and of
the thumb up to the first knuckles, where complete separation occurred.

A considerable number of cases of apparently spontaneous gangrene of
the skin have been recorded in medical literature as occurring
generally in hysteric young women. Crocker remarks that they are
generally classified as erythema gangraenosum, and are always to be
regarded with grave suspicion of being self-induced. Ehrl records an
interesting case of this nature with an accompanying illustration. The
patient was a girl of eighteen whose face, left breast, anus, legs, and
feet became affected every autumn since her sixth year, after an attack
of measles. At first the skin became red, then water-blisters formed,
the size of a grain of corn, and in three days reaching the size of a
hazel-nut; these burst and healed, leaving no scars. The menses
appeared at the fifteenth year, lasted eight days, with great loss of
blood, but there was no subsequent menstruation, and no vicarious
hemorrhage. Afterward the right half of the face became red for three
or four weeks, with a disturbance of the sensibility of this part,
including the right half of the mucosa of the mouth and the conjunctive
of the right eye. At the seventeenth year the patient began to have a
left-sided headache and increased sweating of the right half of the
body. In 1892 the periodically-appearing skin-affection became worse.
Instead of healing, the broken vessels became blackish and healed
slowly, leaving ulcers, granulations, and scars, and the gangrenous
tendency of the skin increased. Disturbance of the sight shortly
intervened, associated with aphonia. The sensibility of the whole body,
with the exception of the face, was greatly impaired, and there was
true gangrene of the corium. A younger sister of the patient was
similarly affected with symptoms of hysteria, hemianesthesia, etc.

Neuroses of the skin consist in augmentation of sensibility or
hyperesthesia and diminution of sensibility or anesthesia. There are
some curious old cases of loss of sensation. Ferdinandus mentions a
case of a young man of twenty-four who, after having been seized with
insensibility of the whole body with the exception of the head, was
cured by purgatives and other remedies. Bartholinus cites the case of a
young man who lost the senses of taste and feeling; and also the case
of a young girl who could permit the skin of her forehead to be pricked
and the skin of her neck to be burned without experiencing any pain. In
his "Surgery" Lamothe mentions a case of insensibility of the hands and
feet in consequence of a horse-kick in the head without the infliction
of any external wound. In the "Memoires de l'Academie des Sciences" for
the year 1743, we read an account of a soldier who, after having
accidentally lost all sensation in his left arm, continued to go
through the whole of the manual exercise with the same facility as
ever. It was also known that La Condamine was able to use his hands for
many years after they had lost their sensation. Rayer gives a case of
paralysis of the skin of the left side of the trunk without any
affection of the muscles, in a man of forty-three of apoplectic
constitution. The paralysis extended from the left mammary region to
the haunch, and from the vertebrae to the linea alba. Throughout this
whole extent the skin was insensible and could be pinched or even
punctured without the patient being aware that he was even touched. The
parts did not present any perceptible alteration in texture or in
color. The patient was free from fever and made no complaint except a
slight headache. Rayer quotes another case in a man of sixty who had
been bitten three years previously by a dog that was not mad. He was
greatly frightened by the accident and every time he saw a dog he
trembled violently, and on one occasion he suffered a convulsive attack
for one and a half hours. The convulsions increased in number and
frequency, he lost his memory, and exhibited other signs of incipient
dementia. He was admitted to the hospital with two small wounds upon
the head, one above the left eyebrow and the other on the scalp,
occasioned by a fall on his entrance into the hospital. For several
days a great degree of insensibility of the skin of the whole body was
observed without any implication of the power of voluntary motion. He
was entirely cured in eighteen days.

Duhring reports a very rare form of disease of the skin, which may be
designated neuroma cutis dolorosum, or painful neuroma of the skin. The
patient was a boiler-maker of seventy who had no family history bearing
on the disease. Ten years previously a few cutaneous tubercles the size
and shape of a split-pea were noticed on the left shoulder, attended
with decided itching but not with pain. The latter symptom did not come
on until three years later. In the course of a year or two the lesions
increased in number, so that in four years the shoulder and arm were
thickly studded with them. During the next five years no particular
changes occurred either in lesions or in the degree of pain. The region
affected simply looked like a solid sheet of variously-sized,
closely-packed, confluent tubercles, hard and dense. The tubercles were
at all times painful to the touch, and even the contact of air was
sufficient to cause great suffering.  During the paroxysms, which
occurred usually at several short intervals every day, the skin changed
color frequently and rapidly, passing through various reddish and
violet tints, at times becoming purplish.

As a paroxysm came on the man was in the habit of gently pressing and
holding the arm closely to his body. At one time he endured the attack
in a standing posture, walking the floor, but usually he seated himself
very near a hot stove, in a doubled-up, cramped position, utterly
unmindful of all surroundings, until the worst pain had ceased.
Frequently he was unable to control himself, calling out piteously and
vehemently and beseeching that his life be terminated by any means. In
desperation he often lay and writhed on the floor in agony. The intense
suffering lasted, as a rule, for about a half hour, but he was never
without pain of the neuralgic type. He was freer of pain in summer than
in winter.  Exsection of the brachial plexus was performed, but gave
only temporary relief. The man died in his eighty-fourth year of senile
debility.

According to Osler the tubercula dolorosa or true fascicular neuroma is
not always made up of nerve-fibers, but, as shown by Hoggan, may be an
adenomatous growth of the sweat-glands.

Yaws may be defined as an endemic, specific, and contagious disease,
characterized by raspberry-like nodules with or without constitutional
disturbance. Its synonym, frambesia, is from the French, framboise, a
raspberry. Yaws is derived from a Carib word, the meaning of which is
doubtful. It is a disease confined chiefly to tropical climates, and is
found on the west coast of Africa for about ten degrees on each side of
the equator, and also on the east coast in the central regions, but
rarely in the north. It is also found in Madagascar, Mozambique,
Ceylon, Hindoostan, and nearly all the tropical islands of the world.
Crocker believes it probable that the button-scurvy of Ireland, now
extinct, but described by various writers of 1823 to 1857 as a
contagious disease which was prevalent in the south and in the interior
of the island, was closely allied to yaws, if not identical with it.
The first mention of the yaws disease is by Oviedo, in 1535, who met
with it in San Domingo. Although Sauvages at the end of the last
century was the first to give an accurate description of this disease,
many physicians had observed it before.

Frambesia or yaws was observed in Brazil as early as 1643, and in
America later by Lebat in 1722. In the last century Winterbottom and
Hume describe yaws in Africa, Hume calling it the African distemper. In
1769 in an essay on the "Natural History of Guiana," Bancroft mentions
yaws; and Thomson speaks of it in Jamaica. Hillary in 1759 describes
yaws in Barbadoes; and Bajou in Domingo and Cayenne in 1777, Dazille
having already observed it in San Domingo in 1742.

Crocker takes his account of yaws from Numa Rat of the Leeward Islands,
who divides the case into four stages: incubation, primary, secondary,
and tertiary. The incubation stage is taken from the date of infection
to the first appearance of the local lesion at the sight of
inoculation. It varies from three to ten weeks. The symptoms are vague,
possibly palpitation, vertigo, edema of the limbs and eyelids. The
primary stage begins with the initial lesion, which consists of a
papule which may be found most anywhere on the body. This papule
ulcerates. The secondary stage commences about a fortnight after the
papule has healed.  There is intermittent fever, headache, backache,
and shooting pains in the limbs and intercostal spaces, like those of
dengue, with nocturnal exacerbations. An eruption of minute red spots
appears first on the face, and gradually extends so that the whole body
is covered at the end of three days. By the seventh day the apex of the
papule is of a pale yellow color, and the black skin has the appearance
of being dotted over with yellow wax. The papule then develops into
nodules of cylindric shape, with a dome-shaped, thick, yellow crust. It
is only with the crust off that there is any resemblance to a
raspberry. During the month following the raspberry appearance the skin
is covered with scabs which, falling off, leave a pale macula; in dark
races the macula becomes darker than normal, but in pale races it
becomes paler than the natural skin, and in neither case is it scarcely
ever obliterated. Intense itching is almost always present, and anemia
is also a constant symptom. The disease is essentially contagious and
occurs at all ages and among all sexes, to a lesser degree in whites
and hybrids, and is never congenital. It seems to have a tendency to
undergo spontaneous recovery.

Furunculus orientalis, or its synonyms, Oriental boil, Aleppo boil,
Delhi boil, Biskra button, etc., is a local disease occurring chiefly
on the face and other uncovered spots, endemic in limited districts in
hot climates, characterized by the formation of a papule, a nodule, and
a scab, and beneath the last a sharply punched-out ulcer. Its different
names indicate the districts in which it is common, nearly always in
tropical or subtropical climates. It differs from yaws in the absence
of febrile symptoms, in its unity, its occurrence often on the feet and
the backs of the hands, its duration, and the deep scar which it
leaves. A fatal issue is rare, but disfiguring and disabling cicatrices
may be left unless great care is employed.

Pigmentary Processes.--Friction, pressure, or scratching, if long
continued, may produce extensive and permanent pigmentation. This is
seen in its highest degree in itching diseases like prurigo and
pityriasis. Greenhow has published instances of this kind under the
name of "vagabond's disease," a disease simulating morbus addisonii,
and particularly found in tramps and vagrants.  In aged people this
condition is the pityriasis nigra of Willan.  According to Crocker in
two cases reported by Thibierge, the oral mucous membrane was also
stained. Carrington and Crocker both record cases of permanent
pigmentation following exposure to great cold. Gautier is accredited
with recording in 1890 the case of a boy of six in whom pigmented
patches from sepia to almost black began to form at the age of two, and
were distributed all over the body. Precocious maturity of the genital
organs preceded and accompanied the pigmentation, but the hair was illy
developed.

Chloasma uterinum presents some interesting anomalies. Swayne records a
singular variety in a woman in whom, during the last three months of
three successive pregnancies, the face, arms, hands, and legs were
spotted like a leopard, and remained so until after her confinement.
Crocker speaks of a lady of thirty whose skin during each pregnancy
became at first bronze, as if it had been exposed to a tropical sun,
and then in spots almost black. Kaposi knew a woman with a pigmented
mole two inches square on the side of the neck, which became quite
black at each pregnancy, and which was the first recognizable sign of
her condition. It is quite possible that the black disease of the Garo
Hills in Assam is due to extreme and acute development of a pernicious
form of malaria. In chronic malaria the skin may be yellowish, from a
chestnut-brown to a black color, after long exposure to the influence
of the fever. Various fungi, such as tinea versicolor and the Mexican
"Caraati," may produce discoloration on the skin.

Acanthosis Nigricans may be defined as a general pigmentation with
papillary mole-like growths. In the "International Atlas of Rare Skin
Diseases" there are two cases pictured, one by Politzer in a woman of
sixty-two, and the other by Janovsky in a man of forty-two. The regions
affected were mostly of a dirty-brown color, but in patches of a
bluish-gray. The disease began suddenly in the woman, but gradually in
the man. Crocker has reported a case somewhat similar to these two,
under the head of general bronzing without constitutional symptoms, in
a Swedish sailor of twenty-two, with rapid onset of pigmentation.

Xeroderma pigmentosum, first described by Kaposi in 1870, is a very
rare disease, but owing to its striking peculiarities is easily
recognized. Crocker saw the first three cases in England, and describes
one as a type. The patient was a girl of twelve, whose general health
and nutrition were good. The disease began when she was between twelve
and eighteen months old, without any premonitory symptom. The disease
occupied the parts habitually uncovered in childhood. The whole of
these areas was more or less densely speckled with pigmented,
freckle-like spots, varying in tint from a light, raw umber to a deep
sepia, and in size from a pin's head to a bean, and of a roundish and
irregular shape.  Interspersed among the pigment-spots, but not so
numerous, were white atrophic spots, which in some parts coalesced,
forming white, shining, cicatrix-like areas. The skin upon this was
finely wrinkled, and either smooth or shiny, or covered with thin,
white scales. On these white areas bright red spots were conspicuous,
due to telangiectasis, and there were also some stellate vascular spots
and strife interspersed among the pigment. Small warts were seen
springing up from some of the pigment spots. These warts ulcerated and
gave rise to numerous superficial ulcerations, covered with yellow
crusts, irregularly scattered over the face, mostly on the right side.
The pus coming from these ulcers was apparently innocuous. The patient
complained neither of itching nor of pain. Archambault has collected 60
cases, and gives a good resume to date. Amiscis reports two cases of
brothers, in one of whom the disease began at eight months, and in the
other at a year, and concludes that it is not a lesion due to external
stimuli or known parasitic elements, but must be regarded as a
specific, congenital dystrophy of the skin, of unknown pathogenesis.
However, observations have shown that it may occur at forty-three years
(Riehl), and sixty-four years (Kaposi). Crocker believes that the
disease is an atrophic degeneration of the skin, dependent on a primary
neurosis, to which there is a congenital predisposition.

Nigrities is a name given by the older writers to certain black
blotches occurring on the skin of a white person--in other words, it is
a synonym of melasma. According to Rayer it is not uncommon to see the
scrotum and the skin of the penis of adults almost black, so as to form
a marked contrast with the pubes and the upper part of the thighs.
Haller met with a woman in whom the skin of the pubic region was as
black as that of a negress.  During nursing the nipples assume a deep
black color which disappears after weaning. Le Cat speaks of a woman of
thirty years, whose forehead assumed a dusky hue of the color of iron
rust when she was pregnant about the seventh month. By degrees the
whole face became black except the eyes and the edges of the lips,
which retained their natural color. On some days this hue was deeper
than on others; the woman being naturally of a very fair complexion had
the appearance of an alabaster figure with a black marble head. Her
hair, which was naturally exceedingly dark, appeared coarser and
blacker. She did not suffer from headache, and her appetite was good.
After becoming black, the face was very tender to the touch. The black
color disappeared two days after her accouchement, and following a
profuse perspiration by which the sheets were stained black. Her child
was of a natural color. In the following pregnancy, and even in the
third, the same phenomenon reappeared in the course of the seventh
month; in the eighth month it disappeared, but in the ninth month this
woman became the subject of convulsions, of which she had one each day.
The existence of accidental nigrities rests on well-established facts
which are distinctly different from the pigmentation of purpura,
icterus, or that produced by metallic salts. Chomel quotes the case of
a very apathic old soldier, whose skin, without any appreciable cause,
became as brown as that of a negro in some parts, and a yellowish-brown
in others. Rustin has published the case of a woman of seventy who
became as black as a negress in a single night. Goodwin relates the
case of an old maiden lady whose complexion up to the age of twenty-one
was of ordinary whiteness, but then became as black as that of an
African. Wells and Rayer have also published accounts of cases of
accidental nigrities. One of the latter cases was a sailor of
sixty-three who suffered from general nigrities, and the other was in a
woman of thirty, appearing after weaning and amenorrhea.

Mitchell Bruce has described an anomalous discoloration of the skin and
mucous membranes resembling that produced by silver or cyanosis. The
patient, a harness-maker of forty-seven, was affected generally over
the body, but particularly in the face, hands, and feet. The
conjunctival, nasal, and aural mucosa were all involved. The skin felt
warm, and pressure did not influence the discoloration. The pains
complained of were of an intermittent, burning, shooting character,
chiefly in the epigastric and left lumbar regions. The general health
was good, and motion and sensation were normal. Nothing abnormal was
discovered in connection with the abdominal and thoracic examinations.
The pains and discoloration had commenced two years before his
admission, since which time the skin had been deepening in tint. He
remained under observation for three months without obvious change in
his symptoms. There was nothing in the patient's occupation to account
for the discoloration. A year and a half previously he had taken
medicine for his pains, but its nature could not be discovered. He had
had syphilis.

Galtier mentions congenital and bronze spots of the skin. A man born in
Switzerland the latter part of the last century, calling himself Joseph
Galart, attracted the attention of the curious by exhibiting himself
under the name of the "Living Angel." He presented the following
appearance: The skin of the whole posterior part of the trunk, from the
nape of the neck to the loins, was of a bronze color. This color
extended over the shoulders and the sides of the neck, and this part
was covered with hairs of great fineness and growing very thick; the
skin of the rest of the body was of the usual whiteness. Those parts
were the darkest which were the most covered with hair; on the back
there was a space of an inch in diameter, which had preserved its
whiteness, and where the hairs were fewer in number, darker at their
bases, and surrounded by a very small black circle; the hair was
thinner at the sides of the neck; there were a great many individual
hairs surrounded by circles of coloring matter; but there were also
many which presented nothing of this colored areola. In some places the
general dark color of the skin blended with the areola surrounding the
roots of the hair, so that one uniform black surface resulted. In many
places the dark color changed into black. The irides were brown. The
man was of very unstable character, extremely undecided in all his
undertakings, and had a lively but silly expression of countenance. A
distinct smell, as of mice, with a mixture of a garlicky odor, was
emitted from those parts where the excessive secretion of the coloring
matter took place. In those places the heat was also greater than
natural. Rayer recites the case of a young man whom he saw, whose
eyelids and adjacent parts of the cheeks were of a bluish tint, similar
to that which is produced on the skin by the explosion of gunpowder.

Billard has published an extraordinary case of blue discoloration of
the skin in a young laundress of sixteen. Her neck, face, and upper
part of the chest showed a beautiful blue tint, principally spreading
over the forehead, the alae, and the mouth. When these parts were
rubbed with a white towel the blue parts of the skin were detached on
the towel, coloring it, and leaving the skin white. The girl's lips
were red, the pulse was regular and natural, and her strength and
appetite like that of a person in health. The only morbid symptom was a
dry cough, but without mucous rattle or any deficiency of the sound of
the chest or alteration of the natural beat of the heart. The catamenia
had never failed. She had been engaged as a laundress for the past two
years. From the time she began this occupation she perceived a blueness
around her eyes, which disappeared however on going into the air. The
phenomenon reappeared more particularly when irons were heated by a
bright charcoal fire, or when she worked in a hot and confined place.
The blueness spread, and her breast and abdomen became shaded with an
azure blue, which appeared deeper or paler as the circulation was
accelerated or retarded.  When the patient's face should have blushed,
the face became blue instead of red. The changes exhibited were like
the sudden transition of shades presented by the chameleon. The
posterior part of the trunk, the axillae, the sclerotic coats of the
eyes, the nails, and the skin of the head remained in their natural
state and preserved their natural color. The linen of the patient was
stained blue. Chemical analysis seemed to throw no light on this case,
and the patient improved on alkaline treatment. She vomited blood,
which contained sufficient of the blue matter to stain the sides of the
vessel. She also stated that in hemorrhage from the nose she had seen
blue drops among the drops of blood.  One cannot but suspect indigo as
a factor in the causation of this anomalous coloration.

Artificial discolorations of the skin are generally produced by
tattooing, by silver nitrate, mercury, bismuth, or some other metallic
salt.

Melasma has been designated as an accidental and temporary blackish
discoloration of the skin. There are several varieties: that called
Addison's disease, that due to uterine disease, etc.  In this affection
the skin assumes a dark and even black hue.

Leukoderma is a pathologic process, the result of which is a deficiency
in the normal pigmentation of the skin, and possibly its appendages.
Its synonyms are leukopathia, vitiligo, achroma, leukasmus, and
chloasma album. In India the disease is called sufaid-korh, meaning
white leprosy. It has numerous colloquial appellations, such as chumba
or phoolyree (Hindoo), buras (Urdu), cabbore (Singalese), kuttam
(Taneil), dhabul (Bengal). It differs from albinism in being an
acquired deficiency of pigment, not universal and not affecting the
eye. Albinism is congenital, and the hair and eyes are affected as well
as the skin.

The disease is of universal distribution, but is naturally more
noticeable in the dark-skinned races. It is much more common in this
country among the negroes than is generally supposed.

The "leopard-boy of Africa," so extensively advertised by dime museums
over the country, was a well-defined case of leukoderma in a young
mulatto, a fitting parallel for the case of ichthyosis styled the
"alligator-boy."

Figure 293 represents a family of three children, all the subjects of
leukoderma. Leukoderma is more common among females.  It is rarely seen
in children, being particularly a disease of middle age. Bissell
reports a case in an Indian ninety years of age, subsequent to an
attack of rheumatism thirty years previous.  It is of varying duration,
nearly every case giving a different length of time. It may be
associated with most any disease, and is directly attributable to none.
In a number of cases collected rheumatism has been a marked feature. It
has been noticed following typhoid fever and pregnancy.

In white persons there are spots or blotches of pale, lustreless
appearance either irregular or symmetric, scattered over the body. In
the negro and other dark-skinned races a mottled appearance is seen. If
the process goes to completion, the whole surface changes to white. The
hair, though rarely affected, may present a mottled appearance. There
seems to be no constitutional disturbances, no radical change in the
skin, no pain--in fact, no disturbance worthy of note. The eye is not
affected; but in a negro the sclerotic generally appears muddy.

It appears first in small spots, either on the lips, nose, eyelids,
soles, palms, or forehead, and increases peripherally--the several
spots fusing together. The skin is peculiarly thin and easily
irritated. Exposure to the sun readily blisters it, and after the
slightest abrasion it bleeds freely.  Several cases have been reported
in which the specific gravity of the urine was extremely high, due to
an excess of urea. Wood calls attention to the wave-like course of
leukoderma, receding on one side, increasing on the other. The fading
is gradual, and the margins may be abrupt or diffuse. The mucous
membranes are rosy. The functions of the swell-glands are unimpaired.

The theory of the absence of pigment causing a loss of the olfactory
sense, spoken of by Wallace, is not borne out by several observations
of Wood and others. Wilson says: "Leukasma is a neurosis, the result of
weakened innervation of the skin, the cause being commonly referable to
the organs of assimilation or reproduction." It is not a dermatitis, as
a dermatitis usually causes deposition of pigment. The rays of the sun
bronze the skin; mustard, cantharides, and many like irritants cause a
dermatitis, which is accompanied by a deposition of pigment.
Leukoderma is as common in housemaids as in field-laborers, and is in
no way attributable to exposure of sun or wind. True leukodermic
patches show no vascular changes, no infiltration, but a partial
obliteration of the rete mucosum. It has been ascribed to syphilis; but
syphilitic leukoderma is generally the result of cicatrices following
syphilitic ulceration.

Many observers have noticed that negroes become several degrees lighter
after syphilization; but no definite relation between syphilis and
leukoderma has yet been demonstrated in this race.  Postmortem
examinations of leukodermic persons show no change in the suprarenal
capsule, a supposed organ of pigmentation.

Climate has no influence. It is seen in the Indians of the Isthmus of
Darien, the Hottentots, and the Icelanders. Why the cells of the rete
mucosum should have the function in some races of manufacturing or
attracting pigment in excess of those of other races, is in itself a
mystery. By his experiments on the pigment-cells of a frog Lister has
established the relation existing between these elements and
innervation, which formerly had been supposititious.

Doubtless a solution of the central control of pigmentation would
confirm the best theory of the cause of leukoderma--i.e., faulty
innervation of the skin. At present, whether the fault is in the cell
proper, the conducting media, or the central center, we are unable to
say. It is certainly not due to any vascular disturbances, as the skin
shows no vascular changes.

White spots on the nails are quite common, especially on young people.
The mechanic cause is the presence of air between the lamellae of the
affected parts, but their origin is unknown.  According to Crocker in
some cases they can be shown to be a part of trophic changes.
Bielschowsky records the case of a man with peripheral neuritis, in
whom white spots appeared at the lower part of the finger-nails, grew
rapidly, and in three weeks coalesced into a band across each nail a
millimeter wide. The toes were not affected. Shoemaker mentions a
patient who suffered from relapsing fever and bore an additional band
for each relapse. Crocker quotes a case reported by Morison of
Baltimore, in which transverse bars of white, alternating with the
normal color, appeared without ascertainable cause on the finger-nails
of a young lady and remained unchanged.

Giovannini describes a case of canities unguium in a patient of
twenty-nine, following an attack of typhoid fever. On examining the
hands of this patient the nails showed in their entire extent a white,
opaque, almost ivory color. An abnormal quantity of air found in the
interior of the nails explains in this particular case their impaired
appearance. It is certain that the nails, in order to have admitted
such a large quantity of air into their interior must have altered in
their intimate structure; and Giovannini suggests that they were
subject to an abnormal process of keratinization. Unna describes a
similar case, which, however, he calls leukonychia.

Plica polonica, or, as it was known in Cracow--weicselzopf, is a
disease peculiar to Poland, or to those of Polish antecedents,
characterized by the agglutination, tangling, and anomalous development
of the hair, or by an alteration of the nails, which become spongy and
blackish. In older days the disease was well known and occupied a
prominent place in books on skin-diseases.  Hercules de Saxonia and
Thomas Minadous, in 1610, speak of plica as a disease already long
known. The greater number of writers fix the date of its appearance in
Poland at about the year 1285, under the reign of Lezekle-Noir.
Lafontaine stated that in the provinces of Cracow and Sandomir plica
formerly attacked the peasantry, beggars, and Jews in the proportion of
1 1/2 in 20; and the nobility and burghers in the proportion of two in
30 or 40. In Warsaw and surrounding districts the disease attacked the
first classes in the proportion of one to ten, and in the second
classes one to 30. In Lithuania the same proportions were observed as
in Warsaw; but the disease has gradually grown rarer and rarer to the
present day, although occasional cases are seen even in the United
States.

Plica has always been more frequent on the banks of the Vistula and
Borysthenes, in damp and marshy situations, than in other parts of
Poland. The custom formerly prevailing in Poland of shaving the heads
of children, neglect of cleanliness, the heat of the head-dress, and
the exposure of the skin to cold seem to favor the production of this
disease.

Plica began after an attack of acute fever, with pains like those of
acute rheumatism in the head and extremities, and possibly vertigo,
tinnitus aurium, ophthalmia, or coryza. Sometimes a kind of redness was
observed on the thighs, and there was an alteration of the nails, which
became black and rough, and again, there was clammy sweat. When the
scalp was affected the head was sore to the touch and excessively
itchy. A clammy and agglutinating sweat then occurred over the cranium,
the hair became unctuous, stuck together, and appeared distended with
an adhesive matter of reddish-brown color, believed by many observers
to be sanguineous. The hair was so acutely sensitive that the slightest
touch occasioned severe pain at the roots. A viscid matter of a very
offensive smell, like that of spoiled vinegar, or according to Rayer
like that of mice or garlic, exuded from the whole surface of each
affected hair. This matter glued the hairs together, at first from
their exit at the skin, and then along the entire length; it appeared
to be secreted from the whole surface of the scalp and afterward dried
into an incrustation. If there was no exudation the disease was called
plica sicca. The hair was matted and stuck together in a variety of
ways, so as to resemble ropes (plica multiformis). Sometimes these
masses united together and formed one single thick club like the tail
of a horse (plica caudiformis). Again, and particularly in females, the
hair would become matted and glued together into one uniform intricate
mass of various magnitudes.  The hair of the whole body was likely to
be attacked with this disease. Kalschmidt of Jena possessed the pubes
of a woman dead of plica, the hair of which was of such length that it
must have easily gone around the body. There was formerly a
superstition that it was dangerous to cut the hair until the discharge
diminished. Lafontaine, Schlegel, and Hartman all assure us that the
section of the affected masses before this time has been known to be
followed by amaurosis, convulsions, apoplexy, epilepsy, and even death.
Alarmed or taught by such occurrences, the common people often went
about all their lives with the plica gradually dropping off. Formerly
there was much theorizing and discussion regarding the etiology and
pathology of plica, but since this mysterious affection has been proved
to be nothing more than the product of neglect, and the matting due to
the inflammatory exudation, excited by innumerable pediculi,
agglutinating the hair together, the term is now scarcely mentioned in
dermatologic works. Crocker speaks of a rare form which he entitles
neuropathic plica, and cites two cases, one reported by Le Page whose
specimen is in the Royal College of Surgeons Museum; and the other was
in a Hindoo described by Pestonji. Both occurred in young women, and in
both it came on after washing the hair in warm water, one in a few
minutes, and the other in a few hours. The hair was drawn up into a
hard tangled lump, impossible to unravel, limited to the right side in
Le Page's patient, who had very long hair, and in Pestonji's case to
the back of the head, where on each side was an elongated mass, very
hard and firm, like a rope and about the size of the fist. There was no
reason to believe that it was ascribable to imposture; the Hindoo woman
cut the lumps off herself and threw them away. Le Page found the most
contracted hairs flattened.  Stellwagon reports a case of plica in a
woman. It occupied a dollar-sized area above the nape of the neck, and
in twelve years reached the length of 12 feet. There was no history of
its manner of onset.

Tinea nodosa is a name given by Morris and Cheadle to a case of nodular
growth on the beard and whiskers of a young man. In a case noticed by
Crocker this disease affected the left side of the mustache of a
medical man, who complained that the hair, if twisted up, stuck
together. When disintegrated the secretion in this case seemed to be
composed of fungous spores. Epithelium fragments, probably portions of
the internal root-sheath, sometimes adhere to the shaft of the hair as
it grows up, and look like concretions. Crocker states that he is
informed by White of Boston that this disease is common in America in
association with alopecia furfuracea, and is erroneously thought to be
the cause of the loss of hair, hence the popular name, "hair-eaters."

Thomson describes a case of mycosis fungoides in a young girl of the
age of fourteen, whom he saw in Brussels toward the end of October,
1893. She was the third of a family of 13 children of whom only five
survived. Of the children born subsequently to the patient, the first
were either premature or died a few days after their births. The
seventh was under treatment for interstitial keratitis and tuberculous
ulceration of the lips and throat. The disease in the patient made its
appearance about seven months previously, as a small raised spot in the
middle of the back just above the buttocks. Many of the patches
coalesced. At the time of report the lumbar region was the seat of the
disease, the affection here presenting a most peculiar appearance,
looking as if an enormous butterfly had alighted on the patient's back,
with its dark blue wings covered with silvery scales, widely expanded.
The patient was not anemic and appeared to be in the best of health.
None of the glands were affected. According to Thomson there is little
doubt that this disease is caused by non-pyogenic bacteria gaining
access to the sweat-glands. The irritation produced by their presence
gives rise to proliferation of the connective-tissue corpuscles.

Jamieson reports a case of mycosis in a native of Aberdeenshire aged
thirty-eight. There was no history of any previous illness.  The
disease began three years previous to his application for treatment, as
a red, itching, small spot on the cheek. Two years later lumps
presented themselves, at first upon his shoulders.  The first thing to
strike an observer was the offensive odor about the patient. In the
hospital wards it made all the occupants sick. The various stages of
the disease were marked upon the different parts of the body. On the
chest and abdomen it resembled an eczema, on the shoulders there were
brown, pinkish-red areas. On the scalp the hair was scanty, the
eye-brows denuded, and the eyelashes absent. The forehead was leonine
in aspect. From between the various nodosities a continual discharge
exuded, the nodosities being markedly irregular over the limbs. The
backs of the hands, the dorsums of the feet, the wrists and ankles, had
closely approximating growths upon them, while under the thick
epidermis of the palms of the hands were blisters. Itching was intense.
The patient became emaciated and died thirteen days after his admission
into the hospital. A histologic examination showed the sarcomatous
nature of the various growths. The disease differed from
"button-scurvy." Mycosis fungoides approximates, clinically and
histologically, granulomata and sarcomata.

Morris described an interesting case of universal dermatitis, probably
a rare variety of mycosis fungoides. The patient had for many years a
disease which had first appeared on the arms and legs, and which was
usually regarded by the physicians who saw the case as eczema. At times
the disease would entirely disappear, but it relapsed, especially
during visits to India. At the time the patient came under the care of
Morris, his general health seemed unaffected. The skin of the whole
body, except the face, the scalp, and the front of the chest, was of a
mahogany color. The skin of the lips was so thickened that it could not
be pinched into folds, and was of a mottled appearance, due to
hemorrhagic spots. All over the thickened and reddened surface were
scattered crops of vesicles and boils. The nails were deformed, and the
toes beyond the nails were tense with a serous accumulation. The glands
in the right axilla and the groin were much enlarged. The hair on the
pubes had disappeared. The abdomen was in a condition similar to that
upon the limbs, but less in degree. The front of the chest below the
nipples was covered with dark papules the size of a pin's head. The
back, the buttocks, the face, and the scalp presented similar lesions.
The most striking lesions were three ulcers--one on the back of the
right hand, one on the right temple, and the other on the left cheek.
The largest was the size of a florin, and had elevated borders,
somewhat infiltrated; they were covered with a brown, dry scab.  The
patient suffered from itching at night so that he could not sleep. He
was kept under observation, and in spite of treatment the malady
advanced in a periodic manner, each exacerbation being preceded by a
feeling of tension in the parts, after which a crop of vesicles would
appear. Sometimes, especially on the feet, bullae formed. The patient
finally left the hospital and died of an intercurrent attack of
pneumonia. A microscopic examination revealed a condition which might
be found with a number of the chronic affections of the skin, but, in
addition, there were certain cell-inclusions which were thought to
represent psorosperms. Morris thought this case corresponded more to
mycosis fungoides than any other malady.



CHAPTER XVII.

ANOMALOUS NERVOUS AND MENTAL DISEASES.

Epilepsy has been professionally recognized as a distinct type of
disease since the time of Hippocrates, but in earlier times, and
popularly throughout later times, it was illy defined. The knowledge of
the clinical symptoms has become definite only since the era of
cerebral local anatomy and localization. Examination of the older
records of epilepsy shows curious forms recorded.  The Ephemerides
speaks of epilepsy manifested only on the birthday. Testa mentions
epilepsy recurring at the festival of St. John, and Bartholinus reports
a case in which the convulsions corresponded with the moon's phases.
Paullini describes epilepsy which occurred during the blowing of wind
from the south, and also speaks of epilepsy during the paroxysms of
which the individual barked. Fabricius and the Ephemerides record
dancing epilepsy. Bartholinus and Hagendorn mention cases during which
various splendors appeared before the eyes during the paroxysm.  Godart
Portius, and Salmuth speak of visions occurring before and after
epileptic paroxysms. The Ephemerides contains records of epilepsy in
which blindness preceded the paroxysm, in which there was singing
during it, and a case in which the paroxysm was attended with
singultus. Various older writers mention cases of epilepsy in which
curious spots appeared on the face; and the kinds of aura mentioned are
too numerous to transcribe.

Baly mentions a case of epilepsy occasioned by irritation in the socket
of a tooth. Webber reports a case of epilepsy due to phimosis and to
irritation from a tooth. Beardsley speaks of an attempt at
strangulation that produced epilepsy. Brown-Sequard records an instance
produced by injury to the sciatic nerve.  Doyle gives an account of the
production of epilepsy from protracted bathing in a pond. Duncan cites
an instance of epilepsy connected with vesical calculus that was cured
by lithotomy. Museroft mentions an analogous case. Greenhow speaks of
epilepsy arising from an injury to the thumb. Garmannus, early in the
eighteenth century, describes epilepsy arising from fright and terror.
Bristowe in 1880, and Farre speak of similar instances. In Farre's case
the disease was temporarily cured by an attack of acute rheumatism.
Thorington of Philadelphia has seen a paroxysm of epilepsy induced by
the instillation of atropia in the eye of a child nearly cured of the
malady. It was supposed that the child was terrified on awakening and
finding its vision suddenly diminished, and that the convulsions were
directly due to the emotional disturbance. Orwin describes epilepsy
from prolonged lactation, and instances of ovarian and uterine epilepsy
are quite common.

There is a peculiar case of running epilepsy recorded. The patient was
a workman who would be suddenly seized with a paroxysm, and
unconsciously run some distance at full speed. On one occasion he ran
from Peterborough to Whittlesey, where he was stopped and brought back.
Once he ran into a pit containing six feet of water, from which he was
rescued. Yeo says that sexual intercourse occasionally induces
epilepsy, and relates a case in which a severe epileptic fit terminated
fatally three days after the seizure, which occurred on the nuptial
night.

Drake reports the case of a man who was wounded in the War of 1812,
near Baltimore, the ball passing along the left ear and temple so close
as to graze the skin. Eighteen years after the accident he suffered
with pain in the left ear and temple, accompanied by epileptic fits and
partial amnesia, together with an entire loss of power of remembering
proper names and applying them to the objects to which they belonged.
He would, for instance, invariably write Kentucky for Louisville.
Beirne records the case of a dangerous lunatic, an epileptic, who was
attacked by a fellow-inmate and sustained an extensive fracture of the
right parietal bone, with great hemorrhage, followed by coma. Strange
to say, after the accident he recovered his intellect, and was cured of
his epileptic attacks, but for six years he was a paralytic from the
hips down.

The Dancing Mania.--Chorea has appeared in various epidemic forms under
the names of St. Vitus's dance, St. Guy's dance, St.  Anthony's dance,
choromania, tanzplage, orchestromania, dance of St. Modesti or St.
John, the dancing mania, etc.; although these various functional
phenomena of the nervous system have been called chorea, they bear very
little resemblance to what, at the present day, is called by this name.
The epidemic form appeared about 1374, although Hecker claims that, at
that time, it was no new thing. Assemblages of men and women were seen
at Aix-la-Chapelle who, impelled by a common delusion, would form
circles, hand in hand, and dance in wild delirium until they fell to
the ground exhausted, somewhat after the manner of the Ghost-Dance or
Messiah-Dance of our North American Indians. In their Bacchantic leaps
they were apparently haunted by visions and hallucinations, the fancy
conjuring up spirits whose names they shrieked out. Some of them
afterward stated that they appeared to be immersed in a stream of blood
which obliged them to leap so high. Others saw the heavens open and
disclose the Saviour enthroned with the Virgin Mary. The participants
seemed to suffer greatly from tympanites which was generally relieved
by compression or thumping on the abdomen. A few months after this
dancing malady had made its appearance at Aix-la-Chapelle it broke out
at Cologne, and about the same time at Metz, the streets of which were
said to have been filled with 1100 dancers.  This rich city became the
scene of the most ruinous disorder.  Peasants left their plows,
mechanics their shops, servants their masters, children their homes;
and beggars and idle vagabonds, who understood how to imitate the
convulsions, roved from place to place, inducing all sorts of crime and
vice among the afflicted. Strasburg was visited by the dancing plague
in 1418, and it was here that the plague assumed the name of St.
Vitus's dance. St. Vitus was a Sicilian youth who, just at the time he
was about to undergo martyrdom by order of Diocletian, in the year 303,
is said to have prayed to God that He might protect all those who would
solemnize the day of his commemoration and fast upon its eve. The
people were taught that a voice from heaven was then heard saying,
"Vitus, thy prayer is accepted."

Paracelsus called this malady (Chorus sancti viti) the lascivious
dance, and says that persons stricken with it were helpless until
relieved by either recovery or death. The malady spread rapidly through
France and Holland, and before the close of the century was introduced
into England. In his "Anatomy of Melancholy" Burton refers to it, and
speaks of the idiosyncrasies of the individuals afflicted. It is said
they could not abide one in red clothes, and that they loved music
above all things, and also that the magistrates in Germany hired
musicians to give them music, and provided them with sturdy companions
to dance with.  Their endurance was marvelous. Plater speaks of a woman
in Basle whom he saw, that danced for a month. In Strasburg many of
them ate nothing for days and nights until their mania subsided.
Paracelsus, in the beginning of the sixteenth century, was the first to
make a study of this disease. He outlined the severest treatment for
it, and boasted that he cured many of the victims.  Hecker conjectures
that probably the wild revels of St. John's day, 1374, gave rise to
this mental plague, which thenceforth visited so many thousands with
incurable aberrations of mind and disgusting distortions of the body.
Almost simultaneous with the dance of "St. With," there appeared in
Italy and Arabia a mania very similar in character which was called
"tarantism," which was supposed to originate in the bite of the
tarantula. The only effective remedy was music in some form. In the
Tigre country, Abyssinia, this disease appeared under the name of
"Tigretier." The disease, fortunately, rapidly declined, and very
little of it seems to have been known in the sixteenth century, but in
the early part of the eighteenth century a peculiar sect called the
"Convulsionnaires" arose in France; and throughout England among the
Methodist sect, insane convulsions of this nature were witnessed; and
even to the present day in some of the primitive religious meetings of
our people, something not unlike this mania of the Middle Ages is
perpetuated.

Paracelsus divided the sufferers of St. Vitus's dance into three
classes .--

(1) Those in which the affliction arose from imagination (chorea
imaginativa).

(2) Those which had their origin in sexual desires depending on the
will.

(3) Those arising from corporeal causes (chorea naturalis). This last
case, according to a strange notion of his own he explained by
maintaining that in certain vessels which are susceptible of an
internal pruriency, and thence produced laughter, the blood is set into
commotion in consequence of an alteration in the vital spirits, whereby
are occasioned involuntary fits of intoxicating joy, and a propensity
to dance. The great physician Sydenham gave the first accurate
description of what is to-day called chorea, and hence the disease has
been named "Sydenham's chorea." So true to life was his portrayal of
the disease that it has never been surpassed by modern observers.

The disease variously named palmus, the jumpers, the twitchers, lata,
miryachit, or, as it is sometimes called, the emeryaki of Siberia, and
the tic-convulsif of La Tourette, has been very well described by Gray
who says that the French authors had their attention directed to the
subject by the descriptions of two American authors--those of Beard
upon "The Jumpers of Maine," published in 1880, and that of Hammond
upon "Miryachit," a similar disease of the far Orient. Beard found that
the jumpers of Maine did unhesitatingly whatever they were told to do.
Thus, one who was sitting in a chair was told to throw a knife that he
had in his hand, and he obeyed so quickly that the weapon stuck in a
house opposite; at the same time he repeated the command given him,
with a cry of alarm not unlike that of hysteria or epilepsy. When he
was suddenly clapped upon the shoulder he threw away his pipe, which he
had been filling with tobacco. The first parts of Virgil's aeneid and
Homer's Iliad were recited to one of these illiterate jumpers, and he
repeated the words as they came to him in a sharp voice, at the same
time jumping or throwing whatever he had in his hand, or raising his
shoulder, or making some other violent motion. It is related by
O'Brien, an Irishman serving on an English naval vessel, that an
elderly and respectable Malay woman, with whom he was conversing in an
entirely unsuspecting manner, suddenly began to undress herself, and
showed a most ominous and determined intention of stripping herself
completely, and all because a by-standing friend had suddenly taken off
his coat; at the same time she manifested the most violent anger at
what she deemed this outrage to her sex, calling the astonished friend
an abandoned hog, and begging O'Brien to kill him. O'Brien,
furthermore, tells of a cook who was carrying his child in his arms
over the bridge of a river, while at the same time a sailor carried a
log of wood in like manner; the sailor threw his log of wood on an
awning, amusing himself by causing it to roll over the cloth, and
finally letting it fall to the bridge; the cook repeated every motion
with his little boy, and killed him on the spot. This miryachit was
observed in Malaysia, Bengal, among the Sikhs and the Nubians, and in
Siberia, whilst Beard has observed it in Michigan as well as in Maine.
Crichton speaks of a leaping ague in Angusshire, Scotland.

Gray has seen only one case of acute palmus, and records it as follows:
"It was in a boy of six, whose heredity, so far as I could ascertain
from the statements of his mother, was not neurotic. He had had trouble
some six months before coming to me.  He had been labeled with a number
of interesting diagnoses, such as chorea, epilepsy, myotonia, hysteria,
and neurasthenia. His palmodic movements were very curious. When
standing near a table looking at something, the chin would suddenly
come down with a thump that would leave a black-and-blue mark, or his
head would be thrown violently to one side, perhaps coming in contact
with some adjacent hard object with equal force, or, while standing
quietly, his legs would give a sudden twitch, and he would be thrown
violently to the ground, and this even happened several times when he
was seated on the edge of a stool. The child was under my care for two
weeks, and, probably because of an intercurrent attack of diarrhea,
grew steadily worse during that time, in spite of the full doses of
arsenic which were administered to him. He was literally covered with
bruises from the sudden and violent contacts with articles of
furniture, the floor, and the walls. At last, in despair at his
condition, I ordered him to be undressed and put to bed, and steadily
pushed the Fowler's solution of arsenic until he was taking ten drops
three times a day, when, to my great surprise, he began to improve
rapidly, and at the end of six weeks was perfectly well.  Keeping him
under observation for two weeks longer I finally sent him to his home
in the West, and am informed that he has since remained perfectly well.
It has seemed to me that many of the cases recorded as paramyoclonus
multiples have been really acute palmus."

Gray mentions two cases of general palmus with pseudomelancholia, and
describes them in the following words:--

"The muscular movements are of the usual sudden, shock-like type, and
of the same extent as in what I have ventured to call the general form.
With them, however, there is associated a curious pseudomelancholia,
consisting of certain fixed melancholy suspicious delusions, without,
however, any of the suicidal tendencies and abnormal sensations up and
down the back of the head, neck, or spine, or the sleeplessness, which
are characteristic of most cases of true melancholia. In both of my
cases the palmus had existed for a long period, the exact limits of
which, however, I could not determine, because the patient scouted the
idea that he had had any trouble of the kind, but which the testimony
of friends and relatives seemed to vouch for.  They were both men, one
thirty-six and one thirty-eight years of age. The pseudomelancholia,
however, had only existed in one case for about a year, and in the
other for six months. One case passed away from my observation, and I
know nothing of its further course. The other case recovered in nine
months' treatment, and during the three years that have since elapsed
he has been an active business man, although I have not seen him myself
during that period, as he took a great dislike to me because I was
forced to take strong measures to keep him under treatment, so
persistent were his suspicions."

Athetosis was first described by Hammond in 1871, who gave it the name
because it was mainly characterized by an inability to retain the
fingers and toes in any position in which they might be planed, as well
as by their continuous motion. According to Drewry "athetosis is a
cerebral affection, presenting a combination of symptoms characterized
chiefly by a more or less constant mobility of the extremities and an
inability to retain them in any fixed position. These morbid,
grotesque, involuntary movements are slow and wavy, somewhat regular
and rigid, are not jerky, spasmodic, nor tremulous. The movements of
the digits are quite different from those attending any other disease,
impossible to imitate even by the most skilful malingerer, and, if once
seen, are not likely to be forgotten. In an athetoid hand, says Starr,
the interossei and lumbricales, which flex the metacarpo-phalangeal and
extend the phalangeal joints, are affected; rarely are the long
extensors and the long flexors affected. Therefore the hand is usually
in the so-called interosseal position, with flexion of the proximal and
extension of the middle and distal phalanges. The athetoid movements of
the toes correspond to those of the fingers in point of action. In a
great majority of cases the disease is confined to one side
(hemiathetosis), and is a sequel of hemiplegia. The differential
diagnosis of athetosis is generally easily made. The only nervous
affections with which it could possibly be confounded are chorea and
paralysis agitans. Attention to the twitching, spasmodic, fibrillary
movements, having a quick beginning and a quick ending, which is
characteristic in Sydenham's chorea, would at once exclude that
disease. These jerky movements peculiar to St.  Vitus's dance may be
easily detected in a few or many muscles, if moderate care and patience
be exercised on the part of the examiner. This form of chorea is almost
always a disease of childhood. So-called post-hemiplegic chorea is, in
the opinion of both Hammond and Gray, simply athetosis. The silly,
dancing, posturing, wiry movements, and the facial distortion observed
in Huntington's chorea would hardly be mistaken by a careful observer
for athetosis. The two diseases, however, are somewhat alike. Paralysis
agitans (shaking palsy), with its coarse tremor, peculiar facies,
immobility, shuffling gait, the 'bread-crumbling' attitude of the
fingers, and deliberate speech, would be readily eliminated even by a
novice. It is, too, a disease of advanced life, usually. Charcot, Gray,
Ringer, Bernhardt, Shaw, Eulenberg, Grassel; Kinnicutt, Sinkler, and
others have written on this affection."

The following is the report of a case by Drewry, of double (or, more
strictly speaking, quadruple) athetosis, associated with epilepsy and
insanity: "The patient was a negro woman, twenty-six years old when she
was admitted into this, the Central State (Va.) Hospital, in April,
1886. She had had epilepsy of the grand mal type for a number of years,
was the mother of one child, and earned her living as a domestic. A
careful physical examination revealed nothing of importance as an
etiologic factor. Following in the footsteps of many of those
unfortunates afflicted with epilepsy, she degenerated into a state of
almost absolute imbecility.

"Some degree of mental deficiency seems usually to accompany athetosis,
even when uncomplicated by any other degenerating neurosis. Athetoid
symptoms of an aggravated character, involving both upper and both
lower extremities, had developed previous to her admission into this
hospital, but it was impossible to find out when and how they began.
She had never had, to the knowledge of her friends, an attack of
'apoplexy,' nor of paralysis. The head was symmetric, and without scars
thereon. The pedal extremities involuntarily assumed various distorted
positions and were constantly in motion. The toes were usually in a
state of tonic spasm,--contracted, and drawn downward or extended,
pointing upward, and slightly separated. Irregular alternate extension
and flexion of the toes were marked. The feet were moved upon the
ankles in a stiff and awkward manner. During these 'complex involuntary
movements,' the muscles of the calf became hard and rigid. The act of
walking was accomplished with considerable difficulty, on account of
contractures, and because the feet were not exactly under the control
of the will. The unnatural movements of the hands corresponded to those
of the lower extremities, though they were more constant and active.
The fingers, including the thumbs, were usually widely separated and
extended, though they were sometimes slightly flexed. The hands were
continually in slow, methodic, quasi-rhythmic motion, never remaining
long in the same attitude. In grasping an object the palm of the hand
was used, it being difficult to approximate the digits. The
wrist-joints were also implicated, there being alternate flexion and
extension. In fact these odd contortions affected the entire limb from
the shoulder to the digital extremities. When standing or walking the
arms were held out horizontally, as if to maintain the equilibrium of
the body. The patient's general physical health was fairly good. She
frequently complained of headache, and when she was exceedingly
irritable and violent all the athetoid movements would be intensified.
Speech was jerky and disordered, which gave it a distinctive character.
The special senses seemed to be unimpaired, and the pupils were normal,
except when an epileptic attack came on.  Death occurred in January,
1895, after an obstinate attack of status epilepticus." Paramyoclonus
multiplex is a condition of chronic muscular spasm affecting the trunk,
occasionally the muscles of the face, abdomen, or diaphragm. The
muscles affected are usually in the trunk and in the limbs, and not in
the toes and hand; occasionally the movements are tonic as well as
clonic; the degree of spasm varies greatly, and according to Gray may
sometimes be so violent as to throw the patient down or out of the
chair.

Saltatoric spasm is an extremely rare condition, first observed by
Bamberger in 1859. The calf, hip, knee, and back-muscles are affected
by clonic spasm, causing springing or jumping movements when the
patient attempts to stand. The disease is transient, and there are no
mental symptoms.

Progressive muscular atrophy has been observed as far back as
Hippocrates, but it is only in recent times that we have had any
definite knowledge of the subject. It is divided into four types, the
hand type (causing the griffin-or claw-hand, or the ape-hand); the
juvenile type (generally in the muscles of the shoulder and arm); the
facial type; and the peroneal type.  Generalized progressive atrophy
leads to a condition that simulates the appearance of a "living
skeleton."

Facial hemiatrophy is an incurable disease, as yet of unknown
pathology. It consists of wasting of the bones, subcutaneous tissues,
and muscles of one-half of the face or head, the muscles suffering but
slightly. The accompanying illustration shows a case in which there was
osseous depression of the cranium and a localized alopecia. The disease
is very rare, only about 100 cases having been reported. Of five cases
seen by Dana, three were in females and two in males; in all the cases
that could be found the origin was between the tenth and twentieth
years. It is a chronic affection, usually beginning in early life,
increasing slowly for years, and then becoming stationary. It is
distinguished from one-sided muscular atrophy by the electric reaction,
which is not lost in the facial muscles in facial hemiatrophy, and
there is no atrophy of other muscles of the body.

Burr contributes an exhaustive paper on hemiatrophy of the tongue with
report of a case as follows: "L. B., female, mulatto, thirty-one years
old, married, came to the Medico-Chirurgical Hospital, Philadelphia,
September 23, 1895, complaining that her 'tongue was crooked.' Save
that she had had syphilis, her personal history is negative. In
February, 1895, she began to suffer from headache, usually behind the
left ear, and often preventing sleep. At times there is quite severe
vertigo. Several weeks after the onset, headache persisting, she awoke
in the night and found the left side of the tongue swollen, black, and
painless. For some hours she could neither speak nor chew, but
breathing was not interfered with. After a few days all symptoms passed
away except headache, and she thought no more of the matter until
recently, as stated above, she noticed by accident that her tongue was
deformed. She is a spare, poorly-fed, muddy-skinned mulatto girl. The
left half of the tongue is only about one-half as large as the right.
The upper surface is irregularly depressed and elevated. There are no
scars. When protruded it turns sharply to the left. Fibrillary
twitching is not present. The mucous membrane is normal. Common
sensation and taste are preserved. The pharyngeal reflex is present.
The palate moves well. There is no palsy or wasting of the face. The
pupils are of normal size and react well to light and with
accommodation. Station and gait are normal. There is no incoordination
of movement in the arms or legs. The knee-jerks are much increased.
There is an attempt at, but no true, clonus; that is, passive flexion
of the foot causes two or three jerky movements. There is no glandular
swelling or tumor about the jaw or in the neck. Touch and pain-sense
are normal in the face and hands, but she complains of numbness in the
hands as if she had on tight gloves. There is no trouble in speaking,
chewing, or swallowing. There is no pain or rigidity in the neck
muscles.  Examination of the pharynx reveals no disease of the bones.
Under specific treatment the patient improved."

Astasia-abasia was named by Blocq, who collected 11 cases.  According
to Knapp, four cases have been reported in America. The disease
consists in an inability to stand erect or walk normally, although
there is no impairment of sensation, of muscular strength, or of the
coordination of other muscles in walking than the lower extremities. In
attempting to walk the legs become spasmodic; there are rapid flexions
and extensions of the legs on the thighs, and of the thighs on the
pelvis. The steps are short, and the feet drag; the body may make great
oscillations if the patient stands, walks, or sits, and the head and
arms make rhythmical movements; walking may become impossible, the
patient appearing to leap up on one foot and then up on the other, the
body and head oscillating as he advances; he may be able to walk
cross-legged, or by raising the legs high; or to walk on his hands and
feet; he may be able to walk at certain times and not at others; or to
hop with both feet together; he may succeed with great strides and with
the arms extended; or finally he may be able to use his legs perfectly
if suspended (Gray). There are various types which have been called the
paralytic, the choreic, and the saltatory. A tendency to go backward or
retropulsion has been observed, according to Gray, as has also a
tendency to go forward or propulsion. A curious phenomenon in this
disease is that the patient can use the legs perfectly well lying in
bed.  The prognosis seems to be favorable.

Meniere's disease is a disease probably of the semicircular canals,
characterized by nausea, vomiting, vertigo, deafness, tinnitus aurium,
and various other phenomena. It is also called aural or auditory
vertigo. The salient symptom is vertigo, and this varies somewhat in
degree according to the portions of the ear affected. If the disease is
in the labyrinth, the patient is supposed to stagger to one side, and
the vertigo is paroxysmal, varying to such a degree as to cause simple
reeling, or falling as if shot. Gray reports the history of a patient
with this sensational record: He had been a peasant in Ireland, and one
day crossing one of the wide moors in a dog-cart, he was suddenly, as
he thought, struck a violent blow from behind, so that he believed that
he lost consciousness for some time. At all events, when he was able to
get up he found his horse and cart some distance off, and, of course,
not a soul in sight. Under the belief that he had been struck by some
enemy he went quietly home and said nothing about it. Some time
afterward, however, in crossing another lonely place he had a similar
experience, and as he came to the conclusion that nobody could have
been near him, he made up his mind that it was some malevolent stroke
of the devil and he consulted a priest who agreed with him in his
belief, and gave him an amulet to wear. A series of similar attacks
occurred and puzzled as to whether there was some diabolical agency at
work, or whether he was the victim of some conspiracy, he emigrated to
America; for several months he had no attacks. A new paroxysm occurring
he consulted Gray, who found indubitable evidence of labyrinthine
disease. The paroxysms of this disease are usually accompanied by
nausea and vomiting, and on account of the paleness of the face, and
the cold, clammy perspiration, attacks have frequently been mistaken
for apoplexy.  In disease of the middle ear the attacks are continuous
rather than paroxysmal. If the disease is in the middle or internal
ears, loud noises are generally heard, but if the disease is in the
external ear, the noises are generally absent, and the vertigo of less
degree but continuous. The prognosis varies with the location of the
disease, but is always serious.

Human rumination has been known for many years. Bartholinus, Paullinus,
Blanchard, Bonet, the Ephemerides, Fabricius Hildanus, Horstius,
Morgagni, Peyer, Rhodius, Vogel, Salmuth, Percy, Laurent, and others
describe it. Fabricius d'Aquapendente personally knew a victim of
rumination, or, as it is generally called, merycism. The dissection by
Bartholinus of a merycol showed nothing extraordinary in the cadaver.
Winthier knew a Swede of thirty-five, in Germany, apparently healthy,
but who was obliged when leaving the table to retire to some remote
place where he might eject his food into his mouth again, saying that
it gave him the sensation of sweetest honey. The patient related that
from his infancy he had been the subject of acid eructations, and at
the age of thirty he commenced rumination as a means of relief. To
those who are interested in the older records of these cases Percy and
Laurent offer the descriptions of a number of cases.

In a recent discussion before the American Neurological Association
Hammond defined merycism as the functions of remastication and
rumination in the human subject. He referred to several cases, among
them that of the distinguished physiologist, Brown-Sequard, who
acquired the habit as a result of experiments performed upon himself.
Hammond reported a case of a young man who was the subject of merycism,
and whose mental condition was also impaired. No special treatment was
undertaken, but the patient was trephined, with the purpose of
improving his mental condition. There were no unusual features
connected with the operation, but it was noticed that there were no
ruminations with the meals he took until the fifth day, when a slight
rumination occurred. Eight days later a similar button was removed from
the corresponding side of the left skull, and from that time (about six
months) to the time of report, there had been no regurgitation. Whether
the cure of the merycism in this case was directly due to the
operations on the cranium, or the result of the mental improvement, is
a question for discussion. Hammond added that, when acquired, merycism
was almost invariably the result of over-eating and loading the
esophagus, or the result of fast eating.

In remarks upon Hammond's paper Knapp said that two cases had come to
his knowledge, both in physicians, but one of them he knew of only by
hearsay. The other man, now over thirty, had regurgitated his food from
early childhood, and he did not know that he had anything very unusual
the matter with him until he began some investigations upon the
functions and diseases of the stomach. This man was not nervous, and
was certainly not an idiot. He had done active work as a physician, and
called himself in perfect health. He was something of an epicure, and
never suffered from indigestion. After a hearty meal the regurgitation
was more marked. Food had been regurgitated, tasting as good as when
first eaten, several hours after the eating. If he attempted to check
the regurgitation he sometimes had a slight feeling of fulness in the
stomach. Lloyd said that these cases were forms of neuroses, and were
types of hysteric vomiting. There was no gustatory satisfaction
connected with any form of hysteric vomiting that he had seen. In some
of these cases of hysteric vomiting the food does not appear to enter
the stomach, but is rejected by a sort of spasm of the esophagus. This
has been called "esophagismus," and is apparently closely allied to
this neurosis, which some have called "merycism." The President of the
Association said that this would seem to be an affection common among
physicians. A student friend of his who had been affected in this way,
had written an elaborate monograph on the subject.  He was disgusted
with the habit, and finally overcame it by the exercise of his
will-power.

Runge discusses three cases of hereditary rumination. These patients
belonged to three generations in the male line. The author subjected
the contents of the stomach of one patient to quite an extensive
analysis, without finding any abnormality of secretion.

Wakefulness.--Generally speaking, the length of time a person can go
without sleep is the same as that during which he can survive without
food. Persons, particularly those of an hysteric nature, are prone to
make statements that they have not slept for many days, or that they
never sleep at all, but a careful examination and watch during the
night over these patients show that they have at least been in a
drowsy, somnolent condition, which is in a measure physiologically
equivalent to sleep. Accounts of long periods of wakefulness arise from
time to time, but a careful examination would doubtless disprove them.
As typical of these accounts, we quote one from Anderson, Indiana,
December 11, 1895:--

"David Jones of this city, who attracted the attention of the entire
medical profession two years ago by a sleepless spell of ninety-three
days, and last year by another spell which extended over one hundred
and thirty-one days, is beginning on another which he fears will be
more serious than the preceding ones. He was put on the circuit jury
three weeks ago, and counting to-day has not slept for twenty days and
nights. He eats and talks as well as usual, and is full of business and
activity. He does not experience any bad effects whatever from the
spell, nor did he during his one hundred and thirty-one days. During
that spell he attended to all of his farm business. He says now that he
feels as though he never will sleep again. He does not seem to bother
himself about the prospects of a long and tedious wake. He cannot
attribute it to any one thing, but thinks that it was probably
superinduced by his use of tobacco while young."

Somnambulism, or, as it has been called, noctambulation, is a curious
phase of nocturnal cerebration analogous to the hypnotic state, or
double consciousness occasionally observed in epileptics. Both
Hippocrates and Aristotle discuss somnambulism, and it is said that the
physician Galen was a victim of this habit. Horstius, ab Heers, and
many others of the older writers recorded interesting examples of this
phenomenon. Schenck remarks on the particular way in which
somnambulists seem to escape injury. Haller, Hoffmann, Gassendi,
Caelius Rhodiginus, Pinel, Hechler, Bohn, Richter,--in fact nearly all
the ancient physiologists and anatomists have written on this subject.
The marvelous manifestations of somnambulism are still among the more
surprising phenomena with which science has to deal. That a person
deeply immersed in thought should walk and talk while apparently
unconscious, excites no surprise, but that anyone should when fast
asleep perform a series of complicated actions which undoubtedly demand
the assistance of the senses is marvelous indeed. Often he will rise in
the night, walk from room to room, go out on porticoes, and in some
cases on steep roofs, where he would not dare to venture while awake.
Frequently he will wander for hours through streets and fields,
returning home and to bed without knowledge of anything having
transpired.

The state of the eyes during somnambulism varies considerably.  They
are sometimes closed, sometimes half-closed, and frequently quite open;
the pupil is sometimes widely dilated, sometimes contracted, sometimes
natural, and for the most part insensible to light.

Somnambulism seems to be hereditary. Willis cites an example in which
the father and the children were somnambulists, and in other cases
several individuals in the same family have been afflicted. Horstius
gives a history of three young brothers who became somnambulistic at
the same epoch. A remarkable instance of somnambulism was the case of a
lad of sixteen and a half years who, in an attack of somnambulism, went
to the stable, saddled his horse, asked for his whip, and disputed with
the toll-keeper about his fare, and when he awoke had no recollection
whatever of his acts, having been altogether an hour in his trance.

Marville quotes the case of an Italian of thirty, melancholic, and a
deep thinker, who was observed one evening in his bed. It was seen that
he slept with his eyes open but fixed and immovable. His hands were
cold, and his pulse extremely slow. At midnight he brusquely tore the
curtains of his bed aside, dressed himself, went to his stable, and
mounted a horse. Finding the gate of the court yard closed he opened it
with the aid of a large stone. Soon he dismounted, went to a billiard
room, and simulated all the movements of one playing. In another room
he struck with his empty hands a harpsichord, and finally returned to
his bed. He appeared to be irritated when anybody made a noise, but a
light placed under his nose was apparently unnoticed. He awoke if his
feet were tickled, or if a horn was blown in his ear. Tissot transmits
to us the example of a medical student who arose in the night, pursued
his studies, and returned to bed without awaking; and there is another
record of an ecclesiastic who finished his sermon in his sleep.

The Archbishop of Bordeaux attests the case of a young ecclesiastic who
was in the habit of getting up during the night in a state of
somnambulism, taking pen, ink, and paper, and composing and writing
sermons. When he had finished a page he would read aloud what he had
written and correct it. In order to ascertain whether the somnambulist
made any use of his eyes the Archbishop held a piece of cardboard under
his chin to prevent his seeing the paper upon which he was writing. He
continued to write without being in the slightest degree incommoded. In
this state he also copied out pieces of music, and when it happened
that the words were written in too large characters and did not stand
over the corresponding notes he perceived his error, blotted them out,
and wrote them over again with great exactness.

Negretti, a sleep-walker, sometimes carried a candle about with him as
if to furnish him light in his employment, but when a bottle was
substituted he carried it, fancying that he had the candle. Another
somnambulist, Castelli, was found by Dr. Sloane translating Italian and
French and looking out words in his dictionary. His candle was
purposely extinguished, whereupon he immediately began groping about,
as if in the dark, and, although other lighted candles were in the
room, he did not resume his occupation until he had relighted his
candle at the fire. He was insensible to the light of every candle
excepting the one upon which his attention was fixed.

Tuke tells of a school-boy who being unable to master a school-problem
in geometry retired to bed still thinking of the subject; he was found
late at night by his instructor on his knees pointing from spot to spot
as though he were at the blackboard. He was so absorbed that he paid no
attention to the light of the candle, nor to the speech addressed to
him. The next morning the teacher asked him if he had finished his
problem, and he replied that he had, having dreamt it and remembered
the dream. There are many such stories on record. Quoted by Gray,
Mesnet speaks of a suicidal attempt made in his presence by a
somnambulistic woman. She made a noose of her apron, fastened one end
to a chair and the other to the top of a window. She then kneeled down
in prayer, made the sign of the cross, mounted a stool, and tried to
hang herself. Mesnet, scientific to the utmost, allowed her to hang as
long as he dared, and then stopped the performance. At another time she
attempted to kill herself by violently throwing herself on the floor
after having failed to fling herself out of the window. At still
another time she tried poison, filling a glass with water, putting
several coins into it, and hiding it after bidding farewell to her
family in writing; the next night, when she was again somnambulistic,
she changed her mind once more, writing to her family explaining her
change of purpose. Mesnet relates some interesting experiments made
upon a French sergeant in a condition of somnambulism, demonstrating
the excitation of ideas in the mind through the sense of touch in the
extremities. This soldier touched a table, passed his hands over it,
and finding nothing on it, opened the drawer, took out a pen, found
paper and an inkstand, and taking a chair he sat down and wrote to his
commanding officer speaking of his bravery, and asking for a medal. A
thick metallic plate was then placed before his eyes so as to
completely intercept vision.  After a few minutes, during which he
wrote a few words with a jumbled stroke, he stopped, but without any
petulance. The plate was removed and he went on writing. Somnambulism
may assume such a serious phase as to result in the commission of
murder. There is a case of a man of twenty-seven, of steady habits, who
killed his child when in a state of somnambulism. He was put on trial
for murder, and some of the most remarkable facts of his somnambulistic
feats were elicited in the evidence. It is said that once when a boy he
arose at night while asleep, dressed himself; took a pitcher and went
for milk to a neighboring farm, as was his custom. At another time he
worked in a lumber-yard in a rain-storm while asleep. Again, when about
twenty-one, he was seen in a mill-pond wading about attempting to save
his sister who he imagined was drowning. The worst phase of his
somnambulism was the impending fears and terrible visions to which he
was subjected. Sometimes he would imagine that the house was on fire
and the walls about to fall upon him, or that a wild beast was
attacking his wife and child; and he would fight, screaming
inarticulately all the while. He would chase the imaginary beast about
the room, and in fact had grasped one of his companions, apparently
believing he was in a struggle with a wild beast. He had often injured
himself in these struggles, and had often attacked his father, his
wife, sister, fellow-lodgers, and while confined in jail he attacked
one of his fellow-prisoners. His eyes would always be wide open and
staring; he was always able to avoid pieces of furniture which were in
his way, and he occasionally threw them at his visionary enemies. At
the time of the murder of his child, in a somnambulistic attack, he
imagined that he saw a wild beast rise up from the floor and fly at his
child, a babe of eighteen months. He sprang at the beast and dashed it
to the ground, and when awakened, to his horror and overwhelming grief
he found that he had killed his beloved baby.  A similar record has
been reported of a student who attempted during the night to stab his
teacher; the man was disarmed and locked up in another portion of the
building; but he had not the slightest remembrance of the events of the
night.

Yellowlees speaks of homicide by a somnambulist. According to a
prominent New York paper, one of the most singular and at the same time
sad cases of somnambulism occurred a few years ago near Bakersville,
N.C. A young man there named Garland had been in the habit of walking
in his sleep since childhood. Like most other sleep-walkers when
unmolested, his ramblings had been without harm to himself or others.
Consequently his wife paid little attention to them. But finally he
began to stay away from the house longer than usual and always returned
soaking wet. His wife followed him one night. Leaving his home he
followed the highway until he came to a rough, narrow pig-trail leading
to the Tow River. His wife followed with difficulty, as he picked his
way through the tangled forest, over stones and fallen trees and along
the sides of precipitous cliffs. For more than a mile the sleeper
trudged on until he came to a large poplar tree, which had fallen with
its topmost branches far out in the river.  Walking on the log until he
came to a large limb extending over the water, he got down on his hands
and knees and began crawling out on it. The frightened wife screamed,
calling to him to wake up and come back. He was awakened by the cries,
fell into the river, and was drowned. Each night for weeks he had been
taking that perilous trip, crawling out on the limb, leaping from it
into the river, swimming to the shore, and returning home unconscious
of anything having happened.

Dreams, nightmare, and night terrors form too extensive a subject and
one too well known to be discussed at length here, but it might be well
to mention that sometimes dreams are said to be pathognomonic or
prodromal of approaching disease. Cerebral hemorrhage has often been
preceded by dreams of frightful calamities, and intermittent fever is
often announced by persistent and terrifying dreams. Hammond has
collected a large number of these prodromic dreams, seeming to indicate
that before the recognizable symptoms of disease present themselves a
variety of morbid dreams may occur. According to Dana, Albers says:
"Frightful dreams are signs of cerebral congestion. Dreams about fire
are, in women, signs of impending hemorrhage. Dreams about blood and
red objects are signs of inflammatory conditions.  Dreams of distorted
forms are frequently a sign of abdominal obstruction and diseases of
the liver."

Catalepsy, trance, and lethargy, lasting for days or weeks, are really
examples of spontaneously developed mesmeric sleep in hysteric patients
or subjects of incipient insanity. If the phenomenon in these cases
takes the form of catalepsy there is a waxy-like rigidity of the
muscles which will allow the limbs to be placed in various positions,
and maintain them so for minutes or even hours. In lethargy or
trance-states the patient may be plunged into a deep and prolonged
unconsciousness lasting from a few hours to several years. It is in
this condition that the lay journals find argument for their stories of
premature burial, and from the same source the fabulous "sleeping
girls" of the newspapers arise. Dana says that some persons are in the
habit of going into a mesmeric sleep spontaneously. In these states
there may be a lowering of bodily temperature, a retarding of the
respiration and heart-action, and excessive sluggishness of the action
of the bowels. The patients can hear and may respond to suggestions,
though apparently insensible to painful impressions, and do not appear
to smell, taste, or see; the eyes are closed, turned upward, and the
pupils contracted as in normal sleep.

This subject has been investigated by such authorities as Weir Mitchell
and Hammond, and medical literature is full of interesting cases, many
differing in the physiologic phenomena exhibited; some of the most
striking of these will be quoted. Van Kasthoven of Leyden reports a
strange case of a peasant of Wolkwig who, it is alleged, fell asleep on
June 29, 1706, awakening on January 11, 1707, only to fall asleep again
until March 15th of the same year. Tuke has resurrected the remarkable
case reported by Arnold of Leicester, early in this century. The
patient's name was John Engelbrecht. This man passed into a condition
of catalepsy in which he heard everything about him distinctly, but in
his imagination he seemed to have passed away to another world, this
condition coming on with a suddenness which he describes as with "far
more swiftness than any arrow can fly when discharged from a
cross-bow." He also lost his sensation from the head downward, and
recovered it in the opposite direction. At Bologna there was observed
the case of a young female who after a profound grief had for forty-two
successive days a state of catalepsy lasting from midday to midnight.
Muller of Lowenburg records a case of lethargy in a young female,
following a sudden fright in her fourteenth year, and abrupt
suppression of menstruation. This girl was really in a sleep for four
years. In the first year she was awake from one minute to six hours
during the day. In the second and third years she averaged four hours
wakefulness in ninety-six hours. She took very little nourishment and
sometimes had no bowel-movement for sixteen days. Scull reports the
history of a man of twenty-seven suffering with incipient phthisis, who
remained bedridden and in a state of unconsciousness for fifteen
months. One day while being fed he spoke out and asked for a glass of
water in his usual manner, and so frightened his sister that she ran
from the room. The man had remembered nothing that had occurred during
the fifteen months, and asked who was president and seemed eager for
news. One curious fact was that he remembered a field of oats which was
just sprouting about the time he fell in the trance.  The same field
was now standing in corn knee-high. After his recovery from the trance
he rapidly became worse and died in eighteen months. There is a record
of a man near Rochester, N.Y., who slept for five years, never waking
for more than sixteen hours at a time, and then only at intervals of
six weeks or over.  When seized with his trance he weighed 160, but he
dwindled down to 90 pounds. He passed urine once or twice a day, and
had a stool once in from six to twenty days. Even such severe treatment
as counter-irritation proved of no avail. Gunson mentions a man of
forty-four, a healthy farmer, who, after being very wet and not
changing his clothes, contracted a severe cold and entered into a long
and deep sleep lasting for twelve hours at a time, during which it was
impossible to waken him. This attack lasted eight or nine months, but
in 1848 there was a recurrence accompanied by a slight trismus which
lasted over eighteen months, and again in 1860 he was subjected to
periods of sleep lasting over twenty-four hours at a time. Blaudet
describes a young woman of eighteen who slept forty days, and again
after her marriage in her twentieth year she slept for fifty days; it
was necessary to draw a tooth to feed her. Four years later, on Easter
day, 1862, she became insensible for twelve months, with the exception
of the eighth day, when she awoke and ate at the table, but fell asleep
in the chair. Her sleep was so deep that nothing seemed to disturb her;
her pulse was slow, the respirations scarcely perceptible, and there
were apparently no evacuations.

Weir Mitchell collected 18 cases of protracted sleep, the longest
continuing uninterruptedly for six months. Chilton's case lasted
seventeen weeks. Six of the 18 cases passed a large part of each day in
sleep, one case twenty-one hours, and another twenty-three hours. The
patients were below middle life; ten were females, seven males, and one
was a child whose sex was not given. Eight of the 18 recovered easily
and completely, two recovered with loss of intellect, one fell a victim
to apoplexy four months after awakening, one recovered with insomnia as
a sequel, and four died in sleep. One recovered suddenly after six
months' sleep and began to talk, resuming the train of thought where it
had been interrupted by slumber. Mitchell reports a case in an
unmarried woman of forty-five. She was a seamstress of dark complexion
and never had any previous symptoms. On July 20, 1865, she became
seasick in a gale of wind on the Hudson, and this was followed by an
occasional loss of sight and by giddiness.  Finally, in November she
slept from Wednesday night to Monday at noon, and died a few days
later. Jones of New Orleans relates the case of a girl of twenty-seven
who had been asleep for the last eighteen years, only waking at certain
intervals, and then remaining awake from seven to ten minutes. The
sleep commenced at the age of nine, after repeated large doses of
quinin and morphin. Periods of consciousness were regular, waking at 6
A.M.  and every hour thereafter until noon, then at 3 P.M., again at
sunset, and at 9 P.M., and once or twice before morning. The sleep was
deep, and nothing seemed to arouse her. Gairdner mentions the case of a
woman who, for one hundred and sixty days, remained in a lethargic
stupor, being only a mindless automaton.  Her life was maintained by
means of the stomach tube. The Revue d'Hypnotisme contains the report
of a young woman of twenty-five, who was completing the fourth year of
an uninterrupted trance.  She began May 30, 1883, after a fright, and
on the same day, after several convulsive attacks, she fell into a
profound sleep, during which she was kept alive by small quantities of
liquid food, which she swallowed automatically. The excretions were
greatly diminished, and menstruation was suppressed. There is a case
reported of a Spanish soldier of twenty-two, confined in the Military
Hospital of San Ambrosio, Cuba, who had been in a cataleptic state for
fourteen months. His body would remain in any position in which it was
placed; defecation and micturition were normal; he occasionally sneezed
or coughed, and is reported to have uttered some words at night. The
strange feature of this case was that the man was regularly nourished
and increased in weight ten pounds. It was noted that, some months
before, this patient was injured and had suffered extreme depression,
which was attributed to nostalgia, after which he began to have
intermittent and temporary attacks, which culminated as related.
Camuset and Planes in January, 1896, mention a man who began to have
grand hallucinations in 1883. In March, 1884, he exhibited the first
signs of sleep, and on March 10th it was necessary to put him to bed,
where he remained, more or less continuously for three months,
awakening gradually, and regaining his normal condition by the middle
of June. He was fed by hand three times daily, was placed on a
night-chair, and with one exception never evacuated in bed. Five months
afterward he showed no signs of relapse. The latest report of a
"sleeping girl" is that of the young Dutch maiden, Maria Cvetskens, of
Stevenswerth, who on December 5, 1895, had been asleep for two hundred
and twenty days. She had been visited by a number of men of good
professional standing who, although differing as to the cause of her
prolonged sleep, universally agreed that there was no deception in the
case. Her parents were of excellent repute, and it had never occurred
to them to make any financial profit out of the unnatural state of
their daughter.

Hypnotism.--The phenomenon of hypnotism was doubtless known to the
Oriental nations, and even to the Greeks, Romans, and Egyptians, as
well as to other nations since the downfall of the Roman Empire. "The
fakirs of India, the musicians of Persia, the oracles of Greece, the
seers of Rome, the priests and priestesses of Egypt, the monastic
recluses of the Middle Ages, the ecstatics of the seventeenth and early
part of the eighteenth century exhibited many symptoms that were, and
are still, attributed by religious enthusiasts to supernatural
agencies, but which are explainable by what we know of hypnotism. The
Hesychasts of Mount Athos who remained motionless for days with their
gaze directed steadily to the navel; the Taskodrugites who remained
statuesque for a long period with the finger applied to the nose; the
Jogins who could hibernate at will; the Dandins of India who became
cataleptoid by 12,000 repetitions of the sacred word Om; St.  Simeon
Stylites who, perched on a lofty pillar, preserved an attitude of
saint-like withdrawal from earthly things for days; and even Socrates,
of whom it was said that he would stand for hours motionless and
wordless--all these are probable instances of autohypnotism." (Gray.)

Hypnotism is spoken of as a morbid mental state artificially produced,
and characterized by perversion or suspension of consciousness, and
abeyance of volition; a condition of suggestibility leads the patient
to yield readily to commands of external sense-impressions, and there
is intense concentration of the mental faculties upon some idea or
feeling. There are several methods of inducing hypnosis, one of which
is to give particular direction to the subject's imagination by
concentrating the attention upon an arbitrary point, or by raising an
image of the hypnotic state in the patient's mind. The latter is most
readily induced by speech. Faria formerly strained the attention of the
subject as much as possible, and suddenly called out, "Sleep!" This
method has been used by others. Physical methods consist of certain
stimuli of sight, hearing, and touch. Taste and smell have generally
given negative results. Fixation of the gaze has been the most
successful, but the ticking of a watch has been used. According to
Moll, among uncivilized races particular instruments are used to
produce similar states, for example, the magic drum's sound among the
Lapps, or among other races the monotony of rhythm in song, etc.
Instead of these continuous, monotonous, weak stimulations of the
senses, we find also that sudden and violent ones are made use of--for
example in the Salpetriere, the field of Charcot's work, the loud noise
of a gong, or a sudden ray of light; however, it is more than doubtful
whether these sudden, strong, physical stimuli, without any mental
stimuli, can induce hypnosis. Perhaps we have to do here with states
not far removed from paralysis from fright. The sense of touch is also
brought into play in hypnosis; Richet set great value on the so-called
mesmeric strokes or passes. It is often stated that touches on the
forehead induce a sleepy state in many persons. Hypnotism is practiced
by stimulation of the muscular sense, such as cradle-rocking, used to
send little children to sleep. Similar states are said to be produced
among uncivilized people by violent whirling or dancing movements; the
movements are, however, accompanied by music and other mental
excitations.

Hypnosis is spoken of by Huc and Hellwald of the Buddhist convents in
Thibet; and Sperling, who has had a particularly wide experience in the
field of hypnotism, and whose opinion is of particular value, says that
he has seen dervishes in Constantinople who, from the expression of
their eyes and their whole appearance, as well as from peculiar
postures they maintain for a long time, impressed him as being in a
hypnotic state. The state may have been induced by singing and uniform
whirling motions. Hildebrandt, Jacolliot, Fischer, Hellwald, and other
trustworthy witnesses and authors tell us strange things about the
fakirs of India, which set any attempt at explanation on the basis of
our present scientific knowledge at defiance--that is, if we decline to
accept them as mere juggler's tricks. Hypnotism seems to be the only
explanation. It is a well known fact that both wild and domestic beasts
can be hypnotized and the success of some of the animal-tamers is due
to this fact. In hypnotism we see a probable explanation for the
faith-cures which have extended over many centuries, and have their
analogy in the supposed therapeutic powers of the Saints.

The medicolegal aspect of hypnotism may be called in to answer whether
crime may be committed at suggestion. Such examples have already been
before the public in the recent trial of the Parisian strangler,
Eyraud. It was claimed that his accomplice in the crime, Gabrielle
Bompard, had been hypnotized. Bernheim narrates a case of outrage
effected in the hypnotic condition, which was brought to light by a
trial in the South of France.

As to the therapeutic value of hypnotism, with the exception of some
minor benefits in hysteric cases and in insomnia, the authors must
confess that its use in Medicine seems very limited.

African sleep-sickness is a peculiar disorder, apparently infectious in
character, which occurs among the negroes of the western coast of
Africa. It has been transported to other regions but is endemic in
Africa. According to Dana it begins gradually with malaise and
headache. Soon there is drowsiness after meals which increases until
the patient is nearly all the time in a stupor. When awake he is dull
and apathetic. There is no fever; the temperature may be subnormal. The
pulse, too, is not rapid, the skin is dry, the tongue moist but coated,
the bowels regular.  The eyes become congested and prominent. The
cervical glands enlarge. The disease ends in coma and death. Recovery
rarely occurs. Sometimes the disease is more violent, and toward the
end there are epileptic convulsions and muscular tremors. Autopsies
have revealed no pathologic changes.

Recently Forbes contributes an interesting paper on the sleeping
sickness of Africa. The disease may occur in either sex and at any age,
though it is most frequent from the twelfth to the twentieth years, and
in the male sex. It begins with enlargement of the cervical glands, and
drowsiness and sleep at unusual hours. At first the patient may be
aroused, but later sinks into a heavy stupor or coma. Death occurs in
from three to twelve months, and is due to starvation. Forbes reports
11 fatal cases, and two that passed from observation. At the autopsy
are found hyperemia of the arachnoid, and slight chronic
leptomeningitis and pachymeningitis. There is also anemia of the
brain-substance.  In one of his cases the spleen was enlarged. He was
inclined to regard the disease as a neurosis.

Aphasia is a disease of the faculty of language, that is, a disturbance
of the processes by which we see, hear, and at the same time appreciate
the meaning of symbols. It includes also the faculty of expressing our
ideas to others by means of the voice, gesture, writing, etc. The
trouble may be central or in the conducting media. The varieties of
aphasia are:--

(1) Amnesia of speech.

(2) Amnesia of speech and written language.

(3) Amnesia of speech, written language, and gesture.

In most cases there is no paralysis of the tongue or speech-forming
organs. As a rule the intellect is unaffected, the patient has the
ideas, but lacks the power to give them proper expression through
words, written language, or gesture. If the patient is enable to write,
the condition is known as agraphia.  Word-blindness, word-deafness,
etc., are terms of different forms of aphasia.

What was probably a case of incomplete aphasia is mentioned by Pliny,
that of Messala Corvinus who was unable to tell his own name; and many
instances of persons forgetting their names are really nothing but
cases of temporary or incomplete aphasia. In some cases of incomplete
and in nearly all cases of complete aphasia, involuntary sentences are
ejaculated. According to Seguin a reverend old gentleman affected with
amnesia of words was forced to utter after the sentence, "Our Father
who art in heaven," the words "let Him stay there." A lady seen by
Trousseau would rise on the coming of a visitor to receive him with a
pleased and amiable expression of countenance, and show him to a chair,
at the same time addressing to him the words, "cochon, animal, fichue
bete," French words hardly allowable in drawing-room usage. She was
totally aphasic but not paralyzed.  Women often use semi-religious
expressions like "Oh dear," or "Oh Lord." Men of the lower classes
retain their favorite oaths remarkably. Sometimes the phrases
ejaculated are meaningless, as in Broca's celebrated case.

Aphasia may be the result of sudden strong emotions, in such cases
being usually temporary; it may be traumatic; it may be the result of
either primary or secondary malnutrition or degeneration.

There are some cases on record in which the sudden loss and the sudden
return of the voice are quite marvelous.

Habershon reports the case of a woman who on seeing one of her children
scalded fell unconscious and motionless, and remained without food for
three days. It was then found that she suffered from complete aphasia.
Five weeks after the incident she could articulate only in a very
limited vocabulary.

In the Philosophical Transactions Archdeacon Squire tells of the case
of Henry Axford, who lost the power of articulation for four years;
after a horrible dream following a debauch he immediately regained his
voice, and thereafter he was able to articulate without difficulty.

Ball records a curious case of what he calls hysteric aphonia.  The
patient was a young lady who for several months could neither sing nor
speak, but on hearing her sister sing a favorite song, she began to
sing herself; but, although she could sing, speech did not return for
several weeks. Ball remarks that during sleep such patients may cry out
loudly in the natural voice.

Wadham reports the case of a boy of eighteen who was admitted to his
ward suffering with hemiplegia of the left side. Aphasia developed
several days after admission and continued complete for three months.
The boy gradually but imperfectly recovered his speech. Over six months
after the original admission he was readmitted with necrosis of the
jaw, for which he underwent operation, and was discharged a month
later. From this time on he became progressively emaciated until his
death, twelve months after Wadham first saw him. A postmortem
examination showed nearly total destruction of the Island of Reil,
popularly called the speech-center. Jackson mentions a hemiplegic
patient with aphasia who could only utter the words "come on to me,"
"come on," and "yes" and "no." Bristowe cites the history of a sailor
of thirty-six, a patient of St. Thomas Hospital, London, who suffered
from aphasia for nine months. His case was carefully explained to him
and he nodded assent to all the explanations of the process of speech
as though he understood all thoroughly. He was gradually educated to
speak again by practicing the various sounds. It may be worth while to
state that after restoration of speech he spoke with his original
American accent.

Ogle quotes six cases of loss of speech after bites of venomous snakes.
Two of the patients recovered. According to Russ this strange symptom
is sometimes instantaneous and in other instances it only appears after
an interval of several hours. In those who survive the effects of the
venom it lasts for an indefinite period. One man seen by Russ had not
only lost his speech in consequence of the bite of a fer-de-lance
snake, but had become, and still remained, hemiplegic. In the rest of
Russ's cases speech alone was abolished. Russ remarks that the
intelligence was altogether intact, and sensibility and power of motion
were unaffected. One woman who had been thus condemned to silence,
suddenly under the influence of a strong excitement recovered her
speech, but when the emotion passed away speech again left her.  Ogle
accounts for this peculiar manifestation of aphasia by supposing that
the poison produces spasm of the middle cerebral arteries, and when the
symptom remains a permanent defect the continuance of the aphasia is
probably due to thrombosis of arteries above the temporary constriction.

Anosmia, or loss of smell, is the most common disorder of olfaction; it
may be caused by cortical lesions, olfactory nerve-changes, congenital
absence, or over-stimulation of the nerves, or it may be a symptom of
hysteria.

Ogle, after mentioning several cases of traumatic anosmia, suggests
that a blow on the occiput is generally the cause. Legg reports a
confirmatory case, but of six cases mentioned by Notta two were caused
by a blow on the crown of the head, and two on the right ear. The
prognosis in traumatic anosmia is generally bad, although there is a
record of a man who fell while working on a wharf, striking his head
and producing anosmia with partial loss of hearing and sight, and who
for several weeks neither smelt nor tasted, but gradually recovered.

Mitchell reports a case of a woman of forty who, after an injury to her
nose from a fall, suffered persistent headache and loss of smell. Two
years later, at bedtime, or on going to sleep, she had a sense of
horrible odors, which were fecal or animal, and most intense in nature.
The case terminated in melancholia, with delirium of persecution,
during which the disturbance of smell passed away.

Anosmia has been noticed in leukoderma and allied disturbances of
pigmentation. Ogle mentions a negro boy in Kentucky whose sense of
smell decreased as the leukoderma extended. Influenza, causing
adhesions of the posterior pillars of the fauces, has given rise to
anosmia.

Occasionally overstimulation of the olfactory system may lead to
anosmia. Graves mentions a captain of the yeomanry corps who while
investigating the report that 500 pikes were concealed at the bottom of
a cesspool in one of the city markets superintended the emptying of the
cesspool, at the bottom of which the arms were found. He suffered
greatly from the abominable effluvia, and for thirty-six years
afterward he remained completely deprived of the sense of smell.

In a discussion upon anosmia before the Medico-Chirurgical Association
of London, January 25, 1870, there was an anosmic patient mentioned who
was very fond of the bouquet of moselle, and Carter mentioned that he
knew a man who had lost both the senses of taste and smell, but who
claimed that he enjoyed putrescent meat. Leared spoke of a case in an
epileptic affected with loss of taste and smell, and whose paroxysms
were always preceded by an odor of peach-blossoms.

Hyperosmia is an increase in the perception of smell, which rarely
occurs in persons other than the hysteric and insane. It may be
cultivated as a compensatory process, as in the blind, or those engaged
in particular pursuits, such as tea-tasting.  Parosmia is a rare
condition, most often a symptom of hysteria or neurasthenia, in which
everything smells of a similar, peculiar, offensive odor.
Hallucinations of odor are sometimes noticed in the insane. They form
most obstinate cases, when the hallucination gives rise to imaginary
disagreeable, personal odors.

Perversion of the tactile sense, or wrong reference to the sensation of
pain, has occasionally been noticed. The Ephemerides records a case in
which there was the sense of two objects from a single touch on the
hypochondrium. Weir Mitchell remarks that soldiers often misplace the
location of pain after injuries in battle. He also mentions several
cases of wrong reference of the sensation of pain. These instances
cannot be called reflex disturbances, and are most interesting. In one
case the patient felt the pain from a urethral injection in gonorrhea,
on the top of the head. In another an individual let an omnibus-window
fall on his finger, causing but brief pain in the finger, but violent
pains in the face and neck of that side. Mitchell also mentions a
naturalist of distinction who had a small mole on one leg which, if
roughly rubbed or pinched, invariably seemed to cause a sharp pain in
the chin.

Nostalgia is the name generally given to that variety of melancholia in
which there is an intense longing for home or country. This subject has
apparently been overlooked in recent years, but in the olden times it
was extensively discussed.  Swinger, Harderus, Tackius, Guerbois,
Hueber, Therrin, Castellanau, Pauquet, and others have written
extensively upon this theme. It is said that the inhabitants of cold
countries, such as the Laplanders and the Danes, are the most
susceptible to this malady. For a long time many writers spoke of the
frequency and intensity of nostalgia among the Swiss. Numerous cases of
suicide from this affliction have been noticed among these hardy
mountaineers, particularly on hearing the mountain-song of their homes,
"Ranz des vaches." This statement, which is an established fact, is
possibly due to the social constitution of the Swiss mountaineers, who
are brought up to a solitary home life, and who universally exhibit
great attachment to and dependence upon their parents and immediate
family. In the European armies nostalgia has always been a factor in
mortality. In the Army of the Moselle, and in Napoleon's Alpine Army,
the terrible ravages of suicide among the young Bretons affected with
nostalgia have been recorded; it is among the French people that most
of the investigation on this subject has been done. Moreau speaks of a
young soldier in a foreign country and army who fell into a most
profound melancholy when, by accident, he heard his native tongue.
According to Swinger and Sauvages women are less subject to nostalgia
than men. Nostalgia has been frequently recorded in hospital wards.
Percy and Laurent have discussed this subject very thoroughly, and cite
several interesting cases among emigrants, soldiers, marines, etc.
Hamilton speaks of a recruit who became prostrated by longing for his
home in Wales. He continually raved, but recovered from his delirium
when assured by the hospital authorities of his forthcoming furlough.
Taylor records two cases of fatal nostalgia. One of the victims was a
Union refugee who went to Kentucky from his home in Tennessee. He died
talking about and pining for his home. The second patient was a member
of a regiment of colored infantry; he died after repeatedly pining for
his old home.

Animals are sometimes subject to nostalgia, and instances are on record
in which purchasers have been compelled to return them to the old home
on account of their literal home-sickness. Oswald tells of a bear who,
in the presence of food, committed suicide by starvation.

Hypochondria consists of a mild form of insanity in which there is a
tendency to exaggerate the various sensations of the body and their
importance, their exaggeration being at times so great as to amount to
actual delusion. All sorts of symptoms are dwelt upon, and the doctor
is pestered to the extreme by the morbid fears of the patient.

Morbid fears or impulses, called by the Germans Zwangsvorstellungen, or
Zwangshandlungen, and by the French, peurs maladies, have only been
quite recently studied, and form most interesting cases of minor
insanity. Gelineau has made extensive investigations in this subject,
and free reference has been made to his work in the preparation of the
following material.

Aichmophobia is a name given by the French to the fear of the sight of
any sharp-pointed instrument, such as a pin, needle, fish-spine, or
naked sword. An illustrious sufferer of this 'phobia was James I of
England, who could never tolerate the appearance of a drawn sword.
Gelineau reports an interesting case of a female who contracted this
malady after the fatigue of lactation of two children. She could not
tolerate knives, forks, or any pointed instruments on the table, and
was apparently rendered helpless in needle-work on account of her
inability to look at the pointed needle.

Agoraphobia is dread of an open space, and is sometimes called
Kenophobia. The celebrated philosopher Pascal was supposed to have been
affected with this fear. In agoraphobia the patient dreads to go across
a street or into a field, is seized with an intense feeling of fright,
and has to run to a wall or fall down, being quite unable to proceed.
There is violent palpitation, and a feeling of constriction is
experienced. According to Suckling, pallor and profuse perspiration are
usually present, but there is no vertigo, confusion of mind, or loss of
consciousness. The patient is quite conscious of the foolishness of the
fears, but is unable to overcome them. The will is in abeyance and is
quite subservient to the violent emotional disturbances. Gray mentions
a patient who could not go over the Brooklyn Bridge or indeed over any
bridge without terror. Roussel speaks of a married woman who had never
had any children, and who was apparently healthy, but who for the past
six months had not been able to put her head out of the window or go
upon a balcony. When she descended into the street she was unable to
traverse the open spaces. Chazarin mentions a case in a woman of fifty,
without any other apparent symptom of diathesis. Gelineau quotes a case
of agoraphobia, secondary to rheumatism, in a woman of thirty-nine.
There is a corresponding fear of high places often noticed, called
acrophobia; so that many people dare not trust themselves on high
buildings or other eminences.

Thalassophobia is the fear of the view of immense spaces or
uninterrupted expanses. The Emperor Heraclius, at the age of
fifty-nine, had an insurmountable fear of the view of the sea; and it
is said that when he crossed the Bosphorus a bridge of boats was
formed, garnished on both sides with plants and trees, obscuring all
view of the water over which the Emperor peacefully traversed on
horseback. The moralist Nicole, was equally a thalassophobe, and always
had to close his eyes at the sight of a large sheet of water, when he
was seized with trembling in all his limbs. Occasionally some accident
in youth has led to an aversion to traversing large sheets of water,
and there have been instances in which persons who have fallen into the
water in childhood have all their lives had a terror of crossing
bridges.

Claustrophobia is the antithesis of agoraphobia. Raggi describes a case
of such a mental condition in a patient who could not endure being
within an enclosure or small space. Suckling mentions a patient of
fifty-six who suffered from palpitation when shut in a railway carriage
or in a small room. She could only travel by rail or go into a small
room so long as the doors were not locked, and on the railroad she had
to bribe the guard to leave the doors unlocked. The attacks were purely
mental, for the woman could be deceived into believing that the door to
a railroad carriage was unlocked, and then the attack would immediately
subside. Suckling also mentions a young woman brought to him at Queen's
Hospital who had a great fear of death on getting into a tram car, and
was seized with palpitation and trembling on merely seeing the car.
This patient had been in an asylum. The case was possibly due more to
fear of an accident than to true claustrophobia. Gorodoichze mentions a
case of claustrophobia in a woman of thirty-eight, in whose family
there was a history of hereditary insanity. Ball speaks of a case in a
woman who was overcome with terror half way in the ascension of the
Tour Saint-Jacques, when she believed the door below was closed.
Gelineau quotes the case of a brave young soldier who was believed to
be afraid of nothing, but who was unable to sleep in a room of which
the door was closed.

Astrophobia or astropaphobia is a morbid fear of being struck by
lightning. It was first recognized by Bruck of Westphalia, who knew a
priest who was always in terror when on a country road with an
unobstructed view of the sky, but who was reassured when he was under
the shelter of trees. He was advised by an old physician always to use
an umbrella to obstruct his view of the heavens, and in this way his
journeys were made tranquil. Beard knew an old woman who had suffered
all her life from astrophobia.  Her grandmother had presented the same
susceptibility and the same fears. Sometimes she could tell the
approach of a storm by her nervous symptoms. Caligula, Augustus, Henry
III, and other celebrated personages, were overcome with fear during a
storm.

Mysophobia is a mild form of insanity characterized by a dread of the
contact of dirt. It was named by Hammond, whose patient washed her
hands innumerable times a day, so great was the fear of contamination.
These patients make the closest inspection of their toilet, their
eating and drinking utensils, and all their lives are intensely worried
by fear of dirt.

Hematophobia is a horror of blood, which seems to be an instinctive
sentiment in civilized man, but which is unknown among savages. When
the horror is aggravated to such an extent as to cause distressing
symptoms or unconsciousness, it takes the name of hematophobia. There
are many cases on record and nearly every physician has seen one or
more, possibly among his colleagues.

Necrophobia and thanatophobia are allied maladies, one being the fear
of dead bodies and the other the fear of death itself.

Anthropophobia is a symptom of mental disease consisting in fear of
society. Beard, Mitchell, Baillarger, and others have made observations
on this disease. The antithesis of this disease is called monophobia.
Patients are not able to remain by themselves for even the shortest
length of time. This morbid dread of being alone is sometimes so great
that even the presence of an infant is an alleviation. Gelineau cites
an instance in a man of forty-five which was complicated with
agoraphobia.

Bacillophobia is the result of abnormal pondering over bacteriology.
Huchard's case was in a woman of thirty-eight who, out of curiosity,
had secretly read the works of Pasteur, and who seemed to take
particular pleasure in conning over the causes of death in the
health-reports. Goyard mentions an instance in a Swiss veterinary
surgeon.

Kleptophobia, examples of which have been cited by Cullere, is the fear
of stealing objects in view, and is often the prelude of kleptomania.
The latter disease has gained notoriety in this country, and nearly
every large store has agents to watch the apparently growing number of
kleptomaniacs. These unfortunate persons, not seldom from the highest
classes of society, are unable to combat an intense desire to purloin
articles. Legal proceedings have been instituted against many, and
specialists have been called into court to speak on this question.
Relatives and friends have been known to notify the large stores of the
thieving propensities of such patients.

Le Grande du Saulle has given to the disease in which there is a morbid
doubt about everything done, the name folie de doute. Gray mentions a
case in a patient who would go out of a door, close it, and then come
back, uncertain as to whether he had closed it, close it again, go off
a little way, again feel uncertain as to whether he had closed it
properly, go back again, and so on for many times. Hammond relates the
history of a case in an intelligent man who in undressing for bed would
spend an hour or two determining whether he should first take off his
coat or his shoes. In the morning he would sit for an hour with his
stockings in his hands, unable to determine which he should put on
first.

Syphilophobia is morbid fear of syphilis. Lyssophobia is a fear of
hydrophobia which sometimes assumes all the symptoms of the major
disease, and even produces death. Gelineau, Colin, Berillon, and others
have studied cases. In Berillon's case the patient was an artist, a
woman of brunet complexion, who for six years had been tormented with
the fear of becoming mad, and in whom the symptoms became so intense as
to constitute pseudobydrophobia. At their subsidence she was the victim
of numerous hallucinations which almost drove her to the point of
suicide.

Spermatophobia has been noticed among the ignorant, caused or increased
by inspection of sensational literature, treatises on the subject of
spermatorrhea, etc. Ferre mentions a woman of thirty-six, of intense
religious scruples, who was married at eighteen, and lost her husband
six years afterward. She had a proposition of marriage which she
refused, and was prostrated by the humid touch of the proposer who had
kissed her hand, imagining that the humidity was due to semen. She was
several times overcome by contact with men in public conveyances, her
fear of contamination being so great. Zoophobia, or dread of certain
animals, has been mentioned under another chapter under the head of
idiosyncrasies. Pantophobia is a general state of fear of everything
and everybody. Phobophobia, the fear of being afraid, is another
coinage of the wordmakers. The minor 'phobias, such as pyrophobia, or
fear of fire; stasophobia, or inability to arise and walk, the victims
spending all their time in bed; toxicophobia or fear of poison, etc.,
will be left to the reader's inspection in special works on this
subject.

Demonomania is a form of madness in which a person imagines himself
possessed of the devil. Ancient records of this disease are frequent,
and in this century Lapointe reports the history of demonomania in
father, mother, three sons, and two daughters, the whole family, with
the exception of one son, who was a soldier, being attacked. They
imagined themselves poisoned by a sorceress, saw devils, and had all
sorts of hallucinations, which necessitated the confinement of the
whole family in an asylum for over a month. They continued free from
the hallucinations for two years, when first the mother, and then
gradually all the other members of the family, again became afflicted
with demonomania and were again sent to the asylum, when, after a
residence therein of five months, they were all sufficiently cured to
return home.

Particular aversions may be temporary only, that is, due to an existing
condition of the organism, which, though morbid, is of a transitory
character. Such, for instance, are those due to dentition, the
commencement or cessation of the menstrual function, pregnancy, etc.
These cases are frequently of a serious character, and may lead to
derangement of the mind. Millington relates the history of a lady who,
at the beginning of her first pregnancy, acquired an overpowering
aversion to a half-breed Indian woman who was employed in the house as
a servant. Whenever this woman came near her she was at once seized
with violent trembling; this ended in a few minutes with vomiting and
great mental and physical prostration lasting several hours. Her
husband would have sent the woman away, but Mrs. X insisted on her
remaining, as she was a good servant, in order that she might overcome
what she regarded as an unreasonable prejudice. The effort was,
however, too great, for upon one occasion when the woman entered Mrs.
X's apartment rather unexpectedly, the latter became greatly excited,
and, jumping from an open window in her fright, broke her arm, and
otherwise injured herself so severely that she was confined to her bed
for several weeks. During this period, and for some time afterward, she
was almost constantly subject to hallucinations, in which the Indian
woman played a prominent part. Even after her recovery the mere thought
of the woman would sometimes bring on a paroxysm of trembling, and it
was not till after her confinement that the antipathy disappeared.

Circular or periodic insanity is a rare psychosis. According to Drewry
reports of very few cases have appeared in the medical journals. "Some
systematic writers," says Drewry, "regard it as a mere subdivision of
periodic insanity (Spitzka). A distinguished alienist and author of
Scotland however has given us an admirable lecture on the subject. He
says: 'I have had under my care altogether about 40 cases of typical
folie circulaire.' In the asylum at Morningside there were, says Dr.
Clouston, in 800 patients 16 cases of this peculiar form of mental
disease. Dr. Spitzka, who was the first American to describe it, found
in 2300 cases of pauper insane four per cent to be periodic, and its
sub-group, circular, insanity. Dr. Stearns states that less than
one-fourth of one per cent of cases in the Hartford (Conn.) Retreat
classed as mania and melancholia have proved to be folie circulaire.
Upon examination of the annual reports of the superintendents of
hospitals for the insane in this country, in only a few are references
made to this as a distinct form of insanity. In the New York State
hospitals there is a regular uniform classification of mental diseases
in which 'circular (alternating) insanity' occupies a place. In the
report of the Buffalo Hospital for 1892, in statistical table No. 4,
'showing forms of insanity in those admitted, etc., since 1888,' out of
1428 cases, only one was 'alternating (circular) insanity.' In the St.
Lawrence Hospital only one case in 992 was credited to this special
class. In the institution in Philadelphia, of which Dr. Chapin is the
superintendent, 10,379 patients have been treated, only three of whom
were diagnosed cases of manie circulaire. Of the 900 cases of insanity
in the State Hospital at Danville, Pa., less than four per cent were
put in this special class. There are in the Central (Va.) State
Hospital (which is exclusively for the colored insane) 775 patients,
three of whom are genuine cases of circular insanity, but they are
included in 'periodic insanity.' This same custom evidently prevails in
many of the other hospitals for the insane."

Drewry reports three cases of circular insanity, one of which was as
follows:--

"William F., a negro, thirty-six years old, of fair education, steady,
sober habits, was seized with gloomy depression a few weeks prior to
his admission to this hospital, in September, 1886. This condition came
on after a period of fever. He was a stranger in the vicinity and
scarcely any information could be obtained regarding his antecedents.
When admitted he was in a state of melancholic hypochondriasis; he was
the very picture of abject misery. Many imaginary ills troubled his
peace of mind. He spoke of committing suicide, but evidently for the
purpose of attracting attention and sympathy. On one occasion he said
he intended to kill himself, but when the means to do so were placed at
his command, he said he would do the deed at another time. The most
trivial physical disturbances were exaggerated into very serious
diseases. From this state of morbid depression he slowly emerged, grew
brighter, more energetic, neater in personal appearance, etc. During
this period of slow transition or partial sanity he was taken out on
the farm where he proved to be a careful and industrious laborer. He
escaped, and when brought back to the hospital a few weeks subsequently
he was in a condition of great excitement and hilarity. His expression
was animated, and he was, as it were, overflowing with superabundance
of spirit, very loquacious, and incessantly moving. He bore an air of
great importance and self-satisfaction; said he felt perfectly well and
happy, but abused the officers for keeping him 'confined unjustly in a
lunatic asylum.' It was his habit almost daily, if not interfered with,
to deliver a long harangue to his fellow-patients, during which he
would become very excited and noisy. He showed evidences of having a
remarkable memory, particularly regarding names and dates. (Unusual
memory is frequently observed in this type of insanity, says Stearns.)
He was sometimes disposed to be somewhat destructive to furniture,
etc., was neat in person, but would frequently dress rather
'gorgeously,' wearing feathers and the like in his hat, etc. He was not
often noisy and sleepless at night, and then only for a short time. His
physical health was good. This 'mental intoxication,' as it were,
lasted nearly a year. After this long exacerbation of excitement there
was a short remission and then depression again set in, which lasted
about fifteen months. At this time this patient is in the depressed
stage or period of the third circle. So, thus the cycles have
continuously repeated their weary rounds, and in all probability they
will keep this up 'until the final capitation in the battle of life has
taken place.'"

Katatonia, according to Gray, is a cerebral disease of cyclic symptoms,
ranging in succession from primary melancholia to mania, confusion, and
dementia, one or more of these stages being occasionally absent, while
convulsive and epileptoid symptoms accompany the mental changes.

It is manifestly impossible to enter into the manifold forms and
instances of insanity in this volume, but there is one case, seldom
quoted, which may be of interest. It appeared under the title, "A
Modern Pygmalion." It recorded a history of a man named Justin, who
died in the Bicetre Insane Asylum. He had been an exhibitor of wax
works at Montrouge, and became deeply impressed with the beautiful
proportions of the statue of a girl in his collection, and ultimately
became intensely enamored with her. He would spend hours in
contemplation of the inanimate object of his affections, and finally
had the illusion that the figure, by movements of features, actually
responded to his devotions.  Nemesis as usual at last arrived, and the
wife of Justin, irritated by his long neglect, in a fit of jealousy
destroyed the wax figure, and this resulted in a murderous attack on
his wife by Justin who resented the demolition of his love. He was
finally secured and lodged in Bicetre, where he lived for five years
under the influence of his lost love.

An interesting condition, which has been studied more in France than
elsewhere, is double consciousness, dual personality, or, as it is
called by the Germans, Doppelwahrnehmungen. In these peculiar cases an
individual at different times seems to lead absolutely different
existences. The idea from a moralist's view is inculcated in
Stevenson's "Dr. Jekyl and Mr. Hyde." In an article on this subject
Weir Mitchell illustrated his paper by examples, two of which will be
quoted. The first was the case of Mary Reynolds who, when eighteen
years of age, became subject to hysteric attacks, and on one occasion
she continued blind and deaf for a period of five or six weeks. Her
hearing returned suddenly, and her sight gradually. About three months
afterward she was discovered in a profound sleep. Her memory had fled,
and she was apparently a new-born individual. When she awoke it became
apparent that she had totally forgotten her previous existence, her
parents, her country, and the house where she lived. She might be
compared to an immature child. It was necessary to recommence her
education. She was taught to write, and wrote from right to left, as in
the Semitic languages. She had only five or six words at her
command--mere reflexes of articulation which were to her devoid of
meaning. The labor of re-education, conducted methodically, lasted from
seven to eight weeks. Her character had experienced as great a change
as her memory; timid to excess in the first state, she became gay,
unreserved, boisterous, daring, even to rashness. She strolled through
the woods and the mountains, attracted by the dangers of the wild
country in which she lived. Then she had a fresh attack of sleep, and
returned to her first condition; she recalled all the memories and
again assumed a melancholy character, which seemed to be aggravated. No
conscious memory of the second state existed. A new attack brought back
the second state, with the phenomenon of consciousness which
accompanied it the first time.  The patient passed successively a great
many times from one of these states to the other. These repeated
changes stretched over a period of sixteen years. At the end of that
time the variations ceased. The patient was then thirty-six years of
age; she lived in a mixed state, but more closely resembling the second
than the first; her character was neither sad nor boisterous, but more
reasonable. She died at the age of sixty-five years.

The second case was that of an itinerant Methodist minister named
Bourne, living in Rhode Island, who one day left his home and found
himself, or rather his second self, in Norristown, Pennsylvania. Having
a little money, he bought a small stock in trade, and instead of being
a minister of the gospel under the Methodist persuasion, he kept a
candy shop under the name of A.  J. Brown, paid his rent regularly, and
acted like other people.  At last, in the middle of the night, he awoke
to his former consciousness, and finding himself in a strange place,
supposed he had made a mistake and might be taken for a burglar. He was
found in a state of great alarm by his neighbors, to whom he stated
that he was a minister, and that his home was in Rhode Island. His
friends were sent for and recognized him, and he returned to his home
after an absence of two years of absolutely foreign existence. A most
careful investigation of the case was made on behalf of the London
Society for Psychical Research.

An exhaustive paper on this subject, written by Richard Hodgson in the
proceedings of the Society for Psychical Research, states that Mr.
Bourne had in early life shown a tendency to abnormal psychic
conditions; but he had never before engaged in trade, and nothing could
be remembered which would explain why he had assumed the name A. J.
Brown, under which he did business. He had, however, been hypnotized
when young and made to assume various characters on the stage, and it
is possible that the name A. J. Brown was then suggested to him, the
name resting in his memory, to be revived and resumed when he again
went into a hypnotic trance.

Alfred Binet describes a case somewhat similar to that of Mary
Reynolds: "Felida, a seamstress, from 1858 up to the present time (she
is still living) has been under the care of a physician named Azam in
Bordeaux. Her normal, or at least her usual, disposition when he first
met her was one of melancholy and disinclination to talk, conjoined
with eagerness for work.  Nevertheless her actions and her answers to
all questions were found to be perfectly rational. Almost every day she
passed into a second state. Suddenly and without the slightest
premonition save a violent pain in the temples she would fall into a
profound slumber-like languor, from which she would awake in a few
moments a totally different being. She was now as gay and cheery as she
had formerly been morose. Her imagination was over-excited.  Instead of
being indifferent to everything, she had become alive to excess. In
this state she remembered everything that had happened in the other
similar states that had preceded it, and also during her normal life.
But when at the end of an hour or two the languor reappeared, and she
returned to her normal melancholy state, she could not recall anything
that had happened in her second, or joyous, stage. One day, just after
passing into the second stage, she attended the funeral of an
acquaintance.  Returning in a cab she felt the period coming on which
she calls her crisis (normal state). She dozed several seconds, without
attracting the attention of the ladies who were in the cab, and awoke
in the other state, absolutely at a loss to know why she was in a
mourning carriage with people who, according to custom, were praising
the qualities of a deceased person whose name she did not even know.
Accustomed to such positions, she waited; by adroit questions she
managed to understand the situation, and no one suspected what had
happened. Once when in her abnormal condition she discovered that her
husband had a mistress, and was so overcome that she sought to commit
suicide. Yet in her normal mind she meets the woman with perfect
equilibrium and forgetfulness of any cause for quarrel. It is only in
her abnormal state that the jealousy recurs. As the years went on the
second state became her usual condition. That which was at first
accidental and abnormal now constitutes the regular center of her
psychic life. It is rather satisfactory to chronicle that as between
the two egos which alternately possess her, the more cheerful has
finally reached the ascendant."

Jackson reports the history of the case of a young dry-goods clerk who
was seized with convulsions of a violent nature during which he became
unconscious. In the course of twenty-four hours his convulsions abated,
and about the third day he imagined himself in New York paying court to
a lady, and having a rival for her favors; an imaginary quarrel and
duel ensued. For a half-hour on each of three days he would start
exactly where he had left off on the previous day. His eyes were open
and to all appearances he was awake during this peculiar delirium. When
asked what he had been doing he would assert that he had been asleep.
His language assumed a refinement above his ordinary discourse. In
proportion as his nervous system became composed, and his strength
improved, this unnatural manifestation of consciousness disappeared,
and he ultimately regained his health.

A further example of this psychologic phenomenon was furnished quite
meetly at a meeting of the Clinical Society of London, where a well
known physician exhibited a girl of twelve, belonging to a family of
good standing, who displayed in the most complete and indubitable form
this condition of dual existence. A description of the case is as
follows:--

"Last year, after a severe illness which was diagnosed to be
meningitis, she became subject to temporary attacks of unconsciousness,
on awakening from which she appeared in an entirely different
character. In her normal condition she could read and write and speak
fluently, and with comparative correctness. In the altered mental
condition following the attack she loses all memory for ordinary
events, though she can recall things that have taken place during
previous attacks. So complete is this alteration of memory, that at
first she was unable to remember her own name or to identify herself or
her parents. By patient training in the abnormal condition she has been
enabled to give things their names, though she still preserves a
baby-fashion of pronouncing. She sometimes remains in the abnormal
condition for days together and the change to her real self takes place
suddenly, without exciting surprise or dismay, and she forthwith
resumes possession of her memory for events of her ordinary life.
During the last month or two she appears to have entered on a new
phase, for after a mental blank of a fortnight's duration she awakened
completely oblivious of all that had happened since June, 1895, and she
alludes to events that took place just anterior to that date as though
they were of recent occurrence; in fact she is living mentally in July,
1895.  These cases, though rare, are of course not infrequently met
with, and they have been carefully studied, especially in France, where
women appear more prone to neurotic manifestations. The hypothesis that
finds most favor is that the two halves of the brain do not work in
unison; in other words, that there has been some interference with the
connections which in the ordinary normal being make of a wonderful
composite organ like the brain one organic whole."

Proust tells a story of a Parisian barrister of thirty-three. His
father was a heavy drinker, his mother subject to nervous attacks, his
younger brother mentally deficient, and the patient himself was very
impressionable. It was said that a judge in a court, by fixing his gaze
on him, could send him into an abnormal state. On one occasion, while
looking into a mirror in a cafe, he suddenly fell into a sleep, and was
taken to the Charite where he was awakened. He suffered occasional loss
of memory for considerable lengths of time, and underwent a change of
personality during these times. Though wide awake in such conditions he
could remember nothing of his past life, and when returned to his
original state he could remember nothing that occurred during his
secondary state, having virtually two distinct memories. On September
23, 1888, he quarreled with his stepfather in Paris and became his
second self for three weeks.  He found himself in a village 100 miles
from Paris, remembering nothing about his journey thereto; but on
inquiry he found that he had paid a visit to the priest of the village
who thought his conduct odd, and he had previously stayed with an
uncle, a bishop, in whose house he had broken furniture, torn up
letters, and had even had sentence passed upon him by a police court
for misdemeanor. During these three weeks he had spent the equivalent
of $100, but he could not recall a single item of expenditure.  Davies
cites a remarkable case of sudden loss of memory in a man who, while on
his way to Australia, was found by the police in an exhausted condition
and who was confined in the Kent County Insane Asylum. He suffered
absolute loss of all memory with the exception of the names of two men
not close acquaintances, both of whom failed to recognize him in his
changed condition in confinement. Four months later his memory returned
and his identity was established.

In the Revue Philosophique for 1885 there are the details of a case of
a young man who seemed able to assume six states of what might be
fairly called different personalities. The memories attached to each of
these states were very different, though only one was completely
exclusive of the others. The handwriting varied from complete
competence to complete incompetence. His character varied between
childish timidity, courteous reserve, and reckless arrogance; and to
four of his conditions there was a form of hysteric paralysis attached.
Mere suggestion would not only induce any one of these varied forms of
paralysis, but also the memories, capacities, and characters habitually
accompanying it.

A young man named Spencer, an inmate of the Philadelphia Hospital, was
exhibited before the American Neurological Society in June, 1896, as an
example of dual personality. At the time of writing he is and has been
in apparently perfect health, with no evidence of having been in any
other condition. His faculties seem perfect, his education manifests
itself in his intelligent performance of the cleric duties assigned to
him at the hospital, yet the thread of continuous recollection which
connects the present moment with its predecessors--consciousness and
memory--has evidently been snapped at some point of time prior to March
3d and after January 19th, the last date at which he wrote to his
parents, and as if in a dream, he is now living another life. The
hospital staff generally believe that the man is not "shamming," as
many circumstances seem to preclude that theory.  His memory is perfect
as to everything back to March 3d. The theory of hypnotism was advanced
in explanation of this case.

The morbid sympathy of twin brothers, illustrated in Dumas's "Corsican
Brothers," has been discussed by Sedgwick, Elliotson, Trousseau,
Laycock, Cagentre, and others. Marshall Hall relates what would seem to
verify the Corsican myth, the history of twin brothers nine months of
age, who always became simultaneously affected with restlessness,
whooping and crowing in breathing three weeks previous to simultaneous
convulsions, etc. Rush describes a case of twin brothers dwelling in
entirely different places, who had the same impulse at the same time,
and who eventually committed suicide synchronously. Baunir describes a
similar development of suicidal tendency in twin brothers. A peculiar
case of this kind was that of the twin brothers Laustand who were
nurses in a hospital at Bordeaux; they invariably became ill at the
same time, and suffered cataract of the lens together.

Automatism has been noticed as a sequel to cranial injuries, and Huxley
quotes a remarkable case reported by Mesnet. The patient was a young
man whose parietal bone was partially destroyed by a ball. He exhibited
signs of hemiplegia on the right side, but these soon disappeared and
he became subject to periodic attacks lasting from twenty-four to
forty-eight hours, during which he was a mere automaton. In these
attacks he walked continually, incessantly moving his jaw, but not
uttering a word. He was insensible to pain, electric shock, or
pin-prick. If a pen was placed in his hand he would write a good
letter, speaking sensibly about current topics. When a cigarette-paper
was placed in his hand he sought his tobacco box, and adroitly rolled a
cigarette and lighted it. If the light went out he procured another,
but would not allow another to substitute a match. He allowed his
mustache to be burned without resistance, but would not allow a light
to be presented to him. If chopped charpie was put in his pocket
instead of tobacco he knew no difference. While in his periods of
automatism he was in the habit of stealing everything within his grasp.
He had been a concert singer, and a peculiar fact was that if given
white gloves he would carefully put them on and commence a pantomime of
the actions of a singer, looking over his music, bowing, assuming his
position, and then singing.

It is particularly in hypnotic subjects that manifestations of
automatism are most marked. At the suggestion of battle an imaginary
struggle at once begins, or if some person present is suggested as an
enemy the fight is continued, the hypnotic taking care not to strike
the person in question. Moll conceded that this looked like simulation,
but repetition of such experiments forced him to conclude that these
were real, typical hypnoses, in which, in spite of the sense-delusions,
there was a dim, dreamy consciousness existing, which influenced the
actions of the subject, and which prevented him from striking at a
human being, although hitting at an imaginary object. Many may regard
this behavior of hypnotics as pure automatism; and Moll adds that, as
when walking in the street while reading we automatically avoid
knocking passers-by, so the hypnotic avoids hitting another person,
although he is dimly or not at all aware of his existence.

Gibbs reports a curious case of lack of integrity of the will in a man
of fifty-five. When he had once started on a certain labor he seemed to
have no power to stop the muscular exercise that the task called forth.
If he went to the barn to throw down a forkful of hay, he would never
stop until the hay was exhausted or someone came to his rescue. If sent
to the wood-pile for a handful of wood, he would continue to bring in
wood until the pile was exhausted or the room was full. On all
occasions his automatic movements could only be stopped by force.

At a meeting in Breslau Meschede rendered an account of a man who
suffered from simple misdirection of movement without any mental
derangement. If from his own desire, or by direction of others, he
wanted to attempt any muscular movement, his muscles performed the
exact opposite to his inclinations. If he desired to look to the right,
his eyes involuntarily moved to the left. In this case the movement was
not involuntary, as the muscles were quiet except when called to action
by the will, and then they moved to the opposite.

Presentiment, or divination of approaching death, appearing to be a
hypothetic allegation, has been established as a strong factor in the
production of a fatal issue in many cases in which there was every hope
for a recovery. In fact several physicians have mentioned with dread
the peculiar obstinacy of such presentiment.  Hippocrates, Romanus,
Moller, Richter, Jordani, and other older writers speak of it.
Montgomery reports a remarkable case of a woman suffering from
carcinoma of the uterus. He saw her on October 6, 1847, when she told
him she had a strong presentiment of death on October 28th. She stated
that she had been born on that day, her first husband had died on
October 28th, and she had married her second husband on that day. On
October 27th her pulse began to fail, she fell into a state of extreme
prostration, and at noon on the 28th she died. In substantiation of the
possibility of the influence of presentiment Montgomery cites another
case in which he was called at an early hour to visit a lady, the
mother of several children. He found her apparently much agitated and
distressed, and in great nervous excitement over a dream she had had,
in which she saw a handsome monument erected by some children to their
mother. She had awakened and became dreadfully apprehensive, she could
not tell as to what.  The uneasiness and depression continued, her
pulse continued to grow weak, and she died at twelve that night without
a struggle.  Andrews has made several observations on this subject, and
concludes that presentiment of death is a dangerous symptom, and one
which should never be overlooked. One of his cases was in a man with a
fractured leg in the Mercy Hospital at Pittsburg. The patient was in
good health, but one day he became possessed of a cool, quiet, and
perfectly clear impression that he was about to die. Struck with his
conviction, Andrews examined his pulse and general condition minutely,
and assured the patient there was not the slightest ground for
apprehension. But he persisted, and was attacked by pneumonia three
days later which brought him to the verge of the grave, although he
ultimately recovered. In another instance a young man of ruddy
complexion and apparent good health, after an operation for varicocele,
had a very clear impression that he would die. Careful examination
showed no reason for apprehension. After five or six days of
encouragement and assurance, he appeared to be convinced that his
reasoning was foolish, and he gave up the idea of death. About the
ninth day the wound presented a healthy, rosy appearance, and as the
patient was cheerful he was allowed to leave his bed. After a few hours
the nurse heard the noise of labored breathing, and on investigation
found the patient apparently in a dying condition.  He was given
stimulants and regained consciousness, but again relapsed, and died in
a few moments. At the necropsy the heart was found healthy, but there
were two or three spots of extravasated blood in the brain, and
evidences of cerebral congestion. Vos remarks that he remembers a case
he had when dressing for Mr. Holden at St. Bartholomew's Hospital: "A
man who had been intemperate was rolling a sod of grass, and got some
grit into his left palm. It inflamed; he put on hot cow-dung poultices
by the advice of some country friends. He was admitted with a
dreadfully swollen hand. It was opened, but the phlegmonous process
spread up to the shoulder, and it was opened in many places, and at
last, under chloroform, the limb was amputated below the joint. The
stump sloughed, and pus pointing at the back of the neck, an opening
was again made. He became in such a weak state that chloroform could
not be administered, and one morning he had such a dread of more
incisions that, saying to us all standing round his bed, 'I can bear it
no more, I must now die,' he actually did die in a few minutes in our
presence. His was the last arm that Mr. Holden ever amputated at St.
Bartholomew's."



CHAPTER XVIII.

HISTORIC EPIDEMICS.

A short history of the principal epidemics, including as it does the
description of anomalous diseases, many of which are now extinct, and
the valuable knowledge which finally led to their extinction, the
extraordinary mortalities which these epidemics caused, and many other
associate points of interest would seem fitting to close the
observations gathered in this volume. As the illustrious Hecker says,
in the history of every epidemic, from the earliest times, the spirit
of inquiry was always aroused to learn the machinery of such stupendous
engines of destruction; and even in the earliest times there was
neither deficiency in courage nor in zeal for investigation. "When the
glandular plague first made its appearance as a universal epidemic,
whilst the more pusillanimous, haunted by visionary fears, shut
themselves up in their closets, some physicians at Constantinople,
astonished at the phenomena opened the boils of the deceased. The like
has occurred both in ancient and modern times, not without favorable
results for Science; nay, more mature views excited an eager desire to
become acquainted with similar or still greater visitations among the
ancients, but, as later ages have always been fond of referring to
Grecian antiquity, the learned of those times, from a partial and
meagre predilection, were contented with the descriptions of
Thucydides, even where nature had revealed, in infinite diversity, the
workings of her powers."

There cannot but be a natural interest in every medical mind to-day in
the few descriptions given of the awful ravages of the epidemics which,
fortunately, in our enlightened sanitary era, have entirely
disappeared. In the history of such epidemics the name of Hecker stands
out so prominently that any remarks on this subject must necessarily,
in some measure, find their origin in his writings, which include
exhaustive histories of the black death, the dancing mania, and the
sweating sickness. Few historians have considered worthy of more than a
passing note an event of such magnitude as the black death, which
destroyed millions of the human race in the fourteenth century and was
particularly dreadful in England. Hume has given but a single paragraph
to it and others have been equally brief. Defoe has given us a journal
of the plague, but it is not written in a true scientific spirit; and
Caius, in 1562, gave us a primitive treatise on the sweating sickness.
It is due to the translation of Hecker's "Epidemics of the Middle Ages"
by Babbington, made possible through the good offices of the Sydenham
Society, that a major part of the knowledge on this subject of the
English-reading populace has been derived.

The Black Death, or, as it has been known, the Oriental plague, the
bubonic plague, or in England, simply the plague, and in Italy, "la
Mortalega" (the great mortality) derived its name from the Orient; its
inflammatory boils, tumors of the glands, and black spots, indicative
of putrid decomposition, were such as have been seen in no other
febrile disease. All the symptoms were not found in every case, and in
many cases one symptom alone preceded death. Although afflicted with
all the manifestations of the plague, some patients recovered.
According to Hecker the symptoms of cephalic affliction were seen; many
patients were stupefied and fell into a deep sleep, or became
speechless from palsy of the tongue, while others remained sleepless
and without rest. The fauces and tongue were black and as if suffused
with blood; no beverage could assuage the burning thirst, so that
suffering continued without alleviation until death, which many in
their despair accelerated with their own hands. Contagion was evident,
for attendants caught the disease from their parents and friends, and
many houses were emptied of their inhabitants. In the fourteenth
century this affection caused still deeper sufferings, such as had not
been hitherto experienced. The organs of respiration became the seats
of a putrid inflammation, blood was expectorated, and the breath
possessed a pestiferous odor. In the West an ardent fever, accompanied
by an evacuation of blood, proved fatal in the first three days. It
appears that buboes and inflammatory boils did not at first appear, but
the disease in the form of carbuncular affection of the lungs (anthrax
artigen) caused the fatal issue before the other symptoms developed.
Later on in the history of the plague the inflammatory boils and buboes
in the groins and axillae were recognized at once as prognosticating a
fatal issue.

The history of this plague extends almost to prehistoric times.  There
was a pest in Athens in the fifth century before Christ.  There was
another in the second century, A.D., under the reign of Marcus
Aurelius, and again in the third century, under the reign of the Gauls;
following this was the terrible epidemic of the sixth century, which,
after having ravaged the territory of the Gauls, extended westward. In
542 a Greek historian, Procopius, born about the year 500, gives a good
description of this plague in a work, "Pestilentia Gravissima," so
called in the Latin translation. Dupouy in "Le Moyen Age Medical," says
that it commenced in the village of Peleuse, in Egypt, and followed a
double course, one branch going to Alexandria and the other to
Palestine. It reached Constantinople in the Spring of 543, and produced
the greatest devastation wherever it appeared. In the course of the
succeeding half century this epidemic became pandemic and spread over
all the inhabited earth. The epidemic lasted four months in
Constantinople, from 5000 to 10,000 people dying each day. In his
"History of France," from 417 to 591, Gregorius speaks of a malady
under the name inguinale which depopulated the Province of Arles. In
another passage this illustrious historian of Tours says that the town
of Narbonne was devastated by a maladie des aines. We have records of
epidemics in France from 567 to 590, in which bubonic symptoms were a
prominent feature. About the middle of the fourteenth century the
bubonic plague made another incursion from the East. In 1333, fifteen
years before the plague appeared in Europe, there were terrible
droughts in China followed by enormous floods in which thousands of
people perished. There are traditions of a plague in Tche in 1334,
following a drought, which is said to have carried off about 5,000,000
people. During the fifteen years before the appearance of the plague in
Europe there were peculiar atmospheric phenomena all over the world,
besides numerous earthquakes. From the description of the stinking
atmosphere of Europe itself at this time it is quite possible that part
of the disease came, not from China, but originated in Southern Europe
itself. From China the route of caravans ran to the north of the
Caspian Sea, through Asia, to Tauris. Here ships were ready to take the
produce of the East to Constantinople, the capital of commerce, and the
medium of communication between Europe, Asia, and Africa. Other
caravans went from Europe to Asia Minor and touched at the cities south
of the Caspian Sea, and lastly there were others from Bagdad through
Arabia to Egypt; the maritime communication on the Red Sea to Arabia
and Egypt was also not inconsiderable. In all these directions
contagion found its way, though doubtless Constantinople and the
harbors of Asia Minor were the chief foci of infection, whence it
radiated to the most distant seaports and islands. As early as 1347 the
Mediterranean shores were visited by the plague, and in January, 1348,
it appeared in the south of France, the north of Italy, and also in
Spain. Place after place was attacked throughout the year, and after
ravishing the whole of France and Germany, the plague appeared in
England, a period of three months elapsing before it reached London.
The northern kingdoms were attacked in 1349, but in Russia it did not
make its appearance before 1351.

As to the mortality of this fearful epidemic Dupony considers that in
the space of four years more than 75,000,000 fell victims, that is,
about half of the population of the countries visited. Hecker estimates
that from 1347 to 1351, 25,000,000 people died, or one-quarter of the
total population of Europe. It was reported to Pope Clement that
throughout the East, probably with the exception of China, nearly
24,000,000 people had fallen victims to the plague. Thirteen millions
are said to have died in China alone. Constantinople lost two-thirds of
its population.  When the plague was at its greatest violence Cairo
lost daily from 10,000 to 15,000, as many as modern plagues have
carried off during their whole course. India was depopulated. Tartary,
Mesopotamia, Syria, Armenia, and Arabia were covered with dead bodies.
In this latter country Arabian historians mention that Maara el nooman,
Schisur, and Harem in some unaccountable manner remained free. The
shores of the Mediterranean were ravaged and ships were seen on the
high seas without sailors. In "The Decameron" Boccaccio gives a most
graphic description of the plague and states that in Florence, in four
months, 100,000 perished; before the calamity it was hardly supposed to
contain so many inhabitants. According to Hecker, Venice lost 100,000;
London, 100,000; Paris, 50,000; Siena, 70,000; Avignon, 60,000;
Strasburg, 16,000; Norwich, 51,100. Dupony says that in one month there
were 56,000 victims in Marseilles, and at Montpellier three-quarters of
the population and all the physicians were stricken with the epidemic.

Johanna of Burgundy, wife of King Philip VI of Valois; Johanna II,
Queen of Navarre, granddaughter of Philippe le Bel; Alphonse XI of
Castile, and other notable persons perished. All the cities of England
suffered incredible losses. Germany seems to have been particularly
spared; according to a probable calculation, only about 1,250,000
dying. Italy was most severely visited, and was said to have lost most
of its inhabitants. In the north of Europe two of the brothers of
Magnus, King of Sweden, died; and in Westgothland alone 466 priests
died. The plague showed no decrease in the northern climates of Iceland
and Greenland, and caused great havoc in those countries.

The moral effect of such a great pandemic plague can be readily
surmised. The mental shock sustained by all nations during the
prevalence of the black plague is beyond parallel and description. An
awful sense of contrition and repentance seized Christians of every
community. They resolved to forsake their vices, and to make
restitution for past offenses; hence extreme religious fanaticism held
full sway throughout Europe. The zeal of the penitents stopped at
nothing. The so-called Brotherhood of the Cross, otherwise known as the
Order of Flagellants, which had arisen in the thirteenth century, but
was suppressed by the mandates and strenuous efforts of the Church, was
revived during the plague, and numbers of these advocates of
self-chastisement roamed through the various countries on their great
pilgrimages.  Their power increased to such an extent that the Church
was in considerable danger, for these religious enthusiasts gained more
credit among the people, and operated more strongly on their minds than
the priests from whom they so entirely withdrew that they even absolved
each other. Their strength grew with such rapidity, and their numbers
increased to such an extent daily, that the State and the Church were
forced to combine for their suppression. Degeneracy, however, soon
crept in, crimes were committed, and they went beyond their strength in
attempting the performance of miracles. One of the most fearful
consequences of this frenzy was the persecution of the Jews. This alien
race was given up to the merciless fury and cruelty of the populace.
The persecution of the Jews commenced in September and October, 1348,
at Chillon on Lake Geneva, where criminal proceedings were instituted
against them on the mythic charge of poisoning the public wells. These
persecuted people were summoned before sanguinary tribunals, beheaded
and burned in the most fearful manner. At Strasburg 2000 Jews were
burned alive in their own burial-ground, where a large scaffold had
been erected, their wealth being divided among the people. In Mayence
12,000 Jews were said to have been put to a cruel death. At Eslingen
the whole Jewish community burned themselves in their synagogue, and
mothers were often seen throwing their children on the pile, to prevent
them from being baptized, and then precipitating themselves into the
flames. The cruel and avaricious desires of the monarchs against these
thrifty and industrious people added fuel to the flames of the popular
passion, and even a fanatic zeal arose among the Jews to perish as
martyrs to their ancient religion. When we sum up the actual effects as
well as the after effects of the black death, we are appalled at the
magnitude of such a calamity, the like of which the world had never
seen before.

In the fifteenth and sixteenth centuries the plague was generally
diffused throughout Europe, and in the latter half of the seventeenth
century a final Occidental incursion of the plague took place. From
1603 to 1604 over 30,000 people perished in London from the plague, and
in 1625 the mortality in that city amounted to 35,417 persons. But the
great plague of London did not begin until 1664. In this plague the
patient at first became sensible of great weariness and fatigue, had
slight chills, nausea, vomiting, vertigo, and pains in the loins. The
mental disturbance rapidly increased, and stupor and delirium ensued.
The face was alternately flushed and pallid, and a sense of
constriction was experienced in the region of the heart. Darting pains
were felt all over the body, soon followed by the enlargement of the
lymphatic glands, or by the formation of carbuncles in various parts of
the body. About the third day the tongue became dry and brown, and the
gums, tongue, and teeth were covered with a dark fur, and the
excretions became offensive; paralysis intervened; ecchymosed patches
or stripes due to extravasation appeared on the skin; finally the pulse
sank, the body grew cold and clammy, delirium or coma seized the
victim, and in five or six days, sometimes in two or three, the painful
struggle was at an end.

It was supposed that the disease originated in the Orient and was
brought to London from Holland. In his "Journal of the Plague in
London" Defoe describes its horrors, and tells of the dead-cart which
went through the streets gathering the victims. A few extracts from
Pepys's "Diary," the evidence of an eye-witness and a contemporary,
show the ghastly aspects of this terrible visitation. On August 31st he
writes: "In the City, this week, died 7496, and of them 6102 died of
the plague. But it is found that the true number of the dead this week
is nearer 10,000; partly from the poor who cannot be taken care of
through the greatness of the number, and partly from the Quakers and
others that will not have any bell rung for them." According to Adams,
John Evelyn noted in his "Kalendarium":--"Sept. 7th.--Near 10,000 now
died weekly; however, I went all along the City and suburbs from Kent
street to St. James's, a dismal passage, and dangerous to see so many
coffins exposed in the streets; the streets thin of people, the shops
shut up, and all in silence, no one knowing whose turn might be next."

As the cold weather came on the plague diminished in intensity and the
people regained their confidence and returned to the city. According to
Adams, in the first week of March, 1666, deaths by the plague had
decreased to 42; and by the end of the month it was nearly extinct
after carrying off about 100,000 victims. In our days we can hardly
comprehend the filthy hygienic conditions under which the people in the
cities lived, and it was probably to this fact that the growth and
perpetuation of this plague was due.

As to the bubonic plague recently raging in Camptown, China, Mary Niles
says that it was the same disease as the great London plague, and was
characterized mainly by glandular enlargement. It had not appeared in
the Canton district for forty years or more, though it was endemic in
Yunnan. In some places it began in the winter; and as early as January
she herself found the first case in Canton in an infected house. In no
case was direct contagiousness found to exist. The glands enlarged
twelve hours after the fever began, and sometimes suppurated in
nonfatal cases in a short time. Kitasato has recently announced the
discovery of the specific cause of the bubonic plague.

Sweating Sickness.--According to Hecker, very shortly after Henry's
triumphant march from Bosworth Field, and his entry into the capital on
August 8, 1485, the sweating sickness began its ravages among the
people of the densely populated city. According to Lord Bacon the
disease began about September 21st, and lasted to the end of October,
1485. The physicians could do little or nothing for the people, and
seemed to take no account of the clinical history of the disease,--in
this respect not unlike the Greek physicians who for four hundred years
paid no attention to small-pox because they could find no description
of it in the immortal works of Galen. The causes seemed to be
uncleanliness, gluttony, immoderate drinking, and also severe
inundations leaving decaying vegetation. Richmond's army has been
considered a factor in the germination of the seeds of pestilent
disorder which broke out soon after in the camps of Litchfield, and on
the banks of the Severn.

Sweating sickness was an inflammatory rheumatic fever, with great
disorder of the nervous system, and was characterized by a profuse and
injurious perspiration. In the English epidemic the brain, meninges,
and the nerves were affected in a peculiar manner. The functions of the
pneumogastric nerves were violently disordered in this disease, as was
shown by the oppressed respiration and extreme anxiety, with nausea and
vomiting,--symptoms to which modern physicians attach much importance.
The stupor and profound lethargy show that there was an injury to the
brain, to which, in all probability, was added a stagnation of black
blood in the torpid veins. Probably decomposing blood gave rise to the
offensive odor of the person.  The function of the lungs was
considerably impaired. The petechial fever in Italy in 1505 was a form
of the sweating sickness. There were visitations in 1506 and in 1515 in
England.  In 1517 the disease lasted full six months and reached its
greatest height about six weeks after its appearance, but was
apparently limited to England. Meningeal symptoms were characteristic
of the third visitation of the disease. In 1528 and 1529 there was a
fourth visitation which resulted in the destruction of the French Army
before Naples. It is said that in 1524 a petechial fever carried off
50,000 people in Milan, and possibly this was the same disease. In 1529
the disease had spread all over Europe, attended with great mortality.

Germany, France, and Italy were visited equally. The famine in Germany,
at this time, is described by authorities in a tone of deep sympathy.
Swabia, Lorraine, Alsace, and provinces on the border of the lower
Rhine, were frightfully affected, so that the disease reached the same
heights there as in France. In England Henry VIII endeavored to avoid
the epidemic by continual traveling, until at last he grew tired of so
unsettled a life and determined to await his destiny at Tytynhangar. It
was not the inhabitants of the land alone who were affected, but even
fish and the fowls of the air sickened. According to Schiller, in the
neighborhood of Freiburg in Breisgau, dead birds were found scattered
under the trees with boils as large as peas under their
wings,--indicating among them a disease, and this extended far beyond
the southern districts of the Rhine. The disease was undoubtedly of a
miasmatic infectious nature, as was proved by its rapid spread and the
occasional absence of a history of contagion. It was particularly
favored in its development by high temperature and humidity.

The moral effect of the sweating sickness, similar to that of the black
plague, was again to increase religious fanaticism and recreate the
zeal of persecution.

On the 15th of April, 1551, there was an outbreak of the fifth and last
epidemic of sweating fever in Shrewsbury, on the Severn.  With stinking
mists it gradually spread all over England, and on the 9th of July it
reached London. The mortality was very considerable. The English
residents were particularly susceptible, foreigners being comparatively
exempt. The epidemic terminated about the 30th of September. Since that
time the sweating sickness has never reappeared in England; but in the
beginning of the eighteenth century a disease very similar in symptoms
and course broke out in Picardy, in Northern France.  Toward the end of
the century it spread to the South of France, and since that time has
appeared epidemically, 195 distinct outbreaks having been observed in
the course of one hundred and sixty-nine years, from 1618 to 1787. The
disease has frequently appeared in Italy since 1755, and in various
parts of Germany since 1801. In Belgium it has been observed in a few
places within the present century (Rohe).

Chronologic Table of the Principal Plagues.--In December, 1880, H. P.
Potter, F.R.C.S., published a chronologic table of some of the
principal plagues on record. In comments on his table, Potter says that
he has doubtless included mention of many plagues which, although
described under that name, are probably a dissimilar disease, writers
having applied the terms pestilential and pestilent in a generic sense
to diseases specifically different. It must also be remembered that, in
some cases, death must have been due to famine, want, and privation,
which are so frequently coexistent with pestilence. Following the idea
of Hecker, the dancing manias have been included in this table.

{table omitted}

Small-pox.--From certain Chinese records it appears that small-pox, or
a disease with similar symptoms, was known in China before the
Christian era, and it was supposed to have been known at a very early
period in India. Most likely it was introduced into Europe in the
second century by a Roman army returning from Asia. Before the sixth
century, the terrible century of the great plague, there seem to be no
records of small-pox or other eruptive fevers. Neither Hippocrates,
Galen, nor the Greek physicians who practiced at Rome, mention
small-pox, although it is now believed that the Emperor Marcus Aurelius
died of this disease. According to Dupony, the first document
mentioning variola was in 570 A.D., by Marius, a scholar of Avenches,
in Switzerland. ("Anno 570, morbus validus cum profluvio ventris, et
variola, Italiam Galliamque valde affecit.") Ten years later Gregory of
Tours describes an epidemic with all the symptoms of small-pox in the
fifth reign of King Childebert (580); it started in the region of
Auvergne, which was inundated by a great flood; he also describes a
similar epidemic in Touraine in 582. Rhazes, or as the Arabs call him,
Abu Beer Mohammed Ibn Zacariya Ar-Razi, in the latter part of the ninth
century wrote a most celebrated work on small-pox and measles, which is
the earliest accurate description of these diseases, although Rhazes
himself mentions several writers who had previously described them, and
who had formulated rules for their cure. He explained these diseases by
the theory of fermentation, and recommended the cooling treatment.
Adams remarks that although it is probable that small-pox existed for
ages in Hindoostan and China, being completely isolated in those
countries from the European world, it was not introduced into the West
until the close of the seventh century. Imported into Egypt by the
Arabians, it followed in the tracks of their conquests, and was in this
way propagated over Europe. The foregoing statement disagrees with
Dupony and others. It is well known that small-pox was prevalent in
Europe before Rhazes's description of it, and after the Crusades it
spread over Central and Western Europe, but did not extend to the
northern countries until some years later. In 1507 the Spaniards
introduced it into San Domingo, and in 1510 into Mexico, where it
proved a more fatal scourge than the swords of Cortez and his
followers, for according to Robertson it swept away in Mexico three
millions and a half of people. In 1707 it appeared in Iceland, and
carried off more than one-fourth of its inhabitants; in 1733, according
to Collinson, it almost depopulated Greenland.  The Samoyeds, Ostiaks,
and other natives of Eastern Siberia, have frequently suffered from
devastating epidemics. In Kamchatka the disease was introduced in 1767,
and many villages were completely depopulated. According to Moore, at
the beginning of the eighteenth century nearly one-fourteenth of the
population died from small-pox in England, and at the end of the
century the number of the victims had increased to one-tenth. In the
last century the statement was made in England that one person in every
three was badly pock-marked. The mortality of the disease at the latter
half of the eighteenth century was about three to every thousand
inhabitants annually. India has always been a fertile ground for the
development of small-pox, and according to Rohe the mortality from
small-pox has been exceedingly great for the past twenty years. From
1866 to 1869, 140,000 persons died in the Presidencies of Bombay and
Calcutta, and several years later, from 1873 to 1876, 700,000 died from
this disease. China, Japan, and the neighboring countries are
frequently visited with small-pox, and nearly all the inhabitants of
Corea are said to bear evidences of the disease. In the Marquesas
Islands one-fourth of the inhabitants had fallen victims to the disease
since 1863. It was first introduced into the Sandwich Islands in 1853,
and it then carried off eight per cent of the natives.  Australia,
Tasmania, New Zealand, and the Fiji Archipelago have to the present day
remained exempt from small-pox; although it has been carried to
Australia in vessels, rigorous quarantine methods have promptly checked
it. On the American continent it was believed that small-pox was
unknown until the conquest of Mexico. It has been spread through
various channels to nearly all the Indian tribes of both North and
South America, and among these primitive people, unprotected by
inoculation or vaccination, its ravages have been frightful.

That small-pox a disease so general and so fatal at one time--has,
through the ingenuity of man, in civilized communities at least, become
almost extinct, is one of the greatest triumphs of medicine.

Inoculation was known in Europe about 1700, and in 1717 the famous
letter of Lady Montagu from Adrianople was issued, containing in part
the following statements:--

"The small-pox, so fatal and so general amongst us, is here entirely
harmless, by the invention of ingrafting, which is the term they give
it. There is a set of old women who make it their business to perform
the operation every autumn in the month of September, when the great
heat is abated. People send to one another to know if any of their
family has a mind to have the small-pox; they make parties for this
purpose, and when they are met, the old woman comes with a nut-shell
full of the matter of the best sort of small-pox, and asks what vein
you please to have opened. She immediately rips open that you offer her
with a large needle, and puts into the vein as much matter as can lie
upon the head of her needle, and after that binds up the little wound
with a hollow shell, and in this manner opens four or five veins."

Soon after this letter Lady Montagu had her son inoculated in Turkey,
and four years later her daughter was to be the first subject
inoculated in England. She made rapid progress notwithstanding the
opposition of the medical profession, and the ignorance and credulity
of the public. The clergy vituperated her for the impiety of seeking to
control the designs of Providence.  Preaching in 1722, the Rev. Edward
Massey, for example, affirmed that Job's distemper was confluent
small-pox, and that he had been inoculated by the Devil. Lady Montagu,
however, gained many supporters among the higher classes. In 1721 Mead
was requested by the Prince of Wales to superintend the inoculation of
some condemned criminals, the Prince intending afterward to continue
the practice in his own family; the experiment was entirely successful,
and the individuals on whom it was made afterward received their
liberty (Adams).

According to Rohe, inoculation was introduced into this country in 1721
by Dr. Zabdiel Boylston of Boston, who had his attention directed to
the practice by Cotton Mather, the eminent divine.  During 1721 and
1722 286 persons were inoculated by Boylston and others in
Massachusetts, and six died. These fatal results rendered the practice
unpopular, and at one time the inoculation hospital in Boston was
closed by order of the Legislature. Toward the end of the century an
inoculating hospital was again opened in that city.

Early in the eighteenth century inoculation was extensively practiced
by Dr. Adam Thomson of Maryland, who was instrumental in spreading a
knowledge of the practice throughout the Middle States.

Despite inoculation, as we have already seen, during the eighteenth
century the mortality from small-pox increased. The disadvantage of
inoculation was that the person inoculated was affected with a mild
form of small-pox, which however, was contagious, and led to a virulent
form in uninoculated persons.  As universal inoculation was manifestly
impracticable, any half-way measure was decidedly disadvantageous, and
it was not until vaccination from cow-pox was instituted that the first
decided check on the ravages of small-pox was made.

Vaccination was almost solely due to the persistent efforts of Dr.
Edward Jenner, a pupil of the celebrated John Hunter, born May 17, 1749.

In his comments on the life of Edward Jenner, Adams, in "The Healing
Art," has graphically described his first efforts to institute
vaccination, as follows: "To the ravages of small-pox, and the
possibility of finding some preventive Jenner had long given his
attention. It is likely enough that his thoughts were inclined in this
direction by the remembrance of the sufferings inflicted upon himself
by the process of inoculation. Through six weeks that process lingered.
He was bled, purged, and put on a low diet, until 'this barbarism of
human veterinary practice' had reduced him to a skeleton. He was then
exposed to the contagion of the small-pox. Happily, he had but a mild
attack; yet the disease itself and the inoculating operations, were
probably the causes of the excessive sensitiveness which afflicted him
through life.

"When Jenner was acting as a surgeon's articled pupil at Sudbury, a
young countrywoman applied to him for advice. In her presence some
chance allusion was made to the universal disease, on which she
remarked: 'I shall never take it, for I have had the cow-pox.' The
remark induced him to make inquiries; and he found that a pustular
eruption, derived from infection, appeared on the hands of milkers,
communicated from the teats of cows similarly disordered; this eruption
was regarded as a safeguard against small-pox. The subject occupied his
mind so much that he frequently mentioned it to John Hunter and the
great surgeon occasionally alluded to it in his lectures, but never
seems to have adopted Jenner's idea that it might suggest some
efficacious substitute for inoculation. Jenner, however, continued his
inquiries, and in 1780 he confided to his friend, Edward Gardner, his
hope and prayer that it might be his work in life to extirpate smallpox
by the mode of treatment now so familiar under the name of vaccination.

"At the meetings of the Alveston and Radborough Medical Clubs, of both
of which Jenner was a member, he so frequently enlarged upon his
favorite theme, and so repeatedly insisted upon the value of cow-pox as
a prophylactic, that he was denounced as a nuisance, and in a jest it
was even proposed that if the orator further sinned, he should then and
there be expelled. Nowhere could the prophet find a disciple and
enforce the lesson upon the ignorant; like most benefactors of mankind
he had to do his work unaided.  Patiently and perseveringly he pushed
forward his investigations.  The aim he had in view was too great for
ridicule to daunt, or indifference to discourage him. When he surveyed
the mental and physical agony inflicted by the disease, and the thought
occurred to him that he was on the point of finding a sure and certain
remedy, his benevolent heart overflowed with unselfish gladness.  No
feeling of personal ambition, no hope or desire of fame, sullied the
purity of his noble philanthropy. 'While the vaccine discovery was
progressive,' he writes, 'the joy at the prospect before me of being
the instrument destined to take away from the world one of its greatest
calamities, blended with the fond hope of enjoying independence, and
domestic peace and happiness, were often so excessive, that, in
pursuing my favorite subject among the meadows, I have sometimes found
myself in a kind of reverie.  It is pleasant to recollect that those
reflections always ended in devout acknowledgments to that Being from
whom this and all other blessings flow.' At last an opportunity
occurred of putting his theory to the test. On the 14th day of May,
1796,--the day marks an epoch in the Healing Art, and is not less
worthy of being kept as a national thanksgiving than the day of
Waterloo--the cow-pox matter or pus was taken from the hand of one
Sarah Holmes, who had been infected from her master's cows, and was
inserted by two superficial incisions into the arms of James Phipps, a
healthy boy of about eight years of age. The cow-pox ran its ordinary
course without any injurious effect, and the boy was afterward
inoculated for the small-pox,--happily in vain. The protection was
complete; and Jenner thenceforward pursued his experiments with
redoubled ardor. His first summary of them, after having been examined
and approved by several friends, appeared under the title of 'An
Inquiry into the Causes and Effects of the Variolae Vaccinae,' in June,
1798. In this important work he announced the security against the
small-pox afforded by the true cow-pox, and proceeded to trace the
origin of that disease in the cow to a similar affection of the horse's
heel."

This publication produced a great sensation in the medical world, and
vaccination spread so rapidly that in the following summer Jenner had
the indorsement of the majority of the leading surgeons of London.
Vaccination was soon introduced into France, where Napoleon gave
another proof of his far-reaching sagacity by his immediate recognition
of the importance of vaccination. It was then spread all over the
continent; and in 1800 Dr. Benjamin Waterhouse of Boston introduced it
into America; in 1801, with his sons-in-law, President Jefferson
vaccinated in their own families and those of their friends nearly 200
persons. Quinan has shown that vaccination was introduced into Maryland
at least simultaneously with its introduction into Massachusetts. De
Curco introduced vaccination into Vienna, where its beneficial results
were displayed on a striking scale; previously the average annual
mortality had been about 835; the number now fell to 164 in 1801, 61 in
1802, and 27 in 1803. After the introduction of vaccination in England
the mortality was reduced from nearly 3000 per million inhabitants
annually to 310 per million annually. During the small-pox epidemic in
London in 1863, Seaton and Buchanan examined over 50,000 school
children, and among every thousand without evidences of vaccination
they found 360 with the scars of small-pox, while of every thousand
presenting some evidence of vaccination, only 1.78 had any such traces
of small-pox to exhibit. Where vaccination has been rendered
compulsory, the results are surprising. In 1874 a law was established
in Prussia that every child that had not already had small-pox must be
vaccinated in the first year of its life, and every pupil in a private
or public institution must be revaccinated during the year in which his
or her twelfth birthday occurs. This law virtually stamped small-pox
out of existence; and according to Frolich not a single death from
small-pox occurred in the German army between 1874 and 1882.
Notwithstanding the arguments advanced in this latter day against
vaccination, the remembrance of a few important statistic facts is all
that is necessary to fully appreciate the blessing which Jenner
conferred upon humanity. In the last century, besides the enormous
mortality of small-pox (it was computed that, in the middle of the last
century, 2,000,000 victims perished in Russia from small-pox), the
marks of affliction, blindness, deafness, etc., were plain in at least
one member of every family.

Asiatic cholera probably originated centuries ago in India, where it is
now endemic and rages to such an extent as to destroy 750,000
inhabitants in the space of five years. There is questionable evidence
of the existence of cholera to be found in the writings of some of the
classic Grecian and Indian authors, almost as far back as the beginning
of the Christian era. In the sixteenth and seventeenth centuries
travelers in the East gave accounts of this disease. Sonnerat, a French
traveler, describes a pestilence having all the characteristics of
Asiatic cholera which prevailed in the neighborhood of Pondicherry and
the Coromandel coast from 1768 to 1769, and which, within a year,
carried off 60,000 of those attacked. According to Rohe, Jasper Correa,
an officer in Vasco da Gama's expedition to Calicut, states that
Zamorin, the chief of Calicut, lost 20,000 troops by the disease.
Although cholera has frequently extended to Europe and America, its
ravages have never been nearly as extensive as in the Oriental
outbreaks. An excellent short historic sketch of the epidemics of the
cholera observed beyond the borders of India has been given by Rohe. In
1817 cholera crossed the boundaries of India, advancing southeasterly
to Ceylon, and westerly to Mauritius, reaching the African coast in
1820. In the following two years it devastated the Chinese Empire and
invaded Japan, appearing at the port of Nagasaki in 1822. It advanced
into Asiatic Russia, and appeared as far east as St. Petersburg in
1830, from whence it spread north to Finland. In 1831 it passed through
Germany, invading France and the western borders of Europe, entering
the British Isles in 1832, and crossing the Atlantic Ocean for the
first time, appeared in Canada, having been carried thence by some
Irish emigrants.

From Canada it directly made its way to the United States by way of
Detroit. In the same year (1832) it appeared in New York and rapidly
spread along the Atlantic coast.

"During the winter of 1832 it appeared at New Orleans, and passed
thence up the Mississippi Valley. Extending into the Indian country,
causing sad havoc among the aborigines, it advanced westward until its
further progress was stayed by the shores of the Pacific Ocean. In 1834
it reappeared on the east coast of the United States, but did not gain
much headway, and in the following year New Orleans was again invaded
by way of Cuba. It was again imported into Mexico in 1833. In 1835 it
appeared for the first time in South America, being restricted,
however, to a mild epidemic on the Guiana coast.

"In 1846 the disease again advanced beyond its natural confines,
reaching Europe by way of Turkey, in 1848. In the autumn of this year
it also appeared in Great Britain, Belgium, the Netherlands, Sweden,
and the United States, entering by way of New York and New Orleans. In
the succeeding two years the entire extent of country east of the Rocky
Mountains was invaded. During 1851 and 1852 the disease was frequently
imported by emigrants, who were annually arriving in great numbers from
the various infected countries of Europe. In 1853 and 1854 cholera
again prevailed extensively in this country, being, however, traceable
to renewed importation of infected material from abroad. In the
following two years it also broke out in numerous South American
States, where it prevailed at intervals until 1863. Hardly had this
third great pandemic come to an end before the disease again advanced
from the Ganges, spreading throughout India, and extending to China,
Japan, and the East Indian Archipelago, during the years 1863 to 1865.
In the latter year it reached Europe by way of Malta and Marseilles. It
rapidly spread over the Continent, and in 1866 was imported into this
country by way of Halifax, New York, and New Orleans. This epidemic
prevailed extensively in the Western States, but produced only slight
ravages on the Atlantic Coast, being kept in check by appropriate
sanitary measures. In the same year (1866) the disease was also carried
to South America, and invaded for the first time the states bordering
on the Rio de la Plata and the Pacific coast of the Continent.

"Cholera never entirely disappeared in Russia during the latter half of
the sixth decade, and in 1870 it again broke out with violence,
carrying off a quarter of a million of the inhabitants before dying out
in 1873. It spread from Russia into Germany and France and was
imported, in 1873, into this country, entering by way of New Orleans
and extending up the Mississippi Valley. None of the Atlantic coast
cities suffered from this epidemic in 1873, and since that year the
United States has been entirely free from the disease, with the
exception of a few imported cases in New York harbor in 1887" (and in
1893). In 1883 an epidemic of cholera raged in Egypt and spread to many
of the Mediterranean ports, and reappeared in 1885 with renewed
violence. In Spain alone during this latter epidemic the total number
of cases was over one-third of a million, with nearly 120,000 deaths.
In 1886 cholera caused at least 100,000 deaths in Japan. In the latter
part of 1886 cholera was carried from Genoa to Buenos Ayres, and
crossing the Andean range invaded the Pacific coast for a second time.
In Chili alone there were over 10,000 deaths from cholera in the first
six months of 1887. Since then the entire Western hemisphere has been
virtually free from the disease.

In 1889 there was an epidemic of cholera in the Orient; and in 1892 and
1893 it broke out along the shores of the Mediterranean, invading all
the lines of commerce of Europe, Hamburg in the North and Marseilles in
the South being especially affected. In the summer of 1893 a few cases
appeared in New York Bay and several in New York city, but rigorous
quarantine methods prevented any further spread.

Typhus fever is now a rare disease, and epidemics are quite infrequent.
It has long been known under the names of hospital-fever,
spotted-fever, jail-fever, camp-fever, and ship-fever, and has been the
regular associate of such social disturbances as overcrowding,
excesses, famine, and war. For the past eight centuries epidemics of
typhus have from time to time been noticed, but invariably can be
traced to some social derangement.

Yellow Fever is a disease prevailing endemically in the West Indies and
certain sections of what was formerly known as the Spanish Main.
Guiteras recognizes three areas of infection:--

(1) The focal zone from which the disease is never absent, including
Havana, Vera Cruz, Rio, and the other various Spanish-American points.

(2) The perifocal zone, or regions of periodic epidemics, including the
ports of the tropical Atlantic and Africa.

(3) The zone of accidental epidemics, between the parallels of 45
degrees north and 35 degrees south latitude.

In the seventeenth century Guadaloupe, Dominica, Martinique, and
Barbadoes suffered from epidemics of yellow fever. After the first half
of the seventeenth century the disease was prevalent all through the
West Indies. It first appeared in the United States at the principal
ports of Boston, Philadelphia, and Charleston, in 1693, and in 1699 it
reappeared in Philadelphia and Charleston, and since that time many
invasions have occurred, chiefly in the Southern States.

The epidemic of 1793 in Philadelphia, so graphically described by
Matthew Carey, was, according to Osler, the most serious that has ever
prevailed in any city of the Middle States. Although the population of
the city was only 40,000, during the months of August, September,
October, and November the mortality, as given by Carey, was 4041, of
whom 3435 died in the months of September and October. During the
following ten years epidemics of a lesser degree occurred along the
coast of the United States, and in 1853 the disease raged throughout
the Southern States, there being a mortality in New Orleans alone of
nearly 8000. In the epidemic of 1878 in the Southern States the
mortality was nearly 16,000.  South America was invaded for the first
time in 1740, and since 1849 the disease has been endemic in Brazil.
Peru and the Argentine Republic have also received severe visitations
of yellow fever since 1854. In Cuba the disease is epidemic during
June, July, and August, and it appears with such certainty that the
Revolutionists at the present time count more on the agency of yellow
fever in the destruction of the unacclimated Spanish soldiers than on
their own efforts.

Leprosy is distinctly a malady of Oriental origin, and existed in
prehistoric times in Egypt and Judea. It was supposed to have been
brought into Europe by a Roman army commanded by Pompey, after an
expedition into Palestine. Leprosy was mentioned by several authors in
the Christian era. France was invaded about the second century, and
from that time on to the Crusades the disease gradually increased. At
this epoch, the number of lepers or ladres becoming so large, they were
obliged to confine themselves to certain portions of the country, and
they took for their patron St. Lazare, and small hospitals were built
and dedicated to this saint. Under Louis VIII 2000 of these hospitals
were counted, and later, according to Dupony, there were 19,000 in the
French kingdom. Various laws and regulations were made to prevent the
spread of the contagion. In 1540 it was said that there were as many as
660 lepers in one hospital in Paris.

No mention is made in the Hippocratic writings of elephantiasis
graecorum, which was really a type of leprosy, and is now considered
synonymous with it. According to Rayer, some writers insist that the
affection then existed under the name of the Phoenician disease. Before
the time of Celsus, the poet Lucretius first speaks of elephantiasis
graecorum, and assigns Egypt as the country where it occurs. Celsus
gives the principal characteristics, and adds that the disease is
scarcely known in Italy, but is very common in certain other countries.
Galen supplies us with several particular but imperfect
cases--histories of elephantiasis graecorum, with a view to demonstrate
the value of the flesh of the viper, and in another review he adds that
the disease is common in Alexandria. Aretaeus has left a very accurate
picture of the symptoms of elephantiasis graecorum; and Pliny
recapitulates the principal features and tells us that the disease is
indigenous in Egypt. The opinion of the contagiousness of elephantiasis
graecorum which we find announced in Herodotus and Galen is more
strongly insisted upon by Caelius Aurelianus who recommends isolation
of those affected.  Paulus aegenita discusses the disease. The Arabian
writers have described elephantiasis graecorum under the name of juzam,
which their translators have rendered by the word lepra. Later,
Hensler, Fernel Pare, Vesalius, Horstius, Forestus, and others have
discussed it.

The statistics of leprosy in Europe pale before the numbers affected in
the East. The extent of its former ravages is unknown, but it is
estimated that at the present day there are over 250,000 lepers in
India, and the number in China is possibly beyond computation.
According to Morrow, in 1889 in the Sandwich Islands there were 1100
lepers in the settlement at Molokai.  Berger states that there were 100
cases at Key West; and Blanc found 40 cases at New Orleans. Cases of
leprosy are not infrequently found among the Chinese on the Pacific
coast, and an occasional case is seen in the large cities of this
country. At the present day in Europe, where leprosy was once so well
known, it is never found except in Norway and the far East.

Possibly few diseases have caused so much misery and suffering as
leprosy. The banishment from all friends and relatives, the
confiscation of property and seclusion from the world, coupled with
poverty and brutality of treatment,--all emphasize its physical horror
a thousandfold. As to the leper himself, no more graphic description
can be given than that printed in The Ninteenth Century, August, 1884:
"But leprosy! Were I to describe it no one would follow me. More cruel
than the clumsy torturing weapons of old, it distorts, and scars, and
hacks, and maims, and destroys its victim inch by inch, feature by
feature, member by member, joint by joint, sense by sense, leaving him
to cumber the earth and tell the horrid tale of a living death, till
there is nothing left of him. Eyes, voice, nose, toes, fingers, feet,
hands, one after the other are slowly deformed and rot away, until at
the end of ten, fifteen, twenty years, it may be, the wretched leper,
afflicted in every sense himself, and hateful to the sight, smell,
hearing, and touch of others, dies, despised and the most abject of
men."

Syphilis.--Heretofore the best evidence has seemed to prove that
syphilis had its origin in 1494, during the siege of Naples by Charles
VIII of France; but in later days many investigators, prominent among
them Buret, have stated that there is distinct evidence of the
existence of syphilis in prehistoric times. Buret finds evidence of
traces of syphilis among the Chinese five thousand years ago, among the
Egyptians at the time of the Pharaohs, among the Hebrews and Hindoos in
biblic times, and among the Greeks and Romans after Christ. Some
American writers claim to have found evidences of syphilitic disease in
the skulls and other bones of the prehistoric Indian mounds, thus
giving further evidence to the advocates of the American origin of
syphilis. The Spaniards claimed that, returning from America in 1493,
Columbus brought with him syphilis. Friend says: "One thing is
remarkable; the Spaniards, upon their first expedition to America,
brought home from thence this contagious disorder, and soon after
carried another affection thither, the small-pox, of which the Indian
Prince Montezuma died." The first descriptions of syphilis are given
under the name of morbus gallicus, while the French in return called it
morbus neapolitanus or mal d'Italie. The name of syphilis was said to
have been first given to it by a physician of Verona, in a poem
describing the disease.  Inspired by heroic epics Fracastor places
before us the divinities of paganism, and supposes that a shepherd,
whom he called Syphilus, had addressed words offensive to Apollo, and
had deserted his altars. To punish him the God sent him a disease of
the genitals, which the inhabitants of the country called the disease
of Syphilus.

"Syphilidemque ab eo labem dixere coloni."

Buret traces the origin of the word syphilis from sun, with, and filia,
love, the companion of love; which means in plain language that the pox
is a disease transmitted more especially by venereal relations. The
first great epidemic of syphilis occurred between 1493 and 1496, and
attacked all ranks, neither the Church nor the Crown being spared. The
ravages of this disease were increased by the treatment with mercury
which soon afterward was found in proper doses to be a specific in this
disease. It is possible that the terrible manifestations of syphilis of
which we read in the older writers were in a great measure due to the
enormous doses of mercury. At the present day syphilis is universally
prevalent. In his excellent monograph Sturgis estimated in New York, in
1873, that one out of 18 suffered from it; and White of Philadelphia
pronounces the opinion that "not less than 50,000 people in that city
are affected with syphilis." According to Rohe, on this basis Gihon
estimates the number of syphilitics in the United States at one time as
2,000,000.

To-day no disease, except possibly tuberculosis, is a greater agency in
augmenting the general mortality and furthering sickness than syphilis.
Its hereditary features, the numerous ways in which it may be
communicated outside of the performance of the sexual act, and the
careful way in which it is kept from the sanitary authorities render it
a scourge which, at the present day, we seem to have no method of
successfully repressing.

Modern Mortality from Infectious Diseases.--As to the direct influence
on the mortality of the most common infectious diseases of the present
day, tuberculosis, universally prevalent, is invariably in the lead. No
race or geographic situation is exempt from it. Osler mentions that in
the Blood Indian Reserve of the Canadian Northwest Territories, during
six years, among a population of about 2000 there were 127 deaths from
pulmonary consumption. This enormous death-rate, it is to be
remembered, occurred in a tribe occupying one of the finest climates of
the world, among the foothills of the Rocky Mountains, a region in
which consumption is extremely rare among the white population, and in
which cases of tuberculosis from the Eastern provinces do remarkably
well. Mayo-Smith quotes a table illustrating the annual deaths (based
on the returns from 1887 to 1891) from certain infectious diseases per
10,000 European inhabitants. The figures for each disease give a rough
measure of its prevalence in different countries. The large figures as
to small-pox show the absence in Italy and "Hieronymi Fracastorii,"
Veronae, 1530.  Statistics and Sociology, New York, 1885.

Austria of vaccination; diphtheria seems to be very fatal in Germany
and Austria; Italy has a large rate for typhoid fever, and the same is
true of the other fevers; France, Germany, and Austria show a very
large rate for tuberculosis, while Italy has a small rate.

       DEATHS FROM CERTAIN DISEASES PER 10,000 INHABITANTS.

                   Small-       Scarlet Diphtheria Typhoid Tuber-
  COUNTRY.         pox.  Measles. fever            fever.  culosis

  Italy, . . . . .  3.86   6.17    2.99     6.08     7.49    13.61
  France (cities).  2.3    5.18    3.1      6.66     5.32    33.
  England, . . . .  0.11   4.68    2.31     1.74     1.9     16.09
  Ireland, . . . .  0.01   2.01    1.22     0.76     2.33    21.15
  Germany (cities). 0.04   2.8     2.15    10.21     2.11    31.29
  Prussia, . . . .  0.03   3.2     2.46    14.17     2.26    28.06
  Austria, . . . .  4.43   5.36    5.57    13.2      5.42    37.2
  Switzerland, . .  0.06   1.53    1.22     3.53     1.47    21.07
  Belgium, . . . .  1.52   6.2     1.62     5.77     3.83    19.87
  Holland, . . . .  0.02   3.93    0.38     1.45     2.5     19.21
  Sweden, . . . . . 0.01   2.3     3.69     3.89     2.22     0.

Based upon the Tenth Census Reports, we figure that of every 10,000
inhabitants of the United States the number of deaths for the census
year from similar diseases was as follows:--

                      Rural.  Cities.

  Measles, . . . . . . . 1.62   1.54
  Scarlet Fever, . . . . 2.84   5.54
  Diphtheria, . . . . .  7.53   8.
  Croup, . . . . . . . . 3.51   4.08
  Typhoid Fever, . . . . 4.75   3.46
  Tuberculosis, . . . . 16.29   28.55

The general average of deaths from small-pox was about 0.14.





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