tIJ.

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.

WITH 295 ILLUSTRATIONS IN THE TEXT, AND 12 HALF-TONE

AND COLORED PLATES

LONDON :
THE REBMAN PUBLISHING CO. (Ltd.),

11 ADAM STREET, STRAND, W. C.

PHILADELPHIA, U.S. A.:
W. B. SAUNDERS,

925 WALNUT STREET.

1897.

Frintod in America.

WELLCOME
LIBRARY

M

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 anoma-
lous and curious have been of exceptional and persistent fascination to him ;
and especially is this true of the construction and functions of the human body.
Possibly, indeed, it was the anomalous that was largely instrumental in arous-
ing in the savage the attention, thought, and investigation that were finally to
develop into the body of organized truth which we now call Science. As by
the aid of collected experience and careful inference we to-day endeavor to
pass our vision into the dim twilight whence has emerged our civilization, we
find abundant hint and even evidence of this truth. To the highest type of
philosophic minds it is the usual and the ordinary that demand investigation
and explanation. But even to such, no less than to the most naive-minded,
the strange and exceptional is of absorbing interest, and it is often through
the extraordinary that the philosopher gets the most searching glimpses into
the heart of the mystery of the ordinary. Truly it has been said, facts are
stranger than fiction. In monstrosities and dermoid cysts, for example, we
seem to catch forbidden sight of the secret work-room of 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 d VHomine quand il se regarde, c'est son corps,'
says Pascal, and looking at the matter more closely we find that it was the
strange and mysterious things of his body that occupied man's earliest as well
as much of his later attention. In the beginning, the organs and functions of
generation, the mysteries of sex, not the routine of digestion or of locomotion,
stimulated his curiosity, and in them he recognized, as it were, an unseen hand
reaching down into the world of matter and the workings of bodily organiza-
tion, and reining them to impersonal service and far-olf ends. All ethnolo-
gists and students of primitive religion well know the role that has been played
in primitive society by the genetic instincts. Among the older naturalists,
such as Pliny and Aristotle, and even in the older historians, whose scope
included natural as well as civil and political history, the atypic and bizarre,
and especially the aberrations of form or function of the generative organs,

1

2

PREFATORY AND INTRODUCTORY.

caught the eye most quickly. Judging from the records of early writers,
when Medicine began to struggle toward self-consciousness, it was again the
same order of facts that was singled out by the attention. The very names
applied by the early anatomists to many structures so widely separated from
the organs of generation as were those of the brain, give testimony of the state
of mind that led to and dominated the practice of dissection.

In the literature of the past centuries the predominance of the interest in
the curious is exempHfied in the almost ludicrously monotonous iteration of
titles, in which the conspicuous words are curiosa, rara, monstruosa, memor-
abilia, prodigiosa, selccta, exotica, miraculi, lusibus naturae, occultis naturae,
etc., etc. Even when medical science became more strict, it was largely the
curious and rare that were thought worthy of chronicling, and not the estab-
lislunent 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 jour-
nal is without its rare or unique" case, or one noteworthy chiefly by reason
of its anomalous features. A curious case is invariably reported, and the inser-
tion of such a report is generally productive of correspondence and discus-
sion with the object of finding a parallel for it.

In view of all this it seems itself a curious fact that there has never been
any systematic gathering of medical curiosities. It would have been most
natural that numerous encyclopedias should spring into existence in response
to such a persistently dominant interest. The forelying volume appears to
be the first thorough attempt to classify and epitomize the literature of this
nature. It has been our purpose to briefly summarize and to arrange in order
the records of the most curious, bizarre, and abnormal cases that are found
in medical literature of all ages and all languages— a thaumatograjjhia medica.
It will be readily seen that such a collection must have a function far beyond
the satisfoction of mere curiosity, even if that be stigmatized with the word
idle." If, as we believe, reference may here be found to all such cases in
the literature of Medicine (including Anatomy, Physiology, Surgery, Obstet-
rics, etc.) as show the most extreme and exceptional departures from the
ordinary, it follows that the future clinician and investigator must have use
for a handbook that decides whether his own strange case has already been
paralleled or excelled. He will thus be aided in determining the truth of
his statements and the accuracy of his diagnoses. Moreover, to know ex-
tremes gives directly some knowledge of means, and by implication and
inference it frequently does more. Remarkable injuries illustrate to what
extent tissues and organs may be damaged without resultant death, and thus
the surgeon is encouraged to proceed to his operation with greater confidence
and more definite knowledge as to the issue. If a mad cow may blindly
play the part of a successful obstetrician with her horns, certainly a skilled

PREFATORY AND INTRODVCTORY. 3

surgeon may hazard entering the womb with his knife. Jf'^f P^^i^-
of an organ,-the lung, a kidney, parts of the hver, or the bram '^e f,-may
be lost by a;cident, and the patient still live, the phys.eian >s tenght the esson
of uU dlperan<l.«, and that if possible to arrest disease of these organs before
their total dostrnetion, the prognosis and treatment thereby aequn-e new and

more hopeful phases. j- i „„i

Directly or indirectly many similar examples have also clear medicolegal
bearings or suggestions ; in fact, it must be acknowledged that much of the im-
portance of medical jurisprudence lies in a thorough comprehension of the
anomalous and rare cases in Medicine. Expert medical testimony has its chief
value in showing the possibilities of the occurrence of alleged extreme cases
and extraordinary deviations from the natural. Every expert witness should
be able to maintain his argument by a full citation of parallels to any
remarkable theory or hypothesis advanced by his clients ; and it is only by
an exhaustive knowledge of extremes and anomalies that an authority on
medical jurisprudence can hope to substantiate his testimony beyond question.
In every poisoning case he is closely questioned as to the largest dose of the
drug in question that has been taken with impunity, and the smallest dose
that^has killed, and he is expected to have the cases of reported idiosyncrasies
and tolerance at his immediate command. A widow with a child of ten
months' gestation may be saved the loss of reputation by mention of the
authentic cases in which pregnancy has exceeded nine months' duration ; the
proof of the viability of a seven months' child may alter the disposition of
an estate ; the proof of death by a blow on the epigastrium without external
marks of violence may convict a murderer ; and so it is with many other
cases of a medicolegal nature.

It is noteworthy that in old-time medical literature — sadly and unjustly
neglected in our rage for the new — should so often be found parallels of our
most wonderful and peculiar modern cases. We wish, also, to enter a mild
protest against the modern egotism that would set aside with a sneer as
myth and fancy the testimonies and reports of philosophers and physicians,
only because they lived hundreds of years ago. We are keenly appreciative
of the power exercised by the myth-making faculty in the past, but as ap-
plied to early physicians, we suggest that the suspicion may easily be too
active. When Par6, for example, pictures a monster, we may distrust his
art, his artist, or his engraver, and make all due allowance for his primitive
knowledge of teratology, coupled with the exaggerations and inventions of the
wonder-lover; but when he describes in his own writing what he or his confreres
have seen on the battle-field or in the dissecting room, we think, within moder-
ate limits, we owe him credence. For the rest, we doubt not that the modern
reporter is, to be mild, quite as much of a myth-maker as his elder brother,
especially if we find modern instances that are essentially like the older cases
reported in reputable journals or books, and by men presumably honest. In

4

PREFATORY AND INTRODUCTORY.

our collection we have endeavored, so far as possible, to cite similar cases
from the older and from the more recent literature.

This connection suggests the question of credibility in general. It need
hardly be said that the lay-journalist and newspaper reporter have usually been
ignored by us, simply because experience and investigation have many times
proved that a scientific tact, by presenta,tion 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 medi-
cal men, than to cite author and source and leave the matter there, where
our responsibility must end.

But where our proper responsibility seemed likely never to end was in
carrying out the enormous labor requisite for a reasonable certainty that we
had omitted no searching that might lead to undiscovered facts, ancient or
modern. Choice in selection is always, of course, an affair de gustihus, 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 un-
known or unique, or that are worthy of particular interest or further investi-
gation. To prevent unnecessary loading of the book with foot-notes, in those
instances in which there are a number of cases of the same nature, and a descrip-
tion has not been thought necessary, mere citation being sufficient, references
are but briefly given or omitted altogether. For the same reason a biblio-
graphic index has been added at the end of the text. This contains the
most important sources of information used, and each journal or book therein
has its own number, which is used in its stead all through the book (thus,
476 signifies The Lancet, London ; 597, the New York Medical Journal;
etc.). These bibliographic numbers begin at 100.

PREFA TORY AND INTR OD UCTOR Y. ^

Notwithstanaing that every effort has been made to ^^^^tl^
factorily .n-oup the thousands of cases contained in the book (a laboi of no
m t4ortL hi itself), a complete general index is a practical necess ^
b the fin success of what is essentially a reference-volume, and con e-
nuen ly one has been added, in which may be found not only the subjects und
^sidLtion and numerous cross-references, but also t YX^:;,' t
authors of the most important reports. A table of contents follows this

We' assume the responsibility for innovations in orthography, cert^iin
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 repoits,
uniformity of nomenclature and numeration is almost impossible

As we contemplate consfamtly increasing our data, we shall be glad to
receive information of any unpublished anomalous or curious cases, either ot

the past or in the future.

For manv courtesies most generously extended in aiding our research-
work we wisii, among others, to acknowledge our especial gratitude and in-
debtedness to the officers and assistants of the Surgeon-General's Library at
WashiuiTton, D. C, the Library of the Royal College of Surgeons of Lon-
don the Library of the British Museum, the Library of the British ISIedieal
Association, the Biblioth&que de Faculty de M6decine de Paris, the Bibho-
theque Rationale, and the Library of the College of Physicians of Phila-

delphia. ^

George M. Gould.

A> . 7 y<?Q/? Walter L. Pyle.

Philadelphia, October, 1896.

TABLE OF CONTENTS.

CHAPTER I.

GENETIC ANOMALIES

Menstruation, 17-Vicarious and compensatory, 18-From the skin, 18-
From the breasts, 19-From the eyes, 23-From the ears, 24-From the month,
24-From the extremities, 25-Frora old nlcers, wounds, or cicatrices, 25-
From the rectum or urinary tract, 26-After removal of the uterus or ovaries,

26- Hematemesis as a means of, 27-Migratory, 27-Postmortem, 27-Black,

27- Suppression of, 27-Iu man, 27-Vicarious, in the male, 28-Durmg preg-
nancy and lactation, 28-Child-bearing after cessation of, 29-Precocious, 29
—Protracted 32-Late establishment of, 33— Precocious impregnation, 34—
Twins born to a child mother, 38-Preguancy before the appearance of menstru-
ation 38-Fecundity in the old, 38— Multiple births in the aged, 40— Impreg-
nation without completion of the copulative act, 40-Artificial impregnation, 42
-Unconscious impregnation, 45— Conception with deficient organs, 45— Concep-
tion soon after a preceding pregnancy, 46-Superfetation, 46-Children of differ-
ent colors, 48.

PAGES

17-49

CHAPTER II.

PRENATAL ANOMALIES

50-112

Extrauterine pregnancy, 50— Termination of, 51— Abortion by the mouth,
52— Discharge of fetal bones by the rectum, 52— By the urinary passages, 53—
Discharge of the fetus through the abdominal walls, 53— Combined intrauterine
and extrauterine gestation, 54— Triple ectopic gestation, 57— Deli very of a viable
extrauterine fetus, 57— Ultimate fate of viable ectopic children, 62— Long reten-
tion of extrauterine pregnancy, 62— Long retention of uterine pregnancy, 63—
Long continuation of fetal movements, 64— Duration of pregnancy, 65— Short
pregnancies, 65— The incubator, 68— Prolonged pregnancies, 68— Unconscious
pregnancy, 72— Pseudocyesis, 73— Sympathetic male nausea of pregnancy, 79—
Perverted appetites of pregnant women, 80— Maternal impressions, 81 — Paternal
impressions, 85— Telegony, 86— Antenatal pathology, 89— Transmission of con-
tagious diseases to the fetus in utero, 90— Small-pox, 90 — Varicella, measles,
pneumonia, and malaria, 91— Effects on the fetus in utero of medicine adminis-
tered to the pregnant mother, 92 — Intrauterine amputations, 94 — Intrauterine
fractures, 97— Multiple fetal fractures, 97— Results to the fetus of injuries to the
pregnant mother, 98 — Injuries about the genitalia, 98 — Injuries from cattle-horns,
99— Major accidents in pregnant women, 100— Operations during pregnancy, 103
— After-effects of abdominal hysteropaxy on subsequent pregnancies, 106 — Coex-
istence of an extensive tumor of the uterus with pregnancy, 106— Protrusion of
the membranes from the vulva several weeks before confinement, 107 — Anomalies
of the umbilical cord, 109 — Anomalous causes of abortion, 109 — Abortion of
one twin, 110— Worms in the pregnant uterus, 111.

7

8

TABLE OF CONTENTS.

CHAPTER III.

OBSTETRIC ANOMALIES

General considerations, 113 — Painless births, 113 — Birth during intoxication,
114 — During hypnotism, 114 — During sleep, lethargies, trances, etc., 114 — Rapid
parturition without usual symptoms, 116 — Unusual places of birth, 119 — Birth
by the rectum, 120 — Tlnough perineal peribration, 121 — Through the abdominal
wall, 122 — Of the fetus enclosed in the membranes, 122 — Dry births, 123 — Post-
mortem delivery, 123— Antepartum crying of the fetus, 127 — Cesarean section,
128 — Repeated Cesarean section, 130 — Cesarean section by the patient herself,
131 — Abdominal section and delivery by cattle-horns, 133 — Delivery by a can-
uonball, 134 — Postmortem Cesarean section, 135 — Rupture of the uterus during
pregnancy, 137 — Spontaneous rupture of the vagina, 138 — Sloughing of the geni-
tals after parturition, 138 — Accidental extraction of the prolapsed pelvic organs,
139 — Accidents incident to labor, 140— Symphysiotomy, 141 — Delay in the birth
of the second twin, 142.

CHAPTER IV.

PROLIFICITY 144-160

General historic observations, 144 — General law, and influence of war, 144
— Influence of rural and urban life, 145 — Effect of climate and race, 145 — Ancient
and modern prolificity, 146 — Legal encouragement, 146 — Old explanations of
prolificity, 146 — Greatest number of children at a single birth, 147 — Proportion
of multiple births, 147— Examples of multiple births, 148 — Twins and triplets,
148 — Quadruplets, 148 — Quintuplets, 150 — Sextuplets, 152 — Multiple births
over six, 152— Seven, 152— Eight, 153— Nine, 153— Eleven, 153— Twelve, 154—
Thirteen, 154— Fifteen, 154 — Repetition of multiple births, 154— Father of 87
children b^' two wives, 156— Extreme prolificity by single births, 157 — Possibil-
ities of paternity, 157 — Multimarriages, 159 — Possible number of descendants,
159 — Animal prolificity, 160.

CHAPTER V.

MAJOR TERATA 161-212

Monstrosities, 161 — Ancient explanations, 161 — Early teratology, 164 —
Double hermaphroditic terata, 165— Scientific teratology, 165 — Artificial produc-
tion of monsters, 166 — Animal teratology, 166 — Classification of monsters, 167 —
Triple monsters, 167— Double monsters, 167— Hindoo sisters, 168— Siamese
twins, 168— Radica-Doddica, 171 — Operations on conjoined twins, 172 — Cranio-
pa<ii, 173 — Pygopagi, 174— Biddenden maids, 174 — Helen and Judith, 177 —
Millie-Christine, 179— Rosa- Josepha Blazek, 179— Tynberg's case, 180— Ischi-
opagi, 181 — Louis and Louise, 181 — Marie-Louise and Hortense-Honorine, 182
—Minna and Minnie Finley, 183— Jones twins, 183— Scottish brothers, 184—
Ritta-Christina, 184— Tocci brothers, 186— Marie-Rosa Drouin, 186— Bi cephalic
monsters, 187 — Edward Mordake, 188 — Fantastic monsters, 189 — Parasitic

terata, 189 — Lazarus- Joannes Baptista Colloredo, 191 — Louise L , 192 —

"Laloo," 192— "A-Ke," 193— Duplication of the lower body, 193— Blanche

Dumas, 194— Mrs. B , 194— Diphallic terata, 194— Jean Baptista dos Santos,

196_Fetus in fetu, 199— Dermoid cysts, 202— Multiple dermoids, 205— Herma-
phroditism, 206 — Interesting instances of, 206— Catherine or Charles Hoffman,
207 — Marie Madeline Lefort, 207— Spurious hermaphroditism, 211— Law of
evolution in hermaphroditism, 211 — Neuter hermaphrodites, 212— Marie Doro-
thea, 212 — Legal aspect of hermaphroditism, 212.

PAGES

113-143

TABLE OF CONTENTS.

CHAPTER VI.

MINOR TERATA

Ancient ideas relative to minor terata, 213— Teratoscopy, 213— Congenital
delect of the epidermis, 217— Elasticity of the skin, 217— " Elastic-Skin Man,"
217— Derraatolysis, 217— Abnormal development of the scalp, 218— Impervious
skin, 219— Albinism, 220— Partial albinism, 221— Melanism, 222— Human horns,
222— Anomalies of the hair, 226— Congenital alopecia, 226— Sexualism and hair-
growth, 228— Bearded women, 228— Hypertrichosis, 230— " Dog- face men," 231
— Noevus pilosus, 232— Hair and beard of great length, 234— Accidental growths
of hair, 235— Anomalies of the color of the hair, 235— Sudden canities, 235—
Temporary and partial canities, 238— Anomalous color-changes of the hair, 239
— Chemic colorations of the hair, 240 — Curious causes of alopecia, 241 — Anoma-
lies of the nails, 241 — Anomalies of dentition, 242 — Triple dentition, 243 — Eden-
tulonsness, 243 — Excessive dentition, 244 — Supernumerary teeth, 244 — Extraoral
dentition, 244 — Anomalies of the head, 245 — Life without a cerebrum, 246 —
Defective development of the cerebellum, 246 — Microcephaly, 247 — Artificial
microcephaly, 248 — Macrocephaly, 248 — Largest healthy brains on record, 249 —
Hydrocephaly, 250 — Deficiency of the cranial bones, 250 — Anomalies of the
maxillary bones, 251 — Congenital absence of the nose, 252 — Large and small
noses, 252 — Congenital division of the nose, 252 — Macrostoma, 253 — Microstoma,
252 — Congenital atresia of the mouth, 253 — Anomalies of the lips, 254 — Hare-lip,

254 — Congenital alisence of the tongue, 254 — Bifid and supernumerarj' tongues,

255 — Large and small tongues, 256 — Anomalies of the palate and uvula, 256 —
Of the epiglottis, 256 — Double epiglottis and double voice, 257 — Anomalies of
eyes, 257 — Absence of the eyes, 257 — Living cyclopia, 258 — "Four-eyed man of
Cricklade," 258— Anomalies of lids, 259— Of the iris, 259— Of the lens, 260—
Heredity in the causation of congenital defects of the eye, 260 — Anomalies of the
ears, 261 — Absence of the limbs, 263— Supernumerary limbs, 269 — Anomalies of
the feet, 270— Of the hand, 270— Absence of the digits, 271— Supernumerary
digits, 273— Hypertrophy of the digits, 276— Talipes, 276— Anomalies of the
vertebrae, 277— Human tails, 277— Vestigial remains, 279— Anomalies of the
spinal canal and contents, 280— Supernumerary ribs, 281— Fissure of the ster-
num, 282— Other thoracic defects, 284— Branchial fissures, 284— Anomalies of
the esophagus, 284— Anomalies of the lungs, 285— Of the diaphragm, 285— Of
the stomach, 286— Of the intestines, 287— Dilatation of the colon, 287—" Bal-
loon-man," 287— Imperforate anus, 288— Anomalies of the liver, 290— Of the
spleen, 290— Transposition of the viscera, 291— Congenital extroversion or even-
tration, 292— Anomalies of kidney, 293— Of the ureters, 294— Of the bladder, 295
—Exstrophy of the bladder, 295— Anomalies of the heart and vascular system,
296— Of the breast, 297— Amazia, 297— Micromazia, 298— Polymazia, 298—
Anonudies of the hymen, 302— Of the female external genitals, 303— Absence of
the vagina, 303— Duplex vagina, 304— Transverse septa of the vagina, 305—
Anonudous openings of the vagina, 305— Anomalies of the labia, 306— Absence
of the nymphaj, 306— Enlarged nympha;, 306— Hottentot women, 307— Ceremo-
nial enlargement of the nymphfe, 307— Anomalies of the clitoris, 307— Circum-
cision of the clitoris in Egypt, 308— Absence of the ovaries, 309— Prolapse of the
ovaries, 310— Supernumerary ovaries, 310— Anomalies of the Fallopian tubes,
311— Of the uterus, 311— Absence of the uterus, 311— Double uterus, 311— Preg-
nancy with double uterus, 311-Triple uterus, 313— Hernia of the uterus, 313—
Absence of the penis, 314— Rudimentary development of the penis, 315— Penis
palme, 316— Torsion of the penis, 316-Ossification of the penis, 316— Absence
of thefrenum and prepuce, 317— Anomalies of the urethra, 317— Duplication of
the urethra, 317— Hypospadias and epispadias, 318-Artificial penis, 318— An-

10 TABLE OF CONTENTS.

PAGES

orchism, 319— Monorchism, 319— Polyorchism, 320— Cryptorchism, 321— Anom-
alous position of the testicles, 322— Inversion of the testicle, 323— Anomalies of
the seminal vesicles, 323.

CHAPTER VII.

ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT 324-31

Giants, 324— Ancient giants, 324— Discoveries of giants' bones, 325— Gen-
eral opinions, 326— Association of acromegaly with gigantism, 327— Celebrated
giants, 328— Giants of history, 333— Dwarfs, 333— Pygmies, 333— Artificial pro-
duction of dwarfs, 335— Ancient popularity of dwarfs, 336— Intellectual dwarfs,
337_\Vomen predisposed to give birth to dwarfs, 337— Species of dwarfs, 338—
Celebrated dwarfs, 338— Geoffrey Hudson, 338— Gibson, 338— B6b6, 339— Borwi-
laski, 339— Greatage in dwarfs, 339— Robert Skinner, 340-" Tom Thumb," 342
—Lucia Zarete, 343— Precocious development, 343— " Man-boys," 343— Small
new-born infants, 347— Large new-born inputs, 348— Congenital asymmetry
and hemihypertrophy, 350— Obesity, 352— Fat children, 352— General remarks
on obesity, 354— Treatment of obesity, 356— Remarkable instances of obesity,
356— Simulation of obesity, 360— " Adiposis dolorosa," 360— Abnormal leanness,
363— "Living skeletons," 364— Extreme muscular atrophy, 364.

CHAPTER VIII.

LONGEVITY ^^^^^^

Scope of the article, 365— General opinions, 365— Testimony of statistics, 365
—Natural term of life, 366— Censuses of centenarians, 366— Effect of class-influ-
ences, occupation, etc., 367-Longevity in ancient times, 368-Difference in
chronology, 368— Alchemy and the "elixir of life," 368— Longevity in Jewish
history, 369— In Egypt, 370— Among the ancient Chinese, 370— Among the
Greeks,' 370— Among the Romans, 370— Among hermits and ecclesiastics, 370—
Among the Brahmin priests of India, 371— Influence of mental culture, 371—
Comprtibility of mental and physical activity with longevity, .371— Longevity
amon- the Royalty, 372— Influence of personal habits, 372-Remarkable in-
stance's of longevity, 373-Henry Jenkins, 373-Thomas Parr, 373-Jean Konn,
373_Setrasch Czarten, 373— Sundry instances of great age, 374-Generative
ability in old age, 376-Influence of stimulants, 377-Rejuvenescence of the
senses in age, 378-Heredity in longevity, 379— Longevity among physicians, 381
—Recent instances of longevity, 382.

CHAPTER IX.

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES 383-526

Anomalies of the secretions, 383-Colored saliva, 383- Abnormalities of uri-
nation 383-Metastasis of tears, 384-Anomalies of the semen, 384-Blue bile,
385-Chromidrosis, 385-Hyperidrosis, 386-Unilateral and localized sweating,
387-Bloody sweat or "stigmata," 388-Louise Lateau, 389-Postmortem
sweating, 391-Anomalies of lactation, 391-Milk-metastasis, 391-Lactation in
the new-born, 392-In children, 392-In the aged, 393-Prolouged lactation and
galactorrhea, 394-Gynecomazia, 394-Men suckling infants, ^97-H"™«"
397_Individual odors, 398-Modifying causes, 398-Odors of races, 399-Odor
of the breath after coitus, 399-Influence of the emotions, 399-Odors associated
^ith mental and nervous diseases, 401-The odor of insanity, 400-Odors of some
diseases 401-Odor of the hair, 401— Sexual influence of odors, 401-Fetichism,
401-Sexual influence of the olfactory sense in animals, 402-Bulimia, 403—

TABLE OF CONTENTS.

11

PAGES

Polydipsia, 404— Polydipsia among glass-blowers, 405— Hydroadipsia, 405—
Perverted appetites, 405— Anthropophagy, 406— Cannibals, 407— Ancient cus-
toms, 409— Depraved appetite for human flesh in civilization, 409— Further ex-
amples ofdepraved appetites, 411-Pica, 412-Chalk-eating, 412-Arsenic eating,
413— Fasting, 413— Older instances, 414- "Fasting girls," 418— Modern in-
stances of fasting, 419— Fasting exhibitionists, 420— Anomalies of temperature,
421--Hyperthermy reaching 148° F., 423— Endurance of external heat, 424—
"Human Salamanders," 424— Fire-worship, 425— Spontaneous combustion of
the human body, 426— Magnetic, phosphorescent, and electric anomalies, 429—
Effects of cold, 431— Eftects of working in compressed air, 433— Remarkable
development of the remaining senses when one or more are lost, 432— Examples
of compensatory sense-development, 433— Laura Dewey Bridgman, 43— Helen
Kellar, 435— Edith Thomas, 437— Remarkable blind savants, 439— Feats of
memory, 439— Boy calculators, etc., 439— Jacques Inaudi, 439— Oscar Moore, 439
—Wolf-children, 444— Artificial manufacture of " wild boys," 448— Equilibrists,
449_Rope-walkers, 449— Blondin, 450— Human pyramids, 450— Jugglers, 451
—Marksmen, 452— Ventriloquists, 453— Athletic feats, 455— Public contests of
Greece, 455— Runners, 455— Couriers, 456— Indian runners, 457— Jinrickisha-
men, 457 — Letter-carriers of India, 458 — "Go-as-you-please" pedestrians, 458
— Modern records for running, 459 — Long-distance traversing, 459 — Riders, 460
— Influence of the spleen in running, 461 — Swimming, 461 — Jumpers and acro-
batic tumblers, 462 — Extraordinary physical development and strength, 463 —
Modern Hercules, 464— Strong women, 468— Strength of the jaws, 468 — Strength
in the hands, 470 — Fraudulent "strong men," 470 — Ofiicially recorded feats of
strength, 470 — Contortionists, 473 — Dislocationists, 473 — Endurance of pain, 475
— Aissaoui, 476 — Malingerers, 478 — Hyperseusitiveness to pain, 480 — Relation
of pain to shock, 480 — Morbid desire for pain, 480 — Pain as a means of sexual
enjoyment, 480 — Masochism, 480 — Flagellation, 480 — Fatal flogging, 481 — Idio-
syncrasies, 481 — Idiosyncrasies in relation to the sense of smell, 482 — Of the
sense of hearing, 484 — To music, 485 — Therapeutic value of music, 485 — Idiosyn-
crasies as to vision, 487 — Of the sense of touch, 488 — Idiosyncrasies to foods, 489
—Eggs, 490— Parsley, 491— Rice, 491— Figs, 491— Wheat-flour, 492 -Food su-
perstitions, 493 — "Totemism," 494— Idiosyncrasies to drugs, 496 — Acids, 497 —
Antimony, 499— Arsenic, 500 — Belladonna, 500 — Digitalis, 502 — Ergot, 502 —
Epsom salts, 503 — lodin, 503 — Iodoform, 503 — Lead-poisoning, 503— Mercury,
504— Croton oil, 504 — Castor oil, 504 — Opium and its derivatives, 505 — Chronic
opium-eating, 506 — Phosphorous, 508— Pilocarpin, 508— Quiniu, 509 — Strych-
nin, 510— Idiosyncrasies in coitus, 511 — Death in coitus, 513— Suspended anima-
tion, 513— Prolonged submersion, 513 — Divers, 514 — Suspension of the cardiac
movements at will, 516— Hibernation, 517 — Human hibernation, 517 — Fakirs of
India, 517 — Recovery after asphyxia from hanging and strangling, 519— Prema-
ture burial, 519— Postmortem anomalies, 522 — Movements of a corpse, 522 —
Postmortem priapism, 523— Retardation of putrefaction, 523— Postmortem
growth of hair and nails, 523— Untoward effects of the emotions on the vital
functions, 523— Death from joy and laughter. 524— Death from grief and sorrow,
524— Death from fear, 525— Death from shock alone following blows that cause
no visible injury, 525— Death from the " wind of the cannon-ball," 526.

CHAPTER X.

SURGICAL ANOMALIES OF THE HEAD AND NECK

Injuries to the eye, 527— Exophthalmos, 527— Avulsion of the eye, 527—
Rupture of the eyeball, 528— Serious sequels of orbital injuries, 528— Gunshot
injuries of the orbit, 529— Foreign bodies in the orbit, 531— Foreign bodies in
the eyeball, 532— Dislocation of the lens, 533— Injury to the eyeball by birds,

12 TABLE OF CONTENTS.

PAGES

533— Rare accident to the eye, 533— Epistaxis through the eyes, 534— Late res-
toration of sight, 535 — Sight spontaneously restored, 536— Nyctalopia, 536—
Henieralopia, 536— Snow-blindness, 537— Eetinal injury from exposure to intense
light, 537— Electric-light injuries of the eye, 537— Injuries to the ear, 537—
Boxing the ears, 537— Rupture of the tympanum, 537— Perforation of the tym-
panum, 538 — Objective tinnitus aurium, 538— Insects in the ear, 539— Other
foreign bodies iu the ear, 539— Scalp-injuries, 542— Cerebral injuries, 545— Pene-
tration and transfixion of the brain, 545— Gunshot injuries of the brain, 549 —
Study of gunshot injuries of tlie brain, 551— Head-injuries with loss of cerebral
substance, 551— " American Crow-bar Case," 551— Loss of brain-substance from
cerebral tumor, 557 — Extensive fractures of the cranium, 558— Diving into
shallow water, 559 — Fracture of the internal table of the cranium, 559— Fracture
of the cranial base, 559— Foreign bodies in the brain, 559— Injuries of the nose,
561 — Nose-making, 56 1— Deformities of the nose, 563— Insects in the nose, 563
— Foreign bodies in the nose, 564 — Tongue-swallowing, 565 — Tongue-sucking,
565 — Injuries to the tongue, 565— Regeneration of a severed tongue, 565 — Artic-
ulation without a tongue, 566— Hypertrophy of the tongue, 566— Macroglossia,
567— Living tish in the pharynx, 567— Leech in the pharynx, 569— Foreign
bodies in the pharynx and esophagus, 570— Migration of foreign bodies from the
esophagus, 571— Abscess or ulceration into neighboring blood-vessels, consequent
upon lodgment of foreign bodies in the esophagus, 571— Esophagotomy, 574—
Injuries of the neck, 574— Ligature of the common carotid artery, 575— Nonfatal
perforating wounds of the trachea and esophagus, 575— Self-decapitation, 576—
Cases of nonfatal cut-throat, 577— Injuries of the cervical vertebrae, 578— Foreign
bodies in the larynx and trachea, 580 — Impaction of artificial teeth in the larynx,
582— Excision of the larynx, 584— Injuries destroying great portions of the face
or jaw, but not causing death, 585 — A curious accident, 587.

CHAPTER XI.

SURGICAL ANOMALIES OF THE EXTREMITIES

Reunion of severed digits, 588— Reproduction and accidental production of
nails, 588— Avulsion of a finger with the entire tendon, 589— Avulsion of the
arm, 590— Avulsion of the leg, 592— Injuries to the sciatic nerve, 592— Recovery
of an injured member after extensive severance and loss of substance, 593— Rup-
ture of the quadriceps tendon, 594-Spontaneous fractures, 594— Evolution of
the treatment of dislocations, 594— Anomalous dislocations, 594-Congeuital
dislocations, 595— Major amputations, 596— Multiple amputations, 596— Sponta-
neous amputation. 597— Artificial limbs, 598— Dismembered athletes, 698-
Forei<ni bodies in the extremities, 599— Osteomalacia, 600— Rachitis, 601—
Achondroplasia, 602— Osteitis deformans, 603— Deformities of the articulations,
603— " Camel-boy," 603— Deformities from infantile spinal paralysis, 604—
Anomalous growth of bones of the extremities, 605.

CHAPTER XII.

SURGICAL ANOMALIES OF THE THORAX AND ABDOMEN • • 606-666

Injuries of the lung and bronchus, 606— Loss of lung-tissue, 607— Surgery
of the lung, 608— Excision of diseased portions of the lung, 608-Rupture of the
lung without fracture of the rib, 608- Spontaneous rupture of the lung, 609-
Penetration and transfixion of the thoracic cavity, 610-Recovery after major
thoracic wounds, 611-Wounds of the diaphragm, 612-Diaphragmatic hernia,
612-Peritonitis in the thoracic cavity, 613-Foreign bodies in the thoracic
cavity 613-Foreign bodies in the bronchi, 614-Cardiac injuries, 616-Instances

TABLE OF CONTENTS. 1^

PAGES

of survival after cardiac injuries, 617— Nonfatal cardiac injuries, 620— Foreign |
bodies in the heart, 624— Injuries to the pericardium, 624— Knptnre of tlie heart, ;
625— Displacement of the heart, 626— Hypertrophy of the heart, 626— Wounds
of the aorta, 626— Sundry cases of vascular injuries, 627— Rupture of the esoph-
agus, 628— Rupture of the stomach, 629— Voluntary vomiting, 630— Wounds of
the stomach, 630— Alexis St. Martin, 630— Gastric fistula?, 631— Gastrotomy
performed on kuife-swallowers, 633— Sword-swallowing, 633— Swallowing I
knives, pebbles, glass, etc., 635— Living animals in the alimentary canal, 636— ^
Other foreign bodies in the alimentary canal, 637— Hair-swallowing, 641— i
Foreign bodies in the intestines, 641— Foreign bodies in the vermiform appendix, .
642— Intestinal injuries, 642— Successful intestinal resection, 643— Sloughing of
the intestines following intussusception, 643— Rupture of the intestines, 644—
Operations upon the gastro-iutestinal tract, 644— Gastrostomy, 644— Pyloro-
plasty, 644— Pylorectomy, 644— Gastrectomy, 644— Enterostomy, 645— Colos-
tomy, 645— Intestinal anastomosis, 645— Foreign bodies in the rectum, 645 —
Transfixion of the abdomen, 648— Evisceration, 650— Nonfatal perforating gun-
shot wounds of the abdomen, 651— Bullets voided from the bowel and bladder,
651_Wouuds of the liver, 652— Surgery of the liver, 652— Resection of the liver,
654— Floating liver, 655— Hypertrophy of the liver, 655— Rupture of the gall-
bladder, 655 — Cholecystotomy and cholecystectomy, 655— Rupture of the spleen,

656— Wounds of the spleen, 656— Splenectomy, 656— Hypertrophy of the spleen,

657 — Injuries of the thoracic duct, 657— Ligation of the abdominal aorta, 658 —

Ligation of the common iliac artery, 658— Foreign bodies loose in the abdominal i
cavity, 658 — Foreign bodies in the skin and muscles of the back, 659 — Fracture j
of the lower spine, 659 — Laminectomy, 660 — Injuries to the spinal cord, 661 — j
Hernia, 662— Spontaneous rupture of the abdominal walls, 666. j

CHAPTER XIII.

SURGICAL ANOMALIES OF THE GENITOURINARY SYSTEM 667-696

Wounds of the kidney, 667 — Operations on the kidney, 668 — Rupture of the
ureter, 668 — Operations on the ureter, 669 — Stricture of the ureter, 669 — Rupture
of the bladder, 670 — Gunshot wounds of the bladder, 671 — Penetration of the
bladder through the anus, vagina, or buttocks, 671 — Arrow-wound of the bladder
through the buttocks, 672 — Wounds of the bladder followed by calculi, 673 —
Fistulse of the bladder, 675 — Worms in the bladder, 676 — Foreign bodies in the
bladder, 676 — Hair in the bladder, 678 — Foreign bodies in the pelvis, 678 — Rup-
ture of the urethra, 679 — Fracture of the penis, 679 — Urethral stricture, 680 —
Sundry injuries to the penis, 680 — Amputation of the penis, 680 — Gunshot
wounds of the penis, 681 — Luxation of the penis, 681 — Spontaneous retraction
of the penis, 681 — Spontaneous gangrene of the penis, 682 — Prolonged priapism,
683— Theories of priapism, 684— Injuries of the testicles and scrotum, 685 —
Avulsion of the male external genitalia, 686 — Preservation of sexual power after
injuries of the genitals, 687— Atrophy of tlie testicles, 687— Retraction of the
testicles, 688— Ectopia of the testicles, 688— Rupture of the spermatic vessels, 689
—Hydrocele, 689— Separation of an ovary, 689— Injuries of the vagina, 689 —
Rupture of the clitoris, 691— Discharge of the vaginal parietes, 691— Injuries
during coitus, 691— Foreign bodies in the vagina, 692— Long retention of pessa-
ries, etc., 693— Leech in the vagina, 694— Foreign bodies in the uterus, 695.

CHAPTER XIV.

MISCELLANEOUS SURGICAL ANOMALIES 697-758

Marvelous recoveries from multiple injuries, 697— Recoveries after injuries
by machinery, with multiple fractures, etc., 699— Miscellaneous multiple frac-

14

TABLE OF CONTENTS.

PAGES

tures, 701— Recoveries from high falls, 703— High dives, 704— Resistance of
children to injuries, 705— Instances of infant-vitality, 706— Operations on the
extreme young and old, 706— Repeated operations, 707— Billroth's marvelous
operation, 708— Self-performed surgical operations, 708— Instances of extensive
loss of blood, with recovery, 709— Extensive venesection, 709— Spontaneous
hemorrhages, 709— Arrow-wounds, 710— Arrow-poison, 711— Multiple arrow-
wounds, 711— Serious insect-stings, 713— Syphilis from a flea-bite, 714— Snake-
bites, 715— Hydrophobia, 719— Shark-bites, 721— Leprosy from a fish-bite, 721—
Alligator-bites, 722— Animal -bites, 722— Injuries from lightning-stroke, 722—
Recovery from lightning-stroke, 723— Therapeutic effect of lightning-stroke, 726—
Grafting, 728— Tooth-replantation, 728— Muscle-transplantation, 729— Tendon-
transplantation, 729— Nerve-grafting, 729— Bone-grafting, 729— Skin-grafting, 729
—Self-mutilations, 731— Self-castration, 732— Miscellaneous mutilations, 735—
"Needle-girls," etc., 735— Wanderings of pins and needles in the body, 736— Prick
of a pin causing death, 737— Manulacture of crippled beggars, 737— Chinese foot-
binding, 737— Professional leg-breaker, 741— Anomalous suicides, 742— Religious
and ceremonial mutilations, 743— Self-bleeding, 745— Exhibition of scars, 745—
Cosmetic mutilations, 746— Manufacture of dimples, 746— Amputation of the
fingers, 746— Knocking out the front teeth, 747— Depilatory customs, 747— Bor-
ing the ear, 749— Tattooing, 749— Infection from tattooing, 751— Infibulation,
752— Chastity-girdles, 753— Infibulation to prevent masturbation, 754 -Slitting
the urethra, 754— Mutilations of the genital organs to prevent conception, 754—
Circumcision, 754— Ceremonial ovariotomy, 755— Castration, 755— Eunuch-
makers, 756— Castration because of excessive cupidity, 756— Castration as a re-
ligious rite, 756— The Skoptzies, 757.

CHAPTER XV.

ANOMALOUS TYPES AND INSTANCES OF DISEASE 759-822

Tumors, 759— Adenoma of the breast, 759— Diffuse hypertrophy of the
breast, 759— Goiter, 761— Extirpation of the thyroid gland, 762— Fibromata,
762— Multiple fibromata of the skin, 762— Keloids, 764— Lipomata, 764— Chon-
dromata, 766— Benign bone-tumors, 768— Exostoses, 768-Gros-nez, 769— Neu-
romata, 770— Carcinomata, 772— Sarcomata, 772— Osteosarcoma, 772— Varicose
veins, 778— Aneurysmal varix, 778— Aneurysm, 779— Large uterine tumors,
780— Ovarian cysts, 782— Enormous dropsies, 786— Ankylosis of the articula-
tions, 787— " Ossified man," 787— Petrefaction, 788— Calculi, 788— Large vesical
calculi, 788— Vesical calculi in very young children, 790— Multiple vesical cal-
culi, 790— Renal calculi, 790— Other extravesical calculi, 791— Retention and
suppression of urine, 792— Persistent constipation, 794— Elephantiasis arabum,
795— Elephantiasis of the lower extremities, 795— Elephantiasis of the upper
extremities, 798 -Elephantiasis of the face and scalp, 798— Elephantiasis of the
breast, 800— Elephantiasis of the scrotum, 800— Statistics of operations on ele-
phantoid scroti, 803— Acromegaly, 803-Chiromegaly, 805-MegalocephaIy, 805
—Cretinism, 805-Sporadic cretinism, 806— Myxedema, 807— Cagots, 808— Per-
sistent hiccough, 811-Anomalous sneezing, 813— " Ear sneezing," 815-Herao-
philia, 815— Hemophilic purpura of the retina, 816— Hemorrhagic diseases of the
new-born, 816— Syphilis hsemorrhagica neonatorum, 816— Winckel's disease,
816— Barlow's disease, 817— Tetanus neonatorum, 817— Human parasites, 818—
Tapeworms, 818— Ascarides, 819-Trichinosis, 820— Ecchinococcus, 820— Fila-
ria sanguinis hominis, 820— " Eaten of worms," 821- Bot-fly, 821— Peenash,
822.

TABLE OF CONTENTS.

16

CHAPTER XVI.

PAGES

ANOMALOUS SKTN-DISEASES 823-851

Icthyosis, 823—" Porcupiue-mau, " 823— "Biped Armadillo," 823— "Alli-
gator-boy," 824— Harlequin fetus, 825— Contagious follicular keratosis, 825—
Keratodermia, 825— " Hide-bound disease," 826— Morphea, 826— Scleroderma
neonatorum, 826— " Elephant-man," 827— Ainhum, 828— Sclerodactylia annu-
laris ainhumoides, 832— Skin-shedding, 832— " Snake-boy, " 835— Dermatitis
exfoliativa neonatorum, 835— Epidemic exfoliative dermatitis, 835 — Sphacelo-
derma, 836— Raynaud's disease, 836— Spontaneous gangrene of the skin. 837 —
Neuroses of the skin, 837— Neuroma cutis dolorosum, 839 — Yaws, 839— Furun-
culosis orientalis, 840— Pigmentary anomalies, 841— Chloasma uterinum, 841—
Acanthosis nigricans, 841— Xeroderma pigmentosum, 842— Nigrities, 842—
Anomalous discolorations of the skin, 843— Metallic discolorations of the skin,
845— Melasma, 845— Leukoderma, 845— " Leopard -boy," 845— Canities un-
guium, 847— Plica polonica, 848— Tinea nodosa, 849— "Hair-eaters," 849— My-
cosis fungoides, 850— Universal dermatitis, 851.

CHAPTER XVII.

ANOMALOUS NEEVOUS AND MENTAL DISEASES 852-890

Anomalous types of epilepsy, 853-The dancing mania. 853—" Tarantism,"
854— Palmus, 855— Athetosis, 857— Paramyclouus multiplex, 859— Saltatoric
spasm, 859— Progressive muscular atrophy, 859— Facial hemiatrophy, 859— Lin-
gual hemiatrophy, 860— Astasia-abasia, 860— M6nifere's disease, 861— Mery-
cism, 862 -Wakefulness, 863-Somnambulism, 863-Pathognomonic dreams
867-Catalepsy, trance, and lethargy, 867-Hypnotism, 870-African sleep sickl
ness, 872 -Aphasia, 872— Aphasia after snake-bites, 874— Anosmia, 874— Hyper-
osmia, 875-Parosmia, 875-Perversion of the tactile sense, 875-Nostal-ia 876
-Hypochondria, 876-Fear-psychoses, 877-Aichmophobia, 877-Agoraphobia,
877-Acrophobia, 877-Thalassophobia, 877-Claustrophobia, 878-Astrophobia,
«^o~^ ^'n^ f'""' Q'^S-Hematophobia, 878-Anthropophobia and monophobia
«^o~J^!'r i""' ^^9-I^l«Pt«'»^^'^ia and kleptophobia, 879-Folie de doute

«In~n '""'^ fear-psychoses, 880-Demonomania, 880-Particular aversions
880-CircuIar insanity, 881-Katatonia, 882-A modern Pygmalion, 882-DoubIe
consciousness, 883-Morbid sympathy of twins as illustrated in the "Corsican
brothers, 887-Automatism, 887-Presentiment of approaching death, 889

CHAPTER XVni.

HISTORIC EPIDEMICS . . .

Preliminary remarks on the great plagues, 891-The black death 899
Mortality of, 893-Moral effect of, 894-The great ph^^L of London,' 8 'l
Modern bubonic plague in China, 896-Sweating sickness 896-Mortality of 897
-Chronologic table ol the principal plagues, 898-Small-pox, 903-Inoculation
905-Lady Montagu, 905-Vaccination, 906-Edward Jenner 90^ T
cholera, 908-Typhus fever, 910-Yello; fever, SlO-Le^osr 911 S^^^^^^
912-Tuberculosis, 913-Modern mortality f^m \nfeLotsXLs! qTs '

891-914

BIBLIOGRAPHIC INDEX
INDEX

915-929

ANOMALIES AND

CURIOSITIES OF MEDICINE.

CHAPTER I.
GEITETIC AISrOMALIES.

Menstruation has always been of interest, not only to the student of
medicine, but to the lay-observer as well. In olden times there were many
opinions concerning its causation, all of which, until the era of physiologic
investigation, were of superstitious derivation. Believing menstruation to
be the natural means of exit of the feminine bodily impurities, the ancients
always thought a menstruating woman was to be shunned ; her very presence
was deleterious to the whole animal economy, as, for instance, among the
older writers we find that Pliny ^ remarks : " On the approach of a woman
in this state, must will become sour, seeds which are touched by her become
sterile, grass withers away, garden plants are parched up, and the fruit
will fall from the tree beneath which she sits." He also says that the
menstruating women in Cappadocia were perambulated about the fields to
preserve the vegetation from worms and caterpillars. According to Flem-
ming,b 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
m a fortnight. Hence, Australian women during this season are forbidden
to touch anythmg that men use.« Aristotle said that the very look of a men-
struatmg woman would take the polish out of a mirror, and the next person
lookmg m it would be bewitched. Frommann<^ mentions a man who said
he saw a tree in Goa which withered because a catamenial napkin was hun^
on It. Bourke remarks that the dread felt by the American Indians in this
respect corresponds witli the particulars recited bv Pliny. Squaws at the
time of menstrual purgation are obliged to seclude' themselves, and in most
instances to occupy isolated lodges, and in all tribes are forbidden to
a 636, L. xxviii., cap. 23. b de Eemediis, 16 and 17

eFrazer, " The Golden Bough. " <i Trac^tatus de Fascinatione,'' Nurembe^ 1675.

18 GENETIC ANOMALIES.

prepare food for anyone save themselves. It was believed that, were a men-
struating woman to step astride a rifle, a bow, or a lance, the weapon would
have no utility. Medicine men are in the habit of making a " protective
clause whenever they concoct a "medicine," which is to the eifect that the
" medicine " will be effective provided that no woman in this condition is
allowed to approach the tent of the official in charge. , , ^ „
Empiricism had doubtless taught the ancient husbands the dangers oi
sexual intercourse during this period, and the after-resulte of many such con-
nections were looked upon as manifestations of the contagiousness of the evi
excretions issuing at this period. Hence at one time menstruation was held
in much awe and abhorrence.

On the other hand, in some of the eastern countries menstruation was
regarded as sacred, and the first menstrual discharge was considered so valua-
ble that premenstrual marriages were inaugurated in order that the first
ovum might not be wasted, but fertilii^ed, because it was supposed to be the
purest and best for the purpose. Such customs are extant at the present day
in some parts of India, despite the efforts of the British Government to sup-
press them, and descriptions of child-marriages and their evil results have
often been given by missionaries.

As the advances of physiology enlightened the mind as to he true nature
of the menstrual period, and the age of superstition gradual y 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 nncontrollable desire of the husband and
the mercenary afms of the prostitute furnish examples of modern disregaid
The anomalies of menstruation must natumlly have attracted much
attention and we find medical literature of all times replete with examples.

some are simply examples of vicarious or compensatory mens rua-
ion nd were so explained even by the older writers, there are many that are
phy iologic curiosities of considerable interest. Lh^ntier- furnishes the
iCted history of the case of a young girl who suffered from suppression
of m nses, which, instead of flowing through the nati^l channels, issued
perX% from vesicles on the leg for a period of six months, when
the seat of the discharge changed to an eruption on the left arm, and con-
"L thi location Ir one year ; then the discharge shifted to a sore on
the Imb and at the end of another six months agam changed, the next
the t lumo, am continued for a period of two

:r Br- :fe Z BolZrarMel'sner describe a case apparently identical

"'ir^^^a^is^^^^^^ ^ i ^

* Ind a half cites 18 instances of menstruation from the skin.
C^hr aUo mi:rd seve., cases of this nature. Chambers, speaks

a 476, 1861, i., 207.

MENSTRUATION FROM THE SKIN.

19

of bloody sweat occurring periodically in a woman of twenty-seven ; the
intervals, however, were occasionally but a week or a fortnight, and the exu-
dation was not confined to any one locality. Van Swieten quotes the
history of a case of suppression of the menstrual function in which there
were convulsive contractions of the body, followed by paralysis of the
right arm. Later on, the patient received a blow on the left eye causing
amaurosis ; swelling of this organ followed, and one month later blood
issued from it, and subsequently blood oozed from the skin of the nose, and
ran in jets from the skin of the fingers and from the nails.

D'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 men-
struation returned, but she never became pregnant, and, later, blood issued
from the healthy skin of the left breast and right forearm, recurring every
month or two, and finally additional dermal hemorrhage developed on the fore-
head. Microscopic examination of the exuded blood showed usual constituents
present. There are two somewhat similar cases spoken of in French literature.''
The first was that of a young lady, who, after ten years' suppression of the
menstrual discharge, exhibited the flow from a vesicular eruption on the
finger. The other case was quite peculiar, the woman being a prostitute,
who menstruated from time to time through spots, the size of a five-franc
piece, developing on the breasts, buttocks, back, axilla, and epigastrium.
Barham records a case similar to the foregoing, in which the menstru-
ation assumed the character of periodic purpura. Duchesne ^ mentions an
instance of complete amenorrhea, in which the ordinary flow was replaced
by periodic sweats.

Parrot speaks of a woman who, when seven months old, suffered from
strumous ulcers, which left cicatrices on the right hand, from whence, at the
age of six years, issued a sanguineous discharge with associate convulsions.
One day, while in violent grief, she shed bloody tears. She menstruated at
the age of eleven, and was temporarily improved in her condition ; but after
any strong emotion the hemorrhages returned. The subsidence of the bleed-
ing followed her first pregnancy, but subsequently on one occasion, when the
menses were a few days in arrears, she exhibited a blood-like exudation from
the forehead, eyelids, and scalp. As in the case under D'Andrad6's obser-
vation, the exudation was found by microscopic examination to consist of
the true constituents of blood. An additional element of complication in
this case was the occurrence of occasional attacks of hematemesis

Menstruation from the Breasts.-Being in close sympathy with the
generative function, we would naturally expect to find the female mammae

a 772 iQ«o , ,

c 656 1847 ^162,1829,212,236.

' <1 Monit. d' hOp, 1856, iv., 661.

20

GENETIC ANOMALIES.

involved in cases of anomalous menstruation, and the truth of this supposi-
tion is substantiated in the abundance of such cases on record. Schenck
reports instances of menstruation from the nipple ; and Richter, de Fonte-
chia, Laurentius,^ Marcellus Donatus,^ Amatus Lusitanus/^ and Bierling
are some of the older writers who have observed this anomaly. Par6 ^ says
the wife of Pierre de F^ure, an iron merchant, living at Chasteaudun,
menstruated such quantities from the breasts each month that several ser-
viettes were necessary to receive the discharge. Cazenave ^ details the his-
tory of a case in which the mammary menstruation was associated with a
similar exudation from the face, and Wolifs 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 men-
struated vicariously from the nipple and stomach. In a London discussion
there was mentioned ' the case of a healthy woman of fifty who never ^vas
pregnant, and whose menstruation had ceased two years previously, but who
for twelve months had menstruated regularly from the nipples, the hemor-
rhage 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. BoulgerJ mentions an instance of periodic men-
strual 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 men-
struation from an ulcer on the right mamma of a woman of twenty (PI. 1).
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 \ inch from its outer edge, imme-
diately under the nipple, there was an ulcer with slightly •elevated edges
measuring about 1^ inches across the base, and having an opening in its center
1 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

a 718, L. ii., obs. 228 ; L. iv., obs. 266. »> 480, L. vii., 278.

c 306, L. iv., c. 26. ^ 119, cent, ii., cur. 21.

e 618, 983. ^

g Obs. raed.-chir., L. i., n. 20. ^ 256, 1825.

1 AIR 1SR2 i 786 j 476, 1840-41, 1., 493.

m 789, 1872, xiv. , 845. ° Southern Jour, of Med. and Pharm. , Charleston, March, 1847.

PLATE I.

Menstruation from the breast (Baker).

MENSTRUATION FROM THE BREASTS.

23

matter were made to exude. This discharge, however, was not offensive to
the smell. On March 17, 1846, the breast became much enlarged and con-
gested, as portrayed in Plate 1 (Fig. 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 mens-
trual 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 pal-
metto. This happened just at the time of the beginning of the menstrual
epoch. The accompanying figures, Plate 1 (Figs. 1, 2), 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 yellow-
ish 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 ap-
peared 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,^i^ and Dodon^us all speak of menstrua-

1533, 1895, May 11th. . „

' ^ Zodiacus, etc., 1680.

24 GENETIC ANOMALIES.

tion from the eye. Jouston" quotes an example of ocular menstruation in
a young Saxon girl, and Bartholiuus ™ an instance associated witii bloody dis-
charge 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 suifered a sudden effusion into the anterior chamber of the eye.
The discliarge 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 ot
retinal hemorrhage m suppressed menstruation, and Sir James Paget says
that he has seen a young girl at Moorfields who Imd a small effusioii o
blood into the anterior chamber of the eye at the menstrual period, which
became absorbed during the intervals of menstruation. Blair « relates the
historv of a case of vicarious menstruation attended with conjunctivitis and
opacitv 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,' PauUini,' and Al-
bert t furnish examples. In PauUini's case the discharge is spoken of a.s
very foul, which makes it quite ' possible that this was a case of middle-ear
dis4se 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 fi^m «ars) which subse-
quentlv occurred periodically, being preceded by much throbb-ng ; 1 nvt the
patieni fiuallv macle a good recovery. Barnes,' Stepanoff,._ and Fielc^ ad-
duce examples of this anomaly. JouiUeton' relates an instance of men-
struation 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 Ephemer,des,'« Mei-
bomCs,- and Rhodius mention instances. The case of Meiboiui™ that
of an infant, and the case mentioned by Rhodius was associated with hemor-
rhages from the lungs, umbilicus, thigh, and tooth-cavity Allport^ rei^^rts
the historv of a case in which there was recession of the gingival margins
Ind alveolar processes, the consequence of amenorrhea. Caso" has an in-

b 476, 1882, i., 786.
a 145, vol. xlvi. io-q o • 11

0 Oglethorpe Med. and Surg^ Jour., Savannah, 18.8-9, x., 11.

d 224. 1869. e 748, n. 63. b -^T^ 1867

g Jour, de M6d. et Chir. de Toulouse, 184o-6. 313, IHbT.

1 317, 1826-7. .i 557, 1885, xxiv., 588-595. ^ 536 .xui.,
1 461 1813, 330. m4.50, 1885, iv., 147. -538, 18.8.

MENSTRUATION FROM ULCERS, ETC.

26

stance 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 men-
struation ; later the menstruation ceased to be regular, and four years pre-
viously, 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 men-
struation at the epoch of menstruation.

Descriptions of menstruation from the extremities are quite numer-
ous. 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 Kerck-
ring cites three similar instances, one of which was associated with hemor-
rhage 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 menstrua-
tion at an ankle-ulcer, and BrinckenJ 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 "bleed-
ing wounds " which are exhibited to the ignorant and superstitious for relig-
ious 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

a 663, 1757, 384.
*il90, cent, i., hist. 13.
g 124, 1859.
j Christiania, 1834.
^490, 1851, xlvii.

b 622, L. i.

e 104, dec. i., ann. i., obs. 96.
^ 473, obs. 60, 85.
1^476, 1879, i., 593.

c 831, L. ix., obs. 13.
f 595, 1841, iv., 215.
i 527, 1735, iii., 380.
1 476, 1885, ii., 515.
° 124, 1859.

26 GENETIC ANOMALIES.

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 "amenorrhea! ulcers." Dupuytren^ speaks of denuda-
tion 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 g 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. Ast-
bury 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 Sahnuth^ speaks of a pregnant woman who had her
monthly flow by the urinary tract. Ford j illustrates this anomaly by
the case of a woman of thirty-two, who began normal menstruation at four-
teen • 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
floatino- kidney in this case may have been responsible for this hemorrhage,
and in^eading 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 aii 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 Keview ° 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

a 310, 1873. b 125, 1884, 912-914. c 547 1882-3. ^ 381 1879.

e Month. Jour. Med. Sci., Lond. , 1855, xx., 347. ^ 363, 1828, i 85^

g ' 1 1840 h 809, 1875. ' 706, cent, in., obs. 36.

g 511, 184U. , J ..

j 125, vol. xxn., 154. ^ 831, L. ix., ods f*. ,

m476, 1880, i., 15. - 548, 1884, i., 662. « 22, 1873, i., 296.

MENSTRUATION IN MAN.

27

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 men-
tioned that reported by Parvin " seen in a woman, who, at the menstrual epoch,
suffered hemoptysis and oozing of blood from the lips and tongue. Occa-
sionally 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 mammie, are found in the older
writers. 'I 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 menstrua-
tion after death, and Testa s 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,i 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 mstances, and modern illustrations are constantly reported
_ Menstruation in Man.-Periodic discharges of blood in man,'constitut-
mg what IS called "male menstruation," have been frequently noticed and
are particularly interesting when the discharge is from the penis or urethra
furnishmg 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 i

^ 306, L. iv., 19. b 108, dec. i., vol. iv., 69. c 764 i«77

d 282, 1733, 359 : and 105, vol. iii ann 168 » Zn

^ 104, dec. iii., ann. iv., obs. 18. ' 758 215 Ion' f

i 724, 217. . obs. 8.

•'190, cent, v., hist. 33.

28

GENETIC ANOMALIES.

mentions a case in a youth ; the Ephemerides several instances ; Zacutus
Lusitanus, Salmuth," Hagedorn, Fabricius Hildanus, Vesalius/ Mead, «
and Acta Eruditorum-i all mention instances. Forel <^ saw menstruation in
a man. Gloninger ' tells of a man of thirty-six, who, since the age of
seventeen years and five months, had had lunar manifestations of menstrua-
tion. Each attack was accompanied by pains in the back and hypogastric
region, febrile disturbance, and a sanguineous discharge from the urethra,
which resembled in color, consistency, etc., the menstrual flux. King^ re-
lates that while attending a course of medical lectures at the University of
Louisiana he formed the acquaintance of a young student who possessed the
normal male generative organs, but in whom the simulated function of men-
struation was periodically performed. The cause was inexplicable, and the
unfortunate victim was the subject of deep chagrin, and was afflicted with
melancholia. He had menstruated for three years in this manner : a fluid
exuded from the sebaceous glands of the deep fossa behind the corona
glandis ; this fluid was of the same appearance as the menstrual flux. The
quantity was from one to two ounces, and the discharge lasted from three to
six days. At this time the student was twenty-two years of age, of a
lymphatic temperament, not particularly lustful, and was never the victim
of any venereal disease. The author gives no account of the after-life of
this man, his whereabouts being, unfortunately, unknown or omitted.

Vicarious Menstruation in the Male.— This simulation of menstrua-
tion by the male assumes a vicarious nature as well as in the female. Van
Swieten ^ quoting from Benivenius, relates a case of a man who once a month
sweated great quantities of blood from his right flank. Pinel mentions a
case of a captain in the army (M. Regis), who was wounded by a bullet m
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 e vacua-
tion since puberty, or shortly after his first sexual intercourse. He would
experience pains of the premenstrual type, about twenty-four hours before
the appearance of the flow, which subsided when the menstruation began.
He was of an intensely voluptuous nature, and constantly gave himself up to
sexual excesses. The flow was abundant on the first day, diminished on the
second, and ceased on the third. Halliburton,^ Jouilleton, and Rayman also

record male menstruation.

Cases of menstruation during pregnancy and lactation are not rare.

a 706, cent, iii., obs. 47. ^ 803, K v cap. 15. « 515, 369.

d 106 ann. 1688, 228. ^ 239, 1869. ^129, 1819.

„ ot;i i«R7 ^ 755, vol. xiii., sect. 1286.

i 302 iv 192. j We^^ly ^^^^

FEE CO CIO US MENSTR UA Tl ON.

29

It is not uncommon to find pregnancy, lactation, and menstruation coexist-
ing. No careful obstetrician will deny pregnancy solely on the regular
occurrence of the menstrual periods, any more than he would make the diag-
nosis of pregnancy from the fact of the suppression of menses. Blake *
reports an instance of catamenia and mammary secretion during pregnancy.
Denaux de Breyne mentions a similar case. The child was born by a face-
presentation. De Saint-Moulin ^ cites an instance of the persistence of men-
struation during pregnancy in a woman of twenty-four, who had never been
regular ; the child was born at term. Gelly speaks of a case in which
menstruation continued until the third month of pregnancy, when abortion
occurred. Post,^ in describing the birth of a two-pound child, mentions
that menstruation had persisted during the mother's pregnancy. Rousset *
reports a peculiar case in which menstruation appeared during the last four
months of pregnancy.

There are some cases on record of child-bearing after the menopause,
as, for instance, that of Pearson,^ of a woman who had given birth to nine
children up to September, 1836 ; after this the menses appeared only slightly
until July, 1838, when they ceased entirely. A year and a half after this
she was delivered of her tenth child. Other cases, somewhat similar, will
be found under the discussion of late conception.

Precocious menstruation is seen from birth to nine or ten years. Of
course, menstruation before the third or fourth year is extremely rare, most
of the cases reported before this age being merely accidental sanguineous
discharges from the genitals, not regularly periodical, and not true catamenia.
However, there are many authentic cases of infantile menstruation on record,
which were generally associated with precocious development in other parts as
well. Billard says that the source of infantile menstruation is the lining
membrane of the uterus ; but Camerer explains it as due to ligature of the
umbilical cord before the circulation in the pulmonary vessels is thoroughly
established. In the consideration of this subject, we must bear in mind the
influence of climate and locality on the time of the appearance of menstruation.
In the southern countries, girls arrive at maturity at an earlier age than
their sisters of the north. Medical reports from India show early puberty
of the females of that country. Campbell remarks that girls attain the age
of puberty at twelve in Siam, while, on the contrary, some observers report
the fact that menstruation does not appear in the Esquimaux women until
the age of twenty-three, and then is very scanty, and is only present in the
summer months.

Cases of menstruation commencing within a few days after birth and
exhibitnig periodical recurrence are spoken of by Penada,^ Neues Han-

e 4?6 1836 ' "^^^^ Bordeaux, 1856.

' Saggio d'osservazioni, iii.

30 GENETIC ANOMALIES.

noverisches Magazii^ Drummond,^ Buxtorf,c Arnold,^ The Lancet,e .^d
the British MedicalJournal. f .^^fimimcr
Cecil ^ relates an instance of menstruation on the sixth day, con mu ng
for five davs, in which six or eight drams of blood >vere lost. Peeples

tes In in;ta;.cc in Texas in an infant at the age of five ^^r^^ ^^'^^
associated .ith a remarkable development of the -g-^ff "

Van Swieten offers an example at the first mond, ; he Br^-h "
Journal' at the second month ; Conarmond at the third month. Ysabel a
; ; slave girl belonging to Don Carlos Pedro of f^:>^^:^
menstruate so^n after birth, and at the first year was regular m th s function,
l UTher mamm. were well developed and her axilla, -re ^^'S'^^f
fred with hair. At the age of thirty-two months she was three feet ten
Zles tall and her genitals and mamma, resembled those of a g.rl of th.r-
te i H r voice Js grave and sonorous ; her moral inclinafons were not
Inown Deever- records an instance of a child two years and seven

mSs olX with the exception of three ^f-;''y^Z::^
remlarlv since the fourth month. Harle >■ speaks of a child, the youngest
of t e g rls, who had a bloody discharge at the age of five months which

+.,nPP thp size of the right, but displayed nothmg striKingiy
ovary was f^J^^^;;^;,;,, j|,aical Journal' cite instances of men-

abnormal. Baillot and tne D .^^^^^^

a ed at the age ot s , descriptions of cases

whose menses began at he twenty ^.^

„p to the time of -Port-g- ^^^^^ J g;,,, ,t the hip was

?3;rchr r "broad andU shaped, and measured lOi

bood 1R7q ii 47 ' 107, vol. vii., 107.

a 586, xvii., 1519. ^ 224, 18.9, n., 47. ^ ^^^^

g 494, 1885. . o.f ' 1 44 1883 ii 1141. -224, 1879, i., 801.

j 599, 1829. ^ 224, 1880, i., 848. ^ 224 1883 a., ^ ^^^^

n 476 1827. o 548, 1864, 382. P 516, 1828.

PRE CO CIO US MENSTR UA TION.

31

inches from the anterior surface of the spinous process of one ilium to that
of the other, being a little more than the standard pelvis of Churchill, and,
in consequence of this pelvic development, her legs were bowed. The
mammae and labia had all the appearance of established puberty, and the
pubes and axillae were covered with hair. She was lady-like and maidenly
in her demeanor, without unnatural constraint or effrontery. A case some-
what similar, though the patient had the appearance of a little old woman,*^ was
a child of three whose breasts were as well developed as in a girl of twenty,
and whose sexual organs resembled those of a girl at puberty. She had
menstruated regularly since the age of two years. WoodrutF*^ describes a
child who began to menstruate at two years of age and continued regularly
thereafter. At the age of six years she was still menstruating, and exhibited
beginning signs of puberty. She was 118 cm. tall, her breasts were devel-
oped, and she had hair on the mons veneris. Van der Veer ^ mentions an
infant who began menstruating at the early age of four months and had
continued regularly for over two years. She had the features and develop-
ment of a child ten or twelve years old. The external labia and the vulva
in all its parts were well formed, and the mons veneris was covered with a
full growth of hair. Sir Astley Cooper, Mandelshof, the Ephemerides,
Rause, Geolfroy-Saint-Hilaire, and several others'^ report instances of
menstruation occurring at three years of age. Le Beau « describes an infant-
prodigy who was born with the mammae well formed and as much hair on
the mons veneris as a girl of thirteen or fourteen. She menstruated at three
and continued to do so regularly, the flow lasting four days and being
copious. At the age of four years and five months she was 421 inches tall ;
her features were regular, the complexion rosy, the hair chestnut, the eyes
blue-gray, her mammae the size of a large orange, and indications that she
would be able to bear children at the age of eight. Prideaux cites a case at
five, and Gaugirau Casals, a doctor of Agde, ^ has seen a girl of six years
who suffered abdominal colic, hemorrhage from the nose, migraine, and neu-
ralgia, all periodically, which, with the association of pruritus of the genitals
and engorged mammae, led him to suspect amenorrhea. He ordered baths,
and shortly the menstruation appeared and became regular thereafter!
Brierre de Boismont records cases of catamenia at five, seven, and eight
years ; and Skene « 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 t« the ordinary time of puberty, many cases are
recorded.

«^ 476, Jan. 29, 1848, 137. b 533, March 7, 1896. c 125

d 458, Jan., 1811, 115 ; 468, 1809, ix., 96 ; and 109, iv., 44. e 104' iggo' xi 42

f 302, iv., 203. g738 49 ■

32

GENETIC ANOMALIES.

Instances of protracted menstruation are, as a rule, reliable, the indi-
viduals themselves being cognizant of the nature of true menstruation, and
themselves furnishing the requisite information as to the nature and perio-
dicity 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,

18 " 51 " ^'

18 52 "

11 " 53 "

13 " 54 "

5 " 55 "

4 56 "

3 at 57 years of age,

3 " 58 " •
1 "59 "

4 " 60 "
4 " 62 "
3 " 63 "

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 sim-
ilar nature : —

Late Dentition.
Male. Female.

Between 40 and 50 0

50 " 60 1

60 " 70 . . .

70 " 80 . . .

80 " 90 . . .

90 " 100 .

Above 100 ...

1

3
3
6
1

6

20

4
4
2
2
2
1
1

16

Late
Lactation.

0
2
1
0
0
0
0

Late
Menstruation.

0

1

0
7
0

1

1

JO

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 fiftv-five years. Motte speaks of a case at sixty-one ; Ryan and
others, at fiftv-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 seve'nty-ei^ht ; Beyrat,« at eighty-seven ; Haller, at one hundred ; and high-
est of all is Blancardi's case, in which menstruation was present at one hun-
dred 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 Nosol-

a 476, 1883, i., 485. ^ 548, 1866, i., 407. ^ 147, ann. xiii.

LATE ESTABLISHMENT OF MENSTRUATION.

33

383 there are instances occurring at seventy-one, eighty, and ninety years.
There was a woman in Italy whose menstrual function continued from twen-
ty-four to ninety years.'' Ennnet ^ cites an instance of menstruation at
seventy, and Brierre de Boismont one of a woman who menstruated regu-
larly 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 mar-
ried a vigorous negro of thirty-five and experienced little difficulty in satisfying
his desires. Du Peyrou de Cheyssiole and Bonhoure speak of an aged peas-
ant Avoman, 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 hemor-
rhagic discharge. On April 23d she was seized again, and a discharge com-
menced 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 sou, in the
second ascribed to fright. It seemed to be a peculiar family idiosyncrasy
Velasquez of Tarentum s 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 groA^i:h 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 mar-
ried many years, and whose menstruation did not appear until her fortv-
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 co!ic in
her fifty-seventh year, she had the usual prodromes of menstruation followed
by the usual discharge. Rodsewitchi speaks of a widow of a peasant who

a 124, vol. vii, o. s., 514. b 125, 1886, 152. c 519 ir^i

d 280, 1787, xiv., 32. e 207 Feb 1840 f r! '

. 22^ 1840 (t^nslation). . f^^, ^r^%,^ [^^J- ^^52, 148.

34 GENETIC ANOMALIES.

menstruated for the first time at the age of thirty-six. Her first coitus took
pUice 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 smce the
catamenial flow had shown itself with great regularity. She had borne
twins in her second, fourth, and eighth confinement, and altogether had lb
children Holdefrund in 1836 mentions a case in which menstruation did
not commence until the seventieth year, and Hoy er - mentions one delayed
to the sev^ntv-sixth year. Marx of Krakau^ speaks of a woman, aged
forty-eio-ht, wlio 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, bhe
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. ^- • ^ ii

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 authori-
ties 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 .adth, more
than substantiates this supposition. Similar examples of precocious pelvic
and sexual development are on record in abundance, and nearly every medi-
cal man of experience has seen cases of infantile masturbation.

The ordinary period of female maturity is astonishingly late when com-
pared with the lower animals of the same size, particularly when viewed
w'th cases of animal precocity on record. Bertholde .peaks of a kid four-
Ten davs old which was impregnated by an adult goat ..id at he usual
period of gestation bore a kid, which was mature but weak, to which it gav
Tilk in abundance, and both the mother and kid grew up strong Compared
with the above, child-bearing by women of eight is not extraordinary.

a 108, 1712. ^ 657, 1889, 9. c 124, 1853. ^ 302, iv., 193. e .02, 32.

PRECO CIO US IMPREGNA TION.

35

The earliest case of conception that has come to the authors' noti(!e is a
quotation in one of the last century books from von Mandelslo'' of im})rej!;-
nation at six ; but a careful search in the British Museum failed to confirm
this statement, and, for the present, Ave 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 1 779 was in a child who had menstruated at two, and
bore a dead fetus when she was but eiglit 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 impreg-
nated 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 con-
ception in a girl of nine, and as far north as St. Petersburg a girl has become
a mother before nine years. The Journal de Sgavans, 1684,-i7o 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 Ephemeri-
dcs, Wolffius,'' Savonarola,^ and others.^ Gleaves ' reports from'Wythevillo
Va., the history of what he calls the case of the youngest mother in Vircri„ia
—Annie H.— who was born in Bland County, July 15, 1885, and, on Sep-
tember 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

l!^^ , .. 1878-9. c 362, March 8, 1878.

g /14, cap. 21, n. 6. h 459, t. xxxvii., 542. i 538, Nov 16 1895

36

GENETIC ANOMALIES.

existence (as it only lived a week) by its grandmother, who had a child only
a few months old. ' The parents of this child were prosperous, intelligent, and
worthy people, and there was no doubt of the child's age. Annie is now
well and plays about with the other children as if nothing had happened."
Harris refers to a Kentucky woman, a mother at teii years, one in Massachu-
setts a mother at ten years, eight months, and seventeen days, and one in Phila-
delphia at eleven years and three months. The first case was one of infantile
precocity, the other belonging to a much later period, the menstrual function
having been established but a few months prior to conception. All these
girls had well-developed pelves, large mammse, and the general marks of
womanhood, and bore living children." It has been remarked of 3 very
markedlv precocious cases of pregnancy that one was the daughter of very
humble parents, one born in an almshouse, and the other raised by her mother
in a house of prostitution. The only significance of this statement is the
greater amount of vice and opportunity for precocious sexual intercourse to
which they were exposed ; doubtless similar cases under more favorable con-
ditions would never be recognized as such.

The instance in the Journal deSgavans 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| 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,
livino- 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 chdd
was a bov 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 nme
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

, 2,0 1775 ^ 783, vol. vii. ^ 218, Feb. 19, 1863.

a 280, 17/5 . f 125, 1874.

d 302, xxxu., 394. ^ ^Di^-

PRECOCIOUS IMPREGNATION.

37

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. A¥ilson « 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 Avho acknoAvledged 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,J 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.

a Au editorial article in the Indian Medical Gazette of Sept., 1890, says :—
"Tiie appearance of menstruation is held by the great majority of natives of India to
be evidence and proof of marriageability, but among the Hindu community it is considered
disgraceful that a girl should remain unmarried until this function is established. The con-
sequence is that girls are married at the age of nine or ten years, but it is understood or pro-
fessed that the consummation of the marriage is delayed until after the first menstrual period.
There is, however, too much reason to believe that the earlier ceremony is very Irequently,
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 ))y 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 Beucml Presidency
during tlie years 1870-71-72.

"Eeform must come from conviction and effort, as in every other case, but meantime the
strong arm of the law should be put forth for the protection of female children from the
degradation and hurt entailed by premature sexual intercourse. This can easily be done by
raising the age of punishable intercourse, which is now fixed at the absurd limit often years
Menstruation very seldom appears iu native girls before the completed age of twelve 'vears'
and If the 'age of consent' were raised to that limit, it would not interfere with the preju-
dices and customs which insist on marriage before menstruation."

h 434, Feb., 1845. c 318, 1861-2. d 476, 1868, ii., 618. e 545 1873

f 286, 1889. g 729, 1859. h 538, 1885. i 593, 1873. .i 668! 1875:

1^143, 1875. 1 526, 1855, xi., 203. m218, 1846-7. n 822, 1876. o 131, 1874.

38

GENETIC ANOMALIES.

In 1816 some girls were admitted to the Paris Maternite as young as
thirteen, and during the Revohition 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, ^vho 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 preg-
nancy before the appearance of menstruation : Ballonius, Vogel, Mor-
gagni, the anatomist of the kidney, Schenck, Bartholinus, Bierling, Zacchias,
Charleton, Mauriceau, Ephemerides, and Fabricius Hildanus.

In some cases this precocity seems to be hereditary, being transmitted
from mother to daughter, bringing about an almost incredible state of affairs,
in which a girl is a grandmother about the ordinary age of maternity. Kay
says that he had reported to him, on " pretty good " authority, an instance
of a Damascus Jewess who became a grandmother at twenty-one years. In
France « they record a young grandmother of twenty-eight. Ketchum<^
speaks of a negress, aged thirteen, who gave birth to a well-developed child
which began to menstruate at ten years and nine months and at thirteen
became pregnant ; hence the negress was a grandmother at twenty-five years
and nine months. She had a second child before she was sixteen, Avho 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 INIarch,
1883, gave birth to a 9-pound boy. The youthful grandmother, not twenty-
nine, \vas present at the birth. This case was remarkable, as the children

were both legitimate.

Fecundity in the old seems to have attracted fully as much attention
among the older observers as precocity. Pliny speaks of Cornelia, of the
family of Serpios, who bore a son at sixty, who was named Volusius
Saturnius ; and Marsa, a physician of Venice, was deceived in a pregnancy

a 490 1848 ^ 224, 1885, ii., 913. ^ 365, 1867, No. 291.

d 770,' 1849.' ' 494, June 9, 1883.

FECUNDITY IN THE OLD.

39

in a woman of sixty, his diagnosis being " dropsy." Tarenta records the history
of the case of a woman who menstruated and bore children when past the
age of sixty. Among tlie okler reports are tliose of Bkmcliard " of a woman
who bore a child at sixty years ; Fielitz,^^'' one at sixty ; Ephemerides, one
at sixty-two ; Rush,*^ one at sixty ; Bernstein,2oi one at sixty years ; Schoepfer,
at seventy years ; and, almost beyond belief, Debes cites an instance as tak-
ing place at the very advanced age of one hundred and three. Wallace^*
speaks of a woman in the Isle of Orkney bearing children when jmst 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 ; Hauler, cases at fifty-eight,
sixty-three, and seventy ; Dewees, at sixty-one ; and Thibaut de Chauvalon,
in a woman of Martinique aged ninety years. There was a woman delivered
in Germany, in 1723, at the age of fifty-five ; one at fifty-one in Kentucky ; ®
and one in Russia at fifty. ^ Depasse^ speaks of a woman of fifty-nine years
and five months old who was delivered of a healthy male child, which she
suckled, weaning it on her sixtieth birthday. She had been a widow for
twenty years, and had ceased to menstruate nearly ten years before. In St.
Peter's Church, in East Oxford, is a monument bearing an inscription re-
cording the death in child-birth of a woman sixty-two years old. Cachot ^
relates the case of a woman of fifty-three, who was delivered of a living
child by means of the forceps, and a year after bore a second child without
instrumental interference. She had no milk in her breasts at the time and
no signs of secretion. This aged mother had been married at fifty-two, five
years after the cessation of her menstruation, and her husband was a young
man, only twenty-four years old.

Kennedy i 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." (^uite recently there died in Great Britain a Mrs. Henry
of Gortree at the age of one hundred and twelve, leaving a daughter of nine
years.

May ham J saw a woman seventy-three years old who recovered after
delivery of a child. A most peculiar case is that of a widow, seventy years
old, a native of Garches.^ She had been in the habit of indulging freely in
wine, and, during the last six months, to decided excess. After an\nusually
prolonged libation she found herself imable to walk home ; she sat down by
the roadside waiting until she could proceed, and was so found by a young
man who knew her and who proposed helping her home. By the time her

a 213, cent, iv., u. 71. b (596 ii. c 290, 248. d 629 vol xxii 543

e 133, 1872, vi., 138. f 811, 1881, vi. g 364 Qct 1 1891

^ 616, 1883-4, xxvi., 394. i 769, 1881. j 542, Jan., 1891. k 739,' Dec. 3, 1881.

40

GENETIC ANOMALIES.

house was readied 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 c^uotes a rather fabulous account of a lady over sixty-two years
of age who gave birtli to triplets, making her total number of children
13. INIontgomery, 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 fer-
tilization, as their power of motility and tenacity of life have been well dem-
onstrated. Percy ^ reports an instance in which semen was found issuing
from the os uteri eight and one-half days after the last intercourse ; and a
microscopic examination of this semen revealed the presence of living as well
as dead spermatozoa. We have occasional instances of impregnation by
rectal coitus, the semen finding its way into an occluded vaginal canal by a
fistulous communication.

• Guillemeau,«i the surgeon of the French king, tells of a girl of eighteen,
who was brought before the French officials in Paris, in 1607, on the cita-
tion of her husband of her inability to allow him completion of the marital
function. He alleged that he had made several unsuccessful attempts to
enter her, and in doing so had caused paraphimosis. On examination by
the surgeons she was found to have a dense membrane, of a fibrous nature,
entirely occluding the vagina, which they incised. Immediately afterward
the woman exhibited morning sickness and the usual signs of pregnancy, and
was delivered in four months of a full-term child, the results of an impreg-
nation occasioned by one of the unsuccessful attempts at entrance. Such
instances are numerous in the older literature, and a mere citation of a few
is considered sufficient here. Zacchias,*^ Amand, Fabricius Hildanus, Graaf,
the discoverer of the follicles that bear his name, Borellus, Blegny, Blanchard,^
Diemerbroeck,« Duddell, Mauriccau, i\ Reyes, Riolan,'^ Harvey, the discoverer
of the circulation of the blood,» Wolfius, Walther, Rongier,' Ruysch, For-
estus, Ephemerides,^ and Schurig all mention cases of conception with intact

a 476, 1867, i., 727.
d 389, L. ii., chap. 8, fol. 108.
g 303, L. i., c. 23.
j 462, T. xlix., 358.

b 538, 1889.
e 830, n. 42.
h686, L. ii., c. 37.

kl04.

c 130, March 9, 1861.
f 213, cent. iii.
i 405, L. ii., c. 11.
Dec. 1, ann. iii., obs. 273.

IMPREGNATION AFTER INCOMPLETE COPULATION. 41

hymen, and in which there was no entrance of the penis. Tolberg has
an example of hymen integrum after tlie birtli 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. Sinmions of St. Louis'' gives
a curious peculiarity of conception, in which there was complete closure of
the vagina, subsequent conception, and delivery at term. He made the
patient's acquaintance from her application to him in regard to a malcondi-
tion of her sexual apparatus, causing much domestic infelicity.

Lawson ^ speaks of a woman of thirty-five, who had been married ten
months, and whose husband could never effect an entrance ; yet she became
pregnant and had a normal labor, desj)ite the fact that, in addition to a tough
and unruptured hymen, she had an occluding vaginal cyst. Hickinbothani
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 tlie tip of the first finger on account of the dense cicatricial
membrane in the orifice, but who gave birth, with comparative ease, to a
child at full term, the only interference necessary being a few slight incisions
to permit the passage of the head. Tweedies saw an Irish girl of twenty-
three, with an imperforate os uteri, who had menstruated only scantily since
fourteen and not since her marriage. She became pregnant and went to
term, and required some operative interference. He incised at the point of
usual location of the os, and one of his incisions was followed by the flow of
liquor amnii, and the head fell u])on the artificial opening, the diameter of
which proved to be one and a half or two inches ; the birth then progressed
promptly, the child being born alive.

Guerard ^ notes an instance in which the opening barely admitted a hair ;
yet the patient reached the third month of pregnancy, at which time she
induced abortion in a manner that could not be ascertained. Roe gives a

a Collect. Acad, de M6d., Paris, 1756, xii., 151. b ojg 187'> 298

c 703, 1847, 62-69. d 224, 1885, i, 1202. e 224^ 188l', i., 1001.

313, 1862. g 490, vol. xx., 202. h 261, 1895, No. 15.

42

GENETIC ANOMALIES.

case of conception in an imperforate uterus,'* and Duncan'' relates the history
of a case of pregnancy in an unruptured hymen, characterized by an extra-
ordinary ascent of tlie 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,j 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 rup-
tured by external means the labor is often effectually obstructed. Among
others reporting cases of this nature are Beale,' Carey,'" Davis, Emond,"
Fethcrston, Leisenring," Mackinlay,!' Martinelli, Palmer,^ Eousseau, Ware,
and Yale.""

There are many cases of stricture or complete occlusion of the vagina, con-
genital or acquired from cicatricial contraction, obstructing delivery, and in
some the impregnation seems more marvelous than cases in which the obstruc-
tion 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 suffi-
cient, 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. Yerdile " records an instance of imperforate vagina in which the
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 Yerdile, in which rectal deliv-
ery 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

a 476, 1851, i., 564. b 769, 1875, iii, 91-93.

c Wien. Med. Wochen., 1876, xxvi., 289-316. ^ 435, 1871, vi., 253.

e 545, 1869, xxi., 314. f 476, 1851, i., 569. 8 812, 1882.

b 476 1876, ii., 237. i 180, 1870. j 547, 1873. k 592, 1858-9.

1 476,' I859', ii., 98. 525, 1855, i., 97. » 363, 1862, xxxv., 214.

o 547, 1870-1, 1., 395. P 476, 1840-1, i., 847. q 778, iv., 211.

r 218 1859-60, Ixi., 295, » Northwest Med. and Snrg. Jonr., St. Paul, 1870-71, 1., 183.

t 363 1849 i., 451. " Morgagui, Napoli, 1875, xvii., 747. ^ 368, 1831.

w Western Lancet, San Francisco, 1873-4, ii., 705. ^ 176, 1874-5, xii,, 457.

ARTIFICIAL IMPREGNATION.

43

hearsay, it has been demonstrated as a practical and useful metliod in those
cases in which, by reason of some unfortunate anatomic malformation on
either the male or the female side, the marriage is unfruitful. Tliere 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
librarv at Alexandria must have contained some information relative to it.
The first authentic account that we have of artificial impregnation is that of
Schwammerdam, who in 1680 attempted it without success by the fecunda-
tion of the eggs of fish. 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 impreg-
nated 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 tlie simple vaginal method ;
while Gigon, d'Angoul^me (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 im-
pregnating 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 injec-
tions of semen, and was finally delivered of a child. He also reports the
case of a distinguished musician who, by reason of hypospadias, had never

* 1^34. b 100, 1868, 409.

44

GENETIC ANOMALIES.

impregnated his wife, and had resorted to injections of semen witli a favor-
able result. This latter case seems hardly warranted when we consider
that men afflicted with hypospadias and epispadias have become fathers.
Percy gives the instance of a gentleman whom he had known for some
time, whose urethra terminated a little below the frenum, as in other persons,
but whose glans bulged (piitc prominently beyond it, rendering urination in
the forward direction impossible. Despite the fact that this man could not
perform the ejaculatory function, lie was the father of three children, two of
them inheriting his penile formation.

The fundamental condition of fecundity being the union of a spermato-
zoid and an ovum, the object of artificial impregnation is to further this union
by introducing semen directly to the fundus of the uterus. The operation is
quite simple and as follows : The husband, having been found perfectly
healthy, is directed to cohabit with his wife, using a condom. The semen
ejaculated is sucked up by an intrauterine syringe (Fig. 1) which lias been

properly disinfected and kept
warm. The os uteri is now
exposed and wiped off with
some cotton which has been
di])ped in an antiseptic fluid ;
the nozzle of the syringe is
introduced to the fundus of
the uterus, and some drops
of the fluid slowly expressed
into the uterus. The woman

Fig. l.-Apparatus for artificial impregnation. t^^en kept iu 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.*^
a 130, 1861.

t The following extraordinary incident of accidental impregnation, quoted from the
American Medical Weekly i by the Lancet,2 is given in brief, not because it bears any sem-
blance of poasibility, but as a curious example from the realms of imagination in medicine.

L. G. Capers of Vicksburg, Mi.ss., relates an incident during the late Civil War, as fol-
lows : A matron and her two daughters, aged fifteen and seventeen years, filled with the
enthu-siasm of patriotism, stood ready to minister to the wonnds of their countrymeu in their

fine residence near the scene of the battle of R , May 12, 1863, between a portion of

Grant's array 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 iu the
house near l)y. 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

1131, Nov. 7, 1874. = 476, 1875, L, 35.

CONCEPTION WITH DEFICIENT ORGANS.

45

Interesting- as are all the anomalies of conception, none are more so than
those of unconscious impregnation ; and some well-anthenticated cases
can be mentioned. Instances of violation in sleep, with subsequent preg-
nancy as a result, have been reported in the last century by Valentini,^'-^^ Gen-
selius,'' and Sclmrig. 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 subsetpiently became pregnant, though her
condition was not ascertained until the fourth month, the peculiar abdominal
sensation exciting suspicion of the true nature of the case, which had pre-
viously been thought impossible.

There is a record of a case ^ of a young girl of great moral purity who
became pregnant without the slightest knowledge of the source ; although, it
might be remarked, such cases must be taken " cum grano sails.''' Cases of
conception without the slightest sexual desire or pleasure, either from fright,
as in rape, or naturally deficient constitution, have been recorded ; as well
as conception during intoxication and in a hypnotic trance, which latter has
recently assumed a much mooted legal aspect. As far back as 1680,"^^^
Duverney speaks of conception without the slightest sense of desire or pleasure
on the part of the female.

Conception with Deficient Organs. — Having spoken of conception
with some obstructive interference, conception with some natural or acquired
deficiency of the functional, organic, or genital apparatus must be considered.
It is a well-known fact that women exhibiting rudimentary development of
the uterus or vagina are still liable to become pregnant, and many such cases
have been recorded ; but the most peculiar cases are those in which pregnancy
has appeared after removal of some of the sexual apparatus.

Pregnancy going to term with a successful delivery frequently follows
the performance of ovariotomy with astonishing rapidity. Olier ^ cites an

daughter suffered an attack of peritonitis, but recovered in two mouths under the treatment
admiuistered.

Marvelous to relate, just two luindred and seventy-eif^ht days after the reception of the
minie-ball, she was delivered of a fine boy, weighing 8 pounds, to the surprise of herself and the
mortification of her parents and friends. The hymen was intact, and the young mother strenu-
ously insisted on her virginity and innocence. About three weeks after this remarkable birth
Dr. Capers was called to see the infant, and the grandmother insisted that there was something
wrong with the child's genitals. Examination showed a rough, swollen, and sensitive scrotum
containing some hard substance. He operated, and extracted a smashed and battered minie-
ball. The doctor, after some meditation, theorized in this manner : He concluded that this was
the same bail 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 api)roaclied 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, tlie heroic pater famih'as.

a 104, 1715. b. 254, 86. c 525, 1855. d 363, xlv., 1140.

46

GENETIC ANOMALIES.

instance of ovariotomy with a pregnancy of twins three months afterward,
and accouchement at term of two well-developed boys. Polaillon * speaks of
a pregnancy consecutive to ovariotomy, the accouchement being normal at
term. Crouch^ reports a case of successful parturition in a patient who had
previously undergone ovariotomy by a large incision. Parsons ^ mentions a
case of twin pregnancy two years after ovariotomy attended with abnormal
development of one of the children. Cutter^' speaks of a case in which a
woman bore a child ,one year after the performance of ovariotomy, and
Pippingsk(')ld ® of two cases of pregnancy after ovariotomy in which the
stump as well as the remaining ovary were cauterized. Brown ^ relates a
similar instance with successful delivery. Bixby,*'' Harding,^ Walker
(1878—9), and Mears^ all report cases, and others are not at all rare. In
the cases following shortly after operation, it has been suggested that they
may be explained by the long retention of the ova in the uterus, deposited
there prior to operation. In the presence of such facts one can but wonder
if artificial fecundation of an ovum derived from another woman may ever
be brought about in the uterus of a sterile woman !

Conception Soon After a Preceding Pregnancy. — Conception some-
times follows birth (or abortion) with astonishing rapidity, and some women
seem for a period of their lives either always pregnant or with infants at
their breasts. This prolificity is often alluded to, and is not confined to
the lower classes, as often stated, but is common even among the nobility.
Illustrative of this, we have examples in some of the reigning families in
Europe to-day. A peculiar instance is given by SparkmanJ in which a
Avoman conceived just forty hours after abortion. Rice ^ mentions the case
of a woman who was confined with her first child, a boy, on July 31, 1870,
and was again delivered of another child on June 4, 1871. She had become
pregnant twenty-eight days after delivery. He also mentions another case
of a Mrs. C, who, at the age of twenty-three, gave birth to a child on
September 13, 1880, and bore a second child on July 2, 1881. She must
have become pregnant twenty-one days after the delivery of her first child.

Superf etation has been known for many centuries ; the Romans had laws
prescribing the laws of succession in such cases, and many medical Avriters have
mentioned it. Hippocrates and Aristotle wrote of it, the former at some length.
Pliny speaks of a slave who bore two infants, one . resembling the master, the
other a man with whom she had intercourse, and cites the case as one of super-
fetation. Schenck ^ relates instances, and Zacchias, Yelchius, and Sinibaldus
mention cases. Pare seemed to be well conversant with the possibility as
well as the actuality of superfetation ; and Harvey reports that a certain

a 168, 1879, vi., 243. b 550, xxxv., 71. c 476, 1866, i., 284. d 538, 1867-8.
e 321, 1880. f 548, 1854, ix., 566. g 476, 1881.

h 476, 1880, i., 93. i 547, 1879. J 264, 1876. k 122, 1881, 206.

1 L. iv., De Superfetation, 617. "^404, fol. 479.

SUPERFETA TION.

47

maid, gotten with child by her master, in order to hide her knavery came to
London in September, where she lay in by stealth, and being recovered,
returned home. In December of the same year she was unexpectedly deliv-
ered of another child, a product of superfetation, which proclaimed the crime
that she had so cunningly concealed before.

Marcellus Donatus, Goret, Schaclier,''" and Mauriceau " mention super-
fetation. In the Acadt^mie des Sciences, at Paris, in 1702, there was men-
tioned the case of a woman who was delivered of a boy ; in the placenta was
discovered a sort of bladder which was found to contain a female fetus of
the age of from four to five montiis ; and in 1729, before the same society, there
was an instance in which two fetuses were born a day apart, one aged forty
days and the other at full term. From the description, it does not seem pos-
sible that either of these were blighted twin pregnancies. Ruysch'' gives an
account of a surgeon's wife at Amsterdam, in 1G8G, 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 symptojiis
indicative of the existence of another fetus, and after five months and six-
teen days she Avas delivered of a remarkably strong and healthy child.

Baudeloque" speaks of a case of superfetation observed by Desgranges
in Lyons in 1780. After the birth of the first infant the lochia failed to
flow, no milk appeared in the breasts, and the belly remained large. In
about three weeks after the accouchement she had connection with her hus-
band, and in a few days felt fetal movements. A second child was born at
term, sixty-eight days after the first; and in 1782 both children M'ere
living. A woman of Aries'^ was delivered on November 11, 1796, of a
child at term ; she had connection with her husband four days after ; the
lochia stopped, and the milk did not flow after this intercourse. About one
and a half months after this she felt quickening again, and naturally sup-
posed that she had become impregnated by the first intercourse after confine-
ment ; but five months after the first accouchement she was delivered of
another child at term, the result of a su])erfetation. 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.

d ;'no o; ' " ^« 1'^^* Accouchemens, ii.

<i ^0^, IV., 181. e De saperfetation vera in utero simplici, Argeutor., 1755.

48

GENETIC ANOMALIES.

A peculiar instance of superfetation was reported by Langmore* in which
there was an abortion of a fetus between the third and fourth months, appar-
ently dead some time, and thirteen hours later a second fetus ; an ovum of
about four weeks and of perfect formation was found adherent near the
fundus. Tyler Smith ^ mentions a lady pregnant for the first time who
miscarried at five months and some time afterward discharged a small clot
containing a perfectly fresh and healthy ovum of about four weeks' forma-
tion. There was no sign of a double uterus, and the patient menstruated
regularly during pregnancy, being unwell three weeks before the abortion.
Harley and Tanner " speak of a woman of thirty-eight who never had borne
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 uter-
ine cavity an embryo of five or six weeks was found inclosed in a sac and
floating in clear liquor amnii. The patient was the mother of nine children,
the youngest of Avhich was three years old.

Young ^ speaks of a woman who three months previously had aborted a
three months' fetus, but a tumor still remained in the abdomen, the auscultation
of which gave evidence of a fetal heart-beat. Vaginal examination revealed
a dilatation of the os uteri of at least one inch and a fetal head pressing out ;
subsequently a living fetus of about six months of age was delivered. Se-
vere hemorrhage complicated the case, but was controlled, and convales-
cence speedily ensued. Huse « cites an instance of a mother bearing a boy
on November 4, 1834, and a girl on August 3, 1835. At birth the boy
looked premature, about seven months old, which 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 Avhite overseer immediately after
her husband left her bed. Dewees^ reports a similar case. Newlin of
Nashville • speaks of a negress who bore twins, one distinctly black with the

a 778, iv., 135. ^ 476, April 12, 1856. « 778, Lond., 1863, iv., 165-169.

d 124^ 1868. e 218, 1856, liv. 294: f Acad, de M6d., Aug., 1825.

g 629, Oct., 1745. ^301, 1805, T. clxxiv. i Quoted in 300, Sept., 1887.

CHILDREN OF DIFFERENT COLORS.

49

typical African features, while the other was a pretty mulatto exhibiting the
distinct characters of the Caucasian race. Both the parents were j)erfect
types of the black African negro. The mother, on being questioned, frankly
acknowledged that shortly after being with her husband she had lain a night
with a white man. In this case each child had its own distinct cord and
placenta.

Archer gives facts illustrating and observations showing: "that a
white woman, by intercourse with a white man and negro, may conceive
twins, one of which shall be white and the other a mulatto ; and that, vice
versa, a black woman, by intercourse with a negro and a white man, may
conceive twins, one of which shall be a negro and the other a mulatto."
Wight'* narrates that he was called to see a woman, the wife of an East
Indian laborer on the Isle of Trinidad, who had been delivered of a fetus
6 inches long, about four months old, and having a cord of about 18 inches
in length. He removed the placenta, and in about half an hour the woman
was delivered of a full-term white female child. The first child was dark,
like the mother and father, and the mother denied any possibility of its
being a white man's child ; but this was only natural on her part, as East
Indian husbands are so intensely jealous that they would even kill an un-
faithful wife. Both the mother and the mysterious white baby are doing
well. Bouillon"^ speaks of a negress in Guadeloupe who bore twins, one a
negro and the other a mulatto. She had sexual congress with both a negro
and a white man.

Delmas,^ a surgeon of 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 preg-
nancy, though living with the white man who first impregnated her. Two
placentae were expelled some time after the twins, and showed a mem-
branous junction. The children died shortly after birth.

Pregnancy often takes place in a unicorn or bicorn uterus, leading to sim-
ilar anomalous conditions. Galle, Hoffman, Massen, and Sanger give inter-
esting accounts of this occurrence, and 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.

a 541, 1809-10. bi24, July 6, 1895, 14. « Bull, de la Soci6t6 de M6d 1821
d 302, iv., 181. e M6dicin, Paris, 1879, v., No. 43. f 778, 1884, xxvi., 117.

4

CHAPTER II.

PEENATAL 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 Albnoasis,"' during the eleventh
century, extrauterine pregnancy is discussed, and later the works oi JN.
Polinus and Cordseus, about tlie sixteenth century, speak of it ; m the case
of Cordseus the fetus was converted into a lithopedion and earned m the
abdomen twenty-eight years. Horstius in the sixteenth century relates the
history of a woman who conceived for the third time in March, 154 <, and
in 1563 the remains of the fetus were still in the abdomen.

Israel Spach, in an extensive gynecologic work published in 1557, hg-
ures a lithopedion drawn in situ in the case of a woman with her belly laid
open He dedicated to this calcified fetus, which he regarded as a reversion,
the following curious epigram, in allusion to the classical myth that after the
flood the world was repopulated by the two survivors, Deuca lonand 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 tilings, 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 m
full extrauterine pregnancy, and Salmuth, Hann>eus, and Bartholinus describe
t From the beginning of the eighteenth century this subject always
demanded the attention and interest of medical observers In more modern
timet Campbell and Geoffroy-Saint-Hilaire, who named it "Grossesse Path-
rgi;ue," have carefully defined and classified the forms and to-day every
textbook on obstetrics gives a scientific discussion and classification of the
different forms of extrauterine pregnancy. „ t, „

The site of the conception is generally the wall of the uterus, the Fallo-
pian tube, or the ovary, although there are instances of pregnancy m the
vagina, as for example when there is scirrhus of the uterus - and again, cases

b 462, T. li.. 55.

a 844, 274.

TERMINATION OF EXTRAUTERINE PREGNANCY. 51

supposed to be only extrauterine have been instances simply of double uterus,
with single or concurrent pregnancy. Koss 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' develop-
ment. After a week she declared that she was still pregnant with another
child, but as the physician had placed his hand in the uterine cavity after the
abortion, he knew the fetus must be elsewhere or that no pregnancy existed.
AVe can readily see how this condition might lead to a diagnosis of extra-
uterine pregnancy, but as the patient insisted on a thorough examination, the
doctor found by the stethoscope the presence of a beating fetal heart, and
by vaginal examination a double uterus. On introducing a sound into the new
aperture he discovered that it opened into another cavity ; but as the woman
was pregnant in this, he proceeded no further. On October 31st she was
delivered of a female child of full growth. She had menstruated from this
bipartite uterus three times during the period between the miscarriage of the
twins and the birth of the child. Both the mother and child did well.

In most cases there is rupture of the fetal sac into the abdominal cavity
or the uterus, and the fetus is ejected into this location, from thence to be
removed or carried therein many years ; but there are instances in which the
conception has been found in situ, as depicted in Figure 2. A sturdy woman ^
of thirty was executed on January 16, 1735, for the murder of her child. It
was ascertained that she had passed her catamenia about the first of the
month, and thereafter had sexual intercourse with one of her fellow-prisoners.
On dissection both Fallopian tubes were found distended, and the left ovary,
which bore signs of conception, was twice as large as the right. Campbell
quotes another such case in a woman of thirty-eight who for twenty years
had practised her vocation as a Cyprian, and who unexpectedly conceived.
At the third month of pregnancy a hard extrauterine tumor was found,
which was gradually increasing in size and extending to the left side of the
hypogastrium, the associate symptoms of pregnancy, sense of pressure, pain,
tormina, and dysuria, being unusually severe. There was subsequently an
attack of inflammatory fever, followed by tumefaction of the abdomen, con-
vulsions, and death on the ninth day. The fetus had been contained in the
peritoneal coat of the ovary until the fourth month, when one of the feet
passed through the cyst and caused the fixtal 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 ojjeration after rupture ; in others the fetus has been
delivered alive by abdominal section ; it may be partially absorbed, or carried
many years in the abdomen ; or it may ulcerate through the confining walls,
enter the bowels or bladder, and the remnants of the fetal body be discharged'

a 476, 1871, ii., 189. b 527, vol. v ., 277.

52

PRENATAL ANOMALIES.

The curious cases mentioned by older writers, and called abortion
by the mouth, etc., are doubtless, in many instances, remnants of extra-
uterine pre<rnancies or dermoid cysts. INIaroldus '''' speaks in full of such
cases; Bartholinus, Salrauth,- and a Reyes ^ speak of women vomiting
remnants of fetuses. In Germany in the seventeenth century, there lived
a woman who on three diiferent occasions is said to have vomited a fetus. The
last miscarriage in this manner was of eight months' growth and was accom-

Fie 2 -Pregnant Fallopian tube laid open, showing the fetus killed by hemorrhage into its membranes, but
^' without the escape of the fetus from the tube (Tuttle aud Cragin).

panied by its placenta. The older observers thought this woman must have
had two orifices to her womb, one of which had some connection with the
stomach, as they had records of the dissection of a female in whom was found
a conformation similar to this.

Discharge of the fetal bones or even the whole of an extrauterine fetus
by the rectum is not uncommon. There are two early cases mentioned ^ in

a 706 cent, iii., No. 94. ^ Campus Elys. Jucund., Qu^st. 41, 90.

c 302; iv., 180. d629, 1748, 1015.

DISCHARGE OF FETUS FROM ABDOMINAL WALLS. 53

which the bones of a fetus were discharged at stool, causing intense pain.
Armstrong describes an anomalous case of pregnancy in a syphilitic patient
who discharged fetal bones by the rectum. Bubendorf ^ reports the sponta-
neous elimination of a fetal skeleton by the rectum after five years of reten-
tion, with recovery of the patient. Butcher speaks of delivery through the
rectum at the fourth month, with recovery. Depaul mentions a similar ex-
pulsion after a pregnancy of about two months and a half. Jackson *^ reports
the dissection of an extrauterine sac which communicated freely with the
large intestine. Peck ® has an example of spontaneous delivery of an extra-
uterine fetus by the rectum, with recovery of the mother. Skippon, ^ in the
early part of the last century, reports the discharge of the bones of a fetus
through an " imposthume " in the groin. Other cases of anal discharge of
the product of extrauterine conception are recorded by Wintlirop, Woodbury,
Tuttle, Atkinson, Browne, Weinlechner, Gibson, Littre, Magruder, Gilland,
and many others. De Brun du Bois-Noir s speaks of the expulsion of extra-
uterine remains by the anus after seven years, and Heyerdahl ^ after thirteen
years. Benham * mentions the discharge of a fetus by the rectum ; there
was a stricture of the rectum associated with syphilitic patches, necessitating
the performance of colotomy.

Bartholinus and Kosseus gpeak 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 J reported an instance of the discharge of fetal
remains through the bladder.

Discharge of the Fetus through the Abdominal Walls.— Margaret
Parry of Berkshire ^ in 1668 voided the bones of a fetus through the flesh
above the os pubis, and in 1684 she was alive and well, having had healthy
children afterward. Brodie^ reports the history of a case in a negress who
voided a fetus from an abscess at the navel about the seventeenth month of
conception. Modern instances of the discharge of the extrauterine fetus
from the walls of the abdomen are frequently reported. Algora speaks of
an abdominal pregnancy in which there was spontaneous perforation of the
anterior abdominal parietes, followed by death. Bouzal ^ cites an extraor-
dinary case of ectopic gestation in which there was natural expulsion of the
fetus through abdominal walls, with subsequent intestinal strangulation. An
artificial anus was established and the mother recovered. Brodie Dunglison
Erich, Rodbard, Fox, and Wilson are among others reporting the expulsion
of remnants of ectopic pregnancies through the abdominal parietes Camp-
bell quotes the case of a Polish woman, aged thirty-five,'' the mother of nine

a 490, 1835, xvi., 51. b 140, I886, xxvi., 269. c Am. Med. Jour St Lonis 1886

d 218, 1865. e 218, 1870, Ixxxiii., 22. f 629, 1731. g 242 1883 ^ 847
^ 224, 1876. J 764 (1878), 1879, iii., 101. k 629 1700 219 l' Ibt

'nClinica, Zaragoza, 1878, ii., 221. 0497, 1884, 513. ' 0 si 'ol xix No 2

64

PRENATAL ANOMALIES.

children, most of whom were stillborn, who conceived for the tenth time, the
gestation being normal up to the lying-in period. She had pains followed
by extraordinary effusion and some blood into the vagina. After various
protracted complaints the abdominal tumor became painful and inflamed in
the umbilical region. A breach in the walls soon formed, giving exit to
purulent matter and all the bones of a fetus. During this process the patient
received no medical treatment, and frequently no assistance in dressing the
opening. She recovered, but had an artificial anus all her life. Sarah
McKinna* was married at sixteen and menstruated for the first time a
month thereafter. Ten months after marriage she showed signs of preg-
nancy and was delivered at full term of a living child ; the second child
was born ten months after the first, and the second month after the second
birth she again showed signs of pregnancy. At the close of nine months
these symptoms, with the exception of the suppression of menses, subsided,
and in this state she continued for six years. During the first four years she
felt discomfort in the region of the umbilicus. About the seventh year
she suffered tumefaction of the abdomen and thought she had conceived
again. The abscess burst and an elbow of the fetus protruded from the
wound. A butcher enlarged the wound and, fixing his finger under the jaw
of the fetus, extracted the head. On looking into the abdomen he perceived
a black object, whereupon he introduced his hand and extracted piecemeal
an entire fetal skeleton and some decomposed animal-matter. The abdomen
was bound up, and in six weeks the woman was enabled to superintend her
domestic affairs ; excepting a ventral hernia she had no bad after-results.
Kimura,^ quoted by Whitney, speaks of a case of extrauterine pregnancy in
a Japanese woman of forty-one similar to the foregoing, in which an arm
protruded through the abdominal wall above the umbilicus and the remains
of a fetus were removed through the aperture. The accompanying illustra-
tion (Fig. 3) shows the appearance of the arm in situ before extraction of
the fetus and the location of the wound.

Bodinier^ and Lusk ^ report instances of the delivery of an extrauterine
fetus by the vagina ; and Mathieson « relates the history of the delivery of a
living ectQpic child by the vagina, with recovery of the mother. Gordon '
speaks of a curious case in a negress, six months pregnant, in which an extra-
uterine fetus passed down from the posterior culdesac and occluded the
uterus. It was removed through the vagina, and two days later labor-pains
set in, and in two hours she was delivered of a uterine child. The placenta
was left 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

a 629 viii 517. b 791, 1893. c 616, v., 79.

d 125,' xix.',' 242. « 224, 1884, i., 99. ^ 817, October, 1848.

COMBINED ECTOPIC AND UTERINE GESTATION.

55

conception was intrauterine and the other of extrauterine gestation, have been
recorded. Clark and Ramsbothani'^ report instances of double conception,
one fetus being born alive in the ordinary manner and the other located
extrauterine. Chasser'^ speaks of a case in which there was concurrent
pregnancy in both the uterus and the Fallopian tube. Smith cites an
instance of a woman of twenty-three who became pregnant in August, 1870.
In the following December she passed fetal bones from the rectum, and a
month later gave birth to an intrauterine fetus of six months' growth.
McGee mentions the case of a woman of twenty-eight who became pregnant
in July, 1872, and on October 20th and 21st passed several fetal bones by the
rectum, and about four months later expelled some from the uterus. From this
time she rapidly recovered her strength and health. Devergie*' quotes an
instance of a woman of thirty who had several children, but who died sud-

Fig. 3.— A, protrusion of aa arm in ectopic gestation ; B, after operation (Kimura).

denly, and being pregnant was opened. In the right iliac fossa was found
a male child weighing 5 pounds and 5 ounces, 8^ inches long, and of
about five months' growth. The uterus also contained a male fetus of about
three months' gestation. Figure 4 shows combined intrauterine and extra-
uterine gestation. Hodgen speaks of a woman of twenty-seven, who was
regular until November, 1872 ; early in January, 1873, she had an attack
of pain with peritonitis, shortly after which what was apparently an extra-
uterine pregnancy gradually diminished. On August 17, 1873, after a labor
of eight hours, she gave birth to a healthy fetus. The hand in the uterus
detected a tumor to the left, which was reduced to about one-fourth the
former size. In April, 1874, the woman still suffered pain and tenderness

a 548, 3856, 591.
d 681, March, 1875.

b 463, Aout, 1812, 415.
e M6decme L6gale, i., 508.

c 481, February, 1873.
f 703, August, 1874.

56

PRENATAL ANOMALIES.

in the tumor. Hodgen believed this to have been originally a tubal preg-
nancy, which burst, causing much 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 menstru-
ated last in November, 1878, and on August 5, 1879, was delivered of a
well-developed dead female child weighing seven pounds. The uterine
contractions were feeble, and the attached placenta was removed only
with difaculty; there was considerable hemorrhage. The hemorrhage

continued to occur at intervals of two
weeks, and an extrauterine tumor re-
mained. Two weeks later septicemia
supervened and life was despaired of.
On the 15th of October a portion of a
fetus of five months' growth in an ad-
vanced stage of decomposition protruded
from the vulva. After the escape of this
putrid mass her health returned, and in
four months she was again robust and
healthy. Whinery « speaks of a young
woman who at the time of her second
child-birth observed a tumor in the ab-
domen on her right side and felt motion
in it. In about a month she was seized
with severe pain which continued a week
and then ceased. Health soon improved,
and the woman afterward gave birth to a third child ; subsequently she
noticed that the tumor had enlarged since the first birth, and she had a recur-
rence of pain and a slight hemorrhage every three weeks, and distinctly felt
motion in the tumor. This continued for eighteen months, when, after a most
violent attack of pain, all movement ceased, and, as she expressed it, she knew
the moment the child died. The tumor lost its natural consistence and felt
flabby and dead. An incision was made through the linea alba, and the
knife came in contact with a hard, gritty substance, three or four lines thick.
The escape of several quarts of dark brown fluid followed the incision, and the
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,
a 459, 1871. ^ 133, April, 1878. <^ 124, 1846.

Fig. 4.— Combined intrauterine and extrauterine
gestation (Brit. Med. Jour., May 12, 1894).

DELIVERY OF A VIABLE ECTOPIC FETUS.

67

soon ceasing altogether, and the wound closed. By December health was
good and the menses had returned.

Alilfeld, Ambrosioni, Galabin, Packard, Thiernesse, Maxson, de Belami-
zaran, Dibot, and Chabert are among others recording the phenomenon of
coexisting extrauterine and intrauterine pregnancy. Argles* mentions
simultaneous extrauterine fetation and superfetation.

Sanger mentions a triple ectopic gestation, in which there was twin
pregnancy in the wall of the uterus and a third ovum at the fimbriated end
of the right tube. Careful examination showed this to be a case of intramural
twin pregnancy at the point of entrance of the tube and the uterus, while at
the abdominal end of the same tube there was another ovum, — the whole
being an example of triple unilateral ectopic gestation.

The instances of delivery of an extrauterine fetus, with viability of
the child, from the abdomen of the mother would attract attention from
their rarity alone, but when coupled with associations of additional interest
they surely deserve a place in a work of this nature. Osiander speaks
of an abdominal fetus being taken out alive, and there is a similar case on
record in the early part of this century. ^ The London Medical and Physical
Journal, in one of its early numbers, contained an account of an abdominal
fetus penetrating the walls of the bladder and being extracted from the walls
of the hypogastrium ; but Sennertus gives a case which far eclipses this, both
mother and fetus surviving. He says that in this case the woman, while
pregnant, received a blow on the lower part of her body, in consequence of
which a small tumor appeared shortly after the accident. It so happened in
this case that the peritoneum was extremely dilatable, and the uterus, with
the child inside, made its way into the peritoneal sac. In his presence
an incision was made and the fetus taken out alive. Jessop^^ gives an ex-
ample of extrauterine gestation in a woman of twenty-six, who had pre-
viously had normal delivery. In this case an incision was made and a fetus
of about eight months' growth was found lying loose in the abdominal cavity
in the midst of the intestines. Both the mother and child Avere 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 concep-
tions. He gives 24 cases of twin conception, one of which was uterine, the
other extrauterine, and says that of 7 in the third month, with no opera-
tion, the mother died in 5. Of 6 cases of from four and a half to seven
months' duration, 2 lived, and in 1 case at the fifth month there

was an

a 476, 1871, ii, 394. . b 261, 1893. c 559, 1809 414

d 778, xviii., 261 ; and 610, December, 1876. e 754, 1882, vi., 444-462.

58

PRENATAL ANOMALIES.

intrauterine fetus delivered which lived. Of 11 such cases at nine months,
6 mothers lived and 6 intrauterine fetuses lived. In 6 of these cases no
operation was performed. In one case the mother died, but both the uterine
and the extrauterine conceptions lived. In another the mother and intra-
uterine fetus died, and the extrauterine fetus lived. Wilson ^ gives an instance
of a woman delivered of a healthy female child at eight months which lived.
The after-birth came away without assistance, but the woman still pre-
sented every appearance of having another child within her, although ex-
amination by the vagina revealed none. Wilson called Chatard in consulta-
tion, and from the fetal heart-sounds and other symptoms they decided that
there was another pregnancy wholly extrauterine. They allowed the case to
go twenty-three days, until pains similar to those of labor occurred, and
then decided on celiotomy. The operation was almost bloodless, and a
living child weighing eight pounds was extracted. Unfortunately, the
mother succumbed after ninety hours, and in a month the intrauterine
child died from inanition, but the child of extrauterine gestation thrived.
Sales ^ gives the case of a negress of twenty-two, who said that she had been
" tricked by a negro," and had a large snake in the abdomen, and could dis-
tinctly feel its movements. She stoutly denied any intercourse. It was
decided to open the abdominal cyst ; the incision was followed by a gush
of blood and a placenta came into view, which was extracted with a living
child. To the astonishment of the operators the uterus was distended, and
it was decided to open it, when another living child was seen and extracted.
The cyst and the uterus were cleansed of all clots and the wound closed.
The mother died of septicemia, but the children both lived and were doing
well six weeks after the operation. A curious case was seen in 1814*= of a
woman who at her fifth gestation suffered abdominal uneasiness at the third
month, and this became intolerable at the ninth month. The head of the
fetus could be felt through the abdomen ; an incision was made through
the parietes ; a fully developed female child was delivered, but, unfortunately,
the mother died of septic infection.

The British Medical Journal quotes : " Pinard (Bull, de d'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
a 125, 1880, xiii., 821-836. ^ 593, October, 1870. « 460, xv., 51.

IDEAL CASE OF ECTOPIC GESTATION. 69

diagnosis and treatment. One of them, thinking she had a fibroid, made
her take in all about an ounce of savin powder, which did not, however, pro-
duce any ill effect. When admitted she looked ill and pinched. The left
thigh and leg were painful and edematous. The abdomen looked like that
of the sixth month of pregnancy. The abdominal wall was tense, smooth,
and without 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 examina-
tion. When contracted the groove between it and the large tumor became
evident. Vaginal examination showed that the cervix, which was slightly
deflected forward and to the right and softened, as in uterine gestation, was
continuous with the smaller tumor. Cephalic ballottement was obtained in
the large tumor. No sound was passed into the uterus for fear of setting up
reflex action ; the diagnosis of extrauterine gestation at about six and a half
months with a living child was established without requiring to be clinched
by proving the uterus empty. The patient was kept absolutely at rest in
bed and the edema of the left leg cured by position. On April 30th the
fundus of the tumor was 35 cm. above the symphysis and the uterus 111 cm. ;
the cervix was soft as that of a primipara at term. Operation, May 2d :
Uterus found empty, cavity 14i cm. long. Median incision in abdominal
wall ; cyst walls exposed ; seen to be very slight and filled ^vith enormous
vessels, some greater than the little finger. On seizing the wall one of these
vessels burst, and the hemorrhage was only rendered greater on attempting
to secure it, so great was the friability of the walls. The cyst was therefore
rapidly opened and the child extracted by the foot. Hemorrhage was re-
strained first by pressure of the hands, then by pressure-forceps and ligatures.
The walls of the cyst were sewn to the margins of the abdominal wound, the
edge of the placenta being included in the suture. A wound was thus formed
10 cm. in diameter, with the placenta for its base ; it was filled with iodo-
form and salicylic gauze. The operation lasted an hour, and the child, a
boy weighing pounds, after a brief period of respiratory difficulties, w'as
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 1 2 pounds. The maternal wound was
not dressed till May 13th, when it was washed with biniodid, 1 : 4000.
The placenta came away piecemeal between May 25th and June 2d. The
wound healed up, and the patient got up on the forty-third day, having
suckled her infant from the first day after its birth."

60

PRENATAL ANOMALIES.

8

n
(4

c

o

•♦J

t-
a>
P.
o

o

to

n to

w a)
bo

<u o 2 c 2

00

CO

00

d

o

o,-

!>r-l

as
i-i

05 >2

13 V

ll> CO

w

a
o

> .

Si

u
»— t

d

o

O)

i:

to
3

o
oj

CQ
O

d

> .

i.s

" to

eS M
S O

03

d

a

o

^3 a 013 «3

to fe*'T3'0_,

s; K- 0) '^'^s 0)
^ js 03 =s ^ ^

■ " o o Q 0

S 2i ^ -

03.5^

S5S-

O
P<

(]>
0)

d

o

03

03
>
O

^ <U C3 V. S d d

S ^-^-SdS .2
5-03 "-^ -

+j D. O d .di'S C3

03

d

o

03
to

(13
O

O

d

0) a

> to ^

P.

„ ^ _ >, J-'Ooo)

= O Si'S O 03 03 oj (-

I- 0) 5 ^ aj_ a ►»

o c

d ^

03 oj_QJ
03

o

«^ io 03 O

C o S ;S d. M

C3 ^

- ^

■C • d o >^

o d

.■^ 03 +-.-^-"0

03

a CO ;

Q3v

g 5
o p.

g be

-5 d

03 0--H > a O u
3 ? 5 S ',2 d.

■g Xd

•d I' o a S °

^ ^ 03 ^ "

0)

03 ^

<5
" " 2

-id be 3 ^ .ti S

.g -ti > d

to -rt w 5 °*
ir; to c3 ^ 03

c3

at

u d.s
a o ci >-i

d ? dj3
be?

03 tS 03 O

P'd'o'^
■

d

03
03

d

03
O
03

" 03 o d S * a p.d

'O 03 d S " ^•iS'd 03

g M .2* !»3 d d >•

B'rjrrt 2 'to 3
d

^. d S.B

03-0

c o

C W I' 03 I

03

S2 - =3

•jz: 03 , >>
d ?

03 03 03 ^ 03

d

^ +J 03

9^d^ , 03 B ^
03 0_ 5

OS — 'o-d'C p<

03^-0^^

- ^ 13 'O

>^t3 03 5= t« 03

^ C t» ^ Ci
3 03 ;r oi

% t.

3 O 03

=3^-0- J •-■d'° '"^^^

*^ d d t« °

03

03^ 03

O 03^3

^ -M 03

gd*^

S)03-O

£'22

5- o 53 ^
p-d S ® 0^ S s

•E d o'S.sdg

£-03 g « Mto

^ d .d « d

C 03 o . ^-rr bO

03 CO 03 03

2i X o o> S P

" a oj

be 0

5 P .
o3 03 ^ 1

OJ d-g

c3 to
5S"c3

'O'ooS2o03a5 ,dsd3"f.-5

o;d oi-d g
OS a d-^
T^'d 03

o

03 C

eg

03 rj

«bB

03 d

=5'

to

-a

. *— » 03

^ >- p h'd 03 o

C3 — Ci^ 03 03

<iHJ3 to o S f^-'

5=32-=§S«

d „ s Mi*"

CO

03 o

■rf to 03 to i3

*^-d to C3

oi

d- c:"d d O-r: ^ d £-

S=SPP

C3g
bc^

bu

-d S,-- 03

sgd-a^^a

03 c: P

■§B?5fi .d
d.^-5^S.2

tr ^ d o3 ^
P- b£cij3
03 co.dj5'ti_,

OJ g tl-^

2'c §2 Sg.SP 2 d

■desud ^^r-ip-d03i« ^
£ Cm O

d'^ r> 03 1; d 5 d
ds ^^ddidPoH

03 ^ « ^
— 03 >r; ' — !

,0<*^ S 03 C o

03 03 -is

d

^p.

03 ;3
+J P

2 d

-t^<d

h5

- C3 03

^•d-d

P 03
.d -'Oi
4J 03 O

q3 r-<

to ^ ^

2 03 Pi
P« t-< 03
-C^J 03

d
d

•fH

a

03

d

•r-t

-d

03

c3

•d

-d

03

OS

f- 03 .

>^ P
Pt-°

OS >,

03^ 03
to ^-

-'d y

bed d
d d 2

S d<M

h3

-d-d

fd^-P 03

SdS'3

? O 03

^■^03 a

-d -^2==

dn3 to o

«'?3t«

^pg-ts

tOr^ O

d d<

a

_bci bc^
.o3-d

bO'O'S

CO

d

>-.:S P

bo

p

rP '-'

03 >,T3

^ OS d
bcS P

p.d d-^S

03 0)dJ d 03
P- > 0) .
© 03 H d'S'd

t« 2 p,S?-g

P.d

03 S d-""-5

> d^ P
S . Po 03-'-'

M p5 p d

d S o =3 .S^ *^

•3

a

, o3

bod d
P d P § 03 ■
> p,B<hd ©

3

P S

CO

d

o

a

03

to

d
©

a

to

0^2© •

-Ml

p^ 03 is

"d d

la

to

d

©

a

CO

d

©

p a

d 0)
d**

■3uTpao9Jc[
SDtottBnSoid
JO jaqtanti

d-A

d-d

_ <- d

72 03 fl
CSfm 03

S d

03 d
^ 03 P

03 P<'5

boco -dS

^00

.00

> tJD

STATISTICS OF SUCCESSFUL OPERATIONS

u
o

a)

■9. ft

a
>>
o

4j (N

5 n
■O aj O aj

O .

00 _ ■*->
<0 , a! 3 CO

C

rH

S

be P

CO « 03

a >■>,
<s 2 o r

Mo;,i->0

O) 1

c/2

3 00
a* 5

+j to

o

CO

Oi

1- - 1:^' 03

H o
w -a.

a

^ 00

m

00

o

cj
«

5§c

•2 5 a?? 5

r

a ft 2 >

■o c 3
-0.2 8 o g

SiS >

■c ft"55 ^

2 O ic 2 =

J " 5 S. .

3 2.S

ft? IS

3-3

c "^-^

S O
ftt- B.

*j S ^ <D ce:— "^j-

aj y o - »j _ a i<

0)

•S 3

Ji u is ^ S ojC

B «^.S 8 33-1 ft^

03

oi O

? 03 o

^ > « r- t- ^ 3

.t; - g oO

CJ_ LJ —

a> 3.?^ 3-5

; 3 03
' ? a

> 3

03— =3 - ,
O^aj OS tao

03 .—

3 ^

ft;^ -.'^a'fcP'^SoS
03 c u g ^ ^ t,

^5.SS* slice's

3 a> s:

_ t 3 c3ri.-w ojz;

0) O <D J2 ^ 3 t-

OS a

* ■ 3

p a)

^ =S;n 3

3 bri: -k^
? o C

ft:S.^ a> ~ a>

p.-"^ 3
■O ^ *^ c3 i-"

§§ba>.2

22§t^
o S « u

C ^ 0) 3

gssi

5 2 OS

■3 3 a«

K O 3 O -
O 3 o O 03

« O O 03
03 t. Q a) o

.S.S5 is

a) a><" ^ '-'

03 ^^-M g-c
flj -* M s

3 3 0^2
2S S S iJ o

3

^

2 oi 03

O 0) p_,

S o -

he'

2;2-a

£ hU

a
3

ci.st^ 3 ? a « a

a) C W.S IS g ^ S 3
^a)S3_., C>:>c3'Oa)
• ""j; g.S -Ci 3 '-'

3 3 S oj ■''O 3 P o aj
0.7=1 " 3 3.0) 0

:'c_goBgf^.2

a)-k^O>.C^5o3-G3ft

-S^ ft? oi.2

O =3 SUIT'S fe2 2 S 1^
3/3-3 •'■-^^i-l

ajt-i 3
ft C

ai-S 3

^ 3 a>

a; aj

-a a^
' s

a) g.i;
.2a)£^

;3 C t- c3

CD Cd r-.

03 fii o 3

£|oo^ .S'3£-c„^'S5

?* c

„ OS

>>o 6 ^ o S .-T

oi-25 S O.oH Q) 03 ^
■ he

c3

■ -u 3 ^
X2 a)

-O

:a>.

„ci)!aD3a) ^.-J^SosS'^gB'HS

£ ai a) o

oi ftft 3-3 3 ^ £ 03
*^ a) ^3 ft— et2'0

3 OJ

r^ajos.i:

.2
.2 3

-*-' *3
03 3
3

ai

aa

OB O
O

■^S a;
.S *

'S.i;

03

>ft
03 — '
t7

fta>
3 oj
c» "

>.5

s

— a;
<S oi

.S ft

O ® tc

a) ■ * ■

, B
o3

a'
3

a)

c3 =i

- 3 I
C3 '

° a) 3 3
cn yj ^ -r^ m

. — .=n bid
i;-^ a) t« a;

f g.'2^o»

ft O *J (H

CO oi o ft
OS'S CO B<3 o w'.,
BSg4ift„.2

3.B

03

ajra S a)« „

=« a; co-^ cS ^

o > oOtJ a>

o *^ 3 N

cas'o*.S§
a ^ " <s N

3 3 o c a) .3
.3 a) 03 '-S 93 S 3

O . 3" >>>>

> c g -5 S-o

a> I

t,-, a> CO .3 ^

^ ^ +^ .rH 03 +J 'O

62

PRENATAL ANOMALIES.

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 ac-
counted for. Of these, 5 were reported as living and well after operation, Avith
no subsequent report ; 1 was strong and healthy after three weeks, but there
has been no report since ; 1 was well at six months, then was lost sight of;
1 was well at the last report ; 2 live and are well at one year ; 2 are living
and well at two years ; 1 (Beisone's case) is well at seven years ; and 1 (Tait's
case) is well at fourteen and one-half years. The list given on pages 60 and
61 has been quoted by Hirst and Borland.^ It contains data relative to 17
cases in which abdominal section has been successfully performed for advanced
ectopic gestation with living children.

Long Retention of Extrauterine Pregnancy.— The time of the reten-
tion of an extrauterine gestation is sometimes remarkable, and it is no un-
common occurrence for several pregnancies to successfully ensue during such
retention. The Ephemerides contains examples of extrauterine pregnancy
remaining in the abdomen forty-six years Hannseus'^ mentioned an in-
stance remaining ten years, the mother being pregnant in the meantime;
Primperosius speaks of a similar instance ; de Blegny,« one of twenty-five
years in the abdomen ; Birch, a case of eighteen years in the abdomen, the
woman bearing in the meantime ; Bayle,^ one of twenty-six years, and the
Ephemerides, another. In a woman of forty-six,g the labor pains inter-
vened without expulsion of the fetus. Impregnation ensued twice after-
ward, each followed by the birth of a living child. The woman lived to
be ninety-four, and was persuaded that the fetus was still in the abdomen,
and directed a postmortem examination to be made after her decease, which
was done, and a large cyst containing an ossified fetus was discovered in the
left side of the cavity. In 1716'^ a woman of Joigny when thirty years
old, having been married four years, became pregnant, and three months
later felt movements and found milk in her breasts. At the ninth month
she had labor-pains, but the fetus failed to present ; the pains ceased, but
recurred in a month, still with a negative result. She fell into a most sickly
condition and remained so for eighteen months, 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 hypogas-
tric and umbilical regions. It weighed eight pounds and consisted of a male

a 538, Nov. 24, 1894. ^ 843, 372. « 104, cent, x obs. 48.

d Prod. Act., Havn., 107. « 215, Ann. I., obs. 9, Jan.; obs. 8, Feb.

f 629, London, xii. ^ 41 8, 1721, 422. ^ 302, iv., 233.

LONG RETENTION OF UTERINE PREGNANCY.

63

fetus of full term with six teeth ; it had no odor and its sac contained no
li([uid. The bones seemed better developed than ordinarily ; the skin was
thick, callous, and yellowish. The chorion, amnion, and placenta were ossi-
fied and the cord dried up. Walther " mentions the case of an infant which
remained almost petrified in the belly of its mother for twenty-three years.
No trace of the placenta, cord, or enveloping membrane could be found.

Cordier ^ publishes a paper on ectopic gestation, with particular reference
to tubal pregnancy, and mentions that when there is rupture between the
broad ligaments hemorrhage is greatly limited by the resistance of the sur-
rounding structures, death rarely resulting from the primary rupture in this
location. Cordier gives an instance in which he successfully removed a full-
grown child, the result of an ectopic gestation which had ruptured intraliga-
mentally and had been retained nearly two years.

Lospichlerus gives an account of a mother carrying twins, extrauterine,
for six years. Mounsey of Eiga, 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
carrymg an extrauterine fetus for many years, which was only discovered
postmortem. She had ceased to menstruate at forty and had borne a child
at twenty-seven. Watkins ^ speaks of a fetus being retained forty-three
years ; James, others for twenty-five, thirty, forty-six, and fifty years •
Murfee,' fifty-five years; Cunningham, J forty years; Johnson,^ forty-four
years ; Josephi,i fifteen years (in the urinary bladder) ; Craddock,- twenty-
two years, and da Costa Simoes,° twenty-six years.

Long Retention of Uterine Pregnancy.-Ca'ses of long retained intra-
uterine pregnancies are on record and deserve as much consideration as those
that were extrauterine. Albosius speaks of a mother carrying a child in an
ossified condition in the uterus for twenty-eight years.o Cheselden speaks

a Mem. de Berlin, 1774. b Annals of Gynrecol. and P^ediatrv An^ 1 SQ-?

0 Opera, 1737, iii., 89. d 629, 1748, 1018. e 550, vol. v., lol f 629 noi 2n
g 162, March, 1842. h 778, viii., 106. i 774 1886. j glO 8^5

n 21S-^r ' '''' - isll:

° Observatio Lithopaedii Senonensis, 1682.

64

PRENATAL ANOMALIES.

of a case in which a child n\ as carried many years in the uterus, being con-
verted into a clay-like substance, but preserving form and outline. Cald-
well mentions tlie 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. Hanna^us, 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. AVhile
threshing corn she felt violent pain like that of labor, and after an illness
suffered \ constant fetid discharge from the vagina for eleven years, fetal
bones being discharged with occasional pain. This poor creature worked
along for eleven years, at the end of which time she was forced to bed, and
died of symptoms of purulent peritonitis. At the necropsy the uterus was
found adherent to the anterior wall of the abdomen and containing rem-
nants of a putrid fetus with its numerous bones. There is an instance re-
corded g of the death of a fetus occurring near term, its retention and
subsequent discharge being through a spontaneous opening in the abdommal
wall one or two months after.

Meigs ^ cites the case of a woman who dated her pregnancy from March,
1848 and which proceeded normally for nine months, but no labor super-
vened at this time and the menses reappeared. In March, 1849, she passed
a few fetal bones by the rectum, and in May, 1855, she died. At the necropsy
the uterus was found to contain the remains of a fully developed fetus, minus
the portions discharged through a fistulous connection bet^veen the uterme
cavitv and the rectum. In this case there had been retention of a fully
developed fetus for nine years. Cox^ describes the case of a woman who
was pregnant seven months, and who was seized with convulsions ; the sup-
posed labor-pains passed off, and after death the fetus was found in the
womb, having lain there for five years. She had an early return of the
mensel, and these recurred regularly for four years. Dewees - quotes two
cases in one of which the child was carried twenty months m 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 M conceived at
twenty-six, and whose fetus was found, partly ossified, m the uterus after

"^''There are many narratives of the long continuation of fetal move-
ments, and during recent years, in the Southern States, there was quite a

a 318, 1806, ii., 22-24. b 280, 1774, v., 338. c Eyr, Christia.ia, 1827, ii., 134.

d 280 1755 iii 695. e Miscellan., 1728, 822 ;j20, Nov^ 9, 1848

g 124, v., 530. h 124, xxv., 541. ^ 271, 1867, ii., 385. J 318, n., 22.

SHORT PREGNANCIES.

65

prevalence of this kind of impostors. 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 move-
ments. 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 preg-
nancy 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 proposi-
tions as worthy evidence unless associated with other and more convincing
facts, such as the appearance and stage of development of the fetus, or cir-
cumstances 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 Parli-
ament of Paris decreed that an infant of five months possessed that capability
of living the ordinary period of existence, L e., the " viability," 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 eiglit 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 de-
scribes 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 mem-
branes open, saw that it was living. He applied warmth, and partly succeeded
in restoring it ; for a few minutes respiratory movements were performed recni-
larly but it died in six hours. Taylor - quotes Carter concerning the else
of a fetus of five months M^hich cried directly after it was born, and in the
half hour It lived it tried frequently to breathe. He also quotes Davies,

a Jena, 1705. b 447 ark.

5 393, 133-4.

66 PRENATAL ANOMALIES.

mentioning an instance of a fetus of five months, whiol; lived tweWe houj.,
weighing 2 pounds, and measuring 12 inches, and wh.ch cncd vigorously
Tl^e pnpiUarv membrane was entire, the testes had not descended, and the
head Z weil covered with hair. Usher" speaks of a wornan who m 18 <6
was delivered of 2 male children on the one hundred '"f ''"^y-nrnth day
both live<l for an hour; the fir.t weighed 10 ounces 6 drams and meas-
ured 9i incites ; the other 10 ounces 7 drams, with the same length as
h fir t Routh^ speaks of a Mrs. F— , aged thirty-eight who had borne
9 children and hid had 3 miscarriages, *e 'ast concepUon term.natm^
as such. Her husband was away, and returned October 9, 1869 She d,d
not again see her husband until the 3d or 4th of January. The d^te^ of
quickening was not observed, and the chdd was born June 8, 1870. Uur
Z g-tatton she was much frightened by a rat The .^^.W was -eak * -
t^ste^ undescended, and it lived but eighteen days, dyng of symptoms of
TtrmL The pa;ents were poor, of excellent character, and although
a^ordLg to the'evidence, this pregnancy lasted but twenty-two weeks and
two days, there was absolutely no reason to suspect mfidel.ty.
' Rtttel speaks of a child of five months '^^^ ^-"f ,
and he saw male twins born at the sixth month weighing 3 pounds each
tvho were alive and healthy a year after. Barker « cites the case of a female
; ; on the one hundred and ^^f J ^tS

and was 11 inches long. It had rudimentary nails, very „ot
head its eyelids were closed, and the skin much shriveled , it did not
sie properly, and did not walk until nineteen months old Three and a
^fvl^ after the child was healthy and thriving, but weighed only 29i
is A th time of birth it was wrapped up in a box and placed before
C fire Brouzet speaks of living births of from five to six months' preg-
tn^y and Kopp ^ speaks of a six months' child wliidi lived four days. The
Ephemerides eontain-cou^^^^^^^^^^^^ Crthstminating with the
V "Is Tnf YoX:! twenty minutes and the other fifteen.
rir'1% inches long, and wei h d l pou^d^ 3^ „

of premature birth oUow ng P ^ ^ ^j, ^ft^r birth, through

six months, the ^p^^^f^^ZTu^mZn^ who attended the child
the good ,he occasion, it measured 38 cm. long.

^"r;racLditen::: the trustworthy report of the case of a woman
Moore IS accre ^^^^^ ^^^^^^ ^^^^^

who bore a ch Id at the en .^^^
::rrfnd::';re aglr fifteen montl. it was healthy and weighed 18

e 674, 1895, Jan., p. 22. o , ,

SHORT PREGNANCIES.

67

pounds. Eikam* saw a case of abortion at the fifth month in which the
fetus was 6 inches in length and weighed about 8 ounces. The head was
sufficiently developed and the cranial bones considerably advanced in ossifi-
cation. He tied the cord and placed the fetus in warm water. It drew up
its feet and arms and turned its head from one side to the other, opening its
mouth and trying to breathe. It continued in this wise for an hour, the
action of the heart being visible ten minutes after the movements ceased.
From its imperfectly developed genitals it was supposed to have been a
female. Professor J. Miiller, to whom it was shown, said that it was not
more than four months old, and this coincided with the mother's calculation.

Villemin ^ before the 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 voucli, 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|^ 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 33J 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
a 558, B. v., H. 2. b 791, March, 1895. c I68, Dec, 1879. d 476, April 23, 1842.

68

PRENATAL ANOMALIES.

was too feeble to grasp its mother's nipple, and was fed for three weeks by
milk from the breast through a quill. At forty days it weighed 3 pounds
and measured 13 inches. Before the expiration of three months it died
of measles. Dodd describes a case in which the catamenia were on the
24th of June, 1838, and continued a week ; the woman bore twins on
January 11, 1839, one of which survived, the other dying a few minutes
after birth. She was never irregular, prompt to the hour, and this fact,
coupled with the diminutive size of the children, seemed to verify the dura-
tion of the pregnancy. In 1825, Baber of Buxur, India, spoke of a child
born at six and a half months, who at the age of fifty days weighed 1 pound
and 13 ounces and was 14 inches long. The longest circumference of the
head was 10 inches and the shortest 9.1 inches. The child suckled freely
and readily. In Spaeth's clinic ^ there was a viable infant at six and a half
months weighing 900 grams. Spaeth says that he has known a child of six
months to surpass in eventual development its brothers born at full term.

In some cases there seems to be a peculiarity in women which manifests
itself by regular premature births. La Motte, van Swieten, and Fordere
mention females who always brought forth their conceptions at the seventh
month.

The incubator seems destined to be the future means ot preserving
these premature births. Several successful cases have been noticed, and
by means of an incubator Tarnier succeeded in raising infants which at the
age of six months were above the average. A full description of the incu-
bator may be found.« The modified Auvard incubator is easily made ; the
accompanying illustrations (Figs. 5, 6, and 7) explain its mechanism. Several
improved incubators have been described in recent years, but the Auvard ap-
pears to be the most satisfactory.

The question of retardation of labor, like that of premature birth, is
open to much discussion, and authorities differ as to the limit of protraction
with viability. Aulus Gellius * says that, after a long conversation with the
physicians and wise men, the Emperor Adrian decided in a case before
him, that of a woman of chaste manners and irreproachable character, the
child born eleven months after her husband'.s death was legitimate. Under
the Roman law the Decemviri established that a woman may bear a viable
child at the tenth month of pregnancy. Paulus Zacchias,«='o physician to
Pope Innocent X., declared that birth may be retarded to the tenth month,
and sometimes to a longer period. A case was decided in the Supreme
Court of Friesland, a province in the northern part of the Netherlands,
October, 1634, in which a child born three hundred and thirty-three days
after the death of the husband was pronounced legitimate. The Parliament
of Paris was gallant enough to come to the rescue of a widow and save her

a 656, 1841. ^ 118, May 16, 1882. <^ 536, 1883, i., 39.

d L. iii., chap. 16.

LONG PREGNANCIES.

69

reputation by declaring that a child born after a fourteen months' gestation
was legitimate. Bartholinus speaks of an unmarried woman of Leipzig who
was delivered after a pregnancy of sixteen months. The civil code of
France provides that three hundred days shall constitute the longest period

Fig. 5.— Modified Auvard incubator ; v, glass plate of the movable lid, 6 ; H, ventilating tube containing
small rotary fan ; K, ventilating slide ; M, hot^water cans ; O, slide closing hot-air chamber.

of the legitimacy of an infant ; the Scottish law, three hundred days ; and the
Prussian law, three hundred and one days.

There are numerous cases recorded by the older writers. Amman
has one of twelve months' duration ; Enguin,'' one of twelve months' ;

Fig. 6.— Interior view of a modified Auvard incubator.

Buchner,^ a case of twelve months' ; Benedictus,!^^ one of fourteen months' •
de Blegny,« one of nineteen months'; Marteau," Osiander, and others of
forty-two and forty-four weeks' ; and Stark's Archives,'^ one of forty-five

a 462, T. Ixi., 163. b Miscel., 1727, 170. c 215, Aim. i., 23

d462, T. XXV. e ifto T •■ o * o

' e 162, L. u., 3 St. n. 2.

70

PRENATAL ANOMALIES.

weeks', living, and also another case of forty-four Aveeks'. 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'^95 one of forty-six weeks, but the fetus was dead. Schneider^
cites an instance of three hundred and eight days' duration. Campbell says ^
that Simpson had cases of three hundred and nineteen, three hundred and
thirty-two, and three hundred and thirty-six days'; Meigs had one of four
hundred and twenty. James Reid, in a table of 500 mature births, gives
14 as being from three hundred and two to three hundred and fifteen days'.

Not so long ago a jury rendered a verdict of guilty of fornication and
bastardy when it was alleged that the child was born three hundred and
seventeen days after intercourse. Taylor relates a case of pregnancy in
which the wife of a laborer went to America three hundred and twenty-two
days before the birth. Jaffe^ describes an instance of the prolongation of
pregnancy for three hundred and sixty-five days, in which the developments
and measurements corresponded to the length of protraction. Bryan s speaks
of a woman of twenty-five who became pregnant on February 10, 1876, and
on June 17th felt motion. On July 28th she was threatened with miscar-
riage, and by his advice the woman weaned the child at the breast. She
expected to be confined the middle of November, 1876, but the expected
event did not occur until April 26, 1877, nine months after the quickening
and four hundred and forty days from the time of conception. The boy
was active and weighed nine pounds. The author cites Meigs' case, and also
one of Atlee's, at three hundred and fifty-six days.

Talcott,^ Superintendent of the State Homeopathic Asylum for the Insane,
explained the pregnancy of an inmate who had been confined for four years
in this institution as one of protracted labor. He said that many such
cases have been reported, and that something less than two years before he
had charge of a case in which the child was born. He made the report
to the New York Senate Commission on Asylums for the Insane as one of
three years' protraction. Tidd ^ speaks of a woman who was delivered of a
male child at term, and again in ten months delivered of a well-developed
male child weighing 7 1 pounds; he relates the history of another case, m
Clifton, W. Va., of a woman expecting confinement on June 1st going over

a 418 1753 206 ^ 462, T. xxvii., 48. ' 137, B. iii., 257.

d der Heilk.. 1811, Oct., 87. e 512, 188, viii., 145, 149. f 261, 1890^

g 703, 1877. n. s. xiv., 345. ^ 224, 1883, ii., 665. ^ 299, xi., 798.

LONG PREGNANCIES.

71

to September 15th, 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 morn-
ing of November 6th, after a pregnancy of four hundred and seventy-six
days, she was delivered of a male child weighing 13 pounds. Both the
mother and child did well despite the use of chloroform and forceps. The
other case was one lasting sixteen months and twenty days.

In a rather loose argument, Carey reckons a case of three hundred and
fifty days. Menzie ^ gives an instance in a woman aged twenty-eight, the
mother of one child, in whom a gestation was prolonged to the seventeenth
month. The pregnancy was complicated by carcinoma of the uterus. Bal-
lard ° describes the case of a girl of sixteen years and six months, whose
pregnancy, the result of a single intercourse, lasted three hundred and sixty
days. Her labor was short and easy for a primipara, and the child was of
the average size. Mackenzie cites the instance of a woman aged thirty-
two, a primipara, who had been married ten years and who always had been
regular in menstruation. The menses ceased on April 28, 1888, and she felt
the child for the first time in September. She had false pains in January,
1889, and labor did not begin until March 8th, lasting sixty-six hours. If all
these statements are correct, the probable duration of this pregnancy was
eleven months and ten days.

Lundie^ relates an example of protracted gestation of eleven months, in
which an anencephalous fetus was born ; and Martin of Birmingham de-
scribes a similar case of ten and a half months' duration. Kaux'-Tripier ^
has seen protraction to the thirteenth month. Enguin^ reports an observa-
tion of an accouchement of twins after a pregnancy that had been prolonged
for eleven months. Resnikoff'h mentions a pregnancy of eleven months'
duration in an anemic secundipara. The case had been under his observa-
tion from the beginning of pregnancy ; the patient would not submit to
artificial termination at term, which he advised. After a painful labor of
twenty-four hours a macerated and decomposed child was born, together
with a closely-adherent placenta. Tarnier^ reports an instance of partus
serotinus in which the product of conception was carried in the uterus forty

536, 1889, n., 522. e 759, April, 1895. f 933 1047 '

« 460. 1784, 163. h 261, No. 24, 1894. l Jour, des Sages-Femmes, Ma/l, 1894.

72

PRENATAL ANOMALIES.

days after term. The fetus was macerated but not putrid, and the placenta
had undergone fatty degeneration. At a recent meeting of the Chicago
Gynecological Society, Dr. F. A. Stahl reported the case of a German-Bohe-
mian woman in which the fifth pregnancy terminated three hundred and two
days after the last menstruation. Twenty days before there had occurred
pains similar to those of labor, but they gradually ceased. The sacral prom-
ontory was exaggerated, and the anteroposterior pelvic diameter of the inlet
in consequence diminished. The fetus was large and occupied the first posi-
tion. Version was with difficulty eifected 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. CrowelH speaks of a woman of good social position w^ho had
been married seven years, and who had made extensive preparations for a.
long journey, when she was seized with a " bilious colic," and, to her dismay
and surprise, a child was born before the arrival of the doctor summoned on
account of her sudden colic and her inability to retain her water. A peculiar
feature of this case was the fact that mental disturbance set in immediately
afterward, and the mother became morbid and had to be removed to an asy-
lum, but recovered in a few months. Tanner s saw a woman of forty-two who
had been suffering with abdominal pains. She had been 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 preg-
nancy. She was successfully delivered of a girl, which occasioned mucli
rejoicing in the household.

Tasker of Kendall's Mills, Me., reports the case of a young married woman
callinjr him for bilious colic. He found the stomach slightly distended and
questioned her about the possibility of pregnancy. Both slie and her hus-
band informed him that such could not be the case, as her courses had been
regular and her waist not enlarged, as she had worn a certain corset all
the time. There were no signs of quickening, no change in the breasts, and,

a 318, 1826, xxv., 245. ^ 458, 1769. <= 125, 1879, xii., 393.

d Trans. M. Soc. Penna., Phila., 1879. e 458, 1761. f 218, 1878. g 778, 1864.

PSEUDOCYESIS.

73

iu fact, none of the usual signs of pregnancy present. He gave her an opiate,
and to her surprise, in about six hours she was the mother of a boy weigh-
ing five pounds. Both the mother and child made a good recovery. Duke "
cites the instance of a woman who supposed that she was not pregnant up to
the night of her miscarriage. She had menstruated and was suckling a child
sixteen months old. During the night she was attacked with pains resem-
bling those of labor and a fetus slipped into the vagina without any hemor-
rhage ; the placenta came away directly afterward. In this peculiar case the
woman was menstruating regularly, suckling a child, and at the same time
was unconsciously pregnant.

Isham ^ speaks of a case of unconscious pregnancy in which extremely
small twins were delivered at the eighth month. Fox cites an instance
of a woman who had borne eight children, and yet unconscious of
pregnancy. Merriman ^ speaks of a woman forty years of age who had not
borne a child for nine years, but who suddenly gave birth to a stout, healthy
boy without being cognizant of pregnancy. Dayral" tells of a woman who
carried a child all through pregnancy, unconscious of her condition, and who
was greatly surprised at its birth. Among the French observers speak-
ing of pregnancy remaining imrecognized by the mother until the period
of accouchement, Lozes and Rhades record peculiar cases; and Mourou-
valg 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 1^ and Miinzenthaler also record examples of unconscious
pregnancy.

Pseudocyesis.— On the other hand, instances of pregnancv 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 pseudo-
cyesis. Of course, many of the cases are not examples of true pseudocyesis
with its interesting phenomena, but inst^mces 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 becomincr
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

a 312, 1846. b 124, 1874. c 649, 1888. d 218 1828 e ufi

f 146 ISfii^ e At^A 1QOC ■•• ' *^ 14d, 1865.

146, I860. g 454, 1825, xx.u., 281. h 334, 1839. i 533, 1895, 393.

74

PRENATAL ANOMALIES.

and by the child is felt, the physician takes it for granted, and this goes on
until the great diagnostician. Time, corrects the delusion. Then the fat
disappears with remarkable speed, and the reign of this singular simulation
is at an end." In the same article. Dr. Mitchell cites the two following
cases under his personal observation : " I was consulted by a lady in regard
to a woman of thirty years of age, a nurse in whom she was interested.
This person had been married some three years to a very old man possessed
of a considerable estate. He died, leaving his wife her legal share and the
rest to distant cousins, unless the wife had a child. For two months before
he died the woman, who was very anemic, ceased to menstruate. She became
sure that she was pregnant, and thereupon took on flesh at a rate and ni a
way which seemed to justify her belief. Her breasts and abdomen were the
chief seats of this overgrowth. The menses did not return, her pallor in-
creased ; the child was felt, and every preparation made for delivery. At
the eighth month a physician made an examination and assured her of the
absence of pregnancy. A second medical opinion confirmed the first, and
the tenth month found her of immense size and still positive as to her con-
dition. At the twelfth month her menstrual flow returned, and she became
sure it was the early sign of labor. When it passed over she became con-
vinced of her error, and at once dropped weight at the rate of half a pound
a day despite every 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 be-
come exceedingly hysteric. This briefly stated case, which occurred many
years ago, is a fair illustration of my thesis.

" Another instance I saw when in general practice. A lady who had
several children and 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 fLiling, acquiesced in her fate. The menses returned at the ninth month
and were presimied to mean labor. Meanwhile she vomited, up to the eighth
month, and ate little. Nevertheless, she took on fat so as to make the abdo-
men and breasts immense and to excite unusual attention. No physician
examined her until the supposed labor began, when, of course, the truth
came out. She was pleased not to have another child, and in her case, as in
all the others known to me, the fat lessened as soon as the mind was satisfied
as to the non-existence of pregnancy. As I now recall the facts, this
woman was not more than two months in getting rid of the excess of adipose
tissue. Dr. Hirst tells me he has met with cases of women taking on fat
with cessation of the menses, and in which there was also a steady belief in
the existence of pregnancy. He has not so followed up these cases as to
know if in them the fat fell away with speed when once the patient was as-
sured that no child existed within her."

PLATE 2.

Conditions simulating pregnancy (pseudocyesis) (Hirst) : 1. Pendulous belly of rachitis.
2. Normal distention in a primipara at term. 3. Normal distention, seventh month. 4. Pen-
dulous belly of rachitis (Cesarean section). 5. Twins. 6. Pendulous belly of rachitis • fat
and tympany. 7. Hydramnios. '

PSEUD OCYESIS,

11

Hirst,* in an article on the difficulties in the diagnosis of pregnancy, gives
several excellent photographs showing the close resemblance between several
pathologic conditions and the normal distention of the abdomen in preg-
nancy (Plate 2). A woman who had several children fell sick with
a chest-aifection, followed by an edema. For fifteen months she was con-
fined to her bed, and had never had connection with her husband during that
time. Her menses ceased ; her mammae became engorged and discharged
a serous lactescent fluid ; her belly enlarged, and botli she and her phy-
sician felt fetal movements in her abdomen. As in her previous pregnancies,
she suffered nausea. Naturally, a suspicion as to her virtue came into her
husband's mind, but when he considered that she had never left her bed for
fifteen months he thought the pregnancy impossible. Still the wife insisted
that she was pregnant and was confirmed in the belief by a midwife. The
belly continued to increase, and about eleven months after the cessation of
the menses she had the pains of labor. Three doctors and an accoucheur
were present, and when they claimed that the fetal head presented the hus-
band gave up in despair ; but the supposed fetus was born shortly after, and
proved to be ouly 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 abdo-
men progressively increased in size, and between the tenth and eleventh
months she suffered what she thought to be labor-pains. These false pains
ceased upon taking a bath, and with the disappearance of the other signs
was dissipated the fallacious idea of pregnancy.

There is mentioned'^ an instance of medicolegal interest of a young girl
who showed all the signs of pregnancy and confessed to her parents that she
had had commerce with a man. The parents immediately prosecuted the
seducer by strenuous legal methods, but when her ninth month came, and after
the use of six baths, all the signs of pregnancy vanished. Harvey cites sev-
eral instances of pseudocyesis, and says we must not rashly determine of the
the inordinate birth before the seventh or after the eleventh month. In 1646
a woman, after having laughed heartily at the jests of an ill-bred, covetous
clown, was seized with various movements and motions in her belly like those
of a child, and tliese continued for over a month, when the courses appeared
again and the movements ceased. The woman was certain that she was
pregnant.

The most noteworthy historic case of pseudocyesis is that of Queen Mary
of England, or " Bloody Mary," as she was called. To insure the succession
of a Catholic heir, she was most desirous of having a son by her consort,
Philip, and she constantly prayed and wished for pregnancy. Finally her

a 792, May, 1895. b 302, iv., 235. c ibid. d ibid.

78

PRENATAL ANOMALIES.

menses stopped ; the breasts began to enlarge and became discolored around
the nipples. She had morning-sickness of a violent nature and her abdomen
enlarged. On consultation with the ladies of her court, her opinion of preg-
nancy was strongly confirmed. Her favorite amusement then was to make
baby-clothes and count on her fingers the months of pregnancy. 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 am-
bassador had been sent to tell the Pope that Mary could feel the new life
within her, and the people rushed to St. Paul's Cathedral to listen to the
venerable Archbishop of Canterbury describe the baby-prince and give
thanks for his deliverance. The spurious labor pains passed away, and
after being assured that no real pregnancy existed in her case, Mary went
into violent hysterics, and Philip, disgusted with the 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 roll-
ing under the hand. Her abdomen progressively enlarged to the regular
size of matured gestation ; but the extrauterine pregnancy, which was sup-
posed to have existed, was not seen at the autopsy, nothing more than an
enlarged liver being found. The movement was due to spasmodic move-
ments of the abdominal muscles, the causes being unknown. Madden ^ gives
the history of a primipara of twenty-eight, married one year, to whom he
was called. On entering the room he was greeted by the midwife, who said
she expected the child about 8 P. M. The woman was lying in the usual
obstetric position, on the left side, groaning, crying loudly, and pulling hard
at a strap fastened to the bed-post. She had a partial cessation of menses,
and had complained of tumultuous movements of the child and 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 nonexist-
ence of pregnancy ; she became very indignant, triumphantly squeezed lac-
tescent fluid from her breasts, and, insisting that she could feel fetal move-
ments, left to seek a more sympathetic accoucheur. Underbill,^ in the words
of Hamilton, describes a woman as " having acquired the most accurate
description of the breeding symptoms, and with wonderful facility imagined
that she had felt every one of them." He found the woman on a bed com-
plaining of great labor-pains, biting a handkerchief, and pulling on a cloth
a 218, 1870. ^ 310, 1872, liii., 255. ^ 318, 1873-4, xix., ii., 844.

SYMPATHETIC MALE NAUSEA OF PREGNANCY. 79

attached to her bed. The finger on the abdomen or vulva elicited symptoms
of great sensitiveness. He told her she was not pregnant, and the next day
she was sitting up, though the discharge continued, but the simulated throes
of labor, which she had so graphically pictured, had ceased.

Haultain" gives three examples of pseudocyesis, the first with no apparent
cause, the second due to carcinoma of the uterus, while in the third there was
a small fibroid in the anterior wall of the uterus. Some cases are of purely
nervous origin, associated with a purely muscular distention of the abdomen.
Clay reported a case due to ascites. Cases of pseudocyesis in women con-
victed of murder are not uncommon, though most of them are imposters
hoping for an extra lease of life.

Croon ^ speaks of a child seven years old on whom he performed ovari-
otomy for a round-celled sarcoma. She had been well up to May, but since
then she had several times been raped by a boy, in consequence of which she
had constant uterine hemorrhage. Shortly after the first coitus her abdomen
began to enlarge, the breasts to develop, and the areolae to darken. In seven
months the abdomen presented the signs of pregnancy, but the cervix was soft
and patulous ; the sound entered three inches and was followed by some hemor-
rhage. The child was well developed, the mons was covered with hair, and
all the associate symptoms tended to increase the deception.

Sympathetic Male Nausea of Pregnancy. — Associated with preg-
nancy there are often present morning- nausea and vomiting as prominent
and reliable symptoms. Vomiting is often so excessive as to be pro-
vocative of most serious issue and even warranting the induction of
abortion. This fact is well known and has been thoroughly discussed,
but with it is associated an interesting point, the occasional association
of the same symptoms sympathetically in the husband. The belief has
long been a superstition in parts of Great Britain, descending to America,
and even exists at the present day. Sir Francis Bacon has written on this
subject, the substance of his argument being that certain loving husbands
so sympathize with their pregnant wives that they suffer morning-sickness
in their own person. No less an autliority 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 condi-
tion. She was not my patient, but her husband consulted me as to his own

a 124, April, 1891. b 3I8, Feb, 1893.

80

PRENATAL ANOMALIES.

morning-sickness, which came on with the first occurrence of this sign in his
wife, as had been the case twice before in her former pregnancies. I advised
him to leave home, and this proved effectual. I learned later that the
woman continued to gain flesh and be sick every morning until the seventh
month. Then menstruation returned, an examination was made, and when
sure that there was no possibility of her being pregnant she began to lose
flesh, and within a few months regained her usual size."

Hamill ^ reports an instance of morning-sickness in a husband two Aveeks
after the appearance of menstruation in the wife for the last time. He had
daily attacks, and it was not until the failure of the next menses that the
woman had any other sign of pregnancy than her husband's nausea. His
nausea continued for two months, and was the same as that which he had
suffered during his wife's former pregnancies, although not until both he and
his wife became aware of the existence of pregnancy. The Lancet describes
a case in which the husband's nausea and vomiting, as well as that of the wife,
began and ended simultaneously. Judkins " cites an instance of a man who
was sick in the morning while his wife was carrying a child. This occurred
during every pregnancy, and the man related that his own father was simi-
larly affected while his mother was in the early months of pregnancy with
him, showing an hereditary predisposition.

The perverted appetites and peculiar longings of pregnant women
furnish curious matter for discussion. From the earliest times there are
many such records. Borellus cites an instance, and there are many others,
of pregnant women eating excrement with apparent relish. Tulpius, Sennert,
Langius, van Swieten, a Castro, and several others report depraved appe-
tites. Several writers have seen avidity for human flesh in such females.
Fournier ^ knew a woman with an appetite for the blood of her husband.
She gently cut him while he lay asleep by her side and sucked blood
from the wounds— a modern " Succubus." Par§« 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 debaucheiy. 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^so ig that of a
pregnant woman who had a desire for hot and pungent articles of food, and
who in a short time devoured a pound of pepper. Scheidemantel cites a

a 780, 1888 ; and 596, 1888, Ivii., 635. ^ 476, 1878, 66. c 272, 1892.

, ono ■ aoA ® 618, 992.

d 302, XIV,, 624. '

MATERNAL IMPBESSIONS.

81

case in which the perverted appetite, originating in pregnancy, became
permanent, but this is not the experience of most observers. The pregnant
wife of a farmer in Hassfort-on-the-Main ate the excrement of her husband/
Many instances could be quoted, some in which extreme cases of poly-
dipsia and bulimia developed ; these can be readily attributed to the in-
creased call for liquids and food. Other cases of diverse new emotions can
be recalled, such as lasciviousness, dirty habits, perverted thoughts, and, on
the other hand, extreme piety, chastity, and purity of the mind. Some of
the best-natured women are when pregnant extremely cross and irritable,
and many perversions of disposition are commonly noticed in pregnancy.
There is often a longing for a particular kind of food or dish for which no
noticeable desire had been displayed before.

Maternallmpressions. — Another curious fact associated with pregnancy
is the apparent influence of the emotions of the mother on the child in utero.
Every one knows of the popular explanation of many birth-marks, their
supposed resemblance to some animal or object seen by the mother during
pregnancy, etc. The truth of maternal impressions, however, seems to be
more firmly established by facts of a substantial nature. There is a natural
desire to explain any abnormality or anomaly of the child as due to some
incident during the period of the mother's pregnancy, and the truth is often
distorted and the imagination heavily drawn upon to furnish the satisfactory
explanation. It is the customary speech of the dime-museum lecturer to
attribute the existence of some " freak " to an episode in the mother's
pregnancy. The poor " Elephant-man " firmly believed his peculiarity was
due to the fact that his mother while carrying him in utero was knocked down
at the circus by an elephant. In some countries the exhibition of monstrosi-
ties is forbidden because of the supposed danger of maternal impression.
The celebrated " Siamese Twins " for this reason were forbidden to exhibit
themselves for quite a period in France.

We shall cite only a few of the most interesting cases from medical litera-
ture. Hippocrates saved the honor of a princess, accused of adultery with
a negro because she bore a black child, by citing it as a case of maternal
impression, the husband of the princess having placed in her room a paint-
ing of a negro, to the view of which she was subjected during the whole of
her pregnancy. Then, again, in the treatise " De Superfcetatione " there
occurs the following distinct statement : " If a pregnant woman has a long-
mg 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 Avhich is not mentioned by any of the ancient authorities, and is rejected
by practically all the modern ones ; according to Ballantyne, there is there-
fore, no absolute proof that Hippocrates was a believer hi one of the most
popular and long-persisting beliefs concerning fetal deformities.

a Ephem. Physico-Medicorura, Leipzig, 1694, 212.

82 PRENATAL ANOMALIES.

In the explanation of heredity, Hippocrates ^ states " that the body of the
male as well as that of the female furnishes the semen. That which is weak
(unhealthy) is derived from weak (unhealthy) parts, that which is strong
(healthy) from strong (healthy) parts, and the fetus will correspond to the
quality of the semen. If the semen of one part come in greater quantity
from the male than from the female, this part will resemble more closely the
father ; if, however, it comes more from the female, the part will rather
resemble the mother. If it be true that the semen comes from both parents,
then it is impossible for the whole body to resemble either the mother or the
father, or neither the one nor the other in anything, but necessarily the child
will resemble both the one and the other in something. The child will most
resemble the one who contributes most to the formation of the parts." Such
was the Hippocratic theory of generation and heredity, and it was ingen-
iously used to explain the hereditary nature of certain diseases and mal-
formations. For instance, in speaking of the sacred disease (epilepsy),
Hippocrates says : " Its origin is hereditary, like that of other diseases ; for
if a phlegmatic person be born of a phlegmatic, and a bilious of a bilious,
and a phthisical of a phthisical, and one having spleen disease of another
having disease of the spleen, what is to hinder it from happening that where
the father and mother were subject to this disease certain of their oifspring
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,«i» Damascene saw a girl with long hair like a bear,
whose mother had constantly before her a picture of the hairy St. John.
Par6 also appends an illustration showing the supposed resemblance to a bear.
Jonston quotes a case of Heliodorus ; it was an Ethiopian, who by the
eifect of the imagination produced a white child. Par6 describes this case
more fully "Heliodorus says that Persina, Queen of Ethiopia, being
impregnated by Hydustes, also an Ethiopian, bore a daughter with a white
skin and the anomaly was ascribed to the admiration that a picture of Andro-
medl excited in Persina throughout the whole of the pregnancy." \ an
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 seemg
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.
Gas^'sendus 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

^ . -.onr: ^476, 1863, ii., 27.

a 759, Oct., 1895. '

MATERNAL UfPEESSIONS.

83

of a cliild with one eye bkie and the other black, whose mother during con-
finement 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 sis-
ter. This infant died on the third day, but another was born fourteen
months later with the same blisters. Inflammation set in and nearly all the
fingers and toes sloughed off. In a subsequent confinement, long after the
mental agitation, a healthy unmarked infant was born.

Hunt'' describes a case which has since become almost classic of a
woman flitally burned, when pregnant eight months, by her clothes catching
fire at the kitchen grate. The day after the burns labor began and was ter-
minated by the birth of a well-formed dead female child, apparently blis-
tered and burned in extent and in places corresponding almost exactly to the
locations of the mother's injuries. The mother died on the fourth day.

Webb '1 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 Avas no
history of syphilis nor of any eruptive fever in the mother, who died on the
tenth day with tetanus.

Graham describes a woman of thirty-five, the mother of seven children
who while pregnant was feeding some rabbits, when one of the animals
jumped at her with its eyes " glaring " upon her, causing a sudden fright
Her child was born hydrocephalic. Its mouth and face were small and rab-
bit-shaped. Instead of a nose, it had a fleshy growth | inch long by i inch
broad, directed upward at an angle of 45°. The space between this and
the mouth was occupied by a body resembling an adult eye. Within this were

tT 'TlV"'^''^''' ""^"'"^ ^"'^"^^ ^'"^ 1^^^'l^'^ted (ten minutes).

Ihe child s integument was covered with dark, downy, short hair The
woman recovered and afterward bore two normal children,
a 611, No.^19, May 7, 1842. b 1^4. July, 1857.

' ' ■' ■ ^ 224, 1868, i., 51.

84

PRENATAL ANOMALIES.

Parvin mentions an instance of the influence of maternal impression in
the causation of a large, vivid, red mark or splotch on the face : " When the
mother was in Ireland she was badly frightened by a fire in which some cat-
tle were burned. Again, during the early months of her pregnancy she was
frightened by seeing another woman suddenly light the fire with kerosene,
and at that time became firmly impressed with the idea that her child would
be marked." Parvin ^ also pictures the " turtle-man," an individual with de-
formed extremities, who might be classed as an ectro-
melus, perhaps as a phocomclus, or seal-like monster.
According to the story, when the mother was a few
weeks pregnant her husband, a coarse, rough fisherman,
fond of rude jokes, put a large live turtle in the cup-
board. In the twilight the wife went to the cupboard
and the huge turtle fell out, greatly startling her by its
hideous appearance as it fell suddenly to the floor and
began to move vigorously.

Copeland ^ mentions a curious case in which a woman
was attacked by a rattlesnake when in her sixth month
of pregnancy, and gave birth to a child whose arm ex-
hibited the shape and action of a snake, and involun-
tarily went through snake-like movements. The face
and mouth also markedly resembled the head of a snake.
The teeth were situated like a serpent's fangs. The
mere mention of a snake filled the child (a man of
twenty-nine) with great horror and rage, " particularly in the snake season."
Beale'^ gives the history of a case of a child born with its left eye blackened
as by a blow, whose mother was struck in a corresponding portion of the
face eight hours before confinement. There is on record^ an account of a
young man of twenty-one suff'ering from congenital deformities attributed
to the fact that his mother was frightened by a guinea-pig having been thrust
into her face during pregnancy. He also had congenital deformity of the
right auricle. At the autopsy, all the skin, tissues, muscles, and bones were
found involved. Owen ^ speaks of a woman who was greatly excited ten months
previously by a prurient curiosity to see what appearance the genitals of her
brother presented after he had submitted to amputation of the penis on ac-
count of carcinoma. The whole penis had been removed. The woman stated
that from the time she had thus satisfied herself, her mind was unceasingly
engaged in reflecting and sympathizing on the forlorn condition of her
brother While in this mental state she gave birth to a son whose penis was
entirely absent, but who was otherwise well and likely to live. The other
portions of the genitals were perfect and well developed. The appearance of

Fig. 8.— The "turtle-man."

a Internat. Med. Mag., Phila., June, 1892.

c 476, 1863, ii., 27. d 536, 1883, i., 381.

b 218, 1839, 98.
e 476, 1863, 25.

PATERNAL IMPRESSIONS.

85

the nephew and the uncle was identical. A most peculiar case * is stated by
Clerc as occurring in the experience of Kiiss of Strasburg. A woman had
a negro paramour in America with whom she had had sexual intercourse
several times. She was put in a convent on the Continent, where she stayed
two years. On leaving the convent she married a white man, and nine
months after she gave birth to a dark-skinned child. The supposition was
that during her abode in the convent and the nine months subsequently she
had the image of her black paramour constantly before her. Loin ^ speaks
of a woman who was greatly impressed by the actions of a clown at a circus,
and who brought into the world a child that resembled the fantastic features
of the clown in a most striking manner.

Mackay describes five cases in which fright produced distinct marks on
the fetus. There is a case mentioned in which a pregnant woman was
informed that an intimate friend had been thrown from his horse ; the
immediate cause of death was fracture of the skull, produced by the corner
of a dray against which the rider was thrown. The mother was profoundly
impressed by the circumstance, which was minutely described to her by an
eye-witness. Her child at birth presented a red and sensitive area upon the
scalp corresponding in location with the fatal injury in the rider. The
child is now an adult woman, and this area upon the scalp remains red and
sensitive to pressure, and is almost devoid of hair. Mastin of Mobile,
Alabama, reports a curious instance of maternal impression. During the
sixth month of 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 pater-
nal impression eclipse them. Several are on record, but none are of sufficient
authenticity to warrant much discussion on the subject. Those below are
given to illustrate the method of report. Stahl, quoted by Steinan, 1843,
speaks of the case of a child, the father being a soldier who lost an eye in the
war. The child was born with one of its eyes dried up in the orbit, in
this respect presenting an appearance like that of the father. Schneider «

a 239, July 7, 1873. „ g^-

c 476, 1891, ii., 1388. d 844, 213. e 778,' xfvL , '167

86

PRENATAL ANOMALIES.

says a man whose wife was expecting confinement dreamt that his oldest
son stood beside his bedside with his genitals much mutilated and bleeding.
He awoke in a great state of agitation, and a few days later the wife was
delivered of a child with exstrophy of the bladder. Hoare ^ recites the
curious story of a man who vowed that if his next child was a daughter he
would never speak to it. The child proved to be a son, and during the
whole of the father's life nothing could induce the son to speak to his father,
nor, in fact, to any other male person, but after the father's death he talked
fluently to both men and women. Clark ^ reports the birth of a child whose
father "had a stiff knee-joint, and the child's knee was stilf and bent in exactly
the same position as that of its father.

Telegony. The influence of the paternal seed on the physical and

mental constitution of the child is well known. To designate this condition,
Telegony is the word that was coined by Weismann in his " Das Keim-
plasma," and he defines it as " Infection of the Germ," and, at another time,
as " Those doubtful instances in which the offspring is said to resemble, not
the father, but an early mate of the mother,"— or, in other words, the alleged
influence of a previous sire on the progeny produced by a subsequent one
from the same mother. In a systematic discussion of telegony before
the Royal Medical Society, Edinburgh, on March 1, 1895,*' Brunton
Blaikie," as a means of making the definition of telegony plainer by practical
example, prefaced his remarks by citing the classic example which first drew
the attention of the modern scientific world to this phenomenon. The
facts of this case were communicated in a letter from the Earl of Morton
to the President of the Royal Society in 1821, and were as follows:
In the year 1815 Lord Morton put a male quagga to a young chestnut mare
of i Arabian blood, which had never before been bred from. The result was
a female hybrid which resembled both parents. He now sold the mare to
Sir Gore Ousley, who two years after she bore the hybrid put her to
a black Arabian horse. During the two following years she had two foals
which Lord Morton thus describes : " They have the character of the Arabian
breed as decidedly as can be expected when If 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

a 476, 1831-2, i., 441. ^ 548, xv., 258. « 759, July, 1895.

TELEGONY.

87

various examples he goes on to say A friend of mine near this had a
vakiablo Dachshund bitch, which most unfortunately had a litter by a stray
sheep-dog. The next year the owner sent her on a visit to a pure Dachs-
hund dog, but the produce took quite as much of the first father as the
second, and the next year he sent her to another Dachshund, with the same
result. Another case : A friend of mine in Devizes had a litter of puppies,
unsought for, by a setter from a favorite pointer bitch, and after this she
never bred any true pointers, no matter what the paternity was.'

" Lord Polwarth, whose very fine breed of Border Leicesters is famed
throughout Britain, and whose knowledge on the subject of breeding is great,
says that ' In sheep we always consider that if a ewe breeds to a 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 liappens to breed to a dog of another breed, she is of little
use for breeding pure-bred puppies afterward. Animals whicli 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 stilted."

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 ])ut the bitch to a Bedlington terrier dog and get a litter of
puppies Avhich are practically pure, but have much stronger jaws than they
would otherwise have had, and also show nuich of the gameness of the bull-
terrier, thus proving that physiologic as well as anatomic characters may be
transmitted in this way.

After citing the foregoing examples, Blaikie directs his attention to man,
and makes the following interesting remarks :

" We might expect from the foregoing account of telegony amongst ani-
mals that whenever a black woman had a child to a white man, and then
married a black man, her subsequent children would not be entirely black.
Dr. Robert Balfour of Surinam in 1851 wrote to Harvey that he was con-
tinually noticing amongst the colored population of Surinam ' that if a negress

88

PRENATAL ANOMALIES.

had a child or children bv a wliite, and afterward fruitful intercourse with
a negro, the latter oifspring had generally a lighter color than the parents/
But, as far as I know, this is the only instance of this observation on record.
Herbert Spencer has shown that when a pure-bred animal breeds with an
animal of a mixed breed, the offspring resembles much more closely the pa-
rent of pure blood, and this may explain why the circumstance recorded by
Balfour has been so seldom noted. For a negro, who is of very pure blood,
will naturally have a stronger influence on the subsequent progeny than an
Anglo-Saxon, who comes of a mixed stock. If this be the correct explana-
tion, we should expect that when a white woman married first a black man,
and then a white, the children by the white husband would be dark colored.
Unfortunately for the proof of telegony, it is very rare that a white woman
does mariy a black man, and then have a white as second husband ; never-
theless, we have a fair number of recorded instances of dark-colored chil-
dren being born in the above way of white parents.

" Dr. Harvey mentions a case in which ' a young woman, residing in
Edinburgh, and born of white (Scottish) parents, but whose mother, some
time previous to her marriage, had a natural (mulatto) child by a negro man-
servant in Edinburgh, exhibits distinct traces of the negro. Dr. Simpson
— ^afterward Sir James Simpson — whose patient the young woman at one
time was, has had no recent opportunities of satisfying himself as to the pre-
cise extent to w^hich the negro character prevails in her features ; but he
recollects being struck with the resemblance, and noticed particularly that
the hair had the qualities characteristic of the negro.' Herbert Spencer got
a letter from a ' distinguished correspondent ' in the United States, who said
that children by white parents had been ' repeatedly ' observed to show traces
of black blood when the women had had previous connection with {i. e., a
child by) a negro. Dr. Youmans of New York interviewed several medi-
cal professors, who said the above was ' generally accepted as a fact.' Prof.
Austin Flint, in ' A Text-book of Human Physiology,' mentioned this fact,
and when asked about it said : ' He had never heard the statement ques-
tioned.'

" But it is not only in relation to color that we find telegony to have
been noticed in the human subject. Dr. Middleton Michel gives a most in-
teresting case in the American Journal of the Medical Sciences for 1868 :
< A black woman, mother of several negro children, none of whom were de-
formed in any particular, had illicit intercourse with a white man, by whom
she became pregnant. During gestation she manifested great uneasiness of
mind, lest the birth of a mulatto offspring should disclose her conduct. . . .
It so happened that her negro husband possessed a sixth digit on each hand,
but there was no peculiarity of any kind in the white man, yet when the
mulatto child was born it actually presented the deformity of a supernume-
rary finger.' Taruffi, the celebrated Italian teratologist, in speaking of the

ANTENATAL PATHOLOGY.

89

subject, says : ' Our knowledge of this strange fact is by no means recent,
for Fienus, in 1608, said that most of the children born in adultery have a
greater resemblance to the legal than to the real father ' — an observation that
was confirmed by the philosopher Vanini and by the naturalist Ambrosini.
From these observations comes the proverb : ' Filium ex adultera excusare
matrem a culpa.' Osiimder 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 Physiologic), and Dr. Will-
iam Sedgwick have all remarked on this physical resemblance ; and Dr.
Metcalfe, in a dissertation delivered before this society in 1855, observed
that in the cases of widows remarrying the children of the second marriage
frequently resemble the first husband.

"An observation probably having some bearing on this subject was made
by Count de Stuzeleci (Harvey, loo. cit). He noticed that when an aborig-
inal female had had a child by a European, she lost the power of conception
by a male of her own race, but could produce children by a white man. He
believed this to be the case with many aboriginal races ; but it has been dis-
proved, or at all events proved to be by no means a universal law, in every
case except that of the aborigines of Australia and New Zealand. Dr.
William Sedgwick thought it probable that the unfruitfulness of prostitutes
might in some degree be due to the same cause as that of the Australian
aborigines who have had children by white men.

" It would seem as though the Israelites had had some knowledge of
telegony, for in Deuteronomy we find that when a man died leaving no issue,
his wife was commanded to marry her husband's brother, in order that he
might ' raise up seed to his brother.' "

We must omit the thorough inquiry into this subject that is offered by
Mr. Blaikie. The explanations put forward have always been on one of
three main lines : —

(1) The imagination-theory, or, to quote Harvey : "Due to mental causes
so operating either on the mind of the female and so acting on her repro-
ductive powers, or on the mind of the male parent, and so influencing the
qualities of his semen, as to modify the nutrition and development of the
oflFspring."

(2) Due to a local influence on the reproductive organs of the mother.

(3) Due to a general influence through the fetus on the mother.

Antenatal Pathology.^We have next to deal with the diseases, acci-
dents, and operations that aflect the pregnant uterus and its contents ; these
are rich in anomalies and facts of curious interest, and have been recog-
nized from the earliest times. In the various works usually grouped
together under the general designation of " Hippocratic " are to be found

PRENATAL ANOMALIES.

the earliest opinions upon the subject of antenatal pathology which the
medical literature of Greece has handed down to modern times. That there
were medical writers before the time of Hippocrates cannot be doubted, and
that the works ascribed to the " Father of Medicine " were immediately fol-
lowed by those of other physicians, is likewise not to be questioned ; but
whilst nearly all the writings prior to and after Hippocrates have been long
lost to the world, most of those that were written by the Coan physician and
his followers liave been almost miraculously preserved. As Littre puts it,
" Les ecrits hippocratiques demeurent isoles au milieu des debris de I'antique
litterature medicale." — (Ballantyne.)

The first to be considered is the transmission of contagious disease
to the fetus in utero. The first disease to attract attention was small-
pox. Devilliers, Blot, and Depaul all speak of congenitid 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. Yidal reported to the French
Academy of Medicine, May, 1871, the case of a woman who gave birth to
a living child of about six and one-half months' maturation, which died some
hours after birth covered with the pustules of seven or eight days' eruption.
The pustules on the fetus were well umbilicated and typical, and could have
been nothing but those of small-pox ; besides, this disease was raging in the
neighborhood at the time. The mother had never been infected before, and
never was subsequently. Both parents were robust and neither of them
had ever had syphilis. About the time of conception, the early part of
December, 1870, the father had suffered from the semiconfluent type, but the
mother, who had been vaccinated when a girl, had never been stricken
either during or after her husband's sickness. Quirke^^ relates a peculiar
instance .of a child born at midnight, whose mother was covered with the
eruption eight hours after delivery. The child was healthy and showed no
signs of the contagion, and was vaccinated at once. Although it remained
with its mother all through the sickness, it continued well, with the excep-
tion of the ninth day, when a slight fever due to its vaccination appeared.
The mother made a good recovery, and the author remarks that had the
child been born a short time later, it would most likely have been infected.
Ayer ^ reports an instance of congenital variola in twins. Chantreuil^

a 629, 1743-50, 1043. b 224, 1886, i., 201.

c 1851, xHv., 397. d 363, 1870, xliii., 173.

DISEASE TRANSMITTED TO THE FETUS.

91

speaks of a woman pregnant with twins who aborted at five and a half
months. One of the fetuses showed distinct signs of congenital variola,
although the mother and other fetus were free from any symptoms of the
disease. In 1853 Charcot reported the birth of a premature fetus present-
ing numerous variolous pustules together with ulcerations of the derm and
mucous membranes and stomach, although the mother had convalesced of
the disease some time before. Mitchell'^ describes a case of small-pox occur-
ring three days after birth, the mother not having had the disease since
childhood. Shertzer relates an instance of confluent small-pox in the eighth
month of pregnancy. The child was born with the disease, and both mother
and babe recovered. Among many others offering evidence of variola in
utero are Degner, Derliam, John Hunter, Blot, Bulkley, Welch, Wright,
Digk, Forbes, Mariiuis, and Bouteiller.

Varicella, Measles, Pneumonia, and even Malaria are reported as
having been transmitted to the child in utero. Hubbard attended a woman
on March 17, 1878, in her seventh accouchement. The child showed the
rash of varicella twenty-four hours after birth, and passed through the regu-
lar course of chicken-pox of ten days' duration. The mother had no signs
of the disease, but the children all about her were infected. Ordinarily the
period of incubation is from three to four days, with a premonitory fever of
from twenty-four to seventy-two hours' duration, when the rash appears ;
this case must therefore have been infected in utero. Lomer ^ of Ham-
burg tells of the case of a woman, twenty-two years, unmarried, pregnant,
who had measles in the eighth month, and who gave birth to an infant with
measles. The mother was attacked with pneumonia on the fifth day of her
puerperium, but recovered ; the child died in four weeks of intestinal
catarrh. Gautier^ found measles transmitted from the mother to the fetus
in 6 out of 1 1 cases, there being 2 maternal deaths in the 1 1 cases.

iS'etterf 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 g
collected a number of cases of pneumonia occurring during pregnancy, show-
ing a fetal mortality of 80 per cent.

Felkin h relates two instances of fetal malaria in which the infection was
probably transmitted by the male parent. In one case the father near
term suffered severely from malaria ; the mother had never had a chill.
The violent fetal movements induced labor, and the spleen was so large as
to retard it. After birth the child had seven malarial paroxysms but re-
covered, the splenic tumor disappearing.

The modes of infection of the fetus by syphilis, and the infection of
the mother, have been well discussed, and need no mention here.

a 124, 1830, vii., 555. ^ iy., l^Q. « 224, 1878, i., 822. d 261 1889

e 140, 1879, 321. ^ 300, No. 22, 1889. g 140, 1889, 439. h 3I8; June, 1889.

92

PRENATAL ANOMALIES.

There has been much discussion on the effects on the fetus in utero
of medicine administered to the pregnant mother, and the opinions as
to the reliability of this medication are so varied that we are in doubt as to a
satisfactory conclusion. The effects of drugs administered and eliminated
by the mammary glands and transmitted to the child at the breast are
well known, and have been witnessed by nearly every physician, and, as
in cases of strong metallic purges, etc., need no other than the actual test.
However, scientific experiments as to the efficacy of fetal therapeutics have
been made from time to time with varying results.

Gusserow of Strasbourg tested for iodin, chloroform, and salicylic acid
in the blood and secretions of the fetus after maternal administration just
before death. In 14 cases in which iodin had been administered, he
examined the fetal urine of 11 cases ; in 5, iodin was present, and in the
others, absent. He made some similar experiments on the lower animals.
Benicke reports having given salicylic acid just before birth in 25 cases, and
in each case finding it in the urine of the child shortly after birth.

At a discussion held in New York some years ago as to the real effect on
the fetus of giving narcotics to the mother. Dr. Gaillard Thomas was almost
alone in advocating that the effect was quite visible. Fordyce Barker was
strongly on the negative side. 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.
Siinpson advanced a new idea in the recommendation of potassium chlorate
during the latter stages of pregnancy. The efficacy of this suggestion is
known, and whether, as Simpson said, it acts by supplying extra oxygen to
the blood, or whether the salt itself is conveyed to the fetus, has never

been definitely settled.

McClintock,'^ who has been a close observer on this subject, reports some
interesting cases. In his first case he tried a mixture of iron perchlorid and
potassium chlorate three times a day on a woman who had borne three dead
children, with a most successful result. His second case failed, but in a
third he was successful by the same medication with a woman who had
before borne a dead child. In a fourth case of unsuccessful pregnancy for
three consecutive births he was successful. His fifth case was extra-
ordinary : It was that of a woman in her tenth pregnancy, who, with one
exception, had always borne a dead child at the seventh or eighth month.
The one exception lived a few hours only. Under this treatment he was
successful in carrying the woman safely past her time for miscarriage, and
had everv indication for a normal birth at the time of report. Thornburn
believes that the administration of a tonic like strychnin is of benefit to a
fetus which, by its feeble heart-beats and movements, is thought to be un-

a 224, 1877, ii., 513.

MEDICINE TO THE PREGNANT WOMAN.

93

lieiilthy. 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 Terato-
logia.^^^

In this important paper, Porak, after giving some historical notes,
describes a long series of experiments performed on the guinea-pig in order
to investigate the passage of arsenic, copper, lead, mercury, phosphorus,
alizarin, atropin, and eserin through the placenta. The placenta shows
a real affinity for some toxic substances ; in it accumulate copper and mer-
cury, but not lead, and it is therefore through it that the poison reaches the
fetus ; in addition to its pulmonary, intestinal, and renal functions, it fixes
glycogen and acts as an accumulator of poisons, and so resembles in its action
the liver ; therefore the organs of the fetus possess only a potential activity.
The storing up of poisons in the placenta is not so general as the accumula-
tion of them in the liver of the mother. It may be asked if the placenta
does not form a barrier to the passage of poisons into the circulation of the
fetus ; this would seem to be demonstrated by mercury, which was always
found in the placenta and never in the fetal organs. In poisoning by lead
and copper the accumulation of the poison in the fetal tissues is greater than
in the maternal, perhaps from differences in assimilation and disassimilation
or from greater diffusion. Whilst it is not an impermeable barrier to the pas-
sage of poisons, the placenta offers a varying degree of obstruction : it allows
copper and lead to pass easily, arsenic with greater difficulty. The accumu-
lation of toxic substances in the fetus does not follow the same law as in the
adult. They diffiise more widely in the fetus. In the adult the liver is the
chief accumulatory organ. Arsenic, which in the mother elects to accumu-
late in the liver, is in the fetus stored up in the skin ; copper accumulates
in the fetal liver, central nervous system, and sometimes in the skin ; lead,
which is found specially in the maternal liver, but also in the skin, has been
observed in the skin, liver, nervous centers, and elsewhere in the fetus. The
frequent presence of poisons in the fetal skin demonstrates its physiologic
importance. It has probably not a very marked influence on its health.
On the contrary, accumulation in the placenta and nerve centers explains
the pathogenesis of abortion and the birth of dead fetuses (" mortinatalite ").
Copper and lead did not cause abortion, but mercury did so in two out of
six cases. Arsenic is a powerful abortive agent in the guinea-pig, probably
on account of placental hemorrhages. An important deduction is that whilst
the placenta is frequently and seriously affected in syphilis, it is also the
special seat for the accumulation of mercury. May this not explain its
therapeutic action in this disease ? The marked accumulation of lead in the
central nervous system of the fetus explains the frequency and serious char-
acter of saturnine encephalopathic lesions. The presence of arsenic in the
a Archives de M6d. exp6rimentale et d'Anatomie path., March, 1894, p. 192.

94

PRENATAL ANOMALIES.

fetal skin alone gives an explanation of the therapeutic results of the adminis-
tration of this substance in skin diseases.

Intrauterine amputations are of interest to the medical man, par-
ticularly those cases in which the accident has happened in early pregnancy
and the child is born with a very satisfactory and clean stump. Mont-
gomery/ in an excellent paper, advances the theory, which is very plausible,
that intrauterine amputations are caused by contraction of bands or mem-
branes of organized lymph encircling the limb and producing amputation by
the same process of disjunctive atrophy that the surgeons induce by ligature.
Weinlechner ^ speaks of a case in which a man devoid of all four extremi-
ties was exhibited before the Vienna Medical Society. The amputations
were congenital, and on the right side there was a very small stump of the
upper arm remaining, admitting the attachment of an artificial apparatus.
He was twenty-seven years old, and able to write, to thread a needle, pour
water out of a bottle, etc. Cook*' speaks of a female child born of Indian
parents, the fourth birth of a mother twenty-six years old. The child
weighed 5| pounds ; the circumference of the head was 14 inches and that of
the trunk 1 3 inches. The upper extremities consisted of perfect shoulder joints,
but only ^ of each humerus was present. Both sides showed evidences of

amputation, the cicatrix on the right side
being 1 inch long and on the left |'
inch long. The right lower limb was
merely a fleshy corpuscle | inch wide and
I inch long ; to the posterior edge was
attached a body resembling the little toe
of a newly-born infant. On the left side
the limb was represented by a fleshy cor-
puscle 1 inch long and I inch in circumfer-
ence, resembling the great toe of an in-
fant. There was no history of shock or
injury to the mother. The child presented by the breech, and by the ab-
sence of limbs caused much difficulty in diagnosis. The three stages of labor
were one and one-half hours, forty-five minutes, and five minutes, respect-
ively. The accompanying illustration (Fig. 9) shows the appearance of the
limbs at the time of report.

Figure 10 represents a negro boy, the victim of intrauterine amputation,
who learned to utilize his toes for many purposes. The illustration shows
his mode of holding his pen.

There is an instance reported in which a child at full term was born
with an amputated arm, and at the age of seventeen the stump was scarcely
if at all smaller than the other. Blake ' speaks of a case of congenital

Fig. 9.— Intrauterine amputation (Cook).

a 309, 1832.
C1222, Oct., 1837.

b 118, Jau. 22, 1878.

c 224, 1890, i., 1360.
e 218, Dec. 20, 1894.

INTRAUTERINE AMPUTATIONS.

95

amputation of both the upper extremities. Gillilani » mentions a case that
shows the deleterious influence of even the weight of a fetal limb resting on
a cord or band. His case was that of a fetus, the product of a miscarriage
of traumatic origin ; the soft tissues were almost cut through and the bone
denuded by the limb resting on one of the two umbilical cords, not encir-
cling it, but in a sling. The cord was deeply imbedded in the tissues.

The coilings of the cord are not limited to compression about the extremi-
ties alone, but may even decapitate the head by being firmly wrapped several
times about the neck. According to Ballantyne, '^^^ there is in the treatise
De Octimestri Partu, by Hip-
pocrates, a reference to coiling
of the umbilical cord round the
neck of the fetus. This coiling
was, indeed, regarded as one of
the dangers of the eighth month,
and even the mode of its pro-
duction is described. It is said
that if the cord be extended
along one side of the uterus,
and the fetus lie more to the
other side, then when the eif/-
bide 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 farther stated, the mother will
sulfer later and the fetus will
either perish or be born with
difficulty. If the Hippocratic
writers knew that this coiling is
sometimes quite innocuous, they
did not in any place state the fact.

The accompanying illustrations (Fig. 11) show the different ways in which
the funis may be coiled, the coils sometimes being as many as 8.

Bizzen ^ mentions an instance in which from strangulation the head of a
fetus was in a state of putrefaction, the funis being twice tightly bound
around the neck. Cleveland,^ Cuthbert,'^ and Germain ^ report analogous
instances. Matthyssens ^ observed the twisting of the funis about the arm
and neck of a fetus the body of M'hich was markedly wasted. There was
complete absence of amniotic fluid during labor. Blumenthal s presented to the
New York Pathological Society an ovum within which the fetus was under-

a 274, 1872, iii., 230. b 124^ 1352, xxxiii., 565. c 773, xiii., 1. d 610, 1874-5.
e 362, ix., 567. f Ann. Soc. de m6d. d'Auvers, 1842, 372. g 538, 1871, vi., 278!

Fig. 10.— Intrauterine amputation.

96

PRENATAL ANOMALIES.

going intrauterine decapitation. Buchanan ^ describes a case illustrative of
the etiology of spontaneous amputation of limbs in utero. Nebinger ^ reports
a case of abortion, showing commencing amputation of the left thigh from
being encircled by the funis. The death of the fetus was probably due to
compression of the cord. Owen<^ mentions an instance in 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 ^ pub-
lished an article on spontaneous amputation of the forearm and rudimentary
regeneration of the hand in the fetus. Among other contributors to this

Fig. 11.— Coiling of the cord.

subject are Avery, Boncour, Brown, Ware, Wrangell, Young, Nettekoven,
Martin, Macan, Leopold, Hecker, Giinther, and Friedinger.

Wygodzky « finds that the greatest number of coils of the umbilical cord
ever found to encircle a fetus are 7 (Baudelocque), 8 (Cred6), and 9
(Miiller and Gray). His own case was observed this year in Wilna. The
patient was a primipara aged twenty. The last period was seen on
May 10, 1894. On February 19th the fetal movements suddenly ceased.
On the '20th pains set in about two weeks before term. At noon turbid

a 774 1839, x., 41. b 124, 1867, liv., 129. « 656, 1851, 573.

d Month. Jour. Med. Sc., Edin., 1848. « 261; and quoted 545, Feb. 29, 1896.

INTRAUTERINE FRACTURES. 97

liquor amnii escaped. At 2 p. m., on examination, Wygodzivy 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 eng-aged in the pelvic cavity. At 7 p. m. it neared the outlet
at the height of each pain, but retracted immediately afterward. After 10
P. M. the pains grew weak. At midnight Wygodzky delivered the dead
child by expression. Not till then was the cause of delay clear. The funis
was very tense and coiled 7 times round the neck and once round the left
shoulder ; there was also a distinct knot. It measured over 65 inches in
length. The fetus was a male, slightly macerated. It weighed over 5 pounds,
and was easily delivered entire after division and unwinding of the funis.
No marks remained on the neck. The placenta followed ten minutes later
and, so far as naked-eye experience indicated, seemed healthy.

Intrauterine fractures are occasionally seen, but are generally the re-
sults of traumatism or of some extraordinary muscular efforts on the part
of the mother. A blow on the abdomen or a fall may cause them. The
most interesting cases are those in which the fractures are multiple and the
causes unknown. Spontaneous fetal fractures have been discussed thor-
oughly, and the reader is referred to any responsible text-book for the theo-
ries of causation. Atkinson,- De Luna," and Keller report intrauterine
fractures of the clavicle. Filippi^ contributes an extensive paper on the
medicolegal aspect of a case of intrauterine fracture of the os cranium.
Braun of Vienna reports a case of intrauterine fracture of the humerus and
femur. Eodrigue ^ describes a case of fracture and dislocation of the hu-
merus of a fetus in utero. Gaultier*^ reports an instance of fracture of both
femora mtrauterine. Stanley, Vanderveer, and Young cite instances of in-
trauterme fracture of the thigh ; in the case of Stanley the fracture occurred
durmg the last week of gestation, and there was rapid union of the frag-
ments during lactation. Danyau, Proudfoot, and Smith ^ mention intrauterine
fracture of the tibia; in Proudfoot's case there was congenital talipes talus

Dolbeau^ describes an instance in which multiple fractures were found in
a fetus, someof which were evidently postpartum, while others were assuredly
antepartum. Hirschfeld^ describes a fetus showing congenital multiple frac-
ures 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
honrs and at the postmortem examination it was found that some were
already solid, some uniting, whilst others were recent. It often hannens
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 wh cT ht ^^^^
tures are multiple and the cause is not apparent.

a 545, 1859-60, iii., 532. b 124 irtq iwi Ofto r t

^ .24, .854, .„.„.,' m . JeS 1 ■ ^- : T^r- rr^'

98 PRENATAL ANOMALIES.

The results to the fetus of injuries to the pregnant mother are most
diversitied. In some instances the marvelous escape of any serious conse-
quences of one or both is almost incredible, while in others the slightest
injury is fatal. Guillemont - cites the instance of a woman who was kiUed
by a stroke of lightning, but whose fetus was saved ; while Fabricius Hil-
danus ^ describes a case in which there was perforation of the head, fracture
of the skull, and a wound of the groin, due to sudden starting and agony ot
terror of the mother. Here there was not the slightest history of any exter-
nal violence. .

It is a well-known fact that injuries to the pregnant mother show visible
effects on the person of the fetus. The older writers kept a careful recoil
of the anomalous and extraordinary injuries of this character and of their
effects. Brendelius tells us of hemorrhage from the mouth and nose ot the
fetus occasioned by the fall of the mother ; Buchner « mentions a case ot
fracture of the cranium from fright of the mother ; Reuther describes a con-
tusion of the OS sacrum and abdomen in the mother from a fall, with fracture
of the arm and leg of the fetus from the same cause ; Sachse^ speaks of a
fractured tibia in a fetus, caused by a fall of the mother ; Slevogt^ re ates
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- Yerducf offers several examples, one a dislocation of the fetal toot
from a maternal fall; Plocquet^^^ gives an instance of fractured femur ;
Walther ^ describes a case of dislocation of the vertebra from a fall ; and
there isalsoacase^ of a fractured fetal vertebra from a maternal fall. There
is recorded i a fetal scalp injury, together with clotted blood m 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 records
The modern records are much more interesting and wonderf^il on this
subiect than the older ones. Richardson speaks of a woman ftxlling down
a few weeks before her delivery. Her pelvis was roomy and the birth was
easy • but the infant was found to have extensive wounds on the back, reach-
ino: 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.

Iniuries about the genitalia would naturally be expected to exercise
some active influence on the uterine contents ; but there are many instances
reported in which the escape of injury is marvelous. Gibb ^ speaks of a
woman, about eight months pregnant, who fell across a chair, lacerating her

a Lvons, 1590. ^ 334, cent, v., obs. 3. c Misce. 1728, 1026. ^ 452, L.

170 f 7qq T i 197. g 815, obs. 50. n 5^4, v., c>^o.

e 282, ann. x., 172. 799, T_ 1 ^ ^^^^ ^^^^^

i 462, T. XXI. J 106, 171^, ■5t3'4-

INJURIES FROM HORNS OF CATTLE.

99

genitals and causing an escape of liquor ainnii. There was regeneration of
this fluid and delivery beyond term. The labor was tedious and took place
two and a half months after the accident. The mother and the female child
did well. Purcell reports death in a pregnant woman from contused wound
of the vulva. Morland relates an instance of a woman in the fifth month
of her second pregnancy, who fell on the roof of a woodshed by slipping
from one of the steps by which she ascended to the roof, in the act of hang-
ing out some clothes to dry. She suffered a wound on the internal surface
of the left nymplia 1 1 inch long and | 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 stoop-
ing position, milking a cow, was impaled through the vagina by another
cow. The child was born seven days later, with its skull crushed by the
cow's horn. The horn had entered the vagina, carrying the clothing with it.

There are some marvelous cases of recovery and noninterference with
pregnancy after injuries from horns of cattle. Corey speaks of a woman
of thirty-five, three months pregnant, weighing 135 pounds, who was horned
by a cow through the abdominal parietes near the hypogastric region ; she
was lifted into the air, carried, and tossed on the ground by the infuriated
animal. There was a wound consisting of a ragged rent from above the os
pubis, extending obliquely to the left and upward, through which protruded
the great omentum, the descending and transverse colon, most of the small
intestines, as well as the pyloric extremity of the stomach. The great omen-
tum was mangled and comminuted, and bore two lacerations of two inches
each. The intestines and stomach were not injured, but there was consider-
able extravasation of blood into the abdominal cavity. The intestines were
cleansed and an unsuccessful attempt was made to replace them. The intes-
tines remained outside of the body for two hours, and the great 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 twentv minutes the intes-
tmes were all replaced in the abdominal cavity. The edges were pared,
sutured, and the wound dressed. The woman was placed in bed on the

a 313, 1870. b 218, 1858-9. c 521, 1885. d 760, 1884. e 133 'l878

100 PRENATAL ANOMALIES.

right side, and morphin was administered. The sutures were removed on
the ninth day, and the wound had healed except at the point of penetration.
The woman was discharged twenty days after, and, incredible to relate, was
delivered of a well-developed, full-term child just two hundred and two
days from the time of the accident. Both the mother and child did well.

Luce " speaks of a pregnant woman who was horned in the lower part
of the abdomen by a cow, and had a subsequent protrusion of the intestines
through the wound. After some minor complications, the wound healed
fourteen weeks after the accident, and the woman was confined in natural
labor of a healthy, vigorous child. In this case no blood was found on
the cow's horn, and the clothing was not torn, so that the wound must
have been made by the side of the horn striking the greatly distended
abdomen.

Richard,^ quoted also by Tiffany,^^^^ speaks of a woman, twenty-two, who
fell in a dark cellar with some empty bottles in her hand, suffering a wound
in the abdomen 2 inches above the navel on the left side 8 cm. long.
Through this wound a mass of intestines, the size of a man's head, protruded.
Both the mother and the child made a good convalescence. Harris « cites
the instance of a woman of thirty, a multipara, six months pregnant, who
was gored bv a cow ; her intestines and omentum protruded through the rip
aud the uterus was bruised. There was rapid recovery and delivery at
t^rm. Wetmore of Illinois saw a woman who in the summer of 1860,
when about six months pregnant, was gored by a cow, and the large
intestine and the omentum protruded through the wound. Three hours
after the injury she was found swathed in rags wet^with a compound
solution of whiskey and camphor, with a decoction of tobacco. The intes-
tines were cold to the touch and dirty, but were washed and replaced. The
abdomen was sewed up with a darning needle and black linen thread ; the
woman recovered and bore a healthy child at the full maturity of her gesta-
tion d Crowdace « speaks of a female pauper, six months pregnant, Avho
was attacked by a buffalo, and suffered a wound about H inch long and |
inch wide just above the umbilicus. Through this small opening 19 mches
of intestine protruded. The woman recovered, and the fetal heart-beats
could be readily auscultated.

Major accidents in pregnant women are often followed by the happiest
results. There seems to be no limit to what the pregnant uterus can success-
fully endure Tiffany who has collected some statistics on this subject,
as well as on operations successfully performed during pregnancy, which will
be considered later, quotes ^ the account of a woman of twenty-seven, eight
months pregnant, who was almost buried under a clay wall. She received
terrible wounds about the head, 32 sutures being used in this location

a r,A:^ 1859 ^ 236, 1878. 125, xx.

d Hiri25, XX. e 500, 1863, vii., 409. ^ 644, 1881, vi., 203.

MAJOR ACCIDENTS IN PREGNANCY.

101

alone. Subsequentlv she was confined, easily bore a perfectly normal female
child, and both did well. Sibois " describes the case of a woman weigh-
ing 190 pounds, who fell on her head from the top of a wall from 10
to 12 feet high. For several hours she exhibited symptoms of fracture of
the base of the skull, and the case was so diagnosed ; fourteen hours after
the accident she was perfectly conscious and sulfered 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^ pounds. She had therefore lost after the accident one-half
of a double conception.

Verrier^ has collected the results of traumatism during pregnancy, and
summarizes 61 cases. Prowzowsky cites the instance of a patient in the
eighth month of her first pregnancy who was wounded by many pieces of
lead pipe fired from a gun but a few feet distant. Neither the patient nor
the child suffered materially from the accident, and gestation proceeded ; the
child died on the fourth day after birth without apparent cause. Milner
records an instance of remarkable tolerance of injury in a pregnant woman.
During her six months of pregnancy the patient was accidentally shot through
the abdominal cavity and lower part of the thorax. The missile penetrated
the central tendon of the diaphragm and lodged in the lung. The injury was
limited by localized pneumonia and peritonitis, and the wound was drained
through the lung by free expectoration. Recovery ensued, the patient giving
birth to a healthy child sixteen weeks later. Belin^ mentions a stab-wound
in a pregnant woman from which a considerable portion of the epiploon pro-
truded. Sloughing ensued, but the patient made a good recovery, gestation
not being interrupted. Fancon f describes the case of a woman who had an
injury to the knee requiring drainage. She was attacked by erysipelas,
which spread over the whole body with the exception of the head and neck ;
yet her pregnancy was uninterrupted and recovery ensued. Fancon also
speaks of a girl of nineteen, frightened by her lover, who threatened to stab
her, who jumped from a second-story window. For three days after the
fall she had a slight bloody flow from the vulva. Although she was six
months pregnant there was no interruption of the normal course of
gestation.

Bancrofts speaks of a woman who, being mistaken for a burglar, was shot
by her husband with a 44-caliber bullet. The missile entered the second
and third ribs an inch from the sternum, passed through the right lung, and
escaped at the inferior angle of the scapula, about three inches belo4 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

a 788, 1887, July 1, 345. b Rev. MM.-chir. d. Mai. d. Femmes, Paris, 1888 x 5'>9
c 812, 1879, iv., 1113. cl533.1xi.,243. e 236, 1878. f Quoted 8^4, 251. g 5i5, 'l8^6:

102 PRENATAL ANOMALIES.

terra 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 bellv, but there was no deterioration of general health. At her
confinement, which was normal, a strong boy was born, wanting the arm
below the middle, at which point a white bone protruded. The wound
healed and the separated arm came away after birth. Wainwright - relates
the instance of a woman of forty, who when six months pregnant was run
over by railway cars. After a double amputation of the legs she miscarried
and made a good recovery. Neugebauer '> reported the history of a case of a
woman who, while near her term of pregnancy, committed suicide by jump-
ing from a window. She ruptured her uterus, and a dead child with a frac-
ture of the parietal bone was found in the abdominal cavity. Staples ^
speaks of a Swede of twenty-eight, of Minnesota, who was accidentally shot
bv a voung man riding by her side in a wagon. The ball entered the
abdom;n 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
fortv hours there was delivery of a dead child with a bullet m its abdomen.
Labor was normal and the internal recovery complete. \ on C helms,
quoting the younger Naegele, gives a remarkable instance of -y^-^^^^^
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
davs 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 g^od 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 t^he region of the
stomach and soon afterward with convulsions, supposed to have been puer-
peral She died in a few hours, and at the autopsy it was found that labor
a 647 1877, 59. b 782 ; and 261. 1890, 88. e 538, 1876. ^ 218, Oct. 1, 1868.

OPERATIONS DURING PREGNANCY.

103

had not begun, but that the pregnancy had caused a laceration of the spleen,
from which had escaped four or live pints of blood. Edge'' speaks of a case
of chorea in pregnancy in a woman of twenty-seven, not interrupting preg-
nancy or retarding safe delivery. This had continued for four pregnancies,
but in the fourth abortion took place.

Buzzard ^ had a case of nervous tremor in a woman, following a fall at
her fourth month of pregnancy, who at term gave birth to a male child that
was idiotic. Beatty relates a curious accident to a fetus in utero. The
woman was in her first confinement and was delivered of a small but healthy
and strong boy. There was a small puncture in the abdominal parietes,
through which the whole of the intestines protruded and were constricted.
The opening was so small that he had to enlarge it with a bistoury to replace
the bowel, which was dark and congested ; he sutured the wound with silver
wire, but the child subsequently died.

Tiffany of Baltimore has collected excellent statistics of operations
during pregnancy ; and Mann of Buffalo has done the same work, limit-
ing himself to operations on the pelvic organs, where interference is sup-
posed to have been particularly contraindicated in pregnancy. Mann, after
giving his individual cases, makes the following summary and conclusions : —

(1) Pregnancy is not a general bar to operations, as has been supposed.

(2) Union of the denuded surfaces is the rule, and the cicatricial tissue,
formed during the earlier months of pregnancy, is strong enough to resist
the shock of labor at term.

(3) Operations on the vulva are of little danger to mother or child.

(4) Operations on the vagina are liable to cause severe hemorrhage, but
otherwise are not dangerous.

(5) Venereal vegetations or warts are best treated by removal.

(6) Applications of silver nitrate or astringents may be safely made to the
vagina. For such application, phenol or iodin should not be used, pure or in
strong solution.

(7) Operations on the bladder or urethra are not dangerous or liable to
be followed by abortion.

(8) Operations for vesicovaginal fistulse should not be done, as they are
dangerous, and are lialjle to be followed by much hemorrhage and abortion.

(9) Plastic operations may be done in the earlier months of pregnancy
with fair prospects of a safe and successful issue.

(10) Small polypi may be treated by torsion or astringents. If cut,
there is likely to be a subsequent abortion.

(11) Large polypi removed toward the close of pregnancy will cause
hemorrhage.

(12) Carcinoma of the cervix should be removed at once.

A few of the examples on record of operations during pregnancy of

a 244, 1889, i., 516. b 475, 1868, ii., 479. c 224, 1879, i., 701. d 734, 1882.

104

PRENATAL ANOMALIES.

special interest, will be given below. Polaillon " speaks of a double ovari-
otomy on a woman pregnant at three months, with the subsequent birth of a
living child at term. Gordon ^ reports five successful ovariotomies during
pregnancy, in Lebedetf 's clinic. Of these cases, 1 aborted on the fifth day,
2 on the fifteenth, and the other 2 continued uninterrupted. He collected
204 cases with a mortality of only 3 per cent. ; 22 per cent, aborted, and
69.4 per cent, were delivered at full term. Kreutzman reports two cases
in which ovarian tumors were successfully removed from pregnant subjects
without the interruption of gestation. One of these women, a secundipara,
had gone two weeks over time, and had a large ovarian cyst, the pedicle
of which had become twisted, the fluid in the cyst being sanguineous. May ^
describes an ovariotomy performed during pregnancy at Tottenham Hospital.
The woman, aged twenty-two, was pale, diminutive in size, and showed an
enormous abdomen (Fig. 12), which measured 50 inches in circumference at

the umbilicus and 27 inches from the
ensiform cartilage to the pubes. At the
operation, 36 pints of brown fluid were
drawn off. Delivery took place twelve
hours after the operation, the mother re-
covering, but the child was lost. Gala-
bin ® had a case of ovariotomy performed
on a woman in the sixth month of preg-
nancy without interruption of pregnancy ;
Potter ^ had a case of double ovariotomy
, „ , with safe delivery at term ; and Storry ^

l>ad a similar case. Jacobson- cites a

Fig. 12.— Ovariotomy during pregnancy. (May, ^^g^ q£ vaginal litliotomy in a paticut
British Med. Jour., Dec. 2, 1893.) -, , i ^ ,i ' ^ -xi

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 12i ounces and measuring 2 by 2i inches, with
subsequent recovery and continuation of pregnancy. RydygierJ 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 Chirurgie, 1887, contains an account of a woman Avho suffered
internal strangulation, on whom celiotomy Avas 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

a 653 1892. b 261, 1894. ^ Occidental Med. Times, Aug., 1892.

d 224^ Dec.'2, 1893. e 224,' 1880. f 125, 1888. S 476, 1882.

h 476, 1889, i., 628. i 224, Oct. 15, 1887. i 844, 250. ^ 125, May, 1871.

OPERATIONS DURING PREGNANCY.

105

thirty-three, for severe and constant pain. Tiffany removed tlie kidney of
a woman of twenty-seven, five montlis pregnant, witlioiit 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 Aveek of pregnancy and ovariotomy performed without any inter-
ruption of the ordinary course of labor. Russell ^ cites the instance of a
woman who was successfully tapped at the sixth month of pregnancy.

McLean s 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-i reports the
successful performance of a hip-joint amputation for malignant disease of
the femur during pregnancy. The patient, who was five months advanced
in gestation, recovered without aborting.

Robson reports a case of strangulated hernia in the third month of preg-
nancy with stercoraceous vomiting. He performed herniotomy in the
femoral region, and there was a safe delivery at full term. In the second
month of pregnancy he also rotated an ovarian tumor causing acute symptoms,
and afterward performed ovariotomy without interfering with pregnancy.
Mann quotes Mund6 in speaking of an instance of removal of elephantiasis of
the vulva without interrupting pregnancy, and says that there are many cases
of the removal of venereal warts without any interference with gestation.
Campbell of Georgia operated inadvertently at the second and tliird month
in two cases of vesicovaginal fistula in pregnant women. The first case
showed no interruption of pregnancy, but in the second case the woman
nearly died and the fistula remained unhealed. Engelmann operated on a
large rectovaginal fistula in the sixth month of pregnancy without any in-
terruption of pregnancy, which is fiir 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 liair-pin

a 533, April 16, 1887. b 238, 1887. c 648, 1879. d 224 1889

e 224, 1879. f 535, 127, u. s. ii., 430-433. g 582' 185'>

h 476, 1872, ii., 632. i 224, 1878. j 533, March 2Q, 1892^

106 PRENATAL ANOMALIES.

from a woman pregnant six and a half months, withont interrnption, and
according to Maun 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| pounds from a pregnant uterus without interrupting ges-
tation.

The following extract from the University Medical Magazine of Pliila-
delphia illustrates the after-effects of abdominal hysteropaxy on sub-
sequent pregnancies : —

" Fraipont (Annates de la SociM Medico- Chirurgicale de Li^ge, 1894) re-
ports 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 abdom-
inal wall. Even if the adhesions were not broken down they would of ne-
cessity be so stretched as to be useless for their original purpose after deliv-
ery. Bands of adhesion could not share in the process of involution. As,
however, the uterus undergoes perfect involution, it is restored to its original
condition before the onset of the disease which rendered hysteropexy neces-

sary."

The coexistence of an extensive tumor of the uterus with pregnancy-
does not necessarily mean that the product of conception will be blighted.
Brochin ^ speaks of a case in Avhich pregnancy was complicated with fibroma of
the uterus, the accouchement being natural at term. Byrne « mentions a case
of pregnancy complicated with a large uterine fibroid. Delivery was effected
at full term, and although there was considerable hemorrhage the mother
recovered. Ingleby describes a case of fibrous tumor of the uterus termi-
nating fatally, but not until three weeks after delivery. Lusk'^ mentions a
case of pregnancy with fibrocystic tumor of the uterus occluding the cervix.
At the appearance of symptoms of eclampsia version was performed and
delivery effected, followed by postpartum hemorrhage. The mother died
from peritonitis and collapse, but the stillborn child was resuscitated. Rob-
erts f reports a case of pregnancy associated with a large fibrocellular polypus

a 590, 1890, xxv., 306. b 363, xlviii., 1178. « 310, 1877, 170.

d 318, li., 75. « 125, 1876, ix., 94. ^ 476, 1867, i., 333.

>

PROTRUSION OF THE FETAL MEMBRANES. 107

of the uterus. A living child M^as delivered at the seventh month, eerase-
ment was performed, and the mother recovered.

Von Qiiast 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

Kg. 13.— Large fibroid blocking the pelvis (Spiegelberg).

cases of a similar nature to the foregoing are too numerous to mention.
Figure 13, taken from Spiegelberg, shows a large fibroid blocking the pelvis
of a pregnant woman.

There are several peculiar accidents and anomalies not previously men-
tioned which deserve a place here, viz., those of the membranes surround-
ing the fetus. Brown e speaks of protrusion of the membranes from the
vulva several weeks before confinement. Da vies ^ relates an instance in
which there was a copious watery discharge during pregnancy not followed

a Kansas City Med. Index, 1888. b 773, xi., 4. c 124, 1843, vi., 519.

d 593, 1859, xvi., 663. e 778, 1887, xxviii., 170. f 775* 1886' 157

g 616, 1872, XV., 246. h 537 1834

108

PRENATAL ANOMALIES.

by labor. There is a case mentioned ^ in which an accident and an inoppor-
tune dose of ergot at the fifth month of pregnancy were followed by rupture
of the amniotic sac, and subsequently a constant flow of watery fluid con-
tinued for the remaining three months of pregnancy. The fetus died at the
time, and was born in an advanced state of putrefaction, by version, three
months after the accident. The mother died five months after of carcinoma
of the uterus. Montgomery ^ reports the instance of a woman who menstru-
ated last on May 22, 1850, and quickened on September 26th, and continued
well until the 11th of November. At this time, as she was retiring, she
became conscious that there was a watery discharge from the vagina, which
proved to be liquor amnii. Her health was good. The discliarge continued,
her size increased, and the motions of the child continued active. On the
1 8th 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 How 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
liviuiT child. There is another observation s of an accouchement terminating
successfully twenty-three days after the loss of the amniotic fluid. Camp-
bell^ mentions delivery of a living child twelve days after rupture of the
membranes. Chesney ^ relates the history of a double collection of waters.
Wood j reports a case in which there was expulsion of a bag of Avaters be-
fore the rupture of the membranes. Bailly, Chestnut, Bjering, Cowger,
Duncan, and others also record premature rupture of the membranes with-
out interruption of pregnancy.

Harris^ gives an instance of the membranes being expelled from the
uterus a few days before delivery at the full term. Chatard, Jr.,' mentions
extrusion of the fetal membranes at the seventh month of pregnancy while
the patient was taking a long afternoon walk, their subsequent retraction, and
normal labor at term. Thurston tells of a case in which Nature had ap-
parently effected the separation of the placenta without alarming hemorrhage,
the case being one of placenta prsevia, terminating favorably by natural pro-

a 366, 1844-45, v., 163. b 308, 1857. <^ 463, xiii., 33. d 545^ 1877, xxxvii.

e 224, 1871, ii., 612. f 131, 1875, iii., 253. g 461, 1807, xiii., 33. h 218, Ixxxvii., 196.
i 481, 1868-69, ii., 346. j Mouth. Jour. Med. Sci., Lend, and Edinb., ix., 853.

k778, vii., 47. 1 125, 1886. ^224, 1884.

ANOMALIES OF THE UMBILICAL COIW.

109

cesses. Playftiir* 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 tlie 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 s reports a cord 38 inches long ; and
Werner cites the instance of a funis 51 inches long. There are modern in-
stances in which the funis has been bifid or duplex, and there is also a case
reported in which there were two cords in a twin pregnancy, each of them
measuring five feet in length. The Lancet * gives the account of a most pe-
culiar pregnancy consisting of a placenta alone, the fetus wanting. What
this " placenta " was will always be a matter of conjecture.

Occasionally death of the fetus is caused by the formation of knots in
the cord, shutting otF the fetal circulation ; Gery, Grieve, Mastin, Passot,
Piogey, Woets, and others report instances of this nature. Newman j reports
a curious case of twins, in which the cord of one child was encircled by a
knot on the cord of the other. Among others, Latimer ^ and Motte ^ report
instances of the accidental tying of the bowel with the funis, causing an arti-
ficial anus.

The diverse causes of abortion are too numerous to attempt giving
them all, but some are so curious and anomalous that they deserve men-
tion. Epidemics of abortion are spoken of by Fickius, Fischer, and the
Ephemerides. Exposure to cold is spoken of as a cause,'" and the same is
alluded to by the Ephemerides ; ° while another case is given as due to
exposure while nude." There are several cases among the older writers in
which odors are said to have produced abortion, but as analogues are
not to be found in modern literature, unless the odor is very poisonous or
pungent, we can give them but little credence. The Ephemerides gives the

a 610, 1879-80. b 609, 1879-80, ii., 480. c 368, 1842. d 363, xxix., 498.

e Solingen,742 f 104, dec. i., ann. i., obs. 39. g 160, vii., 197 h I60' vii 523

i 476, 1842-43. j 318, 1858, iv., 8-10. k 545, xlvi., 242. 1 242, liv ' 494

m 108, dec. i., ann. ii., 121. n 104, dec. ii., ann. i., obs. 116. o 664,' T. i'v.

110

PRENATAL ANOMALIES.

odor of urine as provocative of abortion ; Sulzberger,^ Meyer,^^^ and Alber-
tus "-^ all mention odors ; and Vesti gives as a plausible cause ^* the odor of
carbonic vapor. The Ephemerides mentions singultus as a cause of abor-
tion. Mauriceau,5>3 Pelargus, and Valentini mention coughing. Hippo-
crates mentions ^ the case of a woman who induced abortion by calling exces-
sively loud to some one. Fabricius Hildanus '^^^ speaks of abortion following
a kick in the region of the coccyx. 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 negli-
gence. Hawley ^ mentions abortion at the fourth or fifth month due to the
absorption of spirits of turpentine. Solingen'^a gpeaks of abortion produced
by sneezing. Osiander cites an instance in which a woman suddenly arose,
and in doing so jolted herself so severely that she produced abortion. Hip-
pocrates speaks of extreme hunger as a cause of abortion. Treuner ^ speaks
of great anger and wrath in a woman disturbing her to the extent of producing
abortion.

The causes that are observed every day, such as tight lacing, excessive
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. In-
formation from India on this subject would be quite valuable.

The Ephemerides speak of bloodless abortion, and there have been modern
instances in which the hemorrhage has been hardly noticeable.

Abortion in a twin pregnancy does not necessarily mean the abortion or
death of both the products of conception. Chapman ^ speaks of the case of the
expulsion of a blighted fetus at the seventh month, the living child remaining
to the full term, and being safely delivered, the placenta following. Crisp ^
says of a case of labor that the head of the child was 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 61 ounces. It is quite
common for a blighted fetus to be retained and expelled at term with a living
child, its twin.

Bacon j speaks of twin pregnancy, with the death of one fetus at the fourth
month and the other delivered at term. Beall ^ reports the conception of t^^dns,

a Diss, de abortu, c. 6. b Diss, de abortu, 21. c 476, dec. ii., ann. 2, obs. 62.

d 416 opp. iv., 600. e 105, 1730, ii., 374. f 231, 1858-59, xiv., 469.

g 160', B. iv., 527. h 550, ix., 194. i 779, xviii., 272.

j Clinique, Chicago, vii., 403. ^ 703, xviii., 122.

WORMS IN THE UTERUS. Ill

with one fetus expelled and the other retained ; Beauchanip cites a similar
instance. Bothwell " describes a twin labor at term, in which one child was
living and the other dead at the fifth montli 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 utcrogestation.

There was a case at Riga in 1839 of a robust girl who conceived in Feb-
ruaiy, and in consequence her menses ceased. In June she aborted, but, to
her dismay, soon afterward the symptoms of advanced pregnancy appeared, and
in November a full-grown child, doubtless the result of the same impregna-
tion as the fetus, was expelled at the fourth month. In 1860 Schuh reported
an instance before the Vienna Faculty of Medicine in which a fetus was dis-
charged at the third month of pregnancy and the other twin retained until
full term. The abortion was attended with much metrorrhagia, and ten
weeks afterward the movements of the other child could be plainly felt and
pregnancy continued its course uninterrupted. Bates s mentions a twin preg-
nancy in which an abortion took place at the second month and was followed
by a natural birth at full term. Hawkins ^ gives a case of miscarriage, followed
by a natural birth at full term ; and Newnham ' cites a similar instance in which
there was a miscarriage at the seventh month and a birth at full term.

Worms in the Uterus. — HainesJ 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.i^ 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

« 224, 1889, ii., 717. b 124, 1855, xxix. c 3IO, 1842-43, xxii 15

d 312, 1843. e 519, 1870, iv., 208. f Month. Jour. Med., Lond., 1855.

g 771, 1874. b 772^ iggl. i 77^ jgog

1 III' 'So ' '''' ^ 8, obs. 32.

1 235, 1856, h., 549. ™ 543, 1889-90. "600,1878-79 129.

112

PRENATAL ANOMALIES.

abortion was caused by worms in the womb — if the associate symptoms were
trustworthy.

We can find fabulous parallels to all of these in some of the older writings.
Par6 * mentions Lycosthenes' account of a woman in Cracovia in 1494 who
bore a dead child which had attached to its back a live serpent, wliich had
gnawed it to death. He gives an illustration (Fig. 14) showing the serjjent
in situ. He also quotes the case of a woman who conceived by a mariner,
and who, after nine months, was delivered by a midwife of a shapeless mass,
followed by an animal with a long neck, blazing eyes, and clawed feet. Bal-
lantyne ^ says that in the writings of Hippocrates there is in the work on
" Diseases " {Ihp'i wuffujv), which is not usually regarded as genuine, a some-

Fig. 14.— Serpent in a fetus (after Par6).

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.

a b759, Oct., 1895.

CHAPTER III.

OBSTETRIC ANOMALIES.

General Considerations. — In discussing obstetric anomalies we shall
first consider those strange instances in which stages of parturition are uncon-
scious and for some curious reason the pains of labor absent. Some women
are anatomically constituted in a manner favorable to child-birth, and pass
through the experience in a comparatively easy manner ; but to the great
majority the throes of labor are anticipated with extreme dread, particularly
by the victims of the present fashion of tight lacing.

It seems strange that a physiologic process like parturition should be
attended by so much pain and difficulty. Savages in their primitive and
natural state seem to have difficulty in many cases, and even animals are not
free from it. We read of the ancient wild Irish women breaking the
pubic bones of their female children shortly after birth, and by some means
preventing union subsequently, in order that these might have less trouble in
child-birth — as it were, a modified and early form 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 Engelmann,='^5 in their most extensive and interesting papers on the modes
of accouchement among the primitive peoples, substantiate the fear, pain, and
difficulty with which labor is attended, even in the lowest grades of society.

In view of the usual occurrence of pain and difficulty with labor, it seems
natural that exceptions to the general rule should in all ages have attracted
the attention of medical men, and that literature should be replete with such
instances. Pechlin^^^ and Maas^ record instances of painless births. The
Ephemerides records a birth as having occurred during asphyxia, and
also one during an epileptic attack. Storck also speaks of birth during
unconsciousness in an epileptic attack ; and Haen and others ^ describe
cases occurring during the coma attending apoplectic attacks King«
reports the histories of two married women, fond mothers and anticipat-
ing the event, who gave birth to children, apparently unconsciously. In
a 601 315. b708, 1719, ii., 610. c 546, 1847, xvi., 234.

^ 113

114

OBSTETRIC ANOMALIES.

the first case, the appearance of the woman verified the assertion ; in the
second, a transient suspension of the menstrual influence accounted for it.
After some months epilepsy developed in this case. Crawford ^ speaks of a
Mrs. D., who gave birth to twins in her first confinement at full term, and
who two years after aborted at three months. In December, 1868, a year
after the abortion, she was delivered of a healthy, living fetus of about five or
six months' growth in the following manner : While at stool, she discovered
something of a shining, bluish appearance protruding 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 dis-
cussed, and Fanton^ reports 12 cases of parturition under the hypnotic influ-
ence. ' He says that none of the subjects sufi"ered 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 <i of a case during sleep. Mont-
gomery 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 confine-
ment, attributed her symptoms to over-fatigue on the previous day. When
summoned, the doctor found that she had severe lumbar pains, and that the os
was dilated to the size of a half-dollar. At ten o'clock he suggested that
everyone retire, and directed that if anything of import occurred he should be
called About 4 A. M. the husband of the girl, in great fright, summoned
the physician saying : " Monsieur le M^decin, il y a quelque chose entre les
iambes de ma femme," and, to Dr. Case's surprise, he found the head of a
child whollv 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

a 579, 1868-69, n. s., W., 305-8. ^ 168, 1890. c 402, /O^.

d 135 ii., 74. ^ ^2"^' ' ' '

DELIVERY DURING SLEEP, ETC.

115

eleven o'clock, and dreamed that she was in great pain and in labor, and
that sometime after a fine child was crawling over the bed. After sleeping
for about four hours she awoke and noticed a discharge from the vagina. Her
husband started for a light, but before he obtained it a child was born by a
head-presentation. In a few minutes the labor-pains returned and the feet of
a second child presented, and the child was expelled in three pains, followed
in ten minutes by the placenta. Here is an authentic case in which labor pro-
gressed to the second stage during sleep.

Weill describes the case of a woman of twenty-three who gave birth to a
robust boy on the 16th of June, 1877, and suckled him eleven months. This
birth lasted one hour. She became pregnant again and was delivered under
the following circumstances : She had been walking on the evening of Sep-
tember 5th and returned home about eleven o'clock to sleep. About 3 A. M.
she awoke, feeling 'the necessity of passing urine. She arose and seated
herself for the purpose. She at once uttered a cry and called her husband,
telling him that a child was born and entreating him to send for a physician.
Weill saw the woman in about ten minutes and she was in the same position,
so he ordered her to be carried to bed. On examining the urinal he found a
female child weighing 10 pounds. He tied the cord and cared for the child.
The woman exhibited little hemorrhage and made a complete recovery. She
had apparently slept soundly through the uterine contractions until the final
strong pain, which awoke her, and which she imagined was a call for urina-
tion.

Samelson ^ says that in 1844 he was sent for in Zabelsdorf, some 30 miles
from Berlin, to attend Hannah Ehode 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
contmued through pregnancy. The woman was apparentlv unconscious of
her condition and was delivered without pain. Cripps<i 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 durincr a

a Quoted, 224, 1881, ii., 871. b 224, 1865, ii Nov

c 476, 1845, i. d 476 I84I-40 \\ 0/57 e t ,i c

' ' ' J- d. sages-femmes. Par., 1882, 9.

116

OBSTETRIC ANOMALIES.

syncope which lasted four hours. Epley* reports painless labor in a patient
with paraplegia. Fahnestock ^ speaks of the case of a woman who was deliv-
ered of a son while in a state of artificial somnambulism, without pain to herself
or injury to the child. Among others mentioning painless or unconscious
labor are Behrens (during profound sleep), Eger, Tempel, Panis, Agnoia,
Blanckmeister, Wliitehill, Gillette, Mattel, Murray, Lemoine, and Moglichkcit.

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,«24 D^rby, 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'^s ^^ys the wife of
Thomas James was delivered of a lusty child while in a wood by herself.
She put the cliild in an apron with some oak leaves, marched stoutly to
her husband's uncle's house a half mile distant, and after two hours' rest
went on her journey one mile farther to her own house ; despite all her exer-
tions she returned the next day to thank her uncle for the two hours' accom-
modation. There is related Hhe 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, feeUng 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«24 relates the account of a woman who, having a cramp wlule
in bed with her sister, went to an outhouse, as if to stool, and was there
delivered of a child. She quickly returned to bed, her going and her return
a 597 xxxvii., 233. 1> 218, xxxv., 194. o 1st edition, 219. ^ 279, 1857.

I

BAPID PARTURITION WITHOUT USUAL SYMPTOMS. 117

not being noticed by her sleeping sister. She buried the child, " and after-
ward confessed her wickedness, and was executed in the Stalford 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 tlie recently delivered child to a remote place, and hid it at the bottom
of a feather tub, covering it with feathers ; she returned without any suspi-
cion on the part of her mistress. It so happened that it was the habit of the
Darby soldiers to peep in at night where they saw a light, to ascertain if
everything was all right, and they thus discovered her secret doings, which
led to her trial at the next sessions at Darbv.

Wagner^ relates the history of a case of great medicolegal interest. An
unmarried servant, who was pregnant, persisted in denying it, and took eveiy
pains to conceal it. She slept in a room with two other maids, and, on ex-
amination, she stated that on the night in question she got up toward morn-
ing, thinking to relieve her bowels. For 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 re-
turned to her bedroom, first calling up the man-servant at the stable. She
awakened her fellow-servants, and feeling tired sat down on a stool. Seeing
the blood on the floor, they asked her if she had made way with the child.
She said : " Do you take me for an old sow ? " But, having their suspicions
aroused, they traced the blood spots to the sand pit. Fetching a spade, they
dug up the child, which was about one foot below the surface. On the access
of air, 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 healthv with the
exception of a club-foot, and must have been under ground at least fifteen
minutes and no air could have reached it. It seems likely that the child was
born asphyxiated and was buried in this state, and only began to assume in-
dependent vitality when for the second time exposed to the air. This curious
case was verified to English correspondents by Dr. Wagner, and is of unques-
tionable authority ; it became the subject of a thorough criminal investiga-
tion in Germany.

During the funeral procession of Marshal MacMahon in Paris an enor-
mous crowd was assembled to see the cortege pass, and in this crowd was a

a 554, Jan. 17, 1838.

I

118

OBSTETRIC ANOMALIES.

woman almost at the time of deUvery ; the jostling which she received in her
endeavors to obtain a place of vantage was sufficient to excite contraction,
and, in an upright position, she gave birth to a fetus, which fell at her feet.
The crowd pushed back and made way for the ambulance officials, and mother
and child were carried off, the mother apparently experiencing little embarrass-
ment. Quoted by Taylor,"^^ Anderson speaks of a woman accused of child
nuirder, who walked a distance of 28 miles on a single day with her two-
days-old child on her back.

There is also a case of a female servant * named Jane May, who was fre-
quently charged by her mistress with pregnancy but persistently denied it.
On October 26th she was sent to market with some poultry. Returning
home, she asked the boy who drove her to stop and allow her to get out.
She went into a recess in a hedge. In five minutes she was seen to leave the
hedge and follow the cart, walking home, a distance of a mile and a half. The
following day she went to work as usual, and would not have been found out
had not a boy, hearing feeble cries from the recess of the hedge, summoned a
passer-by, but too late to save the child. At her trial she said she did not
see her babe breathe nor cry, and she thought by the sudden birth that it
must have been a still-born child.

Shortt^ says that one day, while crossing the esplanade at Villaire, between
seven and eight o'clock in the morning, he perceived three Hindoo women with
large baskets of cakes of " bratties " on their heads, coming from a village
about four miles distant. Suddenly one of the women stood still for a minute,
stooped, and to his surprise dropped a fully developed male child to the ground.
One of her companions ran into the town, about 100 yards distant, for a knife
to divide the cord. A few of the female passers-by formed a screen about the
mother with their clothes, and the cord was divided. The after-birth came
away, and the woman was removed to the town. It was afterward discovered
that she was the mother of two children, was twenty-eight years old, had not
the slightest sign of approaching labor, and was not aware of parturition
until she actually felt the child between her thighs.

Smith of Madras, in 1<S62, says he was hastily summoned to see an Enghsh
lady who had borne a child without the slightest warning. He found the
child, which had been born ten minutes, lying close to the mother's body, with
the funis uncut. The native female maid, at the lady's orders, had left the
child untouched, lifting the bed-clothes to give it air. The lady said that she
arose at 5.30 feeling well, and during the forenoon had walked down a long
flight of steps across a walk to a small summer-house within the enclosure of
her grounds. Feeling a little tired, she had lain down on her bed, and soon
experienced a slight discomfort, and was under the impression that something
solid and warm was lying in contact with her person. She directed the ser-
vant to look below the bed-clothes, and then a female child was discovered.

a 548, 1867, i., 500. b 778, 1863.

UNUSUAL PLACES OF BIRTH.

119

Ilcr other labors hud 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.

T^ungston mentions the case of a woman, tAventy-three, who, between 4
and 5 A. m., felt griping pains in the abdomen. Knowing her condition,
she suspected labor, and determined to go to a friend's house where she could
be confined in safety. She had a distance of about 600 yards to go, and
when she was about half way she was delivered in an upright position of a
child, which fell on the pavement and ruptured its funis in the fall. Shortly
after, the placenta was expelled, and she proceeded on her journey, carrying the
child in her arms. At 5.50 the physician saw the woman in bed, looking well
and free from pain, but complaining of being cold. The child, which was her
first, was healthy, well nourished, and normal, with the exception of a slight
ecchymosis of the parietal bone on the left side. The funis was lacerated
transversely four inches from the umbilicus. Both mother and child progressed
favorably. Doubtless the intense cold had so contracted the blood-vessels as
to prevent fatal hemorrhage to mother and child. This case has a legal bear-
ing in the supposition that the child had been lulled in the fall.

There is reported'' the case of a woman in Wales, who, while walking with
her husband, was suddenly seized with pains, and would have been delivered
by the wayside but for the timely help of Madame Patti, the celebrated diva,
who was driving by, and who took the woman in her carriage to her palatial
residence close by. It was to be christened in a few days with an appropriate
name in remembrance of the occasion. Coleman*^ met an instance in a mar-
ried woman, Avho 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

a 476, 1864, i., 637. b 543, 1887, ii., 157. c 475 1864 ii 377

d 476, 1864, 476. e 520', 1879, CeS. '

120

OBSTETRIC ANOMALIES.

the chamber dropped a cliild. She never felt a labor-pain, and twelve days after-
ward rode 20 miles over a rough road to go to her baby's funeral. Leonhard
describes the case of a mother of thirty-seven, who had borne six children alive,
who was pregnant for the tenth time, and who had miscalculated her pregnancy.
During pregnancy she had an attack of small-pox and suffered all through preg-
nancy with^constipation. She had taken a laxative, and when returning to
bed from stool was surprised to find herself attached to the stool by a band.
The child in the vessel began to cry and was separated from the woman, who
returned to bed and suddenly died one-half hour later. The mother was
entirely unconscious of the delivery. Westphal mentions a delivery in a
water-closet.

Brown « speaks of a woman of twenty-six who had a call of nature while
in bed, and while sitting up she gave birth to a fine, full-grown child, which,
falling on the floor, ruptured the funis. She took her child, lay down with
it for^'some time, and feeling easier, hailed a cab, drove to a hospital with
the child in her arms, and wanted to walk upstairs. She was put to bed and
delivered of the placenta, there being but little hemorrhage from the cord ;
both she and her child made speedy recoveries. Thcbault ^ reports an instance
of delivery in the erect position, with rupture of the funis at the placenta.
There was recently a rumor, probably a newspaper fabrication, that a woman
while at stool in a railway car gave birth to a child which was found alive
on the track afterward.

There is a curious instance on record in which a child was born in a hip-
bath and narrowly escaped drowning.^ The mother was a European woman
aged forty, who had borne two children, the last nine years before. She was
supposed to have dropsy of the abdomen, and among other treatments was the
use of a speculum and caustic applications for inflammation of the womb.
The escape of watery fluid for two days was considered evidence of the rup-
ture of an ovarian cyst. At the end of two days, severe pains set in, and a
warm hip-bath and an opiate were ordered. While in the bath she bore a
fnllv-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. . i . i

Birth by the Rectum.— In some cases in which there is some obstacle

to the delivery of a child by the natural passages, the eftbrts 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 mside of
which was felt a fetal head. He anesthetized the patient and dehvered the

a 554, No. 24, 1837. ^ 807, xxi., 329. J 224, April 3 1863.

d 809, 1875, ii., 230. « 548, 1862, ii., 396. ^ 491, 1886, 542.

BIRTH THROUGH PERINEAL PERFORATION. 121

child with forceps, and without perineal rupture. There was little hemor-
rhage, and the placenta was removed with slight difficulty. Five 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 menstru-
ated easily. Coitus always seemed satisfactory, and no suspicion existed in
the patient's mind, and had never been suggested to her, of her abnormality.

Harrison* saw a fetus delivered by the anus after rupture of the uterus;
the membranes came away by the same route. In this case the neck of
the uterus was cartilaginous and firmly adherent to the adjacent parts. In
seven days after the accouchement the woman had completely regained her
health. Vallisneri "^"^ reports the instance of a woman who possessed two
uteruses, one communicating with the vagina, the other with the rectum. She
had permitted rectal coj)ulation and had become impregnated in this manner.
Louis, the celebrated French surgeon, created a furore by a pamphlet entitled
" De partium externarum generationi inservientium in mulieribus naturali
vitiosa et morbosa dispositione, etc.," for which he was punished by the Sor-
bonne, but absolved by the Pope. He described a young lady who had no
vaginal opening, but who regularly menstruated by the rectum. She allowed
her lover to have connection with her in the only possible way, by the rectum,
which, however, sufficed for impregnation, and at term she bore by the rec-
tum a well-formed child. Hunter'' speaks of a case of pregnancy in a woman
with a double vagina, who was delivered at the seventh month by the rectum.
Mekeln° and Andrews*^ give instances of parturition through the anus.
Morisani^ describes a case of extrauterine pregnancy with tubal rupture and
discharge into the culdesac, in which there was delivery by the rectum. After
an attack of severe abdominal pain, followed by hemorrhage, the woman ex-
perienced an urgent desire to empty the rectum. The fetal movements ceased,
and a recurrence of these symptoms led the patient to go to stool, at which
she passed blood and a seromucoid fluid. She attempted manually to remove
the 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 e reports a case of child-birth through
the perineum. A successful operation was performed fifteen days after the

a Reportorio Med.-Chirurg. di Torino, 1825. ^ Trans. N. Y. Obs Soc 1879 i 348
c 372, 1833, 184. d 526, 1839. e 838, 1889. f 476, 1860, i., 496. g 545, ii.,''l92.

122

OBSTETRIC ANOMALIES.

accident. Dupuytren* speaks of the passage of an infant through a central
opening of the perineum. Capuron, Gravis, and Lebrun all report accouche-
ment through a perineal perforation, without alteration in the sphincter ani or
the fourchet. In his " Diseases of Women " Simpson speaks of a fistula left
by the passage of an infant through the perineum. Wilson, Toloshinofif, 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 pecu-
har 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 deliveiy is usually by means of operative interference (which will be
spoken of later), but rarely, as here, spontaneously. Farquharson ^ and 111 "
both mention rupture of the abdominal parietes during labor.

There have l^een cases reported in which the recto-vaginal septum has been
ruptured, as well as the perineum and the sphincter ani, giving all the appear-
ance of a birth by the anus.

There is an account'^ of a female who had a tumor projecting between the
vagina and rectum, which was incised through the intestine, and proved to be
a dead child. Saviard^^^^ reported what he considered a rather unique case^
in which the uterus was ruptured by external violence, the fetus being thrown
forward into the abdomen and afterward extracted from an umbihcal 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^26 gventrated 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.
AVilloughby recorded the history of a case Mdiich 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 hving. Since Wil-
loughby's time several cases of similar interest have been noticed, one in a
woman « of forty, who had been married sixteen years, and who had had several
pregnancies in her early married life and a recent abortion. Her last preg-
nancy lasted about twenty-eight or twenty-nine weeks, and terminated, after
a short labor, by the expulsion of the ovum entire. The membranes had not
been ruptured, and still enclosed the fetus and the liquor amnii. On break-
ing them, the fetus was seen floating on the waters, alive, and, though very
diminutive, was perfectly formed. It continued to live, and a day afterward
took the breast and began to cry feebly. At six weeks it weighed 2 pounds
2 ounces, and at ten months, 12 pounds, but was still very weak and ill-nour-
a 368, 1832, iii., 684. b 524, 1789. c 600, 1878-9, xli., 43. d 470, 1722. e 492, 1828.

''DRY BIRTHSr

123

ished. Evans * has an instance of a fetus expelled enveloped in its membranes

entire and unruptured. The membranes were opaque and preternatural ly

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 con- i

valcscence, made a good recovery. Forman ^' reports an instance of unruptured

membranes at birth, the delivery following a single pain, in a woman of i

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 j
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 i
nurse to rupture the membranes, and the child, which had been in the unrup-
tured sac for over twenty minutes, began to cry. The infant lived for over a
month, but eventually died of bronchitis.

Cowger^ reports labor at the end of the seventh month without rupture
of the fetal sac. Macknus ^ and Rootes s speak of expulsion of the entire
ovum at the full period of gestation. Roe mentions a case of parturition with
unruptured membrane. Slusser ^ describes the delivery of a full-grown fetus
without rupture of the membrane.

Dry Births." — The reverse of the foregoing are those cases in which,
by reason of the deficiency of the waters, the birth is dry. Numerous causes
can be stated for such occurrences, and the reader is referred elsewhere for
them, the subject being an old one. The Ephemerides speaks of it, and
Rudolph ^^'^ discusses its occurrence exhaustively and tells of the difficulties
of such a labor. Burrall ' mentions a case of labor without apparent liquor
amnii, delivery being effected by the forceps. Strong J records an unusual
obstetric case in which there was prolongation of the pregnancy, with a lari>-e '
child, and entire absence of liquor amnii. The case was also complicated
with interstitial and subserous fibroids and a contracted pelvis, combined with '
a posterior position of the occiput and nonrotation of the head. Lente^^
mentions a case of labor without liquor amnii ; and Townsend^ records de-
livery without any sanguineous discharge. Cosentino ™ mentions a case of the
absence of liquor amnii associated with a fetal monstrosity.

Delivery After Death of the Mother.— Curious indeed are those '

I

c 124, 1860, 569.

f 476, 1846, i., 186. i
i 124, cxL, 446.

1 124, 1854, 342. '

a 252, 1852-3, i., 146. b 533, 1896, Feb. 1, 160.
d 510, 1879, iv., 30.3. e 538, xxv., 84.
g 476, 1845, ii., 474. h West. Lancet, Cincin., xii., 501
j 218, ex., 30. ki24, clxi., 125.

m Arch, di Ostet. e Ginec., p. 41, Feb.-March, 1894.

124

OBSTETRIC ANOMALIES.

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 per-
formed after death and the child successfully deHvered. Bartholinus, Wolff,
Schenck, Horstius, Hagendorn, Fabricius Hildanus, Valerius, Rolfinck, Cor-
narius, Boener, and other older writers cite cases of this kind. Pinard'^
gives a most wonderful case. The patient was a woman of thirty-eight who
had experienced five previous normal labors. On October 27th she fancied
she had labor pains and went to the Lariboisi^re 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 artilicial 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^ to 6 J pounds.

Considerable attention has been directed to the advisability of accelerated
and forced labor in the dying, in order that the child may be saved. Belluzzi
has presented several papers on this subject. Csurgay of Budapest mentions
saving the child by forced labor in the death agonies of the mother. Devil-
liers« considers this question from both the obstetric and medicolegal points of
view. Hyneaux mentions forcible accouchement practised on both the dead
and the dying. Rogowicz advocates artificial delivery by the natural channel
in place of Cesarian section in cases of pending or recent death, and Th6venot ^
discussed this question at length at the International Medico-Legal Congress in
1878. Duer«^ presented the question of postmortem delivery in this country.

Kelly f reports the history of a woman of forty who died in her eighth
pregnancv, and who was delivered of a female child by version and artificial
means. Artificial respiration was successfully practised on the child, although
fifteen minutes had elapsed from the death of the mother to its extraction.
Driver ^ relates the history of a woman of thirty-five, who died in the eighth
month of gestation, and who was delivered postmortem by the vagina, man-
ual means onlv being used. The operator was about to perform Cesarean
^ection when he heard the noise of the membranes rupturing. Thornton
reports the extraction of a living child by version after the death of the
mother. Aveling^ has compiled extensive statistics on all varieties of post-
mortem deliveries, collecting 44 cases of spontaneous expulsion of the fetus
after death of the mother.

a 160, B. 1, 4 St., „. 7. b 140, .lan.. 1889. ! 'f.' ''''' .'.'b'

d 140 1878 ' 125, xii., 1 and 374. ' 125, vm., 558.

g 579, 1860', 494. " 272, 1858. ' 778, 1873, .iv., 240.

DELIVERY AFTER DEATH OF THE MOTHER. 125

Aveling states that in 1820 the Council of Cologne sanctioned the placing
of a gag in the mouth of a dead pregnant woman, thereby hoping to prevent
suffocation of the infant, and there are numerous such laws on record, altliough
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 Hved long afterward under the name of " Fils
de la terre." Willoughby mentions the curious instance in which rum-
bling was heard from the coffin of a woman during her hasty burial. One of
her neighbors returned to the grave, applied her ear to the ground, and was
sure she heard a sighing noise. A soldier with her affirmed her tale, and
together they went to a clergyman and a justice, begging that the grave be
opened. When the coffin was opened it was found that a child had been born,
which had descended to her knees. In Derbyshire, to this day, may be seen
on the parish register: "April ye 20, 1650, was buried Emme, the wife of
Thomas Toplace, who was found delivered of a child after she had lain two
hours in the grave."

Johannes Matthaeus relates the case of a buried woman, and that some
time afterward a noise was heard in the tomb. The coffin was immediately
opened, and a living female child rolled to the feet of the corpse. Hagen-
dom mentions the birth of a living child some hours after the death of the
mother. Dothardingius mentions a healthy child born one-half hour after the
mother's death. In the Gentleman's Magazine * there is a record of an in-
stance, in 1759, in which a midwife, after the death of a woman whom she
had failed to deliver, imagined that she saw a movement under the shroud,
and found a child between its mother's legs. It died soon after. Valerius
Maximus says that while the body of the mother of Gorgia Epirotas was
being carried to the grave, a loud noise was heard to come from the coffin,
and on examination a live child was found between the thighs, — whence arose
the proverb : " Gorgiam prius ad funus elatum, quam natum fuisse."

Other cases of postmortem delivery are less successful, the delivery being
delayed too late for the child to be viable. The first of Aveling's cases was
that of a pregnant woman who was hanged by a Spanish Inquisitor in 1551. "
AYhile 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,

a xxix.. 390.

126

OBSTETRIC ANOMALIES.

she died, and forty-eight hours after death her abdomen swelled to such an
extent as to burst her grave-clothes, and a male child, dead, was seen issuing
from the vagina. Bonet^i^ tells of a woman, who died in Brussels in 1633,
who, undelivered, expired in convulsions on Thursday. On Friday abdomi-
nal movements in the corpse were seen, and on Sunday a dead child was
found hanging between the thighs. According to Aveling, Herman of
Berne reports the instance of a young lady whose body was far advanced in
putrefiiction, 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, accord-
ing to Aveling, relates the story of a case in which malpractice was suspected
on a woman of thirty-seven, who died while pregnant with her seventh child.
The body was exhumed, and a transverse rupture of the womb six inches long
above the cervix was found, and the body of a dead male child lay between
the thighs. In 1862, Lanigan tells of a woman who was laid out for funeral
obsequies, and on removal of the covers for burial a child was found in bed
with her. Swayne is credited with the description of the death of a woman
whom a midwife failed to deliver. Desiring an inquest, the coroner had the
bodv 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.
Slie was kept on her back in a room, covered up and undisturbed, for thirty-
six hours, the members of the family occasionally visiting her to sprinkle holy

a 801, 1854.

ANTEPARTUM CRYING OF THE CHILD.

127

water on her face. There was no remembrance of cadaveric distortion of the
features or any odor. When the undertakers were drawing the shroud on
they noticed a lialf-round, bright-red, smooth-looking body between the geni-
tals which they mistook for a prolapsed uterus. Early on April 2d, a few
hours before interment, tlie men thought to examine the swelling they had
seen the day before. A second look showed it to be a dead female child, now
lying between the thighs and connected with the mother by the umbilical cord.
The interment was stopped, and Mayer was called to examine the body, but
with negative results, though the signs of death were not plainly visible for a
woman dead fifty-eight hours. By its development the body of the fetus con-
firmed the mother's account of a pregnancy of twenty-one weeks. Mayer
satisfies himself at least that the mother was in a trance at the time of delivery
and died soon afterward.

Moritz * gives the instance of a woman dying in i)regnancy, 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 rais-
ing the body to place it in the coffin, a fetus, with the umbilical cord,
escaped from the vagina. There seemed to have been a rapid putrefaction in
this case, generating enough pressure of gas to expel the fetus as well as the
uterus from the body. This at least is the view taken by 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 unbe-
lievable stories have been constructed from these reported occurrences. Quite
possible, however, and worthy of belief are the cases in which the child has
been heard to cry during the progress of parturition — that is, during delivery.
Jonston« speaks of infants crying in the womb, and attempts a scientific
explanation of the fact. He also quotes the following lines in reference to this
subject : —

" Mirandum foetus materna clausus in alvo

Dicitur insuetos ore dedisse sonos.
Causa subest ; doluit se angusta sede teneri,

Et cupiit magnae cernere moliis opus.
Aut quia quaerendi studio vis fessa parentum

Aucupii aptas innuit esse manus. ' '

a Quoted by 124, cvi., 117. b 807, Band 28, 228. c 447 ara

128 OBSTETRIC ANOMALIES.

The Ephemerides * gives examples of the child hiccoughing in the uterus.
Cases of crying before delivery, some in the vagina, some just before the com-
plete expulsion of the head from the os uteri, are very numerous in the older
writers ; and 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 AVolff'® 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 ciying during
parturition.

McLean s describes a case in which he positively states that a child cried
lustily in utero during application of the forceps. He compared the sound as
though from a voice in the cellar. This child 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, Aretaeus,
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 fre-
quent subject in old Roman sculpture, and there are many delineations of the
birth of Bacchus by Cesarean section from the corpse of Semele. Greek
mythology tells us of the birth of Bacchus in the following manner : After
Zeus burnt the house of Semele, daughter of Cadmus, he sent Hermes in great
haste with directions to take from the burnt body of the mother the fruit of
seven months. This child, as we know, was Bacchus, ^sculapius, accord-
ing to the legend of the Romans, had been excised from the belly of his dead
mother, Corinis, who was already on the funeral pile, by his benefactor, Apollo ;
and from this legend all products of Cesarean sections were regarded as sacred
to Apollo, and were thought to have been endowed with sagacity and bravery.

Old records tell us that one of the kings of Navarre was delivered in this
way, and we also have records of the birth of the celebrated Doge, Andreas
Doria, by this method. Jane Seymour was supposed to have been delivered
of Edward VL by Cesarean section, the father, after the consultation of the
physicians was announced to him, replying : " Save the child by all means,
for I shall be able to get mothers enough." Robert II. of Scotland was sup-

a 104, flee, ii., <ann. v., obs. 194, and obs. 15. ^ 190, cent, i., hist. 18.

c Cent, iii., obs. 72. d 306, L. vi., cap. ii., 620.

e Lect. memor., T. ii., 647, 666, 983. f 514, T. iii., 8. g 125, xxii., 166.

CESAREAN SECTION.

129

posed to have been delivered in this way after the death of his mother, Mar-
gery Bruce, who was killed by being thrown from a horse. Sliakespere's
innnortal citation of Macdulf, " who was from his mothei-'s womb untimely
ripped," must have been such a case, possibly crudely done, perchance by cattle-
horn. Pope Gregory XIV. was said to have been taken from his mother's
belly after her death. The Philosophical Transactions,"'-^'-' in the last century,
contain accounts of Cesarean section performed by an ignorant butcher and
also by a midwife ; and there are many records of the celebrated case per-
formed by Jacob Niifer, a cattle gelder, at the beginning of the sixteenth
centur}'.

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 47J
inches tall. It was the ninth American case, according to the calculation
of Harris, only the third successful one, and the first successful one in
Ohio. The woman had a uniformly contracted pelvis whose anteroposterior
diameter was about IJ inches. The hygienic surroundings for the operation
were not of the best, as the woman lived in a cellar. Tait's method of per-
forming the operation was determined upon and successfully performed.
Convalescence was prompt, and in three weeks the case was dismissed. The
child was a female of 7| 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 racliitic 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 cliild 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|
pounds. This monster consisted of two females of about the same size, united
from the sternal notch to the navel, having one cord and one placenta. It was
stillborn. The diagnosis was made before operation by vaginal examination.
In a communication to Croston, Harris remarked that this was the first suc-

a 533, Aug. 9, 1890, 138.
c 218, 1876, ci., 747. d 224, 1894.

9

I' 657, 1888 ; quoted by 124, 1890.
e 218, Dec. 21, 1893.

130

OBSTETRIC ANOMALIES.

cessful Cesarean section for double monstrous conception in America, and added
that in 1881 Collins and Leidy performed the same operation without success.

Instances of repeated Cesarean section were quite numerous, and the pride
of the operators noteworthy, before the uterus was removed at the first opera-
tion, as is now ^renerally done. Bacque ^ reports two sections in the same
woman, and Bertrandi speaks of a case in which the operation was success-
fully executed many times in the same woman, llosenberg ^ reports three
cases repeated successfully by Leopold of Dresden. Skutsch reports a case in

Fig. 15.— Cesarean operation on a dwarf (Baldwin).

which it was twice performed on a woman with a rachitic pelvis, and who
the second time was pregnant with twins ; the children and mother recovered.
Zweifel cites an instance in which two Cesarean sections were performed on a
patient, both of the children dehvered 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.
Merinarf cites an instance of a woman thrice opened. Parravini s gives a

a 463 xi 572. h 125, 1891. « 261, 1889, No. 13. d 368, 1885, iii., 182
e 593! 1849-50, vi., 355. ^ 264, 1856, xi., 172. g 360, 1860, 273.

CESAREAN SECTION BY THE PATIENT HERSELF. 131

similar instance. Charlton » gives an account of the performance carried out
successfully four times in the same woman ; Chisholm ^ mentions a case in
which it was twice performed. Miehaelis 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-i and Gueniot^ both
mention cases in which Cesarean section had been twice performed with success-
ful 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 opera-
tion being done in savage tribes. Felkin ^ gives an account of a successfid
case performed in his presence, with preservation of the lives of both mother
and child, by a native African in Kahura, Uganda Country (Fig. 16). The

Fig. 16. — Cesarean operation iu Uganda. Fig. 17.— Suture of abdominal walls

after Cesarean section in Africa.

Fig. 18.— Knife used in performing Cesarean section in Africa.

young girl was operated on in the crudest manner, the hemorrhage being
checked by a hot iron. The sutures were made by means of seven thin, hot iron
spikes, resembling acupressure-needles, closing the peritoneum and skin (Fig.
17). The wound healed in eleven days, and the mother made a complete re-
covery. Thomas Cowley ^ describes the case of a negro woman who, being
unable to bear the pains of labor any longer, took a sharp knife and made a deep
incision in her belly — deep enough to wound the buttocks of her child, and
extracted the child, placenta and all. A negro horse-doctor was called, who
sewed the wound up in a manner similar to the way dead bodies are closed at
the present time.

a 318, 1837, xlvii., 417. b 313, 1808, iv., 178. c 628, Heft vii., viii., 1836.

d New York Polyclinic, Aug. 15, 1894. e 789, July 5, 1894.

f 125, xxiv., No. 10, 1891. g 318, April, 1884. h Lond. Med. Jour.,' 1785, vi., 366.

132

OBSTETRIC ANOMALIES.

Barker * gives the instance of a woman who, on being abused by her hus-
band after a previous tedious labor, resolved to free herself of the child, and
slyly made an incision five inches long on the left side of the abdomen with a
weaver's knife. When Barker arrived the patient was literally drenched
with blood and to all appearance dead. He extracted a dead child from
the abdomen and bandaged the mother, who lived only forty hours. In his
discourses on Tropical Diseases Moseley speaks of a young negress in Jamaica
who opened her uterus and extracted therefrom a child which lived six days ;
the woman recovered. Barker relates another case ^ in 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 confine-
ment, who, while temporarily insane, laid open her abdomen with a razor, in-
cised the uterus, and brought out a male child. The abdominal wound was five
inches long, and extended from one inch above the umbilicus straight down-
ward. There was little or no bleeding and the uterus was firmly contracted.
She did not see a physician for three hours. The child was found dead and,
with the placenta, was lying by her side. The neighbors were so frightened
by the 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 obhquely
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 sis-
ter a cloth bathed in blood as menstrual proof that she was not pregnant.
On returning home, having walked five hours, she was seized with an attack
of vomiting and fainted. The parents called Drs. Serpieri and Baliva, who
relate the case. Thirteen hours had elapsed from the infliction of the wound,

a 597 1830-1 i 381. ^ 599, ii., 40. « Wien. med. Wocbenschrift, 1880, No. 13.
d476,' 1884, i.', 146. e 359, May 2, 1886.

DELIVERY OF FETUS BY CATTLE-HORN INJURIES. 133

I

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 ciforts to hide her shame.

Cases like the foregoing excite no more interest than those on record in
which an abdominal section has been accidental, as, for instance, by cattle-
horns, and the fetus born through the wound. Zuboldie * speaks of a case
in which a fetus was born from the wound made by a bull's horn in the
mother's abdomen. Deneux-"-*^ describes a case in which the wound made by
the horn was not sufficiently large to permit the child's escape, but it was sub-
sequently brought through the opening. Pigne ^ speaks of a woman of thirty-
eight, who in the eighth month of her sixth pregnancy was gored by a bull,
the horn effecting a transverse wound 27 inches long, running from one an-
terior spine to the other. The woman was found cold and insensible and

Fig. 19.— Accouchement by a bull (after an engraving dated 1647).

with an imperceptible pulse. The small intestines were lying between the
thighs and covered with coagulated blood. In the process of cleansing, a
male child was expelled spontaneously through a rent in the uterus. The
woman was treated with the usual precautions and was conscious at midday.
In a month she was up. She lived twenty years without any inconvenience
except that due to a slight hernia on the left side. The child died at the end
of a fortnight.

In a very exhaustive article Harris of Philadelphia « has collected nearly
all ,the remaining cases on record, and brief extracts from some of them will
be given below. In Zaandam, Holland, 1647, a farmer's wife was tossed by
a furious bull. Her abdomen was ripped open, and the child and membranes
escaped. The child suffered no injuries except a bruised upper lip and lived
nine months. The mother died within forty hours of her injuries. Figure

a 297, ii., n. 43. b 162, July, 1836. c 125, 1887, xx., 673.

134

OBSTETRIC ANOMALIES.

19, taken from an engraving dated 1 647, represents an accouchement by a mad
bull, possibly the same case. In Dillenberg, Germany, in 1779, a multipara
was gored by an ox at her sixth month of pregnancy ; the horn entered the
right epigastric region, three inches from the linea alba, and perforated the
uterus. The right arm of the fetus protruded ; the wound was enlarged and
the fetus and placenta delivered. Thatcher speaks of a woman who was
gored by a cow in King's Park, and both mother and child were safely deliv-
ered and survived.

In the Parish of Zecoytia, Spain, in 1785, Marie Gratien was gored by an
ox in the superior portion of her epigastrium, making a wound eight inches
long- which wounded the uterus in the same direction. Dr. Antonio di
Zubeldia and Don Martin Monaco were called to take charge of the case.
AVhile they were preparing to effect delivery by the vagina, the woman, in an
attack of singultus, ruptured the line of laceration and expelled the fetus,
dead. On the twenty-first day the patient was doing well. The wound
closed at the end of the sixteenth week. The woman subsequently enjoyed
excellent health and, although she had a small ventral hernia, bore and
nursed two children.

Marsh ^ cites the instance of a woman of forty-two, the mother of eight chil-
dren, who when eight months pregnant was horned by a cow. Her clothes
were not torn, but she felt that the child had slipped out, and she caught it
in her dress. She was seen by some neighbors twelve yards from the place
of accident, and was assisted to her house. The bowels protruded and the
child was separated from the funis. A physician saw the woman three-quar-
ters of an hour afterward and found her pulseless and thoroughly exhausted.
There was considerable but not excessive loss of blood, and several feet of
intestine protruded through the wound. The womb was partially inverted
through the wound, and the placenta was still attached to the inverted por-
tion. The wound in the uterus was Y-shaped. The mother died in one and
a half hours from the reception of her injuries, but the child was uninjured.

Scott " mentions the instance of a woman thirty-four years old who was
gored by an infuriated ox while in the ninth month of her eighth pregnancy.
The horn entered at the anterior superior spinous process of the ilium, involv-
ing the parietes and the uterus. The child was extruded 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 investi-
gation^he found to be a living child in its membranes. It was christened
by order of one Cordua and lived for some time after.

Postmortem Cesarean Section.— The possibility of delivering a child

a 319, July, 1850, 88. b 538, 1867. c 5I8, 1885, iii., 341. d Dissert, de Foet. Nutrit. , 45.

POSTMORTEM CESAREAN SECTION.

135

by Cesarean section after the death of the mother has been known for a long
time to the students of medicine. In the olden times there were laws making
compulsory the opening of the dead bodies of pregnant women shortly afler
death. Numa Pompilius established the first law, which was called " lex
regia," and in later times there were many such ordinances. A full
description of these laws is on record.^^'^^ Life was believed possible after a
gestation of six months or over, and, as stated, some famous men were sup-
posed to have been born in this manner. Fran9ois de Civile, who on great
occasions signed himself " trois fois enterr6 et trois fois par le grace de Dieu,
ressucit6," saw the light of the world by a happy Cesarean operation on his
exhumed mother. Fabricius Hildanus and Bourton report similar instances.
Bourton cites among others the case of an infant who was found living twelve
hours after the death of his mother. Dufour and Mauriceau are two older
French medical writers who discuss this subject. Flajani ^ speaks of a case
in which a child was delivered at the death of its mother, and some of the
older 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 Swartzen-
berg, who was burned to death at a ball in Paris in 1810, was said to have had
a living child removed from her body the next day. Like all similar instances,
this was proved to be false, as her body was burned beyond the possibility of
recognition, and, besides, she was only four months pregnant. Harris ^ men-
tions another case of a young woman who threw herself from the Pont Neuf
into the Seine. Her body was recovered, and a surgeon who was present
seized a knife from a butcher standing by and extracted a living child in the
presence of the curious spectators, Campbell discusses this subject most
thoroughly, though he advances no new opinions upon it.

Duer tabulates the successful results of a number of cases of Cesarean
section after death as follows : —

Children extracted between 1 and 5 minutes after death of the mother, 21

" 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

a 462, T. xix., 263. b 125, 1880, 141. c Quoted by 545, Aug. 23, 1879.

136

OBSTETRIC ANOMALIES.

still be born alive, though asphyxiated ; if from ten to twenty-six minutes,
they will be highly asphyxiated. In a great number of these cases the infant
was asphyxiated or dead in one minute. Of course, if the death is sudden,
as by apoplexy, accident, or suicide, the child's chances are better. These
statistics seem conscientious and reliable, and we are safe in taking them as
indicative of the usual result, which discountenances the old reports of death
as taking place some time before extraction.

Peuch ^ is credited with statistics showing that in 453 operations 101 chil-
dren gave signs of life, but only 45 survived.

During the Commune of Paris, Tarnier, one night at the Maternity, 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 min-
utes after death. The patient was a woman of thirty-six, in her eighth month
of pregnancy, who was suddenly seized with eclampsia, which terminated
fatally in ten hours. Ten minutes after her last respiration the Cesarean sec-
tion was performed and a living male child delivered. This infant was nour-
ished with the aid of a spoon, but it died in twenty-five hours in consequence
of its premature birth and enfeebled vitality.

Green speaks of a woman, nine months pregnant, who was run over by a
heavily laden stage-coach in the streets of Southwark. She died in about
twenty minutes, and in about twenty minutes more a living child was ex-
tracted from her by Cesarean section. There was a similar case in the
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

a 844, 644. ^ 844, 645. c 261, 1895, No. 50, 1319.

d 550,' xii., 46-51. e 476, 1877, ii., 89. f 199, 1869.

RUPTURE OF THE UTERUS DURING PREGNANCY. 137

extracted. The child exhibited feeble heart-contractions and was despaired of.
Happily, after numerous and persistent means of resuscitation, applied for
about two and a half hours, regular respirations were established and the
child eventually recovered. Walter reports a successful instance of removal
of the child after the death of the mother from apoplexy.

Cleveland ^ gives an account of a woman of forty-seven which is of special
interest. The mother had become impregnated five months after the cessa-
tion of menstruation, and a uterine sound had been used in ignorance of
the impregnation at this late period. The mother died, and one hour later a
living child was extracted by Cesarean section. There are two other recent
cases recorded of extraction after an hour had expired from the death. One
is cited by Veronden in which the extraction was two hours after death,
a living child resulting, and the other by Blatner ^ in which one hour had
elapsed after death, when the child was taken out alive.

Cases of rupture of the uterus during pregnancy from the pressure
of the contents and delivery of the fetus by some unnatural passage are
found in profusion through medical literature, and seem to have been of
special interest to the older observers. Benivenius ^ saw a case in which the
uterus ruptured and the intestines protruded from the vulva. An instance
similar to the one recorded by Benivenius is also found in the last century in
Germanv.'^ Bouillon*" and Desbois, two French physicians of the last
century, both record examples of the uterus rupturing in the last stages of
pregnancy and the mother recovering. Schreibers gives an instance of rupture
of the uterus occasioned by the presence of a 13-pound fetus, and there is
recorded ^ the account of a rupture caused by a 20-pound fetus that made its
way into the abdomen. We find old accounts of cases of rupture of the
uterus with birth by the umbilicus and the recovery of the woman.^ Vespr^j
describes a case in which the uterus was ruptured by the feet of the fetus.

Farquharson ^ has an account of a singular case in midwifery in which the
abdomen ruptured from the pressure of the fetus ; and quite recently Geo-
ghegan ' illustrates the possibilities of uterine pressure in pregnancy by a post-
mortem examination after a fatal parturition, in which the stomach was found
pushed through the diaphragm and lying under the left clavicle. Heywood
Smith'^ narrates the particulars of a case of premature labor at seven months
in which rupture of the uterus occurred and, notwithstanding the fact that
the case was complicated by placenta prtevia, the patient recovered.

Rupture of the uterus and recovery does not necessarily prevent subsequent
successful pregnancy and delivery by the natural channels. Whinery " relates

a 573, 1855, v., 179. b 125, 1878, xi., 626-632. c 780, 1876, iv., 7.

dl25, 1875, viii., 160. e L. iv., obs. B., 13.

f Histoiie de la Soc. Royale de M6d., Paris, 1776, 310. g 160, iii., 235

liSamml. Medic. Wahruehmuugeu, 1 B., 363. i 108, dec. i., viii., 90.

j 462, T. xlli., 84. k 524, 1789.

1 465,1881,52. m 476^ 1875, 11., 911. n 124, Oct., 1866.

138

OBSTETRIC ANOMALIES,

an instance of a ruptured uterus in a healthy Irish woman of thirty-seven
from whom a dead child was extracted by abdominal section and who was
safely delivered of a healthy female child about one year afterward. Analo-
gous to this case is that of Lawrence,^ who details the instance of a woman
who had been delivered five times of dead children ; she had a very narrow
pelvis and labor was always induced at the eighth month to assure delivery.
In her sixth pregnancy she had miscalculated her time, and, in consequence,
her uterus ruptured in an unexpected parturition, but she recovered and had
several subsequent pregnancies.

Occasionally there is a spontaneous rupture of the vagina during the
process of parturition, the uterus remaining intact. Wiltshire reports such a
case in a woman who had a most prominent sacrum ; the laceration was trans-
verse and quite extensive, but the woman made a good recovery. Schauta
pictures an exostosis on the promontory of the sacrum (Fig. 20). Blcnkin-
sop ^ cites an instance in which the labor was neither protracted nor abnormally
severe, yet the rupture of the vagina took place with the escape of the -child

into the abdomen of the mother, and was
from thence extracted by Cesarean sec-
tion. A peculiarity of tliis case was
the easy expulsion from the uterus, no
instrumental or other manual interfer-
ence being attempted and the uterus
remaining perfectly intact.

In some cases there is extensive
sloughing of the genitals after
parturition with recovery far beyond
Fig. 2o.-Knob-iike exostosis on the promontory expectation. Gooch mentions a case
(Schauta). in which the whole vagina sloughed,

yet to his surprise the patient recov-
ered. Aetius and Benivenius speak of recovery in such cases after loss
of the whole uterus. Cazenave of Bordeaux^ relates a most marvelous
case in which a primipara suffered in labor from an impacted head. She
was twenty-five, of very diminutive stature, and was in labor a long time.
After labor, sloughing of the parts commenced and progressed to such an
extent that in one month there were no traces of the labia, nymphse, vagina,
perineum, or anus. There was simply a large opening extending from the
meatus urinarius to the coccyx. The rectovaginal septum, the lower portion
of the rectum, and the neck of the bladder were obliterated. The woman sur-
vived, although she always experienced great difficulty in urination and in
entirely emptying the rectum. A similar instance is reported ^ in a woman
of thirty who was thirty-six hours in labor. The fundus of the uterus

a 224, 1885, 601.

c 330, No. 84, Feb. 7, 1839.

b fi56, No. xi., Dec. 2, 1841.
d 124, Aug., 1838.

ACCIDENTAL EXTRACTION OF PELVIC ORGANS. 139

descended into the vagina and the whole uterine apparatus was removed.
The lower part of the rectum depended between the labia ; in the presence
of the physician the nurse drew this out and it separated at the sphincter ani.
On examining the parts a single opening was seen, as in the preceding case,
from the pubes to the coccyx. Some time afterward the end of tlie intestine
descended several inches and hung loosely on the concave surface of the rec-
tum. A sponge was introduced to support the rectum and prevent access of
air. The destruction of the parts was so complete and the opening so large
as to bring into view the whole inner surface of the pelvis, in spite of which,
after prolonged suppuration, the 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 ex-
tracted. There have been instances in which the whole uterus and its ap-
pendages, not being recognized, have been dragged out. Walters" cites the
instance of a woman of twenty-two, who was in her third 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 pro-
truding omentum. On the twenty-eighth day, after a marvelous recovery,
she was able to drive to the Royal Berkshire Hospital, a distance of five miles.
At the time of report, two years and six months after the mutilation, she was
in perfect health. Walters looked into the statistics of such cases and found
36 accidental removals of the uterus in the puerperium with 14 recoveries.
All but three of these were without a doubt attended by previous inversion
of the uterus.

A medical man was tried for manslaughter in 1878*^ because he made a
similar mistake. He had delivered a woman by means of the forceps, and,
after delivery, brought away what he thought a tumor. This " tumor " con-
sisted of the uterus, with the placenta attached to the fundus, the funis, a por-
tion of the lateral ligament, containing one ovary and about three inches of
vagina. The uterus was not inverted. A horrible case, with similar results,
happened in France, and was reported by Tardieu.'^ A brutal peasant, whose
wife was pregnant, dragged out a fetus of seven months, together with the
uterus and the whole intestinal canal, from within 50 cm. of the pylorus to
within 8 cm. of the ileocecal valve. The woman was seen three-quarters of

a 476, 1884, ii., 779. b 543, 1878, ii., 728. c 141^ xxxix., 157, 172.

140

OBSTETRIC ANOMALIES.

an hour after the intestines had been found in the yard (where the brute had
thrown tliem), 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, pro-
nounced them false pains, and went away.
On his return he found the girl dying,
with her uterus completely inverted and
hanging between her legs. This unfor-
tunate maiden had been delivered while
standing upriglit, with her elbows on the
back of a chair. The child suddenly
escaped, bringing with it the uterus, but
as the funis ruptured the child fell to the
floor. Wagner pictures partial prolapse
of the womb in labor (Fig. 21).

It would too much extend this chap-
ter to include the many accidents inci-
dent to labor, and only a few of especial
interest will be given. Cases like rupture
of an aneurysm during labor, extensive
hemorrhage, the entrance of air into the
uterine veins and sinuses, and common

Fig. 21.— Partial prolapse of the womb in labor . mi i • i

(Wagner). laccratious Will be omitted, together with

complicated births like those of double
monsters, etc., but there are several other cases that deserve mention.
Eklridge'^ gives an instance of separation of the symphysis pubis during
labor, — a natural symphysiotomy. A separation of | inch could be discerned
at the symphysis, and in addition the sacroiliac synchondrosis was also quite
movable. The woman had not been able to walk in the latter part of
her pregnancy. The child weighed IQi 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.

a 807, 1865. b 124, 1860.

c American System of Obstetrics, Hirst. d 269, 1884, xlix., 495.

S YMPH YSI OTOMY.

141

Sanders * reports a case of the separation of the pubic bones in labor.
Studley ^ mentions a case of fracture of the pelvis during instrumental deliv-
ery. Humphreys cites a most curious instance. The patient, it appears,
had a large exostosis on the body of the pubes which, during parturition, was
forced through the walls of the uterus and bladder, resulting in death. Kilian
reports four cases of death from perforation of the uterus in this manner.
Schauta pictures such an exostosis (Fig. 22).

Chandler relates an instance in which there was laceration of the liver
during parturition ; and Hubbard « records a case of rupture of the spleen
after labor.

Symphysiotomy is an operation consisting of division of the pubic symphy-
sis in order to facilitate delivery in narrow pelves. This operation has under-
gone a most remarkable revival during the past two years. It originated in a
suggestion by Pineau in his work on surgery in 1598,^ and in 1665 was first
performed by La Courv6e upon a dead body in order to save the child, and
afterward by Plenk, in 1766,^ for the same purpose. In 1777 Sigault first
proposed the operation on the living,

and Ferrara was the one to carry out,
practically, the proposition, — although
Sigault is generally considered to be
the first symphysiotomist, and the pro-
cedure is very generally known as the
" Sigaultean operation." From Fer-
rara's time to 1858, when the oper-

ation had practically died out, it had Fig. 22— Exostosis on the symphysis (Schauta),

been performed 85 times, with a re-
corded mortality of 33 per cent. In 1866 the Italians, under the leadership
of Morisani of Naples, revived the operation, and in twenty years had per-
formed it 70 times with a mortality of 24 per cent. Owing to rigid anti-
septic technic, the last 38 of these operations (1886 to 1891) showed a mortality
of only per cent., while the infant-mortality was only 10-| per cent. The
modern history of this operation is quite interesting, and is very completely
reviewed by Hirst and Dorland.^

In November, 1893, Hirst reported 212 operations since 1887, with a
maternal mortality of 12.73 per cent, and a fetal mortality of 28 per cent.
In his later statistics Morisani gives 55 cases with 2 maternal deaths and
1 infantile death, while Zweifel ^ reports 14 cases from the Leipzig clinic
with no maternal death and 2 fetal deaths, 1 from asphyxia and 1 from
pneumonia, two days after birth. All the modern statistics are correspond-
ingly encouraging.

^ Trans. Amer. Instit. Homeopathy,
c 531, 1857-8, iii., 322-326. d 218, xxxiii., 398.

f 533, Jau. 12, 1895. g 843, 401. h 843, 401.

125, 1879, xii., 269.
e 597, XXX., 75.
i 261, No. 22, 1893.

142

OBSTETRIC ANOMALIES.

Irwin reports a case in which the firm attachment of the fetal head to
the uterine parietes rendered delivery without artificial aid impossible, and it
was necessary to 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 tlie other. De Bosch speaks of a delay of seven-
teen days ; and there were 2 cases on record in France in the last century, ^
one of 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 intei'\^al 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. Wildbcrg"^ 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.

a 418, 1751, 107 ; and 418, 1752, 112.
d 611, April 5, 1845.
g 611, April 20, 1844.

b 160, iv. B., 771.
e 136, 1844, 3 Heft.
b224, 1880, i., 242.

c 462, T. xl., 448.
f 546, Dec. 28, 1844.
i 476, 1886, i., 477.

DELAY IN THE BIRTH OF THE SECOND TWIN 143

the patient made a good recovery and the first child lived. A similar case
is reported by Lumby in which a Avoman was delivered on January 18th,
by a midwife, of a full-grown and healthy female child. On the third day
she came down-stairs and resumed her ordinary duties, which she con-
tinued until February 4th (seventeen days after). At this time she was de-
livered of twins, a boy and a girl, healthy and well-developed. The placenta
was of the consistency of jelly and had to be scooped away with the hand.
The mother and children did well. This woman was the mother of ten children
besides the product of this conception, and at the latter occurrence had entire
absence of pains and a very easy parturition.

Pincott ^ had a case with an interval of seven weeks between the births ;
Vale 1 of two months ; Bush ^ 1 of seventeen days ; and Burke ® 1 with an
interval of two months. Douglas ^ cites an instance of twins being born four
days apart. Bessems of Antwerp, in 1866, mentions a woman with a bicor-
nate uterus who bore two twins at fifty -four days' interval.

^ 224, 1878, i., 227. b 224, 1886. c 476, 1842.

d535, 1825, 121. e 582, 1855, 241. f 538, xxvii.. 196.

CHAPTER IV.

PROLIFICITY.

General Historic Observations. — Prolificity is a much discussed sub-
ject, for besides its medical and general interest it is of importance in social
as well as in political economy. Superfluous population was a question that
came to consciousness early ; Aristotle spoke of legislation to prevent the in-
crease of population and the physical and mental deterioration of the race, —
he believed in a population fixed as regards numbers, — and later Lycurgus
transformed these precepts into a terrible law. Strabonius reports that the
inhabitants of Cathea brought their infants at the age of two months before a
magistrate for inspection. The strong and promising were preserved and the
weak destroyed. The founders of the Roman Empire followed a similar
usage. With great indignation Seneca, Ovid, and Juvenal reproved this
barbarity of the Romans. With the domination of Christianity this custom
gradually diminished, and Constantine stopped it altogether, ordering succor
to the people too poor to rear their own children. The old Celts were so
jealous of their vigor that they placed their babes on a shield in the river,
and regarded those that the waves respected as legitimate and worthy to
become members of their clans. In many of the Oriental countries, where the
population is often very excessive and poverty great, the girl babies of the
lower classes were destroyed. At one time the crocodiles, held sacred in the
Nile, were given the surplus infants. By destroying the females the breed-
ing necessarily diminished, and the number of the weaker and dependent
classes became less. In other countries persons having children beyond their
ability to support were privileged to sell them to citizens, who contracted to
raise them on condition that they became their slaves.

General Law, and the Influence of War. — In the increase of the
world's population, altliougli 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

144

INFLUENCE OF RURAL AND URBAN LIFE.

145

from their wives for long periods ; many women are left widows ; the females
become in excess of the males ; the excitement of the times overtops the desire
for sexual intercourse, or, if there is the same desire, the unprolific prostitute
furnishes the satisfaction ; and such facts as these, coupled with many similar
ones, soon produce an astonishing effect upon the comparative birth-rate and
death-rate of the country. The resources of a country, so far as concerns
popidation, 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 birtlis
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. Tlie 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-Smitli, in remarking on the influence of war on the marriage-rate,
says that in 1866 the Prussian rate fell from 18.2 to 15.6, while the Austrian
rate fell from 15.5 to 13.0. In the war of 1870-71 the Prussian rate fell from
17.9 in 1869 to 14.9 in 1870 and 15.9 in 1871 ; but in the two years after
peace was made it rose to 20.6 and 20.2, the highest rates ever recorded. In
France the rate fell from 16.5 to 12.1 and 14.4, and then rose to 19.5 and
17.7, the highest rates ever recorded in France.

Influence of Rural and Urban Life.— Rural districts are always very
prolific, and when we hear the wails of writers on " Social Economy," bemoan-
ing the small birth-rates of their large cities, we need have no fear for urban
extinction, as emigration from the country by many ambitious sons and
daughters, to avail themselves of the superior advantages that the city offers,
will not only keep up but to a certain point increase the population, until the
reaction of overcrowding, following the self-regulating law of compensation
starts a return emigration. ^

The effect of climate and race on prolificity, though much spoken of,
IS not so great a factor as supposed. The inhabitants of Great Britain are
surpassed by none in the point of prolificity ; yet their location is quite
northern. The Swedes have always been noted for their fecundity. Olaf

a Statistics and Sociology, New York, 1895.

146 PROLIFICITY.

Rudbeck' says that from 8 to 12 was the usual family mimber, 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 witli large fanuhes, and
Quebec is still noted for its prolificity. There is little difference in this respect
among nations, woman being limited about the same ever5'where, and the
general average of the range of the productive function remaimng 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
livino. 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,
accorcUng 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 famiUe" made
their claim according to the conditions of the law, and one, Paul Be Hanger
of the River du Loup, claimed 300 acres as his premium, based on the fac
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 tluity
years old, with 17 children. She had triplets twice in the space of five years
Ld 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 bir^h-rate,
and a French medical journal, quoting the foregoing, regretfully wishes for
some countrymen at home like their brothers m Quebec.

Old Explanations of Prolificity.-The old explanation of the causatron
of the remarkable exceptions to the rules of prolificity was similar to that
!d™i ced by Empedocles, who says that the greater the quantity of semen, the
g Ir the number of children at birth. Par6,- later, uses a similar reason
fo etplain the causation of monstrosities, grouping them into two classes, those
due to deficiency of semen, such as the acephalous type, and those due to ex-
tss 1 h a the'double mo'nsters. Hipp<x,rates, in his work on the " Nature
of th Infant," tells ns that twins are the result of a single coitus and we ar
Informed that each infant has a chorion ; so that both kinds of plura
Ltation (monochorionic and dichorionic) were known to the ancients. In tins
& ^ b 788, June, 1895.

a Atlantica, Upsal, 1684.

QUADRUPLETS.

149

A. M. ; found her in labor and at full time, although she assured me that her
' time ' was six weeks ahead. At 8 o'clock a. m. I delivered her of a girl
baby; I found there were triplets, and so informed her. At 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 19J pounds Avithout cloth-
ing ; the first weighed 6 pounds ; the second 5 pounds ; the third 4i 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 Aveighs 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^ ounces
and 4 pounds 3 ounces ; and of 2 females, weighing 4 pounds 3 ounces and
3 pounds 13| ounces, respectively. There was but one placenta, and no
more exhaustion or hemorrhage than at a single birth. The father weighed
169 pounds, was forty-one years old, and was 5 feet 5 inches tall, healthy
and robust. The Journal of St. Petersburg, a newspaper of the highest
standard, stated that at the end of July, 1871, a Jewish 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 surviv-
ing. Bousquet « speaks of a primiparous mother, aged twenty-four, giving
birth to 4 living infants, 3 by the breech and 1 by the vertex, apparently all

a 250, Oct., 1883. b 476, 1857, ii., 259. c 140, 1894, ii., 55

150 PROLIFICITY.

in one bag of membranes. They were nourished by the help of 3 wet-nurses
Bedford - speaks of 4 children at a birth, averaging 5 pounds each, and all

nursing the mother.

Quintuplets are quite rare, and the Index Catalogue of the Surgeon
General's Library, U. S. A., gives only 19 cases, reports of a few of which
will be -iven 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,
givinc birth to 5 girls, 2 of which lived ; the 2 that lived weighed at
birth^'s pounds 12 ounces and 9 pounds, respectively. He discusses the
idea that woman was meant to bear more than one child at a birth, usmg
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 toZ boys and 2 girls. In the same journal was reported the birth
at Wells, Somersetshire, in 1739, of 4 boys and a girl, all of whom were
christened and were healthy. Par6 ^ 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
drls Their length was^ from 1 5i to 1 6^ 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 i 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. Moffitf^ records the

, .ofi- b 629, 1787, 344. ' 374, Oct. 5, 1736.

d fi?8 L XXV chap iii 54. e 302, iv., 183. f 302, xix., 389. g 618, 1014.
I 37i; T; ri827 476, 1837, 7^3. i 476, 1857, ii., 259. ^ 545, 1881.

QUINTUPLETS.

151

birth at Monticello, 111., of quintuplets. The woman was thirty-five years
of age ; examination showed a breech presentation ; the second child was
born by a foot-presentation, as was the third, but the last was by a head-
presentation. The combined weight was something over 19 pounds, and
of the 5, 3 were still-born, and the other 2 died soon after birth. The
Elgin Courant (Scotland), 1858, speaks of a woman named Elspet Gordon,
at Rothes, giving birth to 3 males and 2 females. Although they were
six months' births, the boys all lived until the following morning. The girls
were still-born. One of the boys had two front teeth when born. Dr.
Dawson of Rothes is the obstetrician mentioned in this case.

The following recent instance is given with full details to illustrate the
difficulties attending the births of quintuplets. Stoker has reported the case
of a healthy woman, thirty-five years old, 5 feet 1 inch high, and of slight
build, whom he delivered of 5 fetuses in the seventh month of pregnancy,
none of the children surviving. The patient's mother had on two occasions
given birth to twins. The woman herself had been married for six years and
had borne 4 children at full term, having no difficulty in labor. When she
came under observation she computed that she had been pregnant for six
months, and had had her attention attracted to the unusually large size of
her abdomen. She complained of fixed pain in the left side of the abdomen,
on which side she thought she was larger. Pains set in with regularity and
the labor lasted eight and three-quarter hours. After the rupture of the
membranes the first child presented by the shoulder. Version was readily
performed ; the child was dead (recently). Examination after the birth of
the first child disclosed the existence of more than one remaining fetus.
The membranes protruded and became tense with each contraction. The
presentation was a transverse one. In this case also there was little difficulty
in effecting internal version. The child lived a couple of hours. The third
fetus was also enclosed in a separate sac, which had to be ruptured. The
child presented by the breech and was delivered naturally, and lived for an
hour. In the fourth case the membranes had likewise to be ruptured, and
alarming hemorrhage ensued. Version was at once practised, but the chin
became locked with that of the remaining fetus. There was some difficulty
and considerable delay in freeing the children, though the extent of locking
was not at any time formidable. The child was dead (recently). The fifth
fetus presented by the head and was delivered naturally. It lived for half
an hour. The placenta was delivered about five minutes after the birth of
the last child, and consisted of two portions united by a narrow isthmus.
One, the smaller, had two cords attached centrally and close together; the other,
and larger, had two cords attached in a similar way and one where it'was joined
to the isthmus. The organ appeared to be perfectly healthy. The cord of
the fourth child was so short that it had to be ligated in the vagina. The

'I 476, 1895, ii., 1164.

152

PEOLIFICITY.

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, IS^l,^"' a woman in Dropin
was delivered of 6 daughters, all living, and only a little smaller than
usual in size. The mother was not quite twenty years old, but was of
strong constitution. The 6 lived long enough to be baptized, but died the
evening of their births. There was a case of sextuplets in Italy in 1844.
In Maine, June 27, 1847, a woman was delivered of 6 children, 2 sur-
viving and, together with the mother, doing welL^ In 1885 there was
reported the birth of sextuplets in Lorca, Spain, of which only one survived. <^
At Dallas, Texas, in 1888,^^ Mrs. George Hirsh of Navarro County gave birth
to 6 children, the mother and the children all doing well. There were 4 boys
and 2 girls, and they were all perfect, well formed, but rather small.

Valsalli*^ gives an instance which is quoted by the Medical News^ without
giving the authority. Valsalli's account, which difPers 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 slightlv dilated, and, as no pains were felt, it was agreed to wait. On
the next day the membranes were ruptured and 4 more fetuses were deliv-
ered. Traction on the umbilical cord started hemorrhage, to check which the
physician placed his hand in the uterine cavity. In this most arduous posi-
tion he remained four hours until assistance from Lugano came. Then, in
the presence of the three visiting physicians, a sixth amniotic sac was deliv-
ered with its fetus. The woman had a normal convalescence, and in the fol-
lowing year gave birth to healthy, living tAvins. The News says the chil-
dren all moved vigorously at birth ; there were 4 males and 2 females, and
for the 6 there was only one placenta. The mother, according to the same
authoritv, 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

a 152, 1844, 343. ^ 218, 1847. c 373, 1885.

d 450, Nov. 17, 1888. « 360, 1888. f 533, March 23, 1895.

MULTIPLE BIRTHS OVER SIX.

153

l)irth to 7 children, 4 of whom were baptized. At the Parish of San Ildefonso,

y alkidolid, Julianna, wife of Benito Quesada, gave birth to 3 children in one

day, and during the following night to 4 more/ Sigebcrt, in his Chronicles,

says that the mother of the King of Lombardy had borne 7 children at a

birth. Borelhis ^ 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. Timotliy 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, these 3 boys

and 5 girls, she had borne 12 children

in six years. She herself was a triplet

and her father and her mother were of

twin births and one of her grandmothers

was the mother of 5 pairs of twins.

This case was most celebrated and was

much quoted, several British journals

extracting it.

Watering of Maregnac'^ speaks of

the simultaneous birth of 8 children at

one time. When several months preg-
nant the woman was seized with colicky

pains and thought them a call of nature.

She went into a vineyard to answer it,

and there, to her great astonishment,

gave birth to 8 fetuses. Watering found

them enclosed in a sac, and thought

they probably had died from nuitual
pressure during growth. The mother
made a good recovery.

In 1755 Seignette of Dijon ^ reports
the simultaneous birth of nine children. Franciscus Picus Mirandulse,
quoted by Par6, says that one Dorothea, an Italian, bore 20 children at 2
confinements, the first time bearing 9 and the second time eleven. He
gives a picture of this marvel of prolificity, in which her belly is represented
as hangmg down to her knees, and supported by a girdle from the neck
(Fig. 23). In the Annals, History, and Guide to Leeds and York, according
to Walford,«i=' there is mention of Ann Birch, who in 1781 was delivered

a 373, Nov. 22 1885 ; quoted by 476, 1885, ii., 1125 ; and several other authorities,
b Observ., cent, n., Pans, 165fi. e 218 Sent 96 1872

e28o;i755;r.!'3oo

Fig. 23.— Pregnancy with 11 fetuses (after Par6).

154

PROLIFICITY.

of 10 children. One daughter, the sole survivor of the 10, married a market
gardener named Piatt, who was well known in Leeds. Jonston^*^ quotes
Baytraff as saying that he knew of a case in which 9 children were born
simultaneously ; and also says that the Countess of Altdorf gave birth to
twelve at one birth. Albucasis mentions a case of fifteen well-formed
children at a birth. According to 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 numer-
ous, and sometimes so often repeated as to produce a family the size of which
is almost incredible. Aristotle is credited with saying ^ that he knew the
history of a woman who had quintuplets four times. Pliny's case of qum-
tuplets four times repeated has been mentioned ; and Pare,«i« 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 MiranduljB 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 Antoma, 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
a 302, iv. , 183. ^ 302, xix. ,389. « 374, Sept. , 1783, iii. , 753.

REPETITION OF MULTIPLE BIRTHS. 155

had 21 children in 7 successive births. They were all born alive, and 12
still survived and were healthy. As though to settle the (question as to
whom should be given the credit in this case, the father or the mother, the
father experimented upon a female servant, who, notwithstanding her youth
and delicateness, gave birth to 3 male children that lived three weeks.
According to despatches from Lafayette, Indiana, investigation following the
murder, on December 22, 1895, of Hester Curtis, an aged woman of that
city, developed the rather remarkable fact that she had been the mother of
25 children, including 7 pairs of twins.

According to a French authority the wife of a medical man at Fuente-
major, in Spain, forty-three years of age, ^ was delivered of triplets 13
times. Puech read a paper before the French Academy in which he re-
ports 1262 twin births in Nimes from 1790 to 1875, and states that of the
whole number in 48 cases the twins were duplicated, and in 2 cases
thrice repeated, and in one case 4 times repeated.

Warren ^ gives an instance of a lady, Mrs. M , thirty-two years

of age, married at fourteen, who, after the death of her first child, bore
twins, one living a month and the other six weeks. Later she again
bore twins, both of whom died. She then miscarried with triplets, and
afterward gave birth to 12 living children, as follows : July 24, 1858, 1
child; June 30, 1859, 2 children; March 24, 1860, 2 children; March
1, 1861, 3 children; February 13, 1862, 4 children; making a total
of 21 children in eighteen years, with remarkable prolificity in the later
pregnancies. She was never confined to her bed more than three days, and
the children were all healthy.

A woman in Schlossberg, Germany, gave birth to twins ; after a year, to
triplets, and again, in another year, to 3 fairly strong boys.<= In the
State Papers, Domestic Series, Charles I., according to Walford,^!^ appears
an extract from a letter from George Garrard to Viscount Conway, which is
as follows : " Sir John Melton, who entertained you at York, hath buried
his wife, Curran's daughter. Within twelve months she brought him 4
sons and a daughter, 2 sons last summer, and at this birth 2 more and
a daughter, all alive." Swan'i mentions a woman who gave birth to 6
children in seventeen months in 2 triple pregnancies. The first terminated
prematurely, 2 children dying at once, the other in five weeks. The sec-
ond was uneventful, the 3 children living at the time of the report.
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, 6i pounds ; the

a 365, Oct. 1, 1863. l> 218, 1862, 331. e 2'>4 1878 ii 767

d 512, March, 1893. ' e 612, Columbus, 1881.

156

PROLIFICITY.

third, a male, 5| pounds. The third child lived twenty days, the other two
died of cholera infantum at the sixth month, attributable to the bottle-feed-
ing. Banerjee^ gives the history of a case of a woman of thirty being de-
livered of her fourth pair of twins. Her mother was dead, but she had
3 sisters living, of one of whicli 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 JournaP gives the
following : " About 2 or 3 stations beyond Pompeii, in the City of Nocera,
lives Maddalena Granata, aged forty-seven, who was married at twenty-eight,
and has given birth to 52 living and dead children, 49 being males. Dr. de
Sanctis, of Nocera, states that she has had triplets 15 times."

Peasant Kirilow was presented to the Empress of Russia in 1853, at the
age of seventy years. He had been twice married, and his first wife had
presented him with 57 children, the fruits of 21 pregnancies. She had quad-
ruplets four times, triplets seven times, and twins thrice. By his second wife
he had 1 5 children, twins six times, and triplets once. This man, accordingly,
was the father of 72 children, and, to magnify the wonder, all the children
were alive at the time of presentation. Herman, in some Russian statistics, ^
relates the instance of Fedor Vassilet, a peasant of the Moscow Jurisdiction,
who in 1872, at the age of seventy-five years, was the father of 87 children.
He had been twice married ; his first wife bore him 69 children in 27 accouche-
ments, having twins sixteen times, triplets seven times, and quadruplets four
times,' but never a single birth. His second wife bore him 18 children in 8
accouchements. In 1872, 83 of the 87 children were living. The author
says this case is beyond all question, as the Imperial Academy of St.
Petersburg, as well as the French Academy, have substautial 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

a 540 June 1, 1894. ^ Q"«*«d ^^6, 1886, i., 57.

c 476; i857,ii.,259. d 476, 1878, i., 289.

EXTREME PROLIFICITY BY SINGLE BIRTHS. 157

old. By him she had 78 boys and 7 girls. Pie 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,8'^ 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 hus-
band. She had previously been confined with twins during the year.

It would be the task of a mathematician to figure the possibilities of
paternity in a man of extra long life who had married several prolific women
during his prolonged period of virility. A man by the name of Pearsons
of Lexton, Nottingham, at the time of the report had been married 4 times
By his first 3 wives he had 39 children and by his last 14, making a

a 559, 1806, 1 B., 127. b 224, 1883, ii., 557. c 218, Sept. 26, 1872

158 PROLIFICITY.

total of 53. He was 6 feet tall and lived to his ninety-sixth year. We lla^'^
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 mar-
ried and was the father of 47 children, 35 of whom were living at the time

of his death. . . • +1 +

On a tomb in Elv, Cambridgeshire, there is an inscription saying that

Riehard Woi-ster, buried there, died on May 11, 1856, tlie tomb being m

memory of his 22 sons and 5 daughtei-s.

Aitaxerxes was supposed to have had 106 children ; Conrad, Dul.e ot
Moscow, 80 ; and in the polygamous countries the number seems incredible
Herotinus was said- to liave had 600 ; and Jonston also quotas instances ol
225 and even of 650 in the Eastern countries.

Recently there have been published accounts of the alleged experiments
of Luigi Erba, an Italian gentleman of Perugia, whose results have been an-
nounced. About forty years of age and being quite wealthy, this bizarre
philanthropist visited various quarters of the world, securing women of differ-
ent races; having secured a number sufficient for his purposes, he retired
with them to Polvnesia, where he is accredited with maintaining a unique
establishment with his household of females. In 1896, just seven years after
the experiment commenced, the report say he is the father »/ fldrei.
The following is a report from Raleigh, N. C, on July 28, 1893, to the

New York Evening Post : — . . „ , t

" 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 ol he
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,
Td by the two wives has had bom to him 45 children By the fi^t 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 wa,s accidentally killed some
—I at the age of sTxty-nine. He was married first in 1 84a n 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 afterwai-d she gave birth
to triplets. In the seventh year she gave birth to one child and died soon
Tfter^ard. Heff'ner engaged a young woman to look after his large brood
of bXes, and three months later she became the second Mrs. Heffner. She

a 447, 466.

POSSIBLE DESCENDANTS.

159

presented her husband with 2 children in the first two years of her wedded
life. Five years later she had added 10 more to the family, having twins
5 times. Then for three years she added but 1 a year. At the time of the
death of the second wife 12 of the 32 children had died. The 20 that were
left did not appear to be any obstacle to a young widow with one child con-
senting to become the third wife of the jolly little man, for he was known as
one of the happiest and most genial of men, although it kept him toiling like
a slave to keep a score of mouths in bread. The third Mrs. Heffner became
the mother of 9 children in ten years, and the contentment and happiness of
the couple were proverbial. One day, in the fall of 1885, the father of the
41 children was crossing a railroad track and was run down by a locomotive
and instantly killed. His widow and 24 of the 42 children are still living."

Many Marriages. — In this connection it seems appropriate to mention a
few examples of multimarriages on record, to give an idea of the possibilities of
the extent of paternity. St. Jerome mentions a widow who married her twenty-
second husband, who in his time had taken to himself 20 loving spouses.
A gentleman living in Bordeaux jj-^ ^772 had been married 16 times.
DeL ongueville, 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 s@on get extraordinary
figures. The Madrid Estafette ^ states that a gentleman, Seiior Lucas Ne-
queiras Saez, who emigrated to America seventy years previously, recently
returned to Spain in his own steamer, and brought with him his whole family,
consisting of 197 persons. He had been thrice married, and by his first
wife had 11 children at 7 births; by his second wife, 19 at 13 births, and by
his third wife, 7 at 6 births. The youngest of the 37 was thirteen years
old and the eldest seventy. This latter one had a son aged forty-seven and
16 children besides. He had 34 granddaughters, 45 grandsons, 45 great
granddaughters, 39 great grandsons, all living. Seilor Saez himself was
ninety-three years old and in excellent health.

At Litchfield, Conn., there is said to be the folloAving 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, 10] erandchil-
dren, 274 great grandchildren, and 22 great-greatgrandchildren, 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.

a 224, 1883, ii., 207.

160

PROLIFICITY.

The following is a communication to " Notes and Queries/' March 21,
1891 : " Mrs. Mary Honey wood 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
Honey wood, Esq., of Charing, in Kent. She died in the ninety-third
year of her age, in May, 1620. She had 16 children of her own body, 7
sons and 9 daughters, of whom one had no issue, 3 died young — the young-
est was slain at Newport battle, June 20, 1600. Her grandchildren, in the
second generation, were 114 ; in the third, 228, and in the fourth, 9 ; so that
she could almost say the same as the distich doth of one of the Dalburg
family of Basil : ' Rise up, daughter, and go to thy daughter, for thy daugh-
ter's daughter hath a daughter.'

" In Markshal Church, in Essex, on Mrs. Honey wood's tomb is the follow-
ing inscription : ' Here lieth the body of Mary Waters, the daughter and co-
heir of Robert Waters, of Lenham, in Kent, wife of Robert Honeywood, of
Charing, in Kent, her only husband, who had at her decease, lawfully de-
scended from her, 367 children, 16 of her own body, 114 grandchildren, 228
in the third generation, and 9 in the fourth. She lived a most pious life and
died at Markshal, in the ninety-third year of her age and the forty-fourth
of her widowhood, May 11, 1620.' (From ^Curiosities for the Ingenious,'
1825.) S. S. R."

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

a In illustration we may note the following : In the Illustrated London News, May 11,
1895, is a portrait of "Lady Millard," a fine St. Bernard bitch, the property of Mr. Thorp
of Northwold, with her litter of 21 puppies, born on February 9, 1895, their sire being a
magnificent dog — "Young York." There is quoted an incredible account^ 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.

' 609, 1879, i., 525.

1

CHAPTER V.
MAJOK TEKATA.

Monstrosities have attracted notice from the earliest time, and many
of the ancient philosophers made references to them. In mythology we i
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, Enipedocles and Demo-
critus, and Pliny, Aristotle, and Galen, have all described monsters, ^although j
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 muUebribus, in which it is said that labor is gravely interfered with
when the infant is dead or apoplectic or double. There is also a reference
to monochorionic twins (which are by modern teratologists regarded as mon- i
strosities) 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 I
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 I
on the teratologic records of Chaldea, Ballantyne^ makes the following trite
statements : " Credulity and superstition have never been the peculiar pos-
session of the lower types of civilization only, and the special beliefs that have
gathered round the occurrence of teratologic phenomena have been common !
to the cultured Greek and Roman of the past, the ignorant peasant of modern '
times, and the savage tribes of all ages. Classical writings, the literature of !
the Middle Ages, and the popular beliefs of the present day all contain views i

a 759, 1894, 130. ,

11 161 I

162

MAJOR TERATA.

concerning teratologic subjects which so closely resemble those of the Chal-
dean magi as to be indistinguishable from them. Indeed, such works as
those of Obsequens, Lycostlienes, Licetus, and Ambroise Par6 only repeat,
but with less accuracy of description and with greater freedom of imagina-
tion, the beliefs of ancient Babylon. Even at the present time the most
impossible cases of so-called ' maternal impressions ' are widely scattered
through medical literature ; and it is not very long since I received a letter
from a distinguished member of the profession asking me whether, in my
opinion, I thought it possible for a woman to give birth to a dog. Of course,
I do not at all mean to infer that teratology has not made immense advances
within recent times, nor do I suggest that on such subjects the knowledge of
the magi can be compared with that of the average medical student of the

present ; but what I wish to emphasize is
that, in the literature of ancient Babylonia,
there are indications of an acquaintance
with structural defects and malformations
of the human body which will compare
favorably with even the writings of the
sixteenth century of the Christian era."

Many reasons were given for the exist-
ence of monsters, and in the Middle Ages
these were as faulty as the descriptions
themselves. They were interpreted as divi-
nations, and were cited as forebodings and
examples of wrath, or even as glorifica-
tions of the Almighty. The semi-human
creatures were invented or imagined, and
cited as the results of bestiality and allied
forms of sexual perversion prevalent in
those times. We find minute descriptions
and portraits of these impossible resiilts of wicked practices in many of the
older medical books. According to Par^'^ there was born in 1493, as the
result of illicit intercourse between a woman and a dog, a creature resembling
in its upper extremities its mother, while its lower extremities were the exact
counterpart of its canine father (Fig. 24). This particular case was believed
by Bateman and others to be a precursor to the murders and wickedness that
followed in the time of Pope Alexander I. Volateranus, Cardani, and
many others cite instances of this kind. Lycosthenes says that in the year
1110, in the bourg of 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. Par6
quotes this case and gives an illustration. Rhodiginus^ mentions a shepherd
of Cybare by the name of Cratain, who had connection with a female goat and
a 618 1031. ^ 679, L. xxv., chap. 32.

Fig. 24.— Dog-boy (after Par6).

ANCIENT EXPLANATIONS OF MONSTROSITIES. 163

impregnated her, so that she brought forth a beast with a head resembling
that of the father, but with the lower extremities of a goat. He says that the
likeness to the father was so marked that the head-goat of the herd recog-
nized it, and accordingly slew the goatherd who had sinned so unnaturally.

In the year 1547, at Cracovia,i*-'i 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. Kuelf - says that the pro-
creation of human beings and beasts is brought about —

(1) By the natural appetite ;

(2) By the provocation of nature by delight ;

(3) By the attractive virtue of the matrix, which in beasts and women is
alike.

Plutarch, in his " Lesser Parallels," says that Aristonymus Ephesius, son
of Demonstratus, being tired of women, had carnal knowledge with an ass,
which in the process of time brought forth a very beautiful child, who
became the maid Onoscelin. He also speaks of the origin of the maiden
Hippona, or as he calls her, Hippo, as being from the connection of a man
with a mare. Aristotle mentions this in his paradoxes, and we know that
the patron of horses was Hippona. In Helvetia was reported the exist-
ence of a colt (whose mother had been covered by a bull) that was half horse
and half bull. One of the kings of France was supposed to have been
presented with a colt with the hinder part of a hart, and which could out-
run any horse in the kingdom. Its mother had been covered by a hart.

Writing in 1557, Lycosthenes reports the mythical birth of a serpent by
a woman. It is quite possible that some known and classified type of
monstrosity was indicated here in vague terms. In 1726 Mary Toft, of
Godalming, in Surrey, England, achieved considerable notoriety throughout
Surrey, and even over all England, by her extensively circulated statements
that she bore rabbits. Even at so late a day as this the credulity of the
people was so great that many persons believed in her. The woman was
closely watched, and being detected in her maneuvers confessed her fraud.
To show tlie extent of discussion this case called forth, there are no less
than nine pamphlets and books in the Surgeon-General's library at Wash-
ington devoted 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

•1 "The Expert Midwife," London, 1637. b 269, xlviii., 246.

164

MAJOR TERATA.

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 hapjiened a great
eclipse of the sun, and that women immediately began to bring forth
deformed and double-headed children.

Before ending these preliminary remarks, there might be mentioned the
marine monsters, such as mermaids, sea-serpents, and the like, which
from time to time have been reported ; even at the present day there are
people who devoutly believe that they have seen horrible and impossible

demons in the sea. Par6^ describes and
pictures a monster, at Rome, on Novem-
ber 3, 1520, with the upper portion of a
child apparently about five or six years
old, and the lower part and ears of a fish-
like animal. He also pictures a sea-
devil in the same chapter, together with
other gruesome examples of the power
of imagination.

Early Teratology. — Besides such
cases as the foregoing, we find the medi-
eval writers report likely instances of
terata, as, for instance, 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
Fig. 25.-Bird-boy (after i'ar6). ^^iWdi bom 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. Pie has collected many instances of double terata from reliable
sources, but has interspersed his collection with accounts of some hideous
and impossible creatures, such as are illustrated in the accompanying figure
(Fig. 25), which shows a creature that was born shortly after a battle of

a 618, 1053.

SCIENTIFIC TERATOLOGY.

165

Louis XII., in 1512 ; it had the wings, crest, and lower extremity of a bird
and a human head and trunk ; besides, it was an hermaplirodite, and had an
extra eye in the knee. Anothc^r 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 pos-
sibility of these bust two, or at least represented them as facts. At this time
were also reported double hermaphroditic terata, seemingly without latter-
day analogues. Rhodiginus speaks of a two-headed monster born in Ferrari,
Italy, in 1540, well formed, and with two sets of genitals, one male and the

Fig. 26.— Bicephalic and hermaphroditic Fig. 27. — Double hermaphroditic monster (after

monster (after Par6). Par6).

other female (Fig. 26). Par6'' gives a picture (Fig. 27) of twins, born near
Heidelberg in 1486, which had double bodies joined back to back ; one of
the twins had the aspect of a female and the other of a male, though both
had two sets of genitals.

Scientific Teratology. — About the first half of the eighteenth century
what might be called the positive period of teratology begins. Following
the advent of this era come M6ry, Duverney, Winslow, 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 scien-
tific epoch of teratology. We can almost with a certainty start this era with

«• 679, L. xxiv., chap. 30. b 618, 1016.

166

MAJOR TERATA.

the names of Haller, Morgagni, GeoflProy-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 investiga-
tion in this century, and to enumerate the workers of the present day who
have helped to bring about scientific progress would be a task of many pages.
Even in the artificial production of monsters much has been done, and a
glance at the work of Dareste well repays the trouble. Essays on terato-
genesis, with reference to batrachians, have been offered by Lombardini ;
and by LerebouUet and Knoch with reference to fishes. Foil and AVarynski ^
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 (Fig. 28). Many of the
Museums of Natural History contain
evidences of animal terata. At Hallse
is a two-headed mouse ; the Conant
Museum in Maine contains the skele-
ton of an adult sheep with two heads ;
there was an account of a two-headed
pigeon published in France in 1734 ;^
Fig. 28.-Thre6-headed sheep (after Par6). Lcidy found a two-headed snake in a

field near Philadelphia ; Geoff'roy-
Saint-Hilaire and Conant both found similar creatures, and there is one in
the Museum at Harvard ; Wyman saw a living double-headed snake in the
Jardin des Plantes in Paris in 1853, and many parallel instances are on
record.

Classification. — We shall attempt no scientific discussion of the causa-
tion or cmbryologic derivation of the monster, contenting ourselves with
simple history and description, adding any associate facts of interest that may
be suggested. For further information, the reader is referred to the authors
cited or to any of the standard treatises on teratology.

Many classifications of terata have been offered, and each possesses some
advantage. The modern reader is referred to the modification of the group-
ing of Geoifroy-Saint-Hilairc given by Hirst and PiersoH^'^, or those of
Blanc and Guinard For convenience, we have adopted the following
classification, which will include only those monsters that have lived after

a Recherches sur la production artificielle des monstruosit^s, etc., Paris, 1894, 8".

b Recueil zoologique Suisse, 1883. « 618, 1034. <J M6moires de I'Acad. des Sciences.

TRIPLE MONSTERS.

167

birth, and who have attracted general notice or attained some fame in their
time, as attested by accounts in contemporary literature.

Class 1.-

Class 2.-

Class 3.-

Class 4.-

Class
Class
Class
Class
Class
Class 10,
Class 11
Class 12

-Uuion of several fetuses.

-Union of two distinct fetuses by a connecting band.
-Union of two distinct fetuses by an osseous junction of the cranial bones
-Union of two distinct fetuses in which one or more parts are eliminated by the
junction.

-Fusion of two fetuses by a bony union of the ischii.

-Fusion of two fetuses below the umbilicus into a common lower extremity.

-Biceplialic monsters.

-Parasitic monsters.

-Monsters with a single body and double lower extremities.

-Diphallic terata.

-Fetus in fetu, aud dermoid cysts.

-Hermaphrodites.

Class I.— Triple Monsters.— Haller and Meckel were of the opinion
that no cases of triple monsters worthy of credence are on record, and since
their time this has been the popular opinion.
Surely none have ever lived. Licetus ^^'^
describes a human monster with two feet and
seven heads and as many arms. Bartho-
linus " speaks of a three-headed monster who
after birth gave vent to horrible cries and
expired. Borellus^**^ speaks of a three-
headed dog, a veritable Cerberus. Blasius
published an essay on triple monsters in
1677. Bordenave ^ is quoted as mention-
ing a human monster formed of three fetuses,
but his description proves clearly that it was
only the union of two. Probably the best
example of this anomaly that we have was
described by Galvagni at Cattania in 1834.
This monster had two necks, on one of which
was a single head normal in dimensions. On
the other neck were two heads, as seen in the
accompanying illustration (Fig. 29). Geoifroy-Saint-Hilaire mentions several
cases, and Martin de Pedro publishes a description of a case in Madrid in
1879. There are also on record some cases of triple monster by inclusion
which will be spoken of later. Instances in the lower animals have been
seen, the three-headed sheep of Par6, already spoken of, being one.

Class II. — Double Monsters. — A curious mode of junction, probably
the most interesting, as it admits of longer life in these monstrosities, is that
of a simple cartilaginous band extending between two absolutely distinct and

a 190, cent, vi., obs. 49, 278. b 302, xxxiv., 158.

Fig. 29. —Three-headed monster (Galvagni).

MAJOR TEE ATA.

different individuals. The band is generally in the sternal region. In
17523'* there was described a remarkable monstrosity which consisted of
conjoined twins, a perfect and an imperfect child, connected at their ensiform
cartilages by a band 4 inches in circumference. The Hindoo sisters, de-
scribed by Dr. Andrew Berry,** lived to be seven years old ; they stood face to
face, with their chests ^ inches and their pubes 8^ inches apart. Mitchell ^
describes the full-grown female twins, born at Newport, Ky., called the New-
port twins. The woman who gave birth to them became impregnated, it
is said, immediately after seeing the famous Siamese twins, and the products
of this pregnancy took the conformation of those celebrated exhibitionists.

Perhaps the best known of all
double monsters were the Siamese
twins. They were exhibited all
over the globe and had the additional
benefit and advertisement of a much-
mooted discussion as to the advis-
ability of their severance, in which
opinions of the leading medical men
of all nations were advanced. The
literature on these famous brothers
is simply stupendous. The amount
of material in the Surgeon-General's
library at Washington would sur-
prise an investigator. A curious
volume in this library is a book con-
taining clippings, advertisements, and
divers portraits of the twins. It will
be impossible to speak at all fully on
this subject, but a short history and
running review of their lives will be
Fig. 3o.-siamese twins at eighteen years of age. 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,
a 776, 1821. l> 818, 1832.

SIAMESE TWINS.

169

as Chowpaliyi, the reigning king, had a superstition that such freaks of nature
always presiiged evil to the country. They were really discovered by Robert
Hunter, a British merchant at Bangkok, who in 1824 saw them boatmg
and stripped to the waist. He prevailed on the parents and King Chow-
pahyi to allow them to go away for exhibition. They were first taken out
of the country by a certain Captain Coffin. The first scientific descrip-
tion of them was given by Professor J. C. Warren, who examined them
in Boston, at the Harvard University, in 1829. At that time Eng was
5 feet 2 inches and Chang 5 feet l^ inches in height. They presented all

Fig. 31. — Siamese twins in old age.

the characteristics of Chinamen and wore long black queues coiled thrice
around their heads, as shown by the accompanying illustration (Fig. 30).
After an eight- weeks' tour over the Eastern States they went to London, arriv-
ing at that port November 20, 1829. Their tour in France was forbidden
on the same grounds as the objection to the exhibition of Ritta-Christina,
namely, the possibility of causing the production of monsters by maternal
impressions in pregnant women. After their European tour they returned
to the United States and settled down as farmers in North Carolina, adopt-
ing the name of Bunker. When forty-four years of age they married two sis-

170

MAJOR TERATA.

ters, English women, twenty-six and twenty-eight years of age, respectively..
Domestic infelicity soon compelled them to keep the wives at ditferent houses,
and they alternated weeks in visiting each wife. Chang had six children and
Eng five, all healthy and strong. In 1869 they made another trip to Europe,
ostensibly to consult the most celebrated surgeons of Great Britain and
France on the advisability of being separated. It was stated that a feeling
of antagonistic hatred after a quarrel prompted them to seek " surgical sepa-
ration," but the real cause was most likely to replenish their depleted
exchequer by renewed exhibition and advertisement.

A most pathetic characteristic of these illustrious brothers was the affec-
tion and forbearance they showed for each other until shortly before their

death. They bore each other's
trials and petty maladies with the
greatest sympathy, and in this
manner rendered their lives far
more agreeable than a casual
observer would supj)ose possible.
They both became Christians and
members or attendants of the
Baptist Church.

Figure 31 is a representation
of the Siamese twins in old age.
On each side of them is a son.
The original photograph is in the
Mutter Museum, College of Phy-
sicians, Philadelphia.

The feasibility of the operation
of separating them was discussed
by many of the leading men of
America, and Thompson, Fergus-
son, Syme, Sir J. Y. Simpson,
Nelaton, and many others in Eu-
rope, with various reports and opinions after examination. These opinions
can be seen in full in nearly any large medical library. At this time they
had diseased and atheromatous arteries, and Chang, who was quite intem-
perate, had marked spinal curvature, and shortly afterward became hemi-
plegic. They were both partially blind in their two anterior eyes, possibly
from looking outward and obliquely. The point of junction was about the
sterno-xiphoid angle, a cartilaginous band extending from sternum to
sternum. In 1869 Simpson measured this band and made the distance on
the superior aspect from sternum to sternum inches, though it is most
likely that during the early period of exhibition it was not over 3 inches.
The illustration shows very well the position of the joining band (Fig. 32).

Fig. 32. — Diagram from a cast showing the position of
the ligament and of the primary anterior incisions. Dur-
ing life the twins never assumed the face-to-face position
in which they are here represented, and which is without
doubt that of their fetal life.

"OEISSA SISTERS."

171

The twins died on January 17, 1874, and a committee of snrgoons from
the College of Physicians of Philadelphia, consisting of Doctors Andrews,
Allen, and Pancoast, went to North Carolina to perform an autopsy on the
body, and, if possible, to secure it. They made a long and most interesting
report on the results of their trip to the College. The arteries, as was
anticipated, were found to have undergone calcareous degeneration. There
was an hepatic connection through the band, and also some interlacing
diaphragmatic fibers therein. There was slight vascular intercommunica-
tion of the livers and independence of the two peritoneal cavities and the
intestines (Fig. 33). The band itself was chiefly a coalescence of the xyphoid
cartilages, surrounded by areolar tissue and skin (Fig. 34).

The "Orissa sisters," or Radica-Doddica, shown in Europe in 1893,
were similar to the Siamese twins in conformation. They were born m

Fig. 33. — Diagrammatic representation of the
livers, portraying the relations of the vessels, etc.
The arrows show the direction in which an injection
passed from Chang to Eng.

Fig. 34.— Diagrammatic representation of the
band. A, upper or hepatic pouch of Chang; E, E
(dotted line), union of the ensiform cartilages ; 2>,
connecting liver band, or the " tract of portal con-
tinuity ;" B, the peritoneal pouch of Eng ; C, the
lower peritoneal pouch of Chang ; F, F, lower bor-
der of the band.

Orissa, India, September, 1889, and were the result of the sixth pregnancy,
the other five being normal. They were healthy girls, four years of age, and
apparently perfect in every respect, except that, from the ensiform cartilage
to the umbilicus, they were united by a band 4 inches long and 2 inches
wide (Fig. 35). The children when facing each other could draw their
chests three or four inches apart, and the band was so flexible that they could
sit on either side of the body. Up to the date mentioned it was not known
whether the connecting band contained viscera. A portrait of these twins
was shown at the World's Fair in Chicago.

In the village of Arasoor, district of Bhavany, there was reported a mon-
strosity in the form of two female children, one 34 inches and the other
33| inches high, connected by the sternum. They were said to have had
small-pox and to have recovered. They seemed to have had individual ner-
vous systems, as when one was pinched the other did not feel it, and while one
slept the other was awake. There must have been some vascular connection,
as medicine given to one affected both.

172

MAJOR TERATA.

Fig. 36 shows a mode of cartilaginous junction by which each component
of a double monster may be virtually independent.

Operations on Conjoined Twins.— Swingler ^ speaks of two girls joined
at the xiphoid cartilage and the umbilicus, the band of union being li inches
thick, and running below the middle of it was the umbilical cord, common to
both. They first ligated the cord, which fell off in nine days, and then sepa-
rated the twins with the bistoury. They each made early recovery and lived.

In the Ephemerides of 1690 Konig gives a description of two Swiss
sisters born in 1689 and united belly to belly, who were separated by means

Fig. 35.— Radica-Doddica, the "Orissa Sisters."

Fig. 36.— Skeleton showing a mode of junction
of independent double monsters.

of a ligature and the operation afterward completed by an instrument. The
constricting band was formed by a coalition of the xiphoid cartilages and the
umbilical vessels, surrounded by areolar tissue and covered with skin. Le
Beau ^ says that under the Koman reign, A. D. 945, two male children were
brought from Armenia to Constantinople for exhibition. They were well
formed in every respect and united by their abdomens. After they had been
for some time an object of great curiosity, they were removed by governmen-
tal order, being considered a presage of evil. They returned, however, at
a Quoted 302, vol. xxxiv. b Histoire du Bas-Empire, 1776.

CRANIOPA GI

173

the commencement of the reign of Constantine VII., when one of them took
sick and died. The surgeons undertook to preserve the otlicr by separating
him from the corpse of his brother, but he died on the third day after the
operation.

In 1866 Boehm" gives an account of Guzenhausen's case of twins who
were united sternum to sternum. An operation for separation was per-
formed without accident, but one of the children, already very feeble,
died three days after ; the other survived. The last attempt at an oper-
ation like this was in 1881, when Biaudet and Buginon attempted to
separate conjoined sisters (Marie- Adt4e) born in Switzerland on June 26th.
Unhappily, they were very feeble and life was despaired of when the opera-
tion was performed, on October 29th. 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 some-
times called craniopagi. A very ancient obser-
vation of this kind is cited by GeolFroy-Saint-
Hilaire. These two girls were born in 1495, and
lived to be ten years old. They were normal in
every respect, except that they were joined at the
forehead, causing them to stand face to face and
belly to belly (Fig. 37). When one walked for-
ward, the other was compelled to walk backAvard ;
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 ;

. . Fig. 37.— Craniopagus (after Par6).

the operation necessitated openmg 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.

a 161, 1866, 152. b 573, July, 1855.

174 MAJOR TERATA.

Through extra mobility of their necks they could really lie in a straight line,
one sleeping on the side and the other on the back. There is a report of
two girls joined at their vertices, who survived their birth. With the excep-
tion of this junction they were well formed and independent in existence.
There was no communication of the cranial cavities, but simply fusion of the
cranial bones covered by superficial fascia and skin (Fig. 38). Daubenton
has seen a case of union at the occiput,*^ but further details are not
quoted.

Class IV. — The next class to be considered is that in which the indi-
viduals are separate and well formed, except that the point of fusion is a
common part, eliminating their individual components in this location.
The pygopagous twins belong in this section. According to Bateman,^^^
twins were born in 1493 at Rome joined back to back, and survived their birth.
The same authority speaks of a female child who was born with " 2 bellies,

4 arms, 4 legs, 2 heads, and 2 sets of privates, and
was exhibited throughout Italy for gain's sake."
The " Biddenden Maids " were born in Biddeu-
den, Kent, in 1100.^ Their names were Mary
and Eliza Chulkhurst, and their j^arents 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
Fig. 38.-Twins joined at forehead. (bearing the imprcssiou of their images, to be given

away on each Easter Sunday to all strangers in
Biddenden) and also 270 quartern loaves, with cheese in proportion, to all
the poor in said parish. Ballantyne has accompanied his description of
these sisters by illustrations, one of which shows the cake (Fig. 39).
Heaton *^ gives a very good description of these maids ; and a writer in
"Notes and Queries" of March 27, 1875, gives the following information
relative to the bequest : —

" On Easter Monday, at Biddenden, near Staplehurst, Kent, there is a
distribution, according to ancient custom, of ' Biddenden Maids' cakes,' with
bread and cheese, the cost of which is defrayed from the proceeds of some
a 212, 259. b 302, xxxiv. c 759, Oct., 1895. d 224, 1869, i., 363.

THE " BIDDENDEN MAIDS."

175

20 acres of land, now yielding £35 per annum, and known as the ' Bread
and Cheese Lands.' About the year 1 100 there lived Eliza and Mary Chulk-
hurst, who were joined together after the manner of the Siamese twins, and
who lived for thirty-four vears, one dying, and then being followed by her
sister within six hours. They left by their will the lands above alhided to,
and their memory is perpetuated by imprinting on the cakes their effigies ^ m
their habit as they lived.' The cakes, which are simple flour and water, are
four inches long by two inches wide, and are much sought after as curiosi-
ties. These, which are given away, are distributed at the discretion of the
church- wardens, and are nearly 300 in number. The bread and cheese
amounts to 540 quartern loaves and 470 pounds of cheese. The distribu-
tion is made on land belonging to the charity, known as the Old Poorhouse.
Formerly it used to take place in the
Church, immediately after the service
in the afternoon, but in consequence of
the unseemly disturbance which used to
ensue the practice was discontinued.
The Church used to be filled with a
conffrcffation whose conduct was occa-
sionally so reprehensible that some-
times the church-wardens had to use
their wands for other purposes than sym-
bols of office. The impressions of the
' maids ' on the cakes are of a primitive
character, and are made by boxwood
dies cut in 1814. They bear the date
1100, when Eliza and Mary Chulkhurst
are supposed to have been born, and also
their age at death, thirty-four years."

Ballantyne has summed up about
all there is to be said on this national
monstrosity, and his discussion of the
case from its historic as well as tera-
tologic standpoint is so excellent that
his conclusions will be quoted : —

" It may be urged that the date fixed for the birth of the Biddenden
Maids is so remote as to throw grave doubt upon the reality of the occur-
rence. The year 1100 was, it will be remembered, that in which William
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, sev-
eral ' prodigies ' preceded the death of this profligate and extravagant mon-
arch. Thus it is recorded that ' at Pentecost blood was observed gushing
from the earth at a certain town of Berkshire, even as many asserted who

Fig. 39.— Biddenden Maids' cake (Ballantyne).

176

MAJOR TERATA.

declared that they had seen it. And after this, on the morning after Lam-
mas Day, King AVilliam 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 tlie opinion of the times, be regarded undoubtedly as a most evi-
dent prodigy or omen of evil. Still, even admitting that the date 1100 must
be allowed to stand, its remoteness from the present time is not a convincing
argument against a belief in the real occurrence of the phenomenon ; for of
the dicephalic Scottish brothers, who lived in 1490, we have credible historic
evidence. Further, Lycosthenes, in his "Chronicon Prodigiorum atque
Ostentorum " (p. 397), published in 1557, states, upon what authority I know
not, that in the year 1112 joined twins resembling the Biddenden phenom-
enon in all points save in sex were born in England. The passage is as fol-
lows : ' In Anglia natus est puer geminus a clune ad superiores partes ita
divisus, ut duo haberet capita, duo corpora Integra ad renes cum suis brachiis,
qui baptizatus triduo supervixit.' It is just possible that in some way or
other this case has been confounded with the story of Biddenden ; at any rate,
the occurrence of such a statement in Lycosthenes' work is of more than pass-
ing interest. Had there been no bequest of land in connection with the case
of the Kentish Maids, the whole affair would probably soon have been for-
gotten.

" There is, however, one real difficulty in accepting the story handed down
to us as authentic, — the nature of the teratologic phenomenon itself All
the records agree in stating that the Maids were joined together at the
shoulders and hips, and the impression on the cakes and the pictures on the
' broadsides ' show this peculiar mode of union, and represent the bodies as
quite separate in the space between the above-named points. The Maids
are shown with four feet and two arms, the right and left respectively, whilst
the other arms (left and right) are fused together at the shoulder accord-
ing to one illustration, and a little above the elbow according to another.
Now, although it is not safe to say that such an anomaly is impossible, I do
not know of any case of this peculiar mode of union ; but it may be that,
as Prof A. 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 grou]i 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

HELEN AND JUDITH, THE HUNGARIAN SISTERS. 177

of the first artist who portrayed the Maids (from imagination ?) ; then it may-
be surmised that they were ectopagous twins.

" Pygopagous twins are fetuses united together in the region of the nates
and having each its own pelvis. In the recorded cases the union has
been usually between the sacra and coccyges, and has been either osseous or
(more rarely) ligamentous. Sometimes the point of junction was the middle
line posteriorly, at other times it was rather a posterolateral union ; and it
is probable that in the Biddenden Maids it was of the latter kind ; and it is
likely, from the proposal made to separate the sisters after the death of one,
that it was ligamentous in nature.

"If it be granted that the Biddenden Maids were pygopagous twins, a
study of the histories of other recorded cases of this monstrosity serves to
demonstrate many common characters. Thus, of the 8 cases which Taruffi
has collected, in 7 the twins were female ; and if to these we add the
sisters Eosalie and Josepha Blazek and the Maids, we have 10 cases, of
which 9 were girls. Again, several of the pygopagous twins, of whom
there are scientific records, survived birth and lived for a number of years,
and thus resembled the Biddenden terata. Helen and Judith, for instance,
were twenty-three years old at death ; and the North Carolina twins, although
born in 1851, are still alive. There is, therefore, nothing inherently improb-
able in the statement that the Biddenden Maids lived for thirty-four years.
With regard also to the truth of the record that the one Maid survived
her sister for six hours, there is confirmatory evidence from scientifically
observed instances, for Joly and Peyrat (Bull, de FAcad. M6d., iii., pp. 51
and 383, 1874) state that in the case seen by them the one infant lived
ten hours after the death of the other. It is impossible to make any
statement with regard to the internal structure of the Maids or to the
characters of their genital organs, for there is absolutely no information forth-
coming upon these points. It may simply be said, in conclusion, that the
phenomenon of Biddenden is interesting not only on account of the curious
bequest which arose out of it, but also because it was an instance of a very
rare teratologic type, occurring at a very early period in our national
history."

Possibly the most famous example of twins of this type were Helen and
Judith, the Hungarian sisters, born in 1701 at Szony, in Hungary. They
were the objects of great curiosity, and were shown successively in Holland
Germany, Italy, France, England, and Poland. At the age of nine they
were placed in a convent, where they died almost simultaneously in their
twenty-second year. During their travels all over Europe they were exam-
ined by many prominent physiologists, psychologists, and naturalists • Pope
and several minor poets have celebrated their existence in verse • Buffon
speaks of them in his " Natural History," and all the works on teratology for
a century or more have mentioned them. A description of them can be best

178

MA JOB TERATA.

given by a quaint translation by Fisher of the Latin lines composed by a
Hungarian physician and inscribed on a bronze statuette of them :^ —

Two sisters wonderful to behold, who have thus grown as one,

That naught their bodies can divide, no power beneath the sun.

The town of Szoenii gave them birth, hard by far-famed Komom,

Which noble fort may all the arts of Turkish sultans scorn.

Lucina, woman's gentle friend, did Helen first receive ;

And Judith, when three hours had passed, her mother's womb did leave.

One urine passage serves for both ; — one anus, so they tell ;

The other parts their numbers keep, and serve their owners well.

Their parents poor did send them forth, the world to travel through,

That this great wonder of the age should not be hid from view.

The inner parts concealed do lie hid from our eyes, alas !

But all the body here you view erect in solid brass.

They were joined back to back in the lumbar region, and had all their
parts separate except the anus between the right thigh of Helen and the
left of Judith and a single vulva. Helen was the larger, better looking,

the more active, and the more intelligent.
Judith at the age of six became hemiplegic,
and afterward was rather delicate and de-
pressed. They menstruated at sixteen and
continued with regularity, although one began
before the other. They had a mutual affection,
and did all in their power to alleviate the
circumstances of their sad position. Judith
died of cerebral and pulmonary affections, and
Helen, who previously enjoyed good health,
soon after her sister's first indisposition sud-
denly sank into a state of collapse, although
preserving her mental faculties, and expired
almost immediately after her sister. They had
measles and small-pox simultaneously, but were
affected in different degree by the maladies.
The emotions, inclinations, and appetites were
not simultaneous. Eccardus, in a very inter-
esting paper, discusses the physical, moral, and religious questions in refer-
ence to these wonderful sisters, such as the advisability of separation, the
admissibility of matrimony, and, finally, whether on the last day they would
rise as joined in life, or separated.

There is an account*' of two united females, similar in conjunction to the
" Hungarian sisters," who were born in Italy in 1700. They were killed at
the age of four months by an attempt of a surgeon to separate them.

a 773, 1866. ^ 1^5, v., 445.

Fig. 40.— The Hungarian sisters.

MILLIE CHRISTINE-H OSA- JOSEPH A BLAZEK.

179

In 185G 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 ditferent 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 menstru-
ated regularly from the age of thir-
teen. One from long habit yielded
instinctively to the other's move-
ments, thus preserving the necessary
harmony. They ate separately, had
distinct thoughts, and carried on dis-
tinct conversations at the same time.
They experienced hunger and thirst
generally simultaneously, and defe-
cated and urinated nearly at the same
times. One, in tranquil sleep, would
be wakened by a call of nature of the
other. Common sensibility was ex-
perienced near the location of union.
They were intelligent and agreeable Fig. 41.— Miiue-Christine (Pancoast).

and of pleasant appearance, although

slightly under size ; they sang duets with pleasant voices and accompanied
themselves with a guitar ; they walked, ran, and danced with apparent ease
and grace. Christine could bend over and lift Millie up by the bond of
union.

A recent example of the pygopagus type was Rosa- Josepha Blazek, ^
born in Skerychov, in Bohemia, January 20, 1878. These twins had a broad
bony union in the lower part of the lumbar region, the pelvis being obviously
completely fused. They had a common urethral and anal aperture, but a
double vaginal orifice, with a very apparent septum. The sensation was dis-
tinct in each, except where the pelves joined. They were exhibited in Paris

a 631, 1871, i. b 778, xxii., 265.

180

MAJOR TERATA.

in 1891, being then on an exhibition tour around the world. Rosa wa8 the
stronger, and when she walked or ran forward she drew her sister with her,
who must naturally have reversed her steps. They had independent thoughts
and separate minds ; one could sleep while the other was awake. Many of
their appetites were different, one preferring beer, the other wine ; one relished
salad, the other detested it, etc. Thirst and hunger were not simultaneous.
Baudoin * describes their anatomic construction, their mode of life, and their
mannerisms and tastes in a quite recent article. Fig. 42 is a reproduction
of an early photograph of the twins, and Fig. 43 represents a recent photo-
graph of these " Bohemian twins," as they are now called.

Fig. 42. — Blazek sisters.

The latest record we have of this type of monstrosity" is that given by
Tynberg to the County Medical Society of New York, May 27, 1895. The
mother was present with the remarkable twins in her arms, crying at the top
of their voices. These two children were born at midnight on April 15th.
Tynberg remarked that he believed them to be distinct and separate children,
and not dependent on a common arterial system ; he also expressed his inten-
tion of separating them, but did not believe the operation could be performed
with safety before another year. Jacobi ^ describes in full Tynberg's instance
of pygopagus. He says the confinement was easy ; the head of one was born
first, soon followed by the feet and the rest of the twins. The placenta was

a 728, July 8, 1891. b 165, Oct., 1895.

ISCHIOPAGL

181

single and the cord consisted of two branches. The twins were united
below the third sacral vertebrae in such a manner that they could lie along-
side of each other. They were females, and had two vaginae, two urethrae,
four labia minora, and two labia majora, one anus, but a double rectum
divided by a septum. They micturated independently but defecated simul-
taneously. Tliey virtually lived separate lives, as one might be asleep while
the other cried, etc.

Class V. — While instances of ischiopagi are quite numerous, few have
attained any age, and, necessarily, little notoriety. Pare* speaks of twins

Fig. 43. — Bohemian twins.

united at the pelves, who were born in Paris July 20, 1570. They were
baptized, and named Louis and Louise. Their parents were well known
in the rue des Gravelliers. According to Bateman,i^' and also RueflP, in the
year 1552 there were born, not far from Oxford, female twins, who, from the
description given, were doubtless of the ischiopagus type. They seldom
wept, and one was of a cheerful disposition, while the other was heavy and
drowsy, sleeping continually. They only lived a short time, one expiring a
day before the other. Licetus speaks of Mrs. John Waterman, a resident
of Fishertown, near Salisbury, England, who gave birth to a double female
monster on October 26, 1664, which evidently from the description was

^ 618, 1010.

182

MAJOR TERATA.

joined by the ischii. It did not nurse, but took food by both the mouths ;
all its actions were done in concert ; it was possessed of one set of genito-
urinary organs ; it only lived a short while. Many people in the region
flocked to see the wonderful child, whom Licetus called " Monstrum Angli-
cum." It is said that at the same accouchement the birth of this monster
was followed by the birth of a well-formed female child, who survived.
Geoifroy-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

Fig. 44.— Tynberg's case.

brought to Columbo, where it lived only two months.^ It had two heads
and seemed to have duplication in all its parts except the anus and male
generative organs. Montgomery ^ speaks of a double child born in County
Roscommon, Ireland, on the 24th of July, 1827. It had two heads, two
chests with arms complete, two abdominal and pelvic cavities united end to
end, and four legs, placed two on either side. It had only one anus, which
was situated between the thighs. One of the twins was dark haired and
was baptized Mary, while the other was a blonde and was named Catherine.
These twins felt and acted independently of each other ; they each in succes-
sion sucked from the breast or took milk from the spoon, and used their
limbs vigorously. One vomited without affecting the other, but the feces
were discharged through a common opening.

a 318, vol. Ixi., 58. ^ 313, vol. xv.

MINNA AND MINNIE FIN LEY-'' JONES TWINS." 183

Goodell ^ speaks of Minna and Minnie Finley, who were born in Ohio
and examined by him. They were fused together in a common longitudinal
axis, having one pelvis, two heads, four legs, and four arms. One was weak
and puny and the other robust and active ; it is probable that they had but
one rectum and one bladder. Goodell accompanies his description by the
mention of several analogous cases. Ellis ^ speaks of female twins, born in
Millville, Tenn., and exhibited in New York in 1868, who were joined at
the pelves in a longitudinal axis. Between the limbs on either side were to
be seen well-developed female genitals, and the sisters had been known to
urinate from both sides, beginning and ending at the same time.

Hulf details a description of the Jones twins," born on June 24, 1889,
in Tipton County, Indiana, whose spinal columns were in apposition at the
lower end. The labor, of less than two hours' duration, was completed

Fig. 45.— The Jones twins.

before the arrival of the physician. Lying on their mother's back, they could
both nurse at the same time. Both sets of genitals and ani were on the
same side of the line of union, but occupied normal positions with reference
to the legs on either side. Their weight at birth was 12 pounds and their
length 22 inches. Their mother was a medium-sized brunette of 19, and had
one previous child then living at the age of two ; their father was a finely
formed man 5 feet 10 inches in height. The twins differed in complexion
and color of the eyes and hair. They were publicly exhibited for some time,
and died February 19 and 20, 1891, at St. John's Hotel, Buffalo, N. Y.
Figure 45 shows their appearance several months after birth.

Class VI. — In our sixth class, the first record we have is from the Com-
mentaries of Sigbert, which contains a description of a monstrosity born in the
reign of the Emperor Theodosius, who had two heads, two chests with four

a 547, 1870. b 218, 1871, 218 et seq. c 125, vol. xxii., 923.

184

MAJOR TERATA.

arms attached, but a single lower extremity. The emotions, affections, and
appetites were different. One head might be crying while the other laugliod,
or one feeding A\ liile 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 Normandv, in
1062, there was seen a female monster, consisting of two women joined about
the umbilicus and fused into a single lower extremity. They took their
food by two mouths but expelled it at a single orifice. At one time, one of
the women laughed, feasted, and talked, while the other wept, fasted, and kept
a religious silence. The account relates how one of them died, and the survi-
vor bore her dead sister about for three years before she was overcome by the
oppression and stench of the cadaver. Batemen describes the birth of a boy
in 1529, who had two heads, four ears, four arms, but only two thighs and two
legs. Buchanan'^ speaks at length of the famous "Scottish Brothers,"
who were the cynosure of the eyes of the Court of James III. of Scotland.
This monster consisted of two men, ordinary in appearance in the superior
extremities, whose trunks fused into a single lower extremity. The King
took diligent care of their education, and they became proficient in music,
languages, and other court accomplishments. Between them they would
carry on animated conversations, sometimes merging into curious debates,
followed by blows. Above the point of union they had no synchronous sen-
sations, while below, sensation was common to both. This monster lived
twenty-eight years, surviving the royal patron, who died June, 1488. One
of the brothers died some days before the other, and the survivor, after
carrying about his dead brother, succumbed to "infection from putrescence."
There was reported to have been born^^^ in Switzerland a double-headed
male monster, who in 1538, at the age of thirty, was possessed of a beard on
each face, the two bodies fused at the umbilicus into a single lo\ver extremity.
These two twins resembled one another in contour and countenance. Thev
were so joined that at rest they looked upon one another. They had a
single wife, with whom they were said to have lived in harmony. In the
Gentleman's Magazine about one hundred and fifty years since there was
given the portrait and description of a double woman, who was exhibited all
over the large cities of Europe. Little can be ascertained anatomically of her
construction, with the exception that it was stated that she had two heads,
two necks, four arms, two legs, one pelvis, and one set of pelvic organs.

The most celebrated monster of this type was Ritta-Christina (Figs. 46
and 47), who was born in Sassari, in Sardinia, March 23, 1829. These twins
were the result of the ninth confinement of their mother, a woman of thirty-two.
Their superior extremities were double, but they joined in a common trunk
a Rerum Scoticarum Historia, Aberdeen, 1762, L. xiii.

RITTA- CHRISTINA.

185

at a point a little below the mammfse. Below tliis point they liad a common
trunk and single lower extremities. The right one, christened Ritta, was
feeble and of a sad and melancholy countenance ; the left, Christina, was
vigorous and of a gay and happy aspect. They suckled at different times,
and sensations in the upper extremities were distinct. They expelled urine
and feces simultaneously, and had the indications in common. Their parents,
who were very poor, brought them to Paris for the purpose of public exhibi-
tion, which at first was accomplished clandestinely, but finally interdicted by
the public authorities, who feared that it would open a door for psychologic
discussion and speculation. This failure of the parents to secure public
patronage increased their poverty and hastened the death of the children by
unavoidable exposure in a cold room. The nervous system of the twins had
little in conmion except in the line of union, the anus, and the sexual organs,

Fig. 46.— Skeleton of Ritta-Christina. Fig. 47.— Ritta-Christina.

and Christina was in good health all through Ritta's sickness ; when Ritta
died, her sister, who was suckling at the mother's breast, suddenly relaxed
hold and expired with a sigh. At the postmortem, which was secured
with some difficulty on account of the authorities ordering the bodies to be
burned, the pericardium was found single, covering both hearts. The diges-
tive organs were double and separate as far as the lower third of the ilium,
and the cecum was on the left side and single, in common with the lower
bowel. The livers were fused and the uterus was double. The vertebral
columns, which were entirely separate above, were joined below by a rudi-
mentary OS innominatum. There was a junction between the manubrium of
each. Sir Astley Cooper saw a monster in Paris in 1792 which, by his
description, must have been very similar to Ritta-Christina.

186

MAJOR TERATA.

The Tocci brothers were born in 1877 in the province of Turin, Italy.
They each had a well-formed head, perfect arms, and a perfect thorax to the
sixth rib ; they had a common abdomen, a single anus, two legs, two sacra, two
vertebral columns, one penis, but three buttocks, the central one containing a
rudimentary anus. The right boy was christened Giovanni-Batista, and the

left Giacomo. Each individual
had power over the corresponding
leg on his side, but not over the
other one. Walking was there-
fore impossible. All their sensa-
tions and emotions were distinctly
individual and independent. At the
time of the report, in 1882, they
were in good health and showed
every indication of attaining adult
age. Figure 48 represents these
twins as they were exhibited sev-
eral years ago in Germany.

McCallum^ saw two female
children in Montreal in 1878
named Marie - Rosa Drouin.
They formed a right angle with
their single trunk, which com-
menced at the lower part of the
thorax of each. They had a single
genital fissure and the external
organs of generation of a female.
A little over three inches from the
anus was a rudimentary limb with
a movable articulation ; it meas-
ured five inches in length and
tapered to a fine point, being fur-
nished with a distinct nail, and it
contracted strongly to irritation.
Marie, the left child, was of fair
complexion and more strongly
developed than Rosa. The sen-
sations of hunger and thirst were not experienced at the same time, and one
might be asleep while the other was crying. The pulsations and the respira-
tory movements were not synchronous. They were the products of the
second gestation of a mother aged twenty-six, whose abdomen was of such
preternatural size during pregnancy that she was ashamed to appear in public.

a 778, vol. XX., 120.

Fig, 48.— The Tocci brothers.

BICEPHALIC MONSTERS. 187

The order of birth was as follows : one head and body, the lower extremity,
and the second body and head.

Class VII.— There are many instances of bicephalic monsters on
record. Pare =^ mentions and gives an illustration of a female apparently sin-
gle in conformation, with the exception of having two heads and two necks.
The Ephemerides, Haller, Schenck, and Archenholz cite examples, and there is
an old account ^ of a double-headed child, each of whose heads were baptized,
one called Martha and the other Mary. One was of a gay and the other a
sad visage, and both heads received nourishment ; they only lived a couple
of days. There is another similar record of a Milanese girl who had two
heads, but was in all other respects single, with the exception that after death
she was found to have had two stomachs. Besse mentions a Bavarian woman
of twenty-six with two heads, one of which was comely and the other extremely
ugly ; Batemen quotes what is apparently the same case — a woman in
Bavaria in 1541 with two heads, one of which was deformed, who begged
from door to door, and who by reason of the influence of pregnant women
was given her expenses to leave the country.

A more common occurrence of this type is that in which there is fusion of
the two heads. Moreau " speaks of a monster in Spain which was shown from
town to town. Its heads were fused ; it had two mouths and two noses ; in each
face an eye well conformed and placed above the nose ; there was a third eye
in the middle of the forehead common to both heads ; the third eye was of
primitive development and had two pupils. Each face was well formed and
had its own chin. BufFon mentions a cat, the exact analogue of Moreau's
case. Sutton*^ speaks of a photograph sent to Sir James Paget in 1856 by
William Budd of Bristol. This portrays a living child with a supernumerary
head, which had mouth, nose, eyes, and a brain of its own (Fig. 49). The
eyelids were abortive, and as there was no orbital cavity the eyes stood out
in the form of naked globes on the forehead. When born, the corneas of
both heads were transparent, but then became opaque from exposure. The
brain of the supernumerary head was quite visible from without, and was
covered by a membrane beginning to slough. On the right side of the head
was a rudimentary external ear. The nurse said that when the child sucked
some milk regurgitated through the supernumerary mouth. The great phy-
siologic interest in this case lies in the fact that every movement and every
act of the natural face was simultaneously repeated by the supernumerary
face in a perfectly consensual manner, /. c, 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

a 618, 1006. b 469, 1665. c Quoted, 302, xxxiv., 171.

d275, 1895, 133. e 629, 1791, 299.

188

MAJOR TERATA.

the head. The ordinary head was nearly perfect and of usual volume, but
fused with its vertex and reversed was a supernumerary head (Fig. 50).
Each head had its own separate vessels and brain, and each an individual
sensibility, but if one had milk first the other had an abundance of saliva in
its mouth. It narrowly escaped being burned to death at birth, as the mid-
wife, greatly frightened by the monstrous appearance, threw it into the fire
to destroy it, from whence it was rescued, although badly burned, the vicious
conformation of the accessory head being possibly due to the accident. At
the age of four it was bitten by a venomous serpent and, as a result, died.
Its skull is in the possession of the Royal College of Surgeons in London.

Fig. 49.— Infant with a supernumerary head Fig. 50.— Two-headed boy (Home's case),

(after Sutton).

The following well-known story of Edward Mordake, though taken from
lay sources, is of sufficient notoriety and interest to be mentioned here : —

" One of the weirdest as well as most melancholy stories of human de-
formity is that of Edward Mordake, said to have been heir to one of the
noblest peerages in England. He never claimed the title, however, and com-
mitted suicide in his twenty-third year. He lived in complete seclusion,
refusing the visits even of the members of his own family. He was a young
man of fine attainments, a profound scholar, and a musician of rare ability.
His figure was remarkable for its grace, and his face — that is to say, his
natural face — was that of an Antinous. But upon the back of his head was
another face, that of a beautiful girl, ' lovely as a dream, hideous as a devil.'
The female face was a mere mask, ^occupying only a small portion of
the posterior part of the skull, yet exhibiting every sign of intelligence, of a

PARASITIC TERATA.

189

malignant sort, however.' It wonld be seen to smile and sneer while Mor-
dake was weeping. The eyes would follow the movements of the spectator,
and the lips would ' gibber without ceasing.' No voice was audible, but
Mordake avers that he was kept from his rest at night by the hateful whis-
pers of his 'devil twin,' as he called it, 'which never sleeps, but talks to
me forever of such things as they only speak of in hell. No imagination
can conceive the dreadful temptations it sets before me. For some
unforgiven wickedness of my forefathers I am knit to this fiend — for a
fiend it surely is. I beg and beseech you to crush it out of human
semblance, even if I die for it.' Such were the words of the hapless
Mordake to Manvers and Treadwell, his physicians. In spite of careful
Avatching 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, pseuden-
cephalon, and the janiceps (Fig. 51), prosopthoracopagus (Fig. 52), dispro-
sopus (Fig. 53), etc., although full of interest, will not be discussed here, as
none are ever viable for any length of time, and the declared intention of
this chapter is to include only those beings who have lived.

Class VIII. — The next class includes the parasitic terata, monsters
that consist of one perfect body, complete in every respect, but from the
neighborhood of whose umbilicus depends some important portion of a second
body. 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," Buxtorf^' speaks of a case in
which the nates and lower extremities of one body proceeded out of the
abdomen of the other, which was otherwise perfect. Reichel and Ander-
son mention a living parasitic monster, the inferior trunk of one body pro-
ceeding from the pectoral region of the other.

a 789, Aug. 5, 1848. b 107, vol. vii., n. xii., 101. c 629, vol. Ixxix.

190

MA JOB TERATA.

Pare^ says that there was a man in Paris in 1530, quite forty years of
age, who carried about a parasite without a head, which hung pendant from
his belly. This individual was exhibited and drew great crowds. Par6

Fig. 51.— Janiceps. Fig. 52,— Prosopthoracopagus. Fig. 53.— Disprosopus.

appends an illustration, which is, perhaps, one of the most familiar in all tera-
tology. He also ^ gives a portrait (Fig. 54) of a man who had a parasitic head

Fig. 54.— Parasitic monster (after Par6). Fig. 65.— Thoracopagus. Lazarus-Joannes Baptista

Colloredo.

proceeding from his epigastrium, and who was born in Germany the same
year that peace was made with the Swiss by King Francis. This creature lived

a 618, 1007. b618, 1012.

LAZARUS- JOANNES BAPTISTA COLLOREDO.

191

to manhood and both heads were utilized in alimentation. Bartholinus details
a history of an individual named Lazarus- Joannes Baptista Colloredo (Fig.
55), born in Genoa in 1G17, who exhibited himself all over Europe. From
his epigastrium hung an imperfectly developed twin that had one thigh, hands,
body, arms, and a well-formed head covered with hair, which in the normal
position hung lowest. There were signs of independent existence in the
parasite, movements of respiration, etc., but its eyes were closed, and, although
saliva constantly dribbled from its open mouth, nothing was ever ingested.
The genitals were imperfect and the arms ended in badly formed hands.
Bartholinus examined this monster at twenty-two, and has given the best
report, although while in Scotland in 1642 he was again examined, and ac-
credited with being married and the father of several children who were fully
and admirably developed. Moreau quotes a case of an infant similar in con-
formation to the foregoing monster, who was born in Switzerland in 1764, and
whose supernumerary parts were amputated by means of a ligature. Winslow
reported before the Academic 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 evacu-
ated at interv^als from the parasite, and received into a diaper constantly
worn for this purpose. Sensibility in the two was common, an impres-
sion applied to the parasite being felt by the girl. Winslow gives an inter-
esting report of the dissection of this monster, and mentions that he had
seen an Italian child of eight who had a small head proceeding from under
the cartilage of the third left rib. Sensibility was common, pinching the ear
of the parasitic head causing the child with the perfect head to cry. Each
of the two heads received baptism, one being named John and the other
Matthew. A curious question arose in the instance of the girl, as to whether
the extreme unction should be administered to the acephalous fetus as well
as to the child.

In 1742, during the Ambassadorship of the Marquis de I'Hopital at
Naples, he saw in that city an aged man, well conformed, 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 extra-
ordinary freak of nature, was an amalgamation of two children. From the
body of an otherwise perfectly formed child was a supernumerary head pro-

a 190, hist. Iviii. b 703, 1880.

192

MA JOE TERATA.

truding from a broad base attached to the lower lumbar and sacral region.
This cephalic mass was covered with hair about four or five inches long, and
showed the rudiments of an eye, nose, mouth, and chin. This child was on
exhibition when Dickinson saw it. Montare and Reyes were commissioned
by the Academy of Medicine of Havana to examine and report on a mon-
strous girl of seven months, living in Cuba. The girl was healthy and well
developed, and from the middle line of her body between the xiphoid carti-
lage and the umbilicus, attached by a soft pedicle, was an accessory individual,
irregular, of ovoid shape, the smaller end, representing the head, being upward.
The parasite measured a little over 1 foot in length, 9 inches about the head,
and 7 1 inches around the neck. The cranial bones were distinctly felt, and
the top of the head was covered by a circlet of hair. There were two rudi-
mentary eyebrows ; the left eye was represented by a minute perforation

encircled with hair ; the right eye was traced by one
end of a mucous groove which ran down to another
transverse groove representing the mouth ; the right
third of this latter groove showed a primitive tongue
and a triangular tooth, which appeared at the fifth
month. There was a soft, imperforate nose, and the
elements of the vertebral column could be distinguished
beneath the skin ; there were no legs ; apparently no
vascular sounds ; there was separate sensation, as the
parasite could be pinched without attracting the per-
fect infant's notice. The mouth of the parasite con-
stantly dribbled saliva, but showed no indication of
receiving aliment.*

Louise L., known as "La dame a quatre
jambes," was born in 1869, and had attached to her
pelvis another rudimentary pelvis and two atrophied
legs of a parasite, weighing 8 kilos. The attachment
was 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 (Fig.
56). No genitalia were seen on the f)arasite and it exhibited no active move-
ments, the joints of both limbs being ankylosed. The woman could localize
sensations in the parasite except those of the feet. She had been married
five years, and bore, in the space of three years, two well-formed 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

a 224, 1886, i., 81.

Fig. 56.— Louise L.

DUPLICATION OF THE LOWER EXTREMITIES.

193

to the lower right side of the sternum of the individual by a bony pedicle, and
lower by a fleshy pedicle, and apparently contained intestines. The anus of
the parasite was imperforate ; a well-developed penis was found, but no testi-
cles ; there was a luxuriant growth of hair on the pubes. The penis of the
parasite was said to show signs of erection at times, and urine passed through
it without the knowledge of the boy. Perspiration and elevation of tem-
perature seemed to occur simultaneously in both. To pander to the morbid
curiosity of the curious, the " Dime Mu-
seum " managers at one time shrewdly
clothed the parasite in female attire,
calling the two brother and sister ; but
there is no doubt that all the traces of
sex were of the male type. An anal-
ogous case was that of "A-Ke," a
Chinaman, who was exhibited in London
early in the century, and of whom and
his parasite anatomic models are seen
in our museums. Figure 58 repre-
sents an epignathus, a peculiar type of
parasitic monster, in which the parasite
is united to the inferior maxillary bone
of the autosite.

Class IX.— Of "Lusus nature"
none is more curious than that of dup-
lication 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 Academic des Sciences,

on September 6, 1830, there was pre-
sented by Madame Hen, a midwife, a

living male child with four legs, the

anus being nearly below the middle of

the third buttock; and the scrotum

between the two left thighs, the testicles

not yet descended. There was a well-

formed and single pelvis, and the supernumerary legs were immovable.
Aldrovandus mentions several similar instances, and gives the figure of one
born m Rome ; he also describes several quadruped birds. Bardsley ■> speak,
of a male ehdd w.th one head, four arms, four legs, and double geueltiv
organs He gives a portrait of the child when it was a little over a vear old
Heschl published in Vienna in 1878 a description of a girl of seCte '

a 618, 1012. '
13 ^781, 1838, vol. vi.

Fig. 57.— Laloo.

194 MAJOR TERATA.

who instead of having a duplication of the superior body, as in " Millie-
Christine, the two-headed nightingale," had double parts below the second
lumbar vertebra. Her head and upper body resembled a comely, delicate
girl of twelve.

Wells'^ describes Mrs. B., aged twenty, still alive and healthy (Fig. 59).
The duplication in this case begins just above the waist, the spinal column
dividing at the third lumbar vertebra, below this point everything being
double. Micturition and defecation occur at different times, but menstrua-
tion occurs simultaneously. She was married at nineteen, and became preg-
nant a year later on the left side, but abortion was induced at the fourth
month on account of persistent nausea and the expectation of impossible
delivery. Whaley,^ in speaking of this case, said Mrs. B. utilized her out-
side legs for walking ; he also remarks that when he informed her that she
was pregnant on the left side she replied, I think you are mistaken ; if it

had been on my right side I would come
nearer believing it — and after further
questioning he found, from the patient's
observation, that her right genitals were
almost invariably used for coitus.

Bechlinger of Para, Brazil,*^ describes
a woman of twenty-five, a native of
Martinique, whose father was French
and mother a quadroon, who had a
modified duplication of the lower body.
There was a third leg attached to a con-
tinuation of the processus coccygeus of
the sacrum, and in addition to well-
Fig. 58.— Epignathus. dcvclopcd mammsB regularly situated,

there were two rudimentary ones close to-
gether above the pubes. There were two vaginee 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 super-
numerary' limb attached to the symphysis, without a joint, but with slight
passive movement. There was a duplication of bowel, bladder, and genitalia.
At the junction of the rudimentary limb with the body, in front, were two
rudimentary mammary glands, each containing a nipple (Fig. 60).

Other instances of supernumerary limbs will be found in Chapter VI.
Class X. — The instances of diphallic terata, by their intense interest
to the natural bent of the curious mind, have always elicited much discus-
sion. To many of these cases have been attributed exaggerated function,
a 125, 1888, 1266. t> 224, 1889, i., 96. c Anuals of Gynecology, 1888.

DIPHALLIC TERATA.

195

Fig. 59.— Dipygus (Wells).

notwithstanding the foct that modern observation almost invariably shows
that the virile power diminishes in exact proportion to the extent of duplica-
tion. Taylor quotes a description of a monster, exhibited in London, with
two distinct peniscs, but with only
one distinct testicle on cither side.
He could exercise the function of
either organ.

Schenck, Schurig, Bartholinus,
Loder, and Ollsner report instances
of diphallic terata ; the latter case *
was in a soldier of Charles VI.,
twenty-two years old, who applied
to the surgeon for a bubonic affec-
tion, and who declared that he
passed urine from the orifice of
the left glans and also said that he
was incapable of true coitus. Val-
entini mentions an instance in a
boy of four, in which the two
penises were superimposed. Buc-
chettoni'' speaks of a man with
two penises placed side by side. There was an anonymous case described ^
of a man of ninety-three with a penis which was for more than half its length

divided into two distinct members,
the right being somewhat larger
than the left. From the middle
of the penis up to the symphysis
only the lower wall of the urethra
was split. Jenisch*^ describes a
diphallic infant, the offspring of a
woman of twenty-five who had
been married five years. Her first
child was a well-formed female, and
the second, the infant in question,
cried much during the night, and
several times vomited dark-green
matter. In lieu of one penis there
were two, situated near each other,
the right one of natural size and the
left larger, but not furnished with a prepuce. Each penis had its own
urethra, from which dribbled urine and some meconium. There was a

a Medicorum Siles. Satyrse. Lipsise, 1736. b Anatomia, etc., p. 120, GEniponte, 1740.

c 559, 1808, Band ii., 335. d Med. Corresp.-Blatt des wurttemb. Mrztl. Ver., Stuttg., 1837.

Fig. 60.— Blanche Dumas.

196

MAJOR TERATA.

Fig. 61. — Double penis (Jenisch's case).

duplication of each scrotum, but only one testicle in each, and several
other minor malformations (Fig. 61).

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 ure-
thra, 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 some-
times from one, sometimes from
both.

The most celebrated of all
the diphallic terata was Jean
Baptista dos Santos, who when but six months old was spoken of by
Acton. His father and mother were healthy and had two well-formed
cliildren. He was easily
born after an uneventful
pregnancy. He was good-
looking, well proportion-
ed, and had two distinct
penises, each as large as
that of a child of six
months. Urination pro-
ceeded simultaneously
from both penises ; he had
also two scrotums. Behind
and between the legs there
was another limb, or rather
two, united throughout
their length. It was con-
nected to the pubis by a
short stem | inch long
and as large as the little
finger, consisting of separ-
ate bones and cartilages. There was a patella in the supernumerary limb
on the anal aspect, and a joint freely movable. This compound limb had no

a 283, 1844.

Fig. 62.— Jean Baptista dos Santos.

I

JEAN BAPTISTA DOS SANTOS. 197

power of motion, but was endowed with sensibility. A journal in London/
after quoting Acton's description, said that the child had been exhibited
in Paris, and that the surgeons advised operation. Fisher,'^ to whom^ we
are indebted for an exhaustive work in Teratology, received a report from
Havana in July, 1865, which detailed a description of Santos at twenty-
two years of age, and said that he was possessed of extraordinary animal
passion, the sight of a female alone being sufficient to excite him. He was
said to use both penises, after finishing with one continuing with the other ;
but this account of him does not agree with later descriptions, in which no
excessive sexual ability had been noticed. Hart describes the adult Santos
in full, and accompanies his article with an illustration. At this time he
was said to have developed double genitals, and possibly a double bladder
communicating by an imperfect septum. At adulthood the anus was three
inches anterior to the os coccygeus. In the sitting or lying posture the
supernumerary limb rested on the front of the inner surface of the lower third
of his left thigh. He was in the habit of wearing this limb in a sling, or
bound firmly to the right thigh, to prevent its unseemly dangling when erect.
The perineum proper was absent, the entire space between the anus and the
posterior edge of the scrotum being occupied by the pedicle. Santos' mental
and physical functions were developed above normal, and he impressed
everybody with his accomplishments. Geoffroy-Saint-Hilaire records an in-
stance in which the conformation was similar to that of Santos. There was
a third lower extremity consisting of two limbs fused into one with a single
foot containing ten distinct digits. He calls the case one of arrested twin
development.

Van Buren and Keyes** describe a case in a man of forty-two, of good,
healthy appearance. The two distinct penises of normal size were appa-
rently well formed and were placed side by side, each attached at its root to
the symphysis. Their covering of skin was common as far as the base of the
glans ; at this point they seemed distinct and perfect, but the meatus of the
left was imperforate. The right meatus was normal, and through it most of
the urine passed, though some always dribbled through an opening in the
perineum at a point where the root of the scrotum should have been. On
lifting the double-barreled penis this opening could be seen and was of suffi-
cient size to admit the finger. On the right side of the aperture was an
elongated and rounded prominence similar in outline to a labium majus.
This prominence contained a testicle normal in shape and sensibility, but
slightly undersized, and surrounded, as was evident from its mobility, by a
tunica vaginalis. The left testicle lay on the tendon of the adductor longus
in the left groin ; it was not fully developed, but the patient had sexual de-
sires, erections, and emissions. Both penises became erect simultaneously,

a 549, April, 1847, 322. b 773, I866. c 475, 1866, i., 71.

d " Surgical Diseases of the Geni to- Urinary Organs," New York, 1874.

198

MAJOR TERATA.

the right more vigorously. The left leg was shorter than the right and con-
genitally smaller ; the mammse 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 beliind 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 \ ov \ inch apart at birth. The urethra bifurcated
in the perineal region and sent a branch to each penis, and urine passed from
each meatus. The scrotum was divided into three compartments by two
raphes, and each compartment contained a testicle. The anus at birth was
imperforate, but the child was successfully operated on, and at its sixtieth day
weighed 17 pounds.

Lange** says that an infant was brought to Karg for relief of anal
atresia when fourteen days old. It was found to possess duplicate penises,
which communicated each to its distinct half of the bladder as defined by a
median fold. The scrotum was divided into three portions by two raphes, and
each lateral compartment contained a fully formed testicle. This child died*
because of its anal malformation, which we notice is a frequent associate of
malformations or duplicity of the penis. There is an example in an infant
described ^ in which there were two penises, each about \ inch long, and a
divided scrotal sac 2i inches long. Englisch ^ speaks of a German of forty
who possessed a double penis of the bifid type.

Ballantyne and his associates define diphallic terata as individuals pro-
vided with two more or less well-formed and more or less separate penises, who
may show also other malformations of the adjoining parts and organs {e. r/.,
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

a "Lascienza a e la prat. dell. anat. patolog." Pavia, 1875, i., 117. b 775, 1878, 91.
c 579, 1894, 159. <l 720, 1895, 215. e 759, April, 1895. f Quoted 759, Oct., 1895.

FETUS IN FETU.

199

duplication of the female genital organs (double clitoris, vulva, vagina, and
uterus). Although Schurig, Meckel, Hinily, Taruffi, and others give bib-
liographic lists of diphallic terata, even in them erroneous references are
common, and there is evidence to show that many cases have been duplicated
under different names. Ballantyne and Skirving - have consulted all the
older original references available and eliminated duplications of reports,
and, adhering to their original definition, have collected and described indi-
vidually 20 cases ; they offer the following conclusions :—

1 . Diphallus, or duplication of the penis in an otherwise apparently single
individual, is a very rare anomaly, records of only 20 cases having been
found in a fairly exhaustive search through teratologic literature. As a
distinct and well-authenticated type it has only quite recently been recognized
by teratologists.

2. It does not of itself interfere with intrauterine or extrauterine life ; but
the associated anomalies {e. g., atresia ani) may be sources of danger. If not
noticed at birth, it is not usually discovered till adult life, and even then the
discovery is commonly accidental.

3. With regard to the functions of the pelvic viscera, urine may be passed
by both penises, by one only, or by neither. In the last instance it finds
exit by an aperture in the perineum. There is reason to believe that semen
may be passed in the same way; but in most of the recorded cases there has
been sterility, if not inability to perform the sexual act.

4. All the degrees of duplication have been met with, from a fissure of
the glans penis to the presence of two distinct penises inserted at some dis-
tance from each other in the inguinal regions.

5. The two penises are usually somewhat defective as regards prepuce,
urethra, etc. ; they may lie side by side, or more rarely may be situated
anteroposteriorly ; they may be equal in size, or less commonly one is dis-
tinctly larger than the other ; and one or both may be perforate or imperforate.

6. The scrotum may be normal or split ; the testicles, commonly two in
number, may be normal or atrophic, descended or undescended ; the prostate
may be normal or imperfectly developed, as may also the vasa deferentia and
vesiculiB seminales.

7. The commonly associated defects are : More or less completely septate
bladder, atresia ani, or more rarely double anus, double urethra, increased
breadth of the bony pelvis with defect of the symphysis pubis, and possibly
duplication of the lower end of the spine, and hernia of some of the abdom-
inal contents into a perineal pouch. Much more rarely, duplication of the
heart, lungs, stomach, and kidneys has been noted, and the lower limbs may
be shorter than normal.

Class XL — Cases of fetus in fetu, those strange instances in which one
might almost say that a man may be pregnant with his brother or sister, or in

a 759, 1895.

200

MAJOR TERATA.

which an infant may carry its twin without the fact being apparent, will next
be discussed. The older cases were cited as being only a repetition of the
process by which Eve was born of Adam. Figure 63 represents an old
engraving showing the birth of Eve. Bartholinus, the Ephemerides, Otto,
Paullini, Schurig, and Plot speak of instances of fetus in fetu. Euysch *
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 liistory 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.

Duj)uytren gives an example in a
boy of thirteen, in whom was found
a fetus. Gaetano-Nocito, cited by
Philipeaux,^*'- has the history of a
man of twenty-seven who was
taken with a great pain in the
right hyj)ochondriura, and from
which issued subsequently fetal
bones and a mass of macerated
embryo. His mother had had
several double pregnancies, and
from the length of the respective
tibise one of the fetuses seemed to
be of two months' and the other
of three months' intrauterine life.
The man died five years after the
abscess had burst spontaneously.
Brodie ^ speaks of a case in which
fetal remains were taken from the abdomen of a girl of two and one-half years.

Gaither ^ describes a child of two years and nine months, supposed to be
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 ab-
domen and was connected to the side of the cyst by a short umbilical cord ;
nor did the fetus make its ajipearance until the boy was eight or ten years

a 698, Tome ii. b 550, i., 234. c 550, 1819.

d 598, 1809, i., 170 et seq. e 476, 1828-1829, 260.

Fig. 63. — Birth of Eve (after an old engraving).

FETUS IN FETU.

201

okl, wlieu after much enlargement of pregnancy and subsequent flooding the
boy died." Tlie fetus, removed after death, on the wliole not very imper-
fectly formed, was of the size of about six or seven months' gestation. Bury *
cites an account of a child that had a second imj^erfectly 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 rudi-
mentary fetus in a scrotal tumor placed in his hands for operation. His
diagnosis proved correct, and brought him resounding praise, and all won-
dered as to his reasons for expecting a fetal tumor. It appears that he had
read with care a report by Fatti of an operation on the scrotum of a child
whicli had increased in size as the child grew, and was found to contain the
ribs, the vertebral column, the lower extremities as far as the knees, and the
two orbits of a fetus ; and also an account of a similar operation performed
by Wendt of Breslau on a Silesian boy of seven. The left testicle in this
case was so swollen that it hung almost to the knee, and the fetal remains
removed weighed seven ounces.

Sulikowski ^ relates an instance of congenital fetation in the umbilicus of
a girl of fourteen, who recovered after the removal of the anomaly. Are-
tseos described to the members of the medical fraternity in Athens ^ the case
of a woman of twenty-two, who bore two children after a seven months' preg-
nancy. One was very rudimentary and only 2^ 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 sub-
mits quite a remarkable case of congenital ventral gestation, the subject being
a girl of six, who recovered after the discharge of the fetal mass from the
abdomen. Mclntyre * speaks of a child of eleven, playing about and feeling
well, but whose abdomen progressively increased in size 1^ 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 J mentions a fetus that

a 490, 1834. b 302, iv., 179. c 240, 1826. d 240, 1829.

e 233, 1851-2, 17, 143. f 536, April 16, 1862. g 362, No. 26, 1868.

h768, 1879. i 616, Feb., 1894. j 131, 1875.

202

MAJOR TERATA.

was found in a man's bladder. Bouchacourt ^ reports the successful extir-
pation of the remains of a fetus from the rectum of a child of six. Miner ^
describes a successful excision of a congenital gestation.

Modern literature is full of examples, and nearly every one of the fore-
going instances could be paralleled from other sources. 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, accom-
panied by wood-cuts, of a young man from whose body a great surgeon had
extracted a " perfectly developed fetus." One of these wood-cuts represented
a tumor at the back of a man opened and containing a crying baby. In
commenting upon this, after reviewing several similar cases of endocymian
monsters that came under his observation in Mexico, Rodriguez tells what
the case which had been so grossly exaggerated by the lay journals really
was : An Indian boy, aged twenty-two, presented a tumor in the sacrococ-
cygeal region measuring 53 cm. in circumference at the base, having a vertical
diameter of 17 cm. and a transverse diameter of 13 cm. It had no pedicle
and was fixed, showing unequal consistency. At birth this tumor was about
the size of a pigeon's egg. A diagnosis of dermoid cyst was made and two
operations were performed on the boy, death following the second. The
skeleton showed interesting conditions ; the rectum and pelvic organs were
natural, and the contents of the cyst verified the diagnosis.

Quite similar to the cases of fetus in fetu are the instances of dermoid
cysts. For many years they have been a mystery to physiologists, and their
origin now is little more than hypothetic. At one time the fact of finding such
a formation in the ovary of an unmarried woman was presumptive evidence
that she was unchaste ; but this idea was dissipated as soon as examples were
reported in children, and to-day we have a well-defined difference between
congenital and extrauterine pregnancy. Dermoid cysts of the ovary may
consist only of a wall of connective tissue lined with epidermis and contain-
ing distinctly epidermic scales which, however, may be rolled up in firm
masses of a more or less soapy consistency ; this variety is called by Orth
epidermoid cyst ; or, according to Warren, a form of cyst made up of skin
containing small and ill-defined papillae, but rich in hair follicles and seba-
ceous glands. Even the erector pili muscle and the sudoriparous gland are
often found. The hair is partly free and rolled up into thick balls or is
still attached to the walls. A large mass of sebaceous material is also found
in these cysts. Thomson reports a case of dermoid cyst of the bladder con-
taining hair, which cyst he removed. It was a pedunculated growth, and it
was undoubtedly vesical and not expelled from some ovarian source through
the urinary passage, as sometimes occurs.

The simpler forms of the ordinary dermoid cysts contain bone and teeth.
The complicated teratoma of this class may contain, in addition to the pre-

a 368, 1850. b 230, 1874. c 791, April, 1893.

PLATE 3.

Dermoid cyst laid open, .slu)\vin.u- iiiaxiilary bone containing teeth ; tl\e head of one ol" the
lonj; bones ; skin with hair fjrowing from its snrface ; serous membrane (probe passed under-
neath) : mucniis niemlirane ol" stomaeh directly ut'xt to serous membrane (Baldy).

DERMOID CYSTS.

203

viously mentioned structures, cartilage and glands, mucous and serous mem-
brane, muscle, nerves, and cerebral substance, portions of eyes hngers with
nails, mamnu^, 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 (PI. 3), taken

Fig. 64— Dermoid cyst contaiuing long red liair, removed from a light-liaired woman aged forty-four years

(Montgomery).

from Baldy,*"* pictures a dermoid cyst of the complicated variety laid open
and exposing the contents in situ. Mears of Philadelphia reports a case
of ovarian cyst removed from a girl of six and a half by Bradford of
Kentucky in 1875. From this age on to adult life many similar cases are
recorded. Nearly every medical museum has preserved specimens of dermoid
cysts, and almost all physicians are well acquainted with their occurrence.
The curious formations and contents and the bizarre shapes are of great
variety. Graves ^ mentions a dermoid cyst containing the left side of a human
a " An American Text- Book of Gynecology, " Philadelphia, 1894. ^ 533, 1895, 212.

204

MAJOR TERATA.

face, an eye, a molar tooth, and various bones. Dermoid cysts are found also
in regions of the body quite remote from the ovary. The so-called " orbital
wens"^ are true inclusion of the skin of a congenital origin, as are the nasal
dermoids and some of the cysts of the neck.

ed reported the case of a man of twenty-two years who was born with
what was supposed to be a spina bifida in the lower sacral region. Accord-
lug to Senn, the swelling never caused any pain or inconvenience until it in-
flamed, when it opened spontaneously and suppurated, discharging a large
quantity of offensive pus, hair, and sebaceous material, thus proving it to have
been a dermoid. The cyst was freely incised, and there were found numer-
ous openings of sweat glands, from which drops of perspiration escaped when

the patient was sweating.

Dermoid cysts of the
thorax are rare. Bramann
reported a case in which a
dermoid cyst of small size
was situated over the ster-
num at the junction of the
manubrium with the gladi-
olus, and a similar cyst in
the anterior median line of
the neck near the left cornu
of the hyoid bone. Chitten
removed a dermoid from
the sternum of a female of
thirty-nine, the cyst con-
taining 11 ounces of athe-
romatous material. In the
Museum of St. Bartholo-
mew's Hospital in London
there is a congenital tumor
which was removed from the anterior mediastinum of a woman of twenty-
one, and contained portions of skin, fat, sebaceous material, and two pieces
of bone similar to the superior maxilla, and in which several teeth were found.
Dermoids are found in the palate and pharynx, and open dermoids of the
conjunctiva are classified by Sutton with the moles. According to Senn,
Barker collected sixteen dermoid tumors of the tongue. Bryk successfully
removed a tumor of this nature the size of a fist. Wellington Gray
removed an enormous lingual dermoid from the mouth of a negro. It con-
ta,ined 40 ounces of atheromatous material (Fig. 65). Dermoids of the rectum
are reported. Duyse reports the history of a case of labor during which a
rectal dermoid was expelled. The dermoid contained a cerebral vesicle, a

a La Flandre M6d., March 14, 1895.

Fig. 65.— Large lingual dermoid protruding from the mouth
(after Gray).

MULTIPLE DERMOID CYSTS.

206

rudimentary eye, a eanine and a molar tooth, and a piece of bone There
is little doubt "that nmny 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 abfe 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 unlocked for, and
its use had to be abandoned entirely because the thick contents of the cyst
would not flow freely, and the presence of sebaceous matter blocked the in-
strument. As much of the fluid as possible was removed, and the abdominal
incision was enlarged to allow of the removal of the large tumor. An
ovarian hematoma the size of a large orange was removed from the right
side. We washed the intestines quite as one would wash linen, since some
of the contents of the cyst had escaped into the abdominal cavity. The ab-
domen was closed without drainage, and the patient placed in bed without
experiencing the least shock. Her recovery was rapid and uneventful. She
returned to her home in four weeks after the operation.

" The unusual feature in this case was the nature of the contents of the sac.
There was a large quantity of long straight hair growing from the cyst wall
and an equal amount of loose hair in short pieces floating through the tumor-
contents, a portion of which formed nuclei for what were called ' moth-balls,'
of which there were about 1| gallons. These balls, or marbles, varied from
the size of moth-balls, as manufactured and sold by druggists, to that of small
walnuts. They seemed to be composed of sebaceous matter, and were evi-
dently formed around the short hairs by the motion of the fluid produced by
walking or riding. There was some tissue resembling true skin attached to
the inner wall of the sac."

There are several cases of multiple dermoid cysts on record, and they
may occur all over the body. Jamieson ^ reports a case in which there were
250, and in Maclarcn's case there were 132. According to Crocker, Hebra
and Rayer also each had a case. In a case of Sangstcr, 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 w^ere typical dermoid cysts
with the usual conteirts of degenerated epithelium and hair.

a luternat. Med. Ma^az., Pliila., July, 1895. ^ 318, Sept., 1873, 223.

206

MAJOR TERATA.

Hermaphroditism. — Some writers claim that Adam was the first herma-
phrodite and support this by Scriptural evidence.'^ We find in some of the
ancient poets traces of an Egyptian legend in whicli the goddess of the moon
was considered to be both male and female. From mythology we learn that
Hermaphroditus was the son of Hermes, or Mercury, and Venus Aphrodite,
and had the powers both of a father and mother. In speaking of the fore-
going Ausonius writes, "Cujus crat facies in qua paterque materque
cognosci possint, nomcn traxit ab illis." Ovid and Virgil both refer to
legendary hermaphrodites, and the knowledge of their existence was preva-
lent in the olden times. The ancients considered the birth of hermaphro-
dites bad omens, and the Athenians threw them into the sea, the Romans,
into the Tiber. Livy speaks of an hermaphrodite being put to death in
Umbria, and another in Etruria. Cicero, Aristotle, Strabonius, and Pliny all
speak concerning this subject. Martial ^ and Tertullian noticed this anomaly
among the Romans. Aetius and Paulus ^gineta speak of females in Egypt
with prolonged clitorides which made them appear like hermaphrodites.
Throughout the Middle Ages we frequently find accounts, naturally exagger-
ated, of double-sexed creatures. Harvey, Bartholinus, Paullini, Schenck,
Wolff, Wrisberg, Zacchias, Marcellus Donatus, Haller, Hufeland, de GraflF,
and many others discuss hermaphroditism. Many classifications have been
given, as, e. g., real and apparent ; masculine, feminine, or neuter ; horizontal
and vertical; unilateral and bilateral, etc. The anomaly in most cases
consists of a malformation of the external genitalia. A prolonged clitoris,
prolapsed ovaries, grossness of figure, and hirsute appearance have been
accountable for many supposed instances of hermaphrodites. On the other
hand, a cleft scrotum, an ill-developed penis, perhaps hypospadias or epispa-
dias, rotundity of the 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 Albu-
casius"^ describes a necessary operation for the removal of the clitoris.

a Genesis, chap, i., verse 27. ^ 509, lib. 1, ep. 91. c 618, L. xxv., chap. vi.

INTERESTING INSTANCES OF HERMAPHRODITISM. 207

Coliinibiis 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 after-
ward. Fitch speaks of a house-servant ° with masculine features and move-
ments, aged twenty-eight, and 5 feet and 9 inches tall, who Avas 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| inches long and 3f inches in circumference. The
glans penis and the urethra were perfectly formed. The scrotum contained
two testicles, each about an inch long ; the mons veneris was sparsely covered
with straight, black hair. She claimed functional ability with both sets of
genitalia, and said she experienced equal sexual gratification with either.
Semen issued from the penis, and every three weeks she had scanty menstrua-
tion, which lasted but two days.

Beclard'^ showed Marie-Madeline Lefort, nineteen years of age, 1|
meters in height. Her mammae were well developed, her nipples erectile
and surronnded by a brown areola, from which issued several hairs. Her
feet were small, her pelvis large, and her thighs like those of a woman.
Projecting from the vulva was a body looking like a penis 7 cm. long
and slightly erectile at times ; it was imperforate and had a mobile prepuce.
She had a vulva with two well-shaped labia as shown by the accompanying
illustration (Fig. 66). She menstruated slightly and had an opening at the
root of the clitoris. The parotid region showed signs of a beard and she had

a De re anatomica, L. xxv. b 224, 1889, i., 1038.

c 597, Nov. 22, 1890. d Facult6 de M6d. de Paris, 1815.

208

MA JOE TERATA.

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
(Fig. 67). At the autopsy, about two months later, all the essentials of
a female were delineated. A Fallopian tube, ovaries, uterus, and round
ligaments were found, and a drawing in cross-section of the parts was

Fig. 66.— I^Iarie-Madeline Lefort at sixteen
years of age.

Fig. 67.— Marie-Madeline Lefort at sixty-
live years of age.

made (Fig. 68). There is no doubt but that this individual was Marie-
Madeline Lefort in age.

Worbe speaks of a person who was supposed to be feminine for 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 discus-
sion, in which the court took part, that it was definitely settled that this
person was a male.

Adelaide Pr^ville, ^ho was married as a female, and as such lived the
last ten years of her life in France, was found on dissection at the Hotel-

a 461, Jan. et Fev., 1816.

INTERESTING INSTANCES OF HERMAPHRODITISM. 209

Dieii to be a man. A man was spoken of in both France and Germany «
who passed for many years as a female. He had a cleft scrotum and hypo-
spadias, which caused the deception. Sleeping with another servant for three
years, he constantly had sexual congress with her during this period, and
finally impregnated her. It was supposed in this case that the posterior wall
of the vagina supplied the deficiency of the lower boundary of the urethra,
forming a complete channel for the semen to proceed through. Long ago in
Scotland ''^^ a servant was condemned to death by burial alive for impregnat-
ing his master's daughter while in the guise and habit of a woman. He had
always been considered a woman. We have heard of a recent trustworthy
account of a pregnancy and delivery in a girl who had been impregnated by
a bed-fellow who on examina-
tion proved to be a male pseu-
dohermaphrodite.

Fournier ^ speaks of an in-
dividual in Lisbon in 1807
who was in the highest de-
gree of perfection, both male
and female. The figure was
graceful, the voice feminine,
the mammjB well developed,
and menstruation was regular.
The female genitalia were nor-
mal except the labia majora,
which Avere rather diminutive.
The thighs and the pelvis
were not so wide as those of a
woman. There was some beard
on the chin, but it was worn
close. The male genitalia were
of the size and appearance of
a male adult and were covered with the usual hair. This person had been
twice pregnant and aborted at the third and fifth month. During coitus the
penis became erect, etc.

Schrell describes a case in which, independent of the true penis and tes-
ticles, which were well formed, there existed a small vulva furnished with
labia and nymphse, communicating with a rudimentary uterus provided
with round ligaments and imperfectly developed ovaries. Schrell remarks
that in this case we must notice that the female genitalia were imperfectly
developed, and adds that perfect hermaphroditism is a physical impossibility
without great alterations of the natural connections of the bones and other

a 789, Aug. 26, 1856. b 302, iv., 164.

c Med.-Chir. prakt. Archiv vou Bader, etc., i., 1804.

14

Fig. 68. — Mesial section showing the generative organs of
Marie-Madeline Lefort. The sound is introduced into the
vagina, and from thence into the orifice of the urethra; U, the
uterus ; O, the ovary and Fallopian tube.

210

MAJOR TERATA.

parts of the pelvis. Cooper ''describes a woman with an enormous develop-
ment of the clitoris, an imperforate uterus, and absence of vagina ; at first
sight of the parts they appeared to be those of a man.

In 1859 Hugier succeeded in restoring a vagina to a young girl of twenty
who had an hypertrophied clitoris and no signs of a vagina. The accom-
panying illustrations show the conformation of the parts before operation
with all the appearance of ill-developed male genitalia, and the appearance
afterward with restitution of the vaginal opening (Fig. 69).

Virchow in 1872, Boddaert in 1875, and Marchand in 1883 report cases
of duplication of the genitalia, and call their cases true hermaphrodites from
an anatomic standpoint. There is a specimen in St. Bartholomew's Hospital
in London from a man of forty-four, who died of cerebral hemorrhage. He

Fig. 69.— Occlusion of the vulva and hypertrophy of the clitoris, before and after operation ; B, sound introduced
into a narrow vulvar orifice ; C, labium majus containing an ovary ; D, urinary meatus.

was well formed and had a beard and a full-sized penis. He was married,
and it was stated that his Avife had two children.^ The bladder and the in-
ternal organs of generation were those of a man in whom neither testis had
descended into the scrotum, and in whom the uterus masculinus and vagina
were developed to an unusual degree. The uterus, nearly as large as in the
adult female, lay between the bladder and rectum, and was enclosed between
two layers of peritoneum, to which, on either side of the uterus, were attached
the testes. There was also shown '''^^ in London the pelvic organs from a case
of complex or vertical hermaphroditism occurring in a child of nine months
who died from the effects of an operation for the radical cure of a right in-
guinal hernia. The external organs were those of a male with undescended

a 392, 1840, 243. ^ '7~9, xliv., 102.

Plate 4.

Psendo-extoriiiil bilateral hermaphroditism (Km^).

SPURIOUS HERMAPHRODITISM.

211

testo. The bUddcT was normal and ite neck was surronnded by a prostate
gland. Projecting backward were a vagina, uterus, and broad lig..men s,
round ligan.cnts, and Fallopian tubes, with the testes in the pos.t.on of the
ovaries. There were no seminal vesicles. The child d.ed eleven days after
the operation. The family history states that the mother had had 14 chil-
dren and eight miscarriages. Seven of the children were dead and showed
no abnormalities. The fifth and sixth children were boys and had the same

sexual arrangement. .

Barnes, Chalmers, Sippel, and Litten describe cases of spurious herma-
phroditism due to elongation of the clitoris. In Litten's case ^ the chtons
was 3^ inches long, and there was hydrocele of the processus vagmalis 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 familv of nine individuals in whom this anomaly was observed. The first
was ali've and had four children ; the second was christened a female but was
probablv a male ; the third, fourth, and fifth' were normal but died young ;
the sixtii 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
Facultv to be a male ; the ninth was christened a female, but at eighteen the
genital's 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 con-
genital, and on the other a hardened mass having no glandular structure.
The patient was an adult. As we have seen, there seems to be a law of
evolution in hermaphroditism which prevents perfection. If one set of
genitalia are extraordinarily developed, the other set are correspondingly
atrophied. In the case of extreme development of the clitoris and approxi-
mation to the male type we must expect to find imperfectly developed uterus
or ovaries. This would answer for one of the causes of sterility in these

cases.

There is a type of hermaphroditism in which the sex cannot be definitely
a 161, Ixxv. b 778, xxviii., 158. c 368, 1885, ii., 109. «i 124, 1851, 588.

212

MA JOE TERATA.

declared, and sometimes dissection does not definitely indicate the predomi-
nating sex. Such cases are classed under the head of neuter hermaphro-
dites, possibly an analogy of the " genus epicoenum of Quintilian. Marie
Dorothe'e, of the age of twenty-three, was examined and declared a girl by
Hufeland and Mursina, while Stark, Raschig, and Martens maintained that
she was a boy. This formidable array of talent on both sides provoked
much discussion in contemporary publications, and the case attracted much
notice. Marc saw her in 1803,* at which time she carried contradicting
certificates as to her sex. He found an imperforate penis, and on the in-
ferior face near the root an opening for the passage of urine. No traces of
nymphfe, vagina, testicles, nor beard were seen. The stature was small, the
form debilitated, and the voice effeminate. Marc came to the conclusion
that it was impossible for any man to determine either one sex or the other.
Everard Home dissected a dog with apparent external organs of the female,
but discovered that neither sex was sufficiently pronounced to admit of classi-
fication. Home also saw at the Royal Marine Hospital at Plymouth, in
1779, a marine who some days after admission was reported to be a girl.
On examination Home found him to possess a weak voice, soft skin, volum-
inous breasts, little beard, and the thighs and legs of a woman. There was
fat on the pubis, the penis was short and small and incapable of erection, the
testicles of fetal size ; he had no venereal desires whatever, and as regards sex
was virtually neuter.

The legal aspect of hermaphroditism has always been much discussed.
Many interesting questions arise, and extraordinary complications naturally
occur. In Rome a hermaphrodite could be a witness to a testament, the ex-
clusive privilege of a man, and the sex was settled by the predominance. If
the male aspect and traits together with the generative organs of man were
most pronounced, then the individual could call himself a man. " Hermaphro-
ditus an ad testamentum adhiberi possit qualitas sexus incalescentis ostendit."

There is a peculiar case on record ^ in which the question of legal male
inheritance was not settled until the individual had lived as a female for fifty-
one years. This person was married when twenty-one, but finding coitus
impossible, separated after ten years, and though dressing as a female had
coitus with other women. She finally lived with her brother, with whom she
eventually came to blows. She prosecuted him for assault, and the brother
in return charged her with seducing his wife. Examination ensued, and at
this ripe age she was declared to be a male.

The literature on hermaphroditism is so extensive tliat 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.

a 302, xxL, 104. b 359, July 29, 1895.

CHAPTER VI.

MIKOB 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,
Ballantvne ^ quotes Eagozin in saying that the Chaldeo-Babylonians, ni addi-
tion to their other numerous subdivisions of divination, drew presages and
omens for good or evil from the appearance of the liver, bowels, and viscera
of animals offered for sacrifice and opened for inspection, and from the
natural defects or monstrosities of babies or the young of animals. Ballan-
tyne names this latter subdivision of divination fetomancy or teratoscopy,
and thus renders a special chapter as to omens derived from monstrous
births, given by Lenormant : —

" The prognostics which the Chaldeans claimed to draw from monstrous
births in man and the animals are worthy of forming a class by themselves,
insomuch the more as it is the part of their divinatory science with which,
up to the present time, we are best acquainted. The development that their
astrology had given to ' g6n6thliaque,' or the art of horoscopes of births,
had led them early to attribute great importance to all the teratologic facts
which were there produced. They claimed that an experience of 470,000
years of observations, all concordant, fully justified their system, and that in
nothing was the influence of the stars marked in a more indubitable manner
than in the fatal law which determined the destiny of each individual
according to the state of the sky at the moment when he came into the
world. Cicero, by the very terms which he uses to refute the Chaldeans,
shows that the result of these ideas was to consider all infirmities and mon-
strosities that new-born infants exhibited as the inevitable and irremediable
consequence of the action of these astral positions. This being granted, the
observation of similar monstrosities gave, as it were, a reflection of the state
of the sky, on which depended all terrestrial things ; consequently, one might
read in them the future with as much certainty as in the stars themselves.
For this reason the greatest possible importance was attached to the terato-
logic auguries which occupy so much space in the fragments of the great

a 759, i., 127.

213

214

MINOR TERATA.

treatise on terrestrial presages which have up to the present time been pub-
lished."

The rendering into English of the account of 62 teratologic cases in the
human subject with the prophetic meanings attached to them by Chaldean
diviners, after the translation of Opport, is given as follows by Ballantyne,
some of the words being untranslatable : —

" When a woman gives birth to an infant —

(1) that h&s, 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

destroyed ;

(10) that has two ears on the right side and none on the left, the gods will bring about a

stable reign, the country will flourish, and it will be a land of repose ;

(11) whose ears are both closed, sa a au;

(12) that has a bird's beak, the country will be peaceful ;

(13) that has no mouth, the mistress of the house will die ;

(14) that has no right nostril, the people of the world will be injured ;

(15) whose nostrils are absent, the country 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 1{uri ant, 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 luhinu ;

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

troops) ;

ANCIENT IDEAS RELATIVE TO MINOR TERATA. 215

(31) that has the heart open and that has no skin, the country will suffer from calamities ;
(39) 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 m

that of the neighbor ; ■, i v,

(38) that has no feet, the canals of the country will be cut (intercepted) and the house

i-uined ; n i p

(39) that has the right foot in the form of a fish's tail, the booty of the country ot the

humble will not be imas sn hir ;

(40) whose hands and feet are like four fishes' tails (fins), the master (king) shall perish (0

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 ; j \ j -u -u- a

(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 nuister 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 rained ;

(57) that has the beard come out, there will be abundant rains ;

(58) that has some hirtn on the head, the country will be strengthened (reinforced) ;

(59) that has on the head the mouth of an old man and that foams (slabbers), there will be

great prosperity in the land, the god Bin will give a magnificent harvest (inundate
the land with fertility), and abundance shall be in the land ;

(60) that has on one side of the head a thickened ear, the first-born of the men shall live

a long time (?) ;

216

MINOR TEE ATA.

(61) that has on the head two long and thick ears, there will be tranquility and the pacifi-

cation of litigation (contests) ;

(62) that has the figure in horn (Uke 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 doubt-
less the direction and shape of tlie 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 fiir 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 Psychiatric
und Nervenkrankheiten, xx., 1887) and others. The exact malformation indicated in
Nos. 6 and 7 is, of course, not to be determined, although further researches in Assyriologj'
may clear up this point. The 'round ear' (No. 8) is one of Binder's types, and that
with a ' wound below ' (No. 9) probably refers to a case of fistula auris congenita (Toyn-
bee, 'Diseases of the Ear,' 1860). The instance of an infant born with two ears on the
right side (No. 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 hmb : Nos. 25, 26, and 27 were prob-
ably instances of the so-called spontaneous or intrauterine amputation ; and Nos. 28, 29,
and 30 were examples of the comparatively common deformity known as Polydactyly. No.'
31 was probably a case of ectopia cordis.

"Then follow five in.stances of genital abnormalities (Nos. 32-36), consisting of absence
of the penis (epispadias?), absence of penis and umbilicus (epispadias and exomphalos ?),
hermaphroditism, imperforate anus, and nondescent of one testicle. The nine following
cases (Nos. 37-45) were anomalies of the lower limbs : Nos. 37, 38, and 42 may have been
spontaneous amputations ; Nos. 39 and 40 were doubtless instances of webbed toes (syn-
dactyly), and the deformity indicated in No. 45 was presumably talipes equinus. The
infant born with three feet (No. 43) was possibly a case of parasitic monstrosity, several of
which have been reported in recent teratologic literature ; but what is meant by the state-
ment concerning ' male and female legs ' it is not easy to determine.

"Certain of the ten following prodigies (Nos. 46-55) cannot in the present state of our
knowledge be identified. The presence of congenital patches of white or gray hair on the
scalp, as recorded in No. 46, is not an unknown occurrence at the present time ; but what
the Chaldeans meant by ipga, prnde, halt, siksi\ and kali on the head of the new-born
infant it is impossible to tell. The guess may be hazarded that cephalhematoma, hydro-
cephalus, meningocele, nevi, or an excessive amount of vernix caseosa were the conditions
indicated, but a wider acquaintance with the meaning of the cuneiform characters is neces-
sary before any certain identification is possible. The ' pieces of skin hanging from the

ABNORMAL ELASTICITY OF THE SKIN.

217

head' (No. 51) may have been fragments of the membranes ; but there is nuthu.g m the
accompanying prediction to help us to trace the origin of the popular behei n. the good luck
following the baby born with a caul. If No. 53 was a case of congenita horns on the head, it
must be regarded as a unique example, unless, indeed, a form of fetal ichthyosis be indicated.

"The remaining observations (No. 56-62) refer to cases of congenital teeth (No. 56),
to deformity of the ears (Nos. 60 and 61), and a horn (No. 62).

From these early times almost to the present day similar significance has
been attached to minor structural anomalies. In the following pages the
individual anomalies will be discussed separately and the most interesting
examples of each will be cited. It is manifestly evident that the object of
this chapter is to mention the most striking instances of abnormism and to
give accompanying descriptions of associate points of interest, rather than to
offer a scientific exposition of teratology, for which the reader is referred
elsewhere.

Congenital defect of the epidermis and true skin is a rarity in
pathology. Pastorello ^ speaks of a child which lived for two and a half
hours whose hands and feet were entirely destitute of epidermis ; the true
skin of those parts looked like that of a dead and already putrefying child.
Hanks ^ cites the history of a case of antepartum desquamation of the skin
in a living fetus. Hochstetter^ describes a full-term, living male fetus with
cutaneous defect on both sides of the abdomen a little above the umbilicus.
The placenta and membranes were normal, a fact indicating that the defect
was not due to amniotic adhesions ; the child had a club-foot on the left side.
The mother had a fall three weeks before labor.

Abnormal Elasticity of the Skin.— In some instances the skin is
affixed so loosely to the underlying tissues and is possessed of so great elas-
ticity that it can be stretched almost to the same extent as India rubber.
There have been individuals who could take the skin of the forehead and
pull it down over the nose, or raise the skin of the neck over the mouth.
Thev also occasionally have an associate muscular development in the sub-
cutaneous tissues similar to the panniculus adiposus of quadrupeds, giving
them preternatural motile power over the skin. The man recently exhibited
under the title of the Elastic-Skin Man " was an example of this anomaly.
The first of this class of exhibitionists was seen in Buda-Pesth some years
since and possessed great elasticity in the skin of his whole body ; even his
nose could be stretched. Figure 70 represents a photograph of an exhibi-
tionist named Felix Wehrle, who besides having the power to stretch his skin
could readily bend his fingers backward and forward. The photograph was
taken in January, 1888.

In these congenital cases there is loose attachment of the skin without
hypertrophy, to which the term dermatolysis is restricted by Crocker. Job
van Meekren,^*'" the celebrated Dutch physician of the seventeenth century,

a- 153, July, 1845. ^ 125, 1880, 595. c 263, 1894, 542.

218

MINOR TERATA.

states that in 1657 a Spaniard, Georgius Albes, is reported to have been able
to draw the skin of the left pectoral region to the left ear, or the skin under
the face over the chin to the vertex. The skin over the knee could be
extended half a yard, and when it retracted to its normal position it was not
in folds. Seiffert examined a case of this nature in a young man of nineteen,
and, contrary to Kopp's supposition, found that in some skin from over the
left second rib the elastic fibers were quite normal, but there was transforma-
tion of the connective tissue of the dermis into an unformed tissue like a

myxoma, with total disappearance of the
connective-tissue bundles. Laxity of
the skin after distention is often seen in
multipara, botli in the breasts and in the
abdominal walls, and also from obesity,
but in all such cases the skin falls in
folds, and does not have a normal appear-
ance like that of the true " elastic-skin

man

Occasionally abnormal development
of the scalp is noticed. McDowall *
records an instance in an epileptic idiot
of twenty-two. On each side of the
median line of the head there were five
deep furrows (Fig. 71), more curved and
— shorter as the distance from the median

line increased. In the illustration the
vjj^ li^i^ ill the furrows is left longer than

that on the rest of the head. The patient
was distinctly microcephalic and the
right side of the body was markedly
wasted. The folds were due to hyper-
trophy of the muscles and scalp, and the
same sort of furrowing is noticed when
a dog " pricks his ears." This case may
possibly be considered as an example of reversion to inferior types. Co\van ^
records two cases of the foregoing nature in idiots. The first case (Fig. 72)
was a paralytic idiot of thirty-nine, whose cranial development was small in
proportion to the size of the face and body ; the cranium was oxycephalic ; the
scalp was lax and redundant and the hair thin ; there were 13 furrows, five on
each side running anteroposteriorly, and three in the occipital region running
transversely. The occipitofrontalis muscle had no action on them. The
second case was that of an idiot of forty-four of a more degraded type than
the previous one. The cranium was round and bullet-shaped and the hair
a 465, Jan., 1893. b 465, Oct., 1893.

Fig. 70. — .^n "elastic-skin man."

IMPERVIOUS SKIN.

219

generally thick. The scalp was not so lax as in the other case, but the
furrows were more crooked. By tickling the scalp over the back of the
neck the two median furrows involuntarily deepened.

Impervious Skin.— There have been individuals who clanned that their
skin was impervious to ordinary puncture, and from time to time these indi-
viduals have appeared in some of the larger medical clinics of the world for
inspection. According to a recent number of the London Graphic, there is
in Berlin a Singhalese who baffles all investigations by physicians by the
impenetrability of his skin. The bronzed Easterner, a Hercules in shape,
claims to have found an elixir which will render the human skin impervious
to any metal point or sharpened edge of a knife or dagger, and calls himself
the -'Man with Iron Skin." He is now exhibiting himself, and his greatest
feat is to pass with his entire body through a hoop the inside of which is hardly

\

\ -

Fig. 71.-Abnormal .Icvelopinent of scalp (McDowall). Fig. 72.-Abiiormal developmeut of scalp (Cowan).

big enough to admit his body and is closely set with sharp knife-points, dag-
gers, nails, and similar things. Through this hoop he squeezes his body with
absolute impunity. Tlie })liysicians do not agree as to his immunity, and
some of them think that llhannin, which is his name, is a fakir who has by
long practice succeeded in hardening himself against the impressions of
metal upon his skin. The professors of the Berlin clinic, however, consid-
ered it worth while to lecture about the man's skin, pronouncing it an inex-
plicable matter. Tliis individual performed at the London Alliambra in the
latter part of 1895. Besides climbing w^ith bare feet a ladder wliose rungs
were sharp-edged swords, and lying on a bed of nail points with four men
seated upon him, he curled himself up in a barrel, through whose inner edges
nails projected, and was rolled about the stage at a rapid rate. Emerging
from thence uninjured, he gracefully bows himself off the stage.

220

MINOR TERATA.

Some individuals claim immunity from burns and show many interesting
feats in handling fire. As they are nothing but skilful " fire jugglers they
deserve no mention here. The immunity of the participants in the savage
fire ceremonies will be discussed in Chapter IX.

Albinism is characterized by the absolute or relative absence of pigment
of the skin, due to an arrest, insufficiency, or retardation of this pigment.

Following 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 com-
plete form. Heredity
plays no part in a num-
ber of cases investigated
by the authors. D'Aub6,
by his observations on
white rabbits, believes
that the influence of con-
sanguinity is a marked
factor in the production
of albinism ; there are,
however, many instances
of heredity in this ano-
maly on record, and this
idea is possibly in har-
mony with the majority
of observers. GeolFroy-
Saint-Hilaire has noted
that albinism can also
be the consequence of
a pathologic condition
having its origin in ad-
verse surroundings, the

circumstances of the parents, such as the want of exercise, nourishment,
light, etc.

Lesser knew a family in which six out of seven were albinos, and in some
tro])ical 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
th ree were white, born in the following order : two consecutive black boys,

a 124, 1839.

Fig. 73.— An albino family.

ALBINISM.

221

two consecutive white girls, one black girl, one white boy. Syni of Edin-
burgh relates the history of a family of seven children, who were alternately
white and black. All but the seventh were living and in good health and
mentally without defect. The parents and other relatives were dark. Figure
73 portrays an albino family by the name of Cavalier who exhibited ni

Minneapolis in 1887.

Examples of the total absence of pigment occur in all races, but particu-
larly is it interesting when seen in negroes who are found absolutely white
but preserving all the characteristics of their race, as, for instance, the
kinky, woolly hair, flattened nose, thick lips, etc. Ren6 Caill6, in his " Voyage
h Tombouctou," says that he saw a white infant, the offspring of a negro and
negrcss. 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. Buffbn 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 grandftither an albino. Coinde, quoted by
Sedgwick, speaks of a man who, by two different wives, had three albino
children.

A description of the ordinary type of albino would be as follows : The
skin and hair are deprived of pigment ; the eyebrows and eyelashes are of a
brilliant white or are yellowish ; the iris and the choroid are nearly or entirely
deprived of coloring material, and in looking at the eye we see a roseate
zone and the ordinary pink pupil ; from absence of pigment they neces-
sarily keep their eyes three-quarters closed, being photophobic to a high
degree. They are amblyopic, and this is due partially to a high degree of
ametropia (caused by crushing of the eyeball in the endeavor to shut out
light) and from retinal exhaustion and nystagmus. Many authors have
claimed that they have little intelligence, but this opinion is not true. Ordi-
narily the reproductive functions are normal, and if we exclude the results of
the union of two albinos we may say that these individuals are fecund.

Partial albinism is seen. The parts most often affected are the genitals,
the hair, the face, the top of the trunk, the nipple, the back of the hands
and fingers. Folker ° reports the history of a case of an albino girl having
pink eyes and red hair, the rest of the family having piidc eyes and white

a 476, July 11, 1891. ^ 580, Aug., 1888. c 475, 1876, i., 795.

222

MINOR TERATA.

hair. Partial albinism, necessarily congenital, presenting a piebald appear-
ance, must not be confounded with leukoderma, which is rarely seen in the
young and which will be described later.

Albinism is found in the lower animals, and is exemplified ordinarily
by rats, mice, crows, robins, etc. In the Zoologic Garden at Baltimore two
years ago was a pair of pure albino opossums. The white elephant is cele-
brated in the religious history of Oriental nations, and is an object of venera-
tion and worship in Siam. White monkeys and white roosters are also
worshiped. In the Natural History Museum in London there are 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 sim-
plex, sometimes appearing shortly after birth, but generally seen later in life,
will be spoken of in the chapter on Anomalous Skin Diseases.

Human horns are anomalous outgrowths from the skin and are far more
frequent than ordinarily supposed. Nearly all the older writers cite exam-
ples. Aldrovandus, Amatus Lusitanus, Boerhaave, Dupr6, Schenck, River-
ius, Yallisneri, and many others mention horns on the head. In the ancient
times horns were symbolic of wisdom and power. Michael Angelo in his
famous sculpture of Moses has given the patriarch a pair of horns. Rho-
dius observed a Benedictine monk who had a pair of horns and who was
addicted to rumination. Fabricius saw a man with horns on his head,
whose son ruminated ; the son considered that by virtue of his ruminating
characteristics his father had transmitted to him the peculiar anomaly of the
family. Fabricius Hildanus saw a patient with horns all over the body
and another with horns on the forehead. Gastaher speaks of a horn from
the left temple ; Zacutus Lusitanus saw a horn from the heel ; Wroe,*^29 ^j^g
of considerable length from the scapula ; Cosnard, one from the bregma ; the
Ephemerides, from the foot ; Borellus, from the face and foot, and Ash,^ horns
all over the body. Home, Cooper, and Treves have collected examples of
horns, and there is one 1 1 inches long and 21 in circumference in a London
museum. Lozes collected reports of 71 cases of horns, — 37 in females, 31
in males, and three in infants. Of this number, 15 were on the head, eight on
the face, 18 on the lower extremities, eight on the trunk, and three on the glans

a 683, 1696, 254. b 418, 1776. c 629, 176.

HUMAN HOENS.

223

penis. Wilson « collected reports of 90 cases,— 44 females, 39 males, the sex
not being mentioned in the remainder. Of these 48 were on the head, four
on the lace, four on the nose, 11 on the thigh, three on the leg and foot, six
on the back, five on the glans penis, and nine on the trunk. Lebert's col-
lection numbered 109 cases of cutaneous horns. The greater frequency
among females is admitted by all authors. Old age is a p red isposnig^ cause.
Several patients over seventy have been seen and one of ninety-seven.^

Instances of cutaneous horns, when seen and reported by the laity, give
rise to most amusing exaggerations and descriptions. The following account «
is given in New South Wales, obviously embellished with apocryphal details
by^some facetious journalist : The child, five weeks old, was born with hair
two inches long all over the body ; his features were fiendish and his eyes
shone like beads beneath his shaggy brows. He had a tail 18 inches
long, horns from the skull, a full set of teeth, and claw-like hands ; he
snapped like a dog and crawled on all fours, and refused the natural suste-
nance of a normal child. The mother almost became an imbecile after the
birth of the monster. The country people about Bomballa considered this
devil-child a punishment for a rebuff that the mother gave to a Jewish
peddler selling Crucifixion-pictures. Vexed by his persistence, she said she
would sooner have a devil in her house than his picture.

Lamprey^ has made a minute examination of 'the much-spoken-of
" Horned Men of Africa." He found that this anomaly was caused by a
congenital malformation and remarkable development of the infraorbital
ridge of the maxillary bone (Fig. 74). He described several cases, and
through an interpreter found that they were congenital, followed no history
of traumatism, caused little inconvenience, and were unassociated with dis-
turbance of the sense of smell. He also learned that the deformity was
quite rare in the Cape Coast region, and received no information tending to
prove the conjecture that the tribes in West Africa used artificial means to
produce the anomaly, although such custom is prevalent among many
aborigines.

Probably the most remarkable case of a horn was that of Paul Rodrigues,
a Mexican porter,*^ who, from the upper and lateral part of his head, had a
horn 14 inches in circumference and divided into three shafts, which he
concealed by constantly wearing a peculiarly shaped red cap. There is in
Paris a wax model of a horn, eight or nine inches in length, removed from
an old woman by the celebrated SouberbicUc. Figure 75 is from a wax model
supposed to have been taken from life, showing an enormous grayish-black
horn proceeding from the forehead. Warren mentions a case under the care
of Dubois, in a woman from whose forehead grew a horn six inches in diam-
eter and six inches in height. It was hard at the summit and had a fetid

a 550, vol. xxvii., p. fiO. b 418, 1776, i., 311. c Quoted in 759, April, 1894.

(1224, 1887, ii., 1273. e New York Medical Eepository, 1820.

224

MINOR TERATA.

odor. In 1696 there was an old woman in France who constantly shed
long horns from her forehead, one of which was presented to the King.
Bartholinus mentions a horn 12 inches long. Voigte cites the case of an old
woman who had a horn branching into three portions, coming from her fore-
head. Sands * speaks of a woman who had a horn 6| 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 li cm. at the apex, and was quite mobile. It began to
grow at the age of eleven and had constantly increased. Vidal presented

Fig. 74.—" African horned man " (Lamprey). Fig. 75.— Wax model of a large frontal horn.

before the Academic de M6decine in 1886 a twisted horn from the head of
a woman. This excrescence was ten inches long, and at the time of presenta-
tion reproduction of it was taking place in the woman. Figure 76 shows
a case of ichthyosis cornea pictured in the Lancet, 1850.^^

There was a woman of seventy-five, living near York,*^ who had a horny
growth from the face which she broke off and which began to reproduce,
the illustration (Fig. 77) representing the growth during twelve months.
Lall ^ mentions a horn from the cheek ; Gregory reports one that measured 7i
inches long that was removed from the temple of a woman in Edinburgh ;
Chariere of Barnstaple saw a horn that measured seven inches growing from
the nape of a woman's neck ; Kameya Iwa s speaks of a dermal horn of the

a 597, 1851. b 124, 1857. c 749, 1886, 487. d 47G, 1850, ii., 342.

e 779, xvi., 267. f 435,1883. g Tokei Iji Shinslii, 1881.

HUMAN HOBNS.

225

auricle ; Saxton of New York has excised several horns from the tympanic
membrane of the ear ; Noyes speaks of one from the eyelid ; Bigelow ^

Fig. 76. — Ichthyosis cornea.

Fig. 77.— l-'auial horn.

mentions one from the chin ; Minot ° speaks of a horn from the lower lip,
and Doran of one from the neck.

Gould® cites the instance of a horn growing from an epitheliomatous
penis. The patient was fifty-
two years of age and the
victim of congenital phimosis.
He was circumcised four years
previously, and shortly after
the wound healed there ap-
peared a small wart, followed
by a horn about the size of a
marble. Jewett speaks of a
penile horn 3| inches long
and 3| inches in diameter ;
Pick mentions one 2^ inches
long (Fig. 78). There is an
account ^ of a Russian peasant
boy who had a horn on his
penis from earliest childhood.
J ohnson s mentions a case of
a horn from the scrotum,
which was of sebaceous origin
and was subsequently sup-
planted by an epithelioma.
Ash reported the case of a girl

named Annie Jackson, living in Waterford, Ireland, who had horny ex

Fig. 78. -Horn of the penis (after Pick).

excres-

a 538, 1869.

e.7«i«u. -.01 ' 231, 1867, vol. xix. c 218, 1864. d 779, 1881.

« 476, 1887, 1., 421. f 224, Aug. 13, 1887.

15

g 476, 1844.

*

226

MINOR TERATA.

cences from her joints, arms, axilljie, 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 1^ inches in circumference growing from his fingers and toes.

Wagstaife ^ presents a horn which grew from the middle of the leg six
inches below the knee in a woman of eighty. It was a flattened spiral of
more than two turns, and during forty years' growth had reached the length
of 14.3 inches. Its height was 3.8 inches, its skin-attachment 1.5 inches
in diameter, and it ended in a blunt extremity of 0.5 inch in diameter.
Stephens ^ mentions a dermal horn on the buttocks at the seat of a carcino-
matous cicatrix. Harris and Domonceau ^ speak of horns from the leg.
Cruveilhier ^ saw a Mexican Indian who had a horn four inches long and eight
inches in circumference growing from the left lumbar region. It had been
sawed off twice by the patient's son and was finally extirpated by Faget.

The length of the pieces was
12 inches. Bellamy^ saw a
horn on the clitoris about the
size of a tiger^s claw in a
woman of seventy. It had
its origin from beneath the
preputium clitoridis.

Horns are generally soli-
tary, but cases of multiple
formation are known. Lewin
and Heller record a syphilitic
case with eight cutaneous
horns on the palms and soles.
A female patient of Manzu-
roff had as many as 185 horns.
Pancoast s 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
suflPered three attacks of erysipelas from prolonged exposure. When he
consulted Pancoast the horns had nearly all fallen off and were brought to
the physician for inspection ; and the photograph (Fig. 79) was taken after
the ])atient 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

a 779, 1870. ^ 435, 1872. c 527, 1842.

d 462, xiv., 145. « Anat. patbolog. du corps humain. 779, 1870.

g 631, 1878. h 160, 1792.

ANOMALIES OF THE HAIR.

227

never had hair or teeth. Sedgwick ^ quotes the case of a man of fifty-eight
who ever since birth was totally devoid of hair and in whom sensible perspira-
tion and tears were absent. A cousin on his mother's side, born a year before
him, had precisely the same peculiarity. Butfon says that the Turks and
some other people practised depilatory customs by the aid of ointments and
pomades, principally about the genitals. Atkinson ^ exhibited in Philadel-
phia a man of forty who never had any distinct growth of hair since birth,
was edentulous, and destitute of the sense of smell and almost of that of
taste. He had no apparent perspiration, and when working actively he was
obliged to wet his clothes in order to moderate the heat of his body. He
could sleep in wet clothes in a damp cellar without catching cold. There
was some hair in the axillte 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 men-
tions the accounts given of another black tribe, about 500 miles west of
Brisbane, that contained hairless members. This is very strange, as the
Australian aboriginals are a very hairy race of people.

Hutchinson mentions a boy of three and a half in whom there was con-
genital absence of hair and an atrophic condition of the skin and appendages.
His mother was bald from the age of six, after alopecia areata. Scliede re-
ports two cases of congenitally bald children of a peasant woman (a boy of
thirteen and a girl of six months). They had both been born quite bald, and
had remained so. In addition there were neither eyebrows nor eyelashes and
nowhere a trace of lanugo. The children were otherwise healthy and well
formed. The parents and brothers were healthy and possessed a full growth
of hair. Thurman ^ reports a case of a man of fifty-eight, who was almost
devoid of hair all his life and possessed only four teeth. His skin was very
delicate and there was absence of sensible perspiration and tears. The skin
was peculiar in thinness, softness, and absence of pigmentation. The hair on
the crown of the head and back was very fine, short, and soft, and not more
in quantity than that of an infant of three months. There was a similar pecu-
liarity in his cousin-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.

a 222, 1863, i., 453. ^ 218, March 29, 1883. c 224, 1881. i., 177.

d 650, 1885-6, ii., 116. e 550, xxxi., 71.

228

MINOR TERATA.

Rayer quotes the case of Beauvais, who was a patient in the Hopital de la
Charitein 1827. The skin of this man's cranium was apparently completely
naked, although in examining it narrowly it was found to be beset with a
quantity of very white and silky hair, similar to the down that covers the scalp
of infants ; here and there on the temples there were a few black specks, occa-
sioned by the stumps of several hairs which the patient had shaved 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 indi-
cated by a small, whitish point. The beard was so thin and weak that Beauvais
clipped it off only every three weeks. A few straggling hairs were observed on
the breast and pubic region, as in young people on the approach of puberty.
There was scarcely any under the axillae. It was rather more abundant on
the inner parts of the legs. The voice was like that of a full-grown and well-
constituted man. Beauvais was of an amorous disposition and had had syph-
ilis twice. His mother and both sisters had good heads of hair, but his father
presented the same defects as Beauvais.

Instances are on record of women devoid of hair about the genital region.
Riolan says that he examined the body of a female libertine who was totally
hairless from the umbilical region down.

Congenital alopecia is seen in animals. There is a species of dog, a
native of China but now bred in Mexico and in the United States, which
is distinguished for its congenital alopecia. The same fact has been observed
occasionally in horses, cattle, and dogs. Heusner * has seen a pigeon desti-
tute of feathers, and which engendered a female which in her turn transmitted
the same characteristic to two of her young.

Sexualism and Hair Growth. — The growth or development of the hair
may be accelerated by the state of the organs of generation. This is peculiarly
noticeable in the pubic hairs and the beard, and is fully exemplified in the sec-
tion on precocious development (Chapter VII.) ; however, Moreau de la Sarthe
showed a child to the Medical Faculty of Paris in whom precocious develop-
ment of the testicles had influenced that of the hair to such a degree that,
at the age of six, the chest of this boy was as thickly set with hair as is
usually seen in adults. It is well known that eunuchs often lose a great
part of their beards, and after removal of the ovaries women are seen to
develop an extra quantity of hair. Gcrberon 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^

a 390, 153. b 215, ann.,ii.

c 620, cent, iii., obs. 64. d Dissert., etc., Jenae.

BEARDED WOMEN.

229

speaks of '^foeminis barbati." Leblond'^ says that certain women of
Ethiopia and South America have beards and little or no menstruation. He
also says that sterility and exces-
sive chastity are causes of female
beards, and cites the case of
Schott of a young widow who
secluded herself in a cloister
and soon had a beard.

Barbara Urster, who lived in
the 16th century, had a beard to
her girdle. The most celebrated
" bearded woman " was Rosine-
Mars-uerite Miiller, who died in
a hospital in Dresden in 1732,
with a thi(dv beard and heavy
mustache. Julia Pastrana had
her face covered with thick hair
and had a full beard and mus-
tache. She exhibited defective
dentition in both jaws, and the
teeth present Avere arranged in

an irregular fashion. She had pronounced prognathism, which gave her a
simian appearance (Fig. 80). Ecker examined in 1876 a woman who died
at Fribourg, whose face contained a full beard and a luxuriant mustache.

Fig. 80.— Julia Pastrana.

Fig. 81.

Bearded insane women (Harris).

Fig. 82.

Harris reports several cases of bearded women, inmates of the Coton Hill
Lunatic Asylum. One of the patients was eighty-three years of age and had

a 302, iii., 9. b 224, June 2, 1894.

230

MINOR TERATA.

been insane fortv-fonr years following a puerperal period. She would not
permit the hair on her face to be cut, and the curly white hairs had attained
a length of from eight to ten inches on the chin, while on the upper lip the
hairs were scarcely an inch. This patient was quite womanly in all her senti-
ments (Fig. 81). The second case was a woman of thirty-six, insane from
emotional melancholia. She had tufts of thick, curly hair on the chin two
inches long, light yellowish in color, and a few straggling hairs on the upper
lip. The third case (Fig. 82) was that of a woman of sixty-four, who
exhibited a strong passion for the male sex. Her menstruation had been
regular until the menopause. She plaited her beard, and it was seven or

eight inches long on the chin and
one inch on the lip. This woman
had extremely hairy legs. Another
case was that of a woman of sixty-
two, who, though bald, developed
a beard before the climacteric.
Her structural proportions were
feminine in character, and it is said
that her mother, who was sane,
had a beard also. A curious case
was that of a 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
and was free from excessive hair
elsewhere, her nose and forehead
being singularly bare. Her voice
was very sweet ; she was married
at seventeen and a half, having
Fig. 83.—" Bearded woman." two normal children, and nursed

each for one month. " The bearded
woman " of every circus side-show is an evidence of the curious interest in
which these women are held. The accompanying illustration (Fig. 83) is
a representation of a " bearded woman " born in Bracken County, Ky. Her
beard measured 15 inches in length.

There is a class of anomalies in which there is an exaggerated develop-
ment of hair. We would naturally expect to find the primitive peoples, who
are not provided with artificial protection against the wind, supplied with an
extra quantity of hair or having a hairy coat like animals ; but this is some-
times 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

EXAGGERATED DEVELOPMENT OF HAIR.

231

Bible is an early instance. Aldrovandus says that m the sixteenth eentn^^
there came to the Canary Islands a family consistmg of a father, son and
two danghtcrs, who were covered all over their bodies by long ha,r and their
portrait, certainly repr«lneed from life, resembles the modern instances of

" dos: men." . „ i • a •

In 1883 there was shown in England and France, afterward in Ameri«.,
a girl of seven named " Krao," a native of Indo-China. The whole bc^y
of this child was covered with bhick hair. Her face was of the prognathic
type, and this, with her extraordinary prehensile powers of feet and hps, gave
her the title of " Darwin's missing link." In 1875 there was exhibited in
Paris under the name of " I'homme-chien " Adrien Jeftiehew, a Russian

Fig, 84.— Two examples of extreme hirsuties in a family.

peasant of fifty-five, whose face, head, back, and limbs were covered with a
brown hairy coat looking like wool and several centimeters long. The other
parts of the body were also covered with hair, but less abundantly. This
individual had a son of three, Theodore, who was hairy like himself.

A family living in Burmah (Shive-Maon, whose history is told by Craw-
ford and Yule), consisting of a father, a daughter, and a granddaughter, were
nearly covered with hair. Figure 84 represents a somewhat similar family
who were exhibited in this country.

Teresa Gambardella, a young girl of twelve, mentioned by Lombroso, was
covered all over the body, with the exception of the hands and feet, by thick,
bushy hair. This hypertrichosis was exemplified in this country only a few
months since by a person who went the rounds of the dime museums under

232

MINOR TERATA.

the euphonious name of " Jo-Jo, the dog-face boy." His face was truly that
of a skye-terrier (Fig. 85).

Sometimes the hairy anomahes 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, Jablokolf, 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
l)reast and back were covered with light brown hair of considerable length.

Fig. 85.— "Jo-Jo. "

Fig. 86.—" Woman with a mane" (nsevus pilosus).

The surface upon which it grew was of a brownish hue, dilferent from the
color of the surrounding integument. Almost the whole of the right arm was
covered in the same manner. On the lower extremity several tufts of hair
were observed implanted upon brown spots from seven to eight lines in diameter
symmetrically disposed upon both legs. The hair was brown, of the same
color as that of the head. Bichat^ informs us that he saw at Paris an un-
fortunate man who from his birth was afflicted with a hairy covering of his
face like that of a wild boar, and he adds that the stories which were current
among the vulgar of individuals with a boar's head, wolf's head, etc., uii-

•1 Anat. G6ii6rale, Paris, 1812, T. iv., 827,

NjEVUS pilosus.

233

dou])todly referred to cases in which the face was covered to a greater or less
degree with hair. Villerm6 saw a child of six at Poitiers in 1808 whose
body, except the feet and hands, was covered with a great number of promi-
nent brown spots of different dimensions, beset witli 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 pHant, as that of the
head, and, particularly remarkable in this case, the skin
from which it grew was as fine and white as the integument
of the rest of the body. There was a woman exhibited
recently, under the advertisement of " the lady with a mane,"
who had growing from the center of her back between the
shoulders a veritable mane of long, black hair, which
doubtless proceeded from a form of nsevus (Fig. 86).

Duyse ^ reports a case of extensive hypertrichosis of the
back in a girl aged nine years ; her teeth were normal ; there
was pigmentation of the back and numerous pigmentary nevi
on the face. Below each scapula there were tumors of the
nature of fibroma molluscum. In addition to hairy nevi
on the other parts of the body there was localized ichthyosis.

Ziemssen figures an interesting case of nsevus pilosus
resembling "bathing tights" (Fig. 87). There were also
present several benign tumors (fibroma 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 nsevus spread-
ing over the upper parts of the thighs and lower parts of the
trunk, like bathing-tights, and resembling the pelt of an
animal. The same was true of the small hairy parts and
the larger and smaller tumors. Subsequently the altered portions of the skin
had gradually become somewhat larger. The skin of the large hairy 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 nsevus
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
a 162, T. xxvi., 274. ^ La Flandre Mfed., Oct. 4, 1894.

Fig. 87.— Large nse-
vus pilosus resembling
" bathing-tights."

234

MINOR TERATA.

dermatolytic growths.^ A sister of the Peruvian boy referred to had a still
larger growth, extending from the nucha all over the back. Both she and
her brother had hundreds of smaller hairy growths of all sizes scattered
irregularly over the flice, trunk, and limbs. According to Crocker, a still
more extraordinary case, with extensive dermatolytic growths all over the
back and nevi of all sizes elsewhere, is described and engraved in " Lavater's
Physiognomy," 1848. Baker ^ describes an operation in which a large mole
occupying half the forehead was removed by the knife.

In some instances the hair and beard is of an enormous length,

Erasmus Wilson of Lon-
don saw a female of thirty-
eiglit, whose hair measured
1.65 meters long. Leonard
of Philadelphia speaks of a
man in the interior of this
country whose beard trailed
on the ground when he stood
upright, and measured 2.24
meters long. Not long ago
there appeared the famous
so-called " Seven Suther-
land Sisters," whose hair
touched the ground, and
with whom nearly every one
is familiar through a hair
tonic which they extensive-
ly advertised. In Nature,
January 9, 1892, is an ac-
count of a Percheron horse
whose mane measured 13
feet and whose tail meas-
ured almost ten feet, prob-
ably the greatest example of
excessive mane development
on record. Figure 88 represents Miss Owens, an exhibitionist, whose hair
measured eight feet three inches. In Leslie's Weekly, January 2, 1896, there
is a portrait of an old negress named Nancy Garrison whose woolly hair was
equally as long.

The Ephemeridcs contains the account of a woman who had hair from
the mons veneris which hung to the knees ; it was affected with plica polo-
nica, as was also the other hair of the body.

Rayer saw a Picdmontese of twenty-eight, with an athletic build, who had
a 445, iii., 93. b 550, Lsi. c id, dec. 2, an. vi., 1688.

Fig. 88.— Example of excessive growth of hair.

ANOMALIES OF THE COLOR OF THE HAIR.

235

but littlo beanl or hair on the trunk, but whose scalp was covered w,tl a
most extraordinary crop. It was extremely fine and sdky, was art.hcally
fri..led, dark brown in color, and formed a mass nearly hve feet i„ e.rcum-

'Telin 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. Kayer 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 ot
twenty-four, having white skin and hair of deep black, who after a long il -
ness occasioned by an aff-ection analogous to marasmus became covered,
especially on the back, breast, and abdomen, with a multitude of small eleva-
tions similar to those which appear on exposure to cold. These 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 accord-
ing to Rayer, paroxysms of rage, unexpected and unwelcome news, diseases
of the scalp such as favus, wounds of the head, habitual headache, over-
indulgence of the sexual appetite, mercurial courses too frequently repeated,
too great anxiety, etc., have been known to blanch the hair prematurely.

The well-accepted fiict 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 J

a 564, iii., 515.

MINOR TERATA.

inches in lengtli. Her hair soon became striped, and in seven years was
totally white. The same article speaks of a girl in Bedfordshire, Maria
beeley, 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 I.ondon, but no cause could be established.

Voigtel mentions the occurrence of canities almost suddenly. Bichat had
a personal acquaintance whose hair became almost entirely gray in conse-
quence of some distressing news that reached him. Cassan records a
smiilar case. According to Rayer, a woman by the name of Perat sum-
moned before the Chamber of Peers to give evidence in the trial of the
assassin Louvel, was so much affected that her hair became entirely white in
a smgle night. Byron makes mention of this peculiar anomaly in the open-
ing stanzas of the " Prisoner of Chillon :

" My hair is gray, but not with years,
Nor grew it white
In a single night,
As men's have grown from sudden fears."

The commentators say that Byron had reference to Ludovico Sforza and
others. The fact of the change is asserted of Marie Antoinette, the wife of
Louis Xy I., though in not quite so short a period, grief and not fear being the
cause. Ziemssen cites Landois' case of a compositor of thirty-four who was
admitted to a hospital July 9th with symptoms of delirium tremens; until
improvement began to set in (July 13th) he was continually tormented by
terrifying pictures of the imagination. In the night preceding the day last
mentioned the hair of the head and beard of the patient, formerly blond,
became gray. Accurate examination by Landois showed the pigment con-
tents of the hair to be unchanged, and led him to believe that the white color
was solely due to the excessive development of air-bubbles in the hair shaft.
Popular belief brings the premature and especially the sudden whitening
into connection with depressing mental emotions. We might quote the
German expression— " Sich graue Haare etwas wachsen lassen" (''To worry
one's self gray "). Brown-Sequard observed on several occasions in his
own dark beard hairs which had turned white in a night and which he
epilated. He closes his brief communication on the subject with the belief
that it is quite possible for black hair to turn white in one night or even in a
less time, although Hebra and Kaposi discredit sudden canities (Duhring).
Raymond and Vulpian ^ observed a lady of neurotic type whose hair during
a severe paroxysm of neuralgia following a mental strain changed color in
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

a 162, Jan, 1827. b 476, Oct. 14, 1882.

SUDDEN CHANGING OF THE COLOR OF THE HAIR

237

all the red hair became white and a quantity fell off. flje patient recovered
her general health, bnt with almost total loss of hair, only a few red white
and black hairs remaining on the occipiUil and tempora regions. Crocker
cites the case of a Spanish cock which was nearly ki led 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 visi s,
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 ot
sudden canities, several of which will be given :—

"In the Canada Journal of Medical Science, 1882, p. 113, is reported a
case of sudden canities due to business-worry. The microscope showed a
great many air-vesicles both in the medullary substance and between the
medullary and cortical substance.

" In the Boston Medical and Surgical Journal, 1851, is reported a case of
a man thirty years old, whose hair 'was scared' white in a day by a grizzly
bear. He was sick in a mining camp, was left alone, and fell asleep. On
waking he found a grizzly bear standing over him.

" A second case is that of a man of twenty-three years who was gambling
in California. He placed his entire savings of $1100 on the turn of a card;
He was under tremendous nervous excitement while the cards were being
dealt. The next day his hair was perfectly white.

" In the same article is the statement that the jet-black hair of the Pacific
Islanders does not turn gray gradually, but when it does turn it is sudden,
usually the result of fright or sudden emotions."

D'Alben, quoted by Fournier,<= describes a young man of twenty-four, an
officer in the regiment of Touraine in 1781, who spent the night in carnal
dissipation with a mulatto, after which he had violent spasms, rendering flex-
ion of the body impossible. His beard and hair on the right side of the body
was found as white as snow, the left side being unchanged. He appeared be-
fore the Faculty de Montpelier, and tliough 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
a Phihi. Med. Museum, iii., 219. b 476, 1853, i., 556. c 302, iv., 176.

238

MINOR TERATA.

wife, whom he had put to death on a suspicion of her infidelity, had a change
ot color in his hair, which became white almost immediately. Vauvilliers,
the celebrated Hellenist, became white-haired almost immediately after a terri-
ble dream, and Brizard, the comedian, experienced the same change after a
narrow escape from drowning in the Rhone. The beard and the hair of the
Duke of Brunswick whitened in twenty-four hours after hearing that his
father had been mortally wounded at the battle of Auerstadt.

De Schweinitz - speaks of a well-formed and healthy brunette of eighteen
in whom the middle portion of the cilia of the right upper eyelid and a number
of the hairs of the lower lid turned white in a week. Both eyes were myopic,
but no other cause could be assigned. Another similar case is cited by Hirsh-
berg, b 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 ciha 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 decolor-
ization of the eyebrows and lashes in neuralgias of isolated branches of the
trigeminus, especially of the supraorbital nerve.

Temporary and Partial Canities.— Of special interest are those cases in
which whiteness of the hair is only temporary. Thus, Compagne mentions a
case in Avhich 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 tem-
ple, and several like cases are on record. Lorry tells us that grayness of one
side only is sometimes occasioned by severe headache. Hagcdorn 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,
a 792, May, 1889. b 262, 1888.

ANOMALOUS COLOR CHANGES OF THE HAIR.

239

The whitening extended from the roots to a distance of two inches The prob-
able cause was a temporary alteration of the pigment-fornung function. When
the chlorosis was cured the natural color returned. Paulhm and Riedhn, 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 c>f
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 ot
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 hssured
at the points. Soon after bunches of
white hair appeared on the occiput, and
in the succeeding years small patches
of decolored hairs were observed also
on the anterior and lateral portions of
the scalp. In the spring of 1880 the
patient exhibited signs of infiltration of
the apex of the right lung, and afterward
a violent headache came on. At the time
of the report the patient presented the ap-
pearance shown in Figure 89. The com-
plexion was delicate throughout, the eye-
lashes and eyelids dark brown, the mous-
tache and whiskers blond, and in the
latter were a few groups of white hair.
The white patches were chiefly on the left
side of the head. The liairs growing on
them were un pigmented, 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,

Fig. 89.— Mottled hair (Michelson).

240

MINOR TERATA.

been replaced by hair of the same color as the individual had in youth. We
are even assured by Bruley that in 1798 the white hair of a woman sixty
years of age changed to black a few days before her death. The bulbs in
this case were found of great size, and appeared gorged with a substance from
which the hair derived its color. The white hairs that remained, on the con-
trary, grew from shriveled bulbs much smaller than those producing the
black. This patient died of phthisis.'^

A very singular case, published early in the century, was that of a woman
whose hair, naturally fair, assumed a tawny red color as often as she was
affected with a certain fever, and returned to its natural hue as soon as the
symptoms abated.*^ 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

a 458, T. i v., 290. l> 454, T. v., 59.

ANOMALIES OF THE NAILS.

241

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 Ephernerides
speaks of baldness from fright ; and Leo Africanus, in liis description of
Barbary, describes endemic baldness. Neyronis'^ makes the following ob-
servation : A man of seventy-three, convalescent from a fever, one morning,
about six months after recovery perceived that he had lost all his hair, even
his eyelashes, eyebrows, nostril-hairs, etc. Although his health continued
good, the hair was never renewed.

The principal anomalies of the nails observed are absence, hyper-
trophy, and displacement of these organs. Some persons are born with
finger-nails and toe-nails either very rudimentary or entirely absent ; in
others they are of great length and thickness. The Chinese nobility allow
their finger-nails to grow to a
great length and spend much
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 ani-
mals. There is a description of
a person with finger-nails that
resembled the horns of a g^oat. ^

, ^ Fig. 90.— Deformed toe-nails.

JNeuhot, in his books on Tartary

and China, says that many Chinamen have two nails on the little toe, and
other instances of double nails have been reported.

The nails may be reversed or arise from anomalous positions. Bartho-
linus ^ speaks of nails from the inner side of the digits ; in another case, in
which the fingers were wanting, he found the nails implanted on the stumps.
Tulpius says he knew of a case in which nails came from the articulations of
three digits ; and many other curious arrangements of nails are to be found.

Rouhuot sent a description and drawing of some monstrous nails to the
Academic des Sciences de Paris (Fig. 90). The hirgest of these was the left
great toe-nail, which, from its extremity to its root, measured 4| inches ; the
laminae of which it consisted were placed one over the other, like the tiles on a
roof, only reversed. This nail and several of the others were of unequal
thickness and were variously curved, probably on account of the pressure
of the shoe or the neighboring digits. Rayer mentions two nails sent to
him by Bricheteau, physician of the Hopital Necker, belonging to an old

a Diss, calvites, Paris, 1662. b 3O6, L. i., cap. i. p 15

0 463 v.. 73. d282, Nov., 1734, 173. e 190. cent, ii., hist. 44. '

16

242

MINOR TERATA.

woman who had lived in the Salpetriere. Tliey were very thick and spirally
twisted, like the horns of a ram. Saviard informs us that he saw a patient
at the Hotel Dieu wlio had a horn like that of a ram, instead of a nail, on
each great toe, the extremities of which were turned to the metatarsus and
overlapped the whole of the other toes of each foot. The skeleton of Simore,
preserved in Paris, is remarkable for the ankylosis of all the articulations
and the considerable size of all the nails. The fingers and toes, spread out
and ankylosed, ended in nails of great length and nearly of equal thickness.
A woman by the name of Melin, living in the last century in Paris, was
surnamed " the woman with nails ; " according to the description given by
Saillant in 1776 she presented another and not less curious instance of the
excessive growth of the nails.

Musaeus * gives an account of the nails of a girl of twenty, which grew to
such a size that some of those of the fingers were five inches in length. They
were composed of several layers, whitish interiorly, reddish-gray on the ex-
terior, and full of black points. These nails fell off at the end of four months
and were succeeded by others. There were also horny laminae on the
knees and shoulders and elbows which bore a resemblance to nails, or rather
talons. They were sensitive only at the point of insertion into the skin.
Various other parts of the body, particularly the backs of the hands, pre-
sented these horny productions. One of them was four inches in length. This
horny growth appeared after small-pox. Ash, in the Philosophical Trans-
actions, records a somewhat similar case in a girl of twelve.

Anomalies of the Teeth. — Pliny, Colombus, van Swieten, Haller, Mar-
cellus Donatus, Baudelocque, Soemmering, and Gardien all cite instances in
which children have come into the world with several teeth already erupted.
Haller has collected 19 cases of children born with teeth. Polydorus
Viririlus describes an infant who was born with six teeth. Some celebrated
men are supposed to have been born with teeth ; Louis XIV. was accredited
with having two teeth at birth. Bigot, a physician and philosopher of the six-
teenth century ; Boyd, the poet ; Valerian, 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 Academic de M^decine de Paris. One of the
subjects had two middle incisors in the lower jaw and the other had one tooth
well through. Levison ^ saw a female born with two central incisors in the
lower jaw.

Thomas " mentions a case of antenatal development of nine teeth. Puech,
Mattel, Dumas, Belluzi, and others report the eruption of teeth in the new-
born. In Dumas' case the teeth had to be extracted on account of ulceration
of the tongue.

a Diss, de unguibus monstrosis, Hafnise, 1716. b 476, 1846, ii., 699. c 125, vii., 501.

EDENTUL 0 USNESS.

243

Instances of triple dentition late in life are quite numerous, many occur-
ring after a hundred years. Mcntzelius speaks of a man of one hundred and
ten who had nine new teeth. Lord Bacon cites the case of a Countess Desmond,
who when over a century old had two new teeth ; Hufeland saw an instance of
dentition at one hundred and sixteen ; Nitzsch speaks of one at one hundred,
and the Ephemerides contain an account of a triple dentition at one hundred
and twenty. There is an account of a country laborer who lost all his teeth
by the time he arrived at his sixtieth year of age, but about a half year after-
ward a new set made their appearance. Bisset ^ mentions an account of an
old woman who acquired twelve molar teeth at the age of ninety-eight. Carre
notes a case of dental eruption in an individual of eighty-five. Mazzoti
speaks of a third dentition, and Ysabeau ^ writes of dentition of a molar at
the age of ninety-two. There is a record of a physician of the name of Slave
who retained all his second teeth until the age of eighty, when they fell out ;
after five years another set appeared, which he retained until his death at one
hundred. In the same report® there is mentioned an old Scotchman who
died at one hundred and ten, whose teeth were renewed at an advanced age
after he had lost his second teeth. One of the older journals gpg^ks 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 8 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 P^trequin have observed similar cases. Carter ^ describes an ex-
ample of third dentition. LisonJ makes a curious observation of a sixth
dentition.

Edentulousness. — We have already noticed the association of congenital
alopecia witli edentulousness, but, strange to say, Magitot has remarked tliat
" I'homme-chien," was the subject of defective dentition. Borellus found
atropliy of all the dental follicles in a woman of sixty who never had pos-
sessed any teeth. Fanton-Touvet saw a boy of nine who had never had teeth,
and Fox a woman who had but four in both jaws ; Tomes cites several similar
instances. Hutchinson'^ speaks of a child who was perfectly edentulous as
to temporary teeth, but who had the permanent teeth duly and fully erupted.
Guilford' describes a man of forty-eight, who was edentulous from birth^
who also totally lacked the sense of smell, and was almost without the sense

a 534, 1784, iii., 105.
d460, XXXV., 316 (1766).
g 368, 1860.
J 235, xiii., 190.

^524, Lond., 1787, viii., 370.

e 302, vol. iv.

^ 363, Oct. 9, 1875.

1^476, 1883, i., 894.

c 368, 1860, XV., 585.
f 524, 787.
1 133, 1876.
1 296, 1883.

244

MINOR TERATA.

of taste ; the surface of his body was covered with fine hairs and he had
never had visible perspiration. This is probably the same case quoted in the
foregoing paragraph in regard to the anomalies of hair. Otto, quoted by
Sedgwick, speaks of two brothers who were both totally edentulous. It
niip-ht be interestinjz; 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. Girald^s
mentions the absence of teeth in an infant of sixteen months. Bronzet
describes a child of twelve, with only half its teeth, in whom the alveolar
borders receded as in age. Baumes remarks that he had seen a man who
never had any teeth.

The anomalies of excessive dentition are of several varieties, those of
simple supernumerary teeth, double or triple rows, and those in anomalous
positions. Ibbetson saw a child with five incisors in the inferior maxillary
bone, and Fanton-Touvet describes a young lady who possessed five large in-
cisors of the first dentition in the superior maxilla. 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 Soem-
mering has seen one molar too many on each side and in each jaw. Ploucquet
and Tesmer have seen five incisors and Fanchard six. Many persons have
the supernumerary teeth parallel with their neighbors, anteriorly or posteriorly.
Costa ^ reports a case in which there were five canine teeth in the upper jaw,
two placed laterally on either side, and one on the right side behind the other
two. The patient was twenty-six years of age, well formed and in good health.

In some cases there is fusion of the teeth. Pliny, Bartholinus, and
Melanthon pretend to have seen the union of all the teeth, making a continu-
ous mass. In the " Mus^e de I'ficole dentaire de Paris " there are several
milk-teeth, both of the superior and inferior maxilla, which are fused together.
Bloch cites a case in which there were two rows of teeth in the superior
maxilla. Hellwig ^^'^ has observed three rows of teeth, and the Ephemerides
contain an account of a similar anomaly.

Extraoral Dentition. — Probably the most curious anomaly of teeth is
that in which thev 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. Hcister in 1743 wrote a dissertation on extraoral teeth.
The following is a recent quotation —

"In the Norsk Magazin fiir Lsegevidenskabcn, January, 1<S95, it is
reported that Dr. Dave, at a meeting of the Medical Society in Christiania,
showed a tooth removed from the nose of a woman aged fifty-three. The
patient had consulted him for ear-trouble, and the tooth was found acci-
dentally during the routine examination. It was easily removed, having

a 302, viii., 411. ^ 358, March, 1895. c 224, 1895, ii., 512.

EXTRA ORAL DENTITION.

246

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 suggest^^d
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 — sl 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 connnunicated
with the nastil fossa by a fracture of the palatine and maxillary bones ; the
employment of an obturator was necessary. It is not rare to see teeth,
generally canine, make their eruption from the vault of the palate ; and
these teeth are not generally supernumerary, but examples of vice and devia-
tion of position. Fanton-Touvet, however, gives an example of a super-
numerary tooth implanted in the palatine arch. Branch ^ describes a little
negro boy who had two large teeth in the nose ; his dentition was otherwise
normal, but a portion of the nose was destroyed by ulceration. Roy ^
describes a Hindoo lad of fourteen who had a tooth in the nose, supposed to
have been a tumor. It was of the canine type, and was covered with enamel
to the junction with the root, which was deeply imbedded in the side and upper
part of the antrum. The boy had a perfect set of permanent teeth and no
deformity, swelling, or cystic formation of the jaw. This was clearly a case
of 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 w^as canine it had a somewhat bulbulous fang.

Of anomalies of the head the first to be considered will be the anen-
cephalous monsters who, strange to say, have been known to survive birth.
Clericus ® cites an example of life for five days in a child without a cere-

a 548, 1884, i., 425.
d476, 1887, ii., 763.

l>476, 1883, ii., 772.

c 476, 1883, ii., 862.
e 215, 1781.

246

MINOR TERATA.

brum. Heysham ^ records the birth of a child without a cerebrum and re-
marks that it was kept alive for six days. There was a child born alive in Italy
in 1831 without a brain or a cerebellum — in fact, no cranial cavity — and yet
it lived eleven hours.^* A somewhat similar case is recorded in the last cen-
tury, ^os Yi\ the Philosophical Transactions^ there is mentioned a child
virtually born without a head who lived four days ; and Le Due records a
case of a child born without brain, cerebellum, or medulla oblongata, and
who lived half an hour. Brunet^ describes an anencephalous boy born at
term who survived his birth. Saviard delivered an anencephalous child at
term which died in thirty-six hours. Lawrence mentions a child with brain
and cranium deficient that lived five days. Putnam ^ speaks of a female
nosencephalous monster that lived twenty-nine hours. Angell and Eisner in
March, 1895,230 reported a case of anencephaly, or rather pseudencephaly,
associated with double divergent strabismus and limbs in a state of constant
spastic contraction. The infant hved eight days. Geoffroy-Saint-Hilaire
cites an example of anencephaly which lived a quarter of an hour. Fauvel
mentioned one tliat lived two hours, and Sue describes a similar instance in
which life persisted for seven hours and distinct motions were noticed. Mala-
carne saw life in one for twelve hours, and 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 cere-
bellum. They lacked power of coordination and walked with a drunken,
staggering gait ; they could not touch the nose with the finger when their
eyes were shut, etc. The parents of these unfortunate persons were perfectly
healthy, as were the rest of their family. Cruveilhier cites a case of a girl of
eleven who had absolutely no cerebellum, with the same symptoms which are
characteristic in such cases. There is also recorded the history of a man ^
who was deficient in the corpus callosum ; at the age of sixty-two, though of
feeble 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. *

WardJ mentions an instance of congenital absence of the corpora callo-

a 524, iii., 250. b 475, 1832-3, i., 570. c 629, 1700, 23. d Progrfes de la Med., 1698.

e 550, 1814. f Archiv. Scientif. and Prac. M. & S., 1873, 342.

g 381, 1880, 199. h 212, 158. i 827, Oct., 1843. J 490, 1846, li., 575.

MICROCEPHALY.

247

Slim

Paget « and Henry mention cases in which the corpora callosum, the
fornix, and septum hicidum were imperfectly formed. Maiinoiri' reports con-
genital malformation of the brain, consisting of almost complete absence of
the occipital lobe. The patient died at the twenty-eighth month. Combettes «
reports the case of a girl who died at the age of eleven who had complete
absence of the cerebellum in addition to other minor structural defects ; this
was probably the case mentioned by Cruveilhier.*^

Diminution in volume of the head is called microcephaly. Probably
the most remarkable case on record is that mentioned by Lombroso. The

Fig. 91. — Microcephalic "Aztec man."

individual was called " I'homme-oiseau," or the human bird, and his cranial
capacity was only 390 c. c, Lombroso speaks of another individual

a 550, xxix., 55. ^ 242, 1876, i., 163. c 242, 1830, v., 148.

d The argument that the brain is not the sole organ of the mind is in a ineasure sub-
stantiated by a wonderful case of a decapitated rooster, repqrted from Michigan. ^ A stroke
of the knife had severed the larynx and removed the whole mass of the cerebrum, leaving
the inner aspect and base of the skull exposed. The cerebrum was partly removed ; the
external auditory meatus was preserved. Immediately after the decapitation the rooster was
left to its supposed death struggles, but it ran headless to the barn, where it was secured and
subsequently fed by pushing corn down its esophagus, and allowing water to trickle into this
tube from the spout of an oil-can. The phenomena exhibited by the rooster were quite
interesting. It made all the motions of pecking, strutted about, flapped its wings, attempted
to crow, but, of course, without making any sound. It exhibited no signs of incoordination,
but did not seem to hear. A ludicrous exhibition was the absurd, sidelong pas seul made
toward the hens.

»632, 1880, ii., 5.

248

MINOR TEE ATA.

called " Fhomme-lapin/' or man-rabbit, whose cranium was only sliglitly
larger than that of the other, measuring 490 mm. in circumference. Castelli
alludes to endemic microcephaly among some of the peoples of Asia. We
also find it in the Caribbean Islands, and from the skulls and portraits of the
ancient Aztecs we are led to believe that they were also microcephalic.

Two creatures of celebrity were Maximo and Bartola, who for twenty-
five years have been shown in America and in Europe under the name of the
"Aztecs" or the "Aztec children" (Fig. 91). They were male and
female and very short, with heads resembling closely the bas-reliefs on the

ancient Aztec temples of Mexico. Their
facial angle was about 45°, and they had
jutting lips and little or no chin. They
wore their hair in an enormous bunch to
magnify the deformity. These curiosities
were born in Central America and were
possibly half Indian and Negro. They
were little better than idiots in point of
intelligence.

Figure 92 represents a microcephalic
youth known as the " Mexican wild boy,"
who was shown with the Wallace circus.

Virchow exhibited a girl of four-
teen whose face was no larger than that
of a new-born child, and whose head
was scarcely as large as a man's fist.
Magitot reported a case of a micro-
cephalic woman of thirty who weighed
70 pounds.

Hippocrates and Strabonius both
speak of head-binding as a custom in-
ducing artificial microcephaly, and
some tribes of North American Indians
still retain this custom.

As a rule, microcephaly is attended
with associate idiocy and arrested development of the rest of the body.
Ossification of the fontanelles in a mature infant would necessarily prevent
full development of the brain. Osiander and others have noticed this
anomaly. There are cases on record in which the fontanelles have remained
open until adulthood.

Augmentation of the volume of the head is called macrocephaly, and
there are a number of curious examples related. Benvenuti describes
an individual, otherwise well formed, whose head began to enlarge at

a Quoted 538, 1884, 522.

Fig. 92.— Microcephalic boy.

MACROCEPHALY.

249

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.'^

Fournieri' 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 1G16.
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, 21^ inches ; from the
chin over the cranial summit to the suboccipital protuberance, 37^ 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| inches in head-circumference.

The largest healthy brains on record, that is, of men of prominence,
are those of Cuvier, weighing 64|^ ounces ; ^' of Daniel Webster, weighing 63|
ounces (the circumference of whose head was 23 f inches) ; ® of Abercrombie,
weighing 63 ounces, and of Spurzhcim, weighing 55yi^ 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.

a Actes de la soci6te imp6r. des curieux de la nature, torn. viii. b 302 iv. 142.

c 593, 1856, xiii., 778. d 678, Dec, 1883. e 124, 1853, 110. f 242, 1846, xxi., 144.

250

MINOR TERATA.

In this condition there is nsnally no change in the size of the brain-structure

itself, but often the cranial
bones are rent far asunder.
Minot speaks of a hydro-
cephalic infant whose head
measured 27^ inches in cir-
cinnference ; Bright describes
one whose head measured 32
inches; and Klein, one 43
inches. Figure 93 represents
a child of six whose head cir-
cumference was 36 inches.
Figure 94 shows a hydro-
cephalic adult who was ex-
hibited through this country.

There is a record * of a
curious monster born of healthy
half-caste African parents.

Fig. 93.-Hydrocephaiic child. ^hc deformity was causcd by

a deficiency of osseous ma-
terial of the bones of the head. There was considerable arrest of develop-

Fig. 94.— Hydrocephaly in an adult.

ment of the parietal, temporal, and superior maxillary bones, in consequence
of which a very small amount of the cerebral substance could be protected by

a 778, 1868, ix., 31.

AN03IALIES OF THE INFERIOR MAXILLA.

251

the membranous expansion of the cranial centers. The inferior maxilhi and
the frontal bone were both perfect ; the ears were well developed and the
tongue strong and active ; the nos-
trils were imperforate and there
was no roof to the mouth nor floor
to the nares. The eyes were curi-
ously free from eyelashes, eyelids,
or brows. The cornea threatened
to slough. There was double; hare-
lip on the left side ; the second and
third fingers of both hands were
webbed for their whole length ; the
right foot wanted the distal phalanx
of the great toe and the left foot
was clubbed and drawn inward.
The child swallowed when fed from
a spoon, appeared to hear, but ex-
hibited no sense of light. It died
shortly after the accompanying
sketch (Fig. 95) was made.

Occasionally a deficiency in the
osseous material of the cranium or
an abnormal dilatation of the fon-
tanelles gives rise to a hernia of ^

the meninges, which, if accompanied by cerebrospinal fluid in any quantity,
causes a large and peculiarly shaped tumor called meningocele (Fig. 96).
If there is a protrusion of brain-substance itself, a condition known as hernia

cerebri results.

Complete absence of the inferior maxilla is
much rarer in man than in animals. Nicolas and
Prenant have described a curious case of this anomaly
in a sheep. Gurlt has named subjects presenting the
total or partial absence of the inferior maxilla, agna-
thes or hemiagnathes. Simple atrophy of the inferior
maxilla has been seen in man as well as in the lower
animals, but is much less frequent than atrophy of the
superior maxilla. Langenbeck reports the case of a
young man who had the inferior maxilla so atrophied
that in infancy it wa& impossible for him to take milk
from the breast. He had also almost complete im-
mobility of the jaws. Boullard* reports a deformity of the visage, resulting

Fig. 95.— Monster from deficiency of the bones of the
head.

Fig. 96.— Meningocele.

in a deficiency of the condyles of the lower jaw.

a 242, 1849, xxiv., 281.

Maurice'' made an observa-
^ 146, 1861, i., 696.

252

MINOR TERATA.

tion on a vice of conformation of the lower jaw which rendered lactation
mii)ossible, probably cansing 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 ranuis 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 Nortli 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 api^en-

dix, there was a plane surface perforated by two
small openings a little less than one mm. in diam-
eter and three mm. apart.

Exaggeration in volume of the nose is quite
frequent. Ballonius speaks of a nose six times
larger than ordinary. Viewing the Roman celebri-
ties, we find that Numa, to whom was given the
surname Porapilius, had a nose which measured six
inches. Plutarch, Lycurgus, 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 Wed-
ders (or Wadhouse), with a nose 7i inches long, was
exhibited throughout Yorkshire. This man expired
Fig. 97.-Thomas Wedders. as he had lived, in a condition of mind best de-
scribed as the most abject idiocy. The accompany-
ing illustration (Fig. 97) is taken from a reproduction of an old print and is
supposed to be a true likeness of this unfortunate individual.

There are curious pathologic formations about the nose which increase its
volume so enormously as to interfere with respiration and even with alimen-
tation ; but these will be spoken of in another chapter.

There have been some celebrities whose noses were undersized. The Due
de Guise, the Dauphin d'Auvergne, and William of Orange, celebrated in the
romances of chivalry, had extremely short noses.

There are a few recorded cases of congenital division of the nose.
Bartholinus,^ Borellus, and the Ephemerides speak of duplex noses. Thomas
of Tours has observed congenital fissure of the nose. Hiker*' reports the
case of an infant of three weeks who possessed a supernumerary nose on the
right nasal bone near the inner canthus of the eye. It was pear-shaped, with

a 779, xii., 237. b 190, ceut. i., hist. xxv. c 176, 1878, 196.

ANOMALIES OF THE MOUTH.

253

its base down, and was the size of the natural nose of an infant of that age,
and air passed through it. Hubbell, Ronaldson,'^ and Luscha speak of con-
genital occlusion of the posterior nares. Smith ^ and Jarvis^ record
cases of congenital occlusion of the anterior nares.

Anomalies in size of the mouth are not uncommon. Fourmer 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 aboy of seventeen ^ who had
a preternaturally-sized mouth, the transverse diameter being 61 inches, ine
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 arge
mouths and thick lips. A negro called " Black Diamond," recently exhibited
in Philadelphia, could put both his fists in his mouth.

Morgan « reports two cases of congenital macrostoma accompanied by

Fig. 98.— Macrostoma by ascending
lateral fissure.

Fig. 99.— Macrostoma by lateral
fissures.

malformation of the auricles and by auricular appendages. Van Duyse^
mentions congenital macrostoma with preauricular tumors and a dermoid of
the eye. Macrostoma is sometimes produced by lateral fissures (Fig. 99).
In other cases this malformation is unilateral and the fissure ascends (Fig.
98), in which instance the fissure may be accompanied by a fistula of the duct
of Stensen. Sometimes there is associated with these anomalies curious termi-
nations of the salivary ducts, either through the cheek by means of a fistula
or on the anterior part of the neck.

Microstoma. — There are a few cases on record in which the mouth has
been so small or ill-defined as not to admit of alimentation. 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,

a 318, 1880, xxvi., 1035. b 543, 1863, i., 320. c 597, xlvi., 536. <i 206, vol. iv., part iii.
e 548, 1881, ii., 613. <" Ann. Soc. de m6d. de Gand., 1882, 141. g 105, 1730, ii., 210.

254

MINOR TERATA.

Smith,'-^ Sourrouille,'^ and Stankiewicz of Warsaw discuss atresia of the
mouth. Cancrum oris, scarlet fever, burns, scurvy, etc., are occasional
causes that have been mentioned, the atresia in these instances taking place
at any time of life.

Anomalies of the Lips.— The aboriginal tribes are particularly noted
for their large and thick lips, some of which people consider enormous lips
signs of adornment. Elephantiasis or other pathologic hypertrophy of the
labial tissues can produce revolting deformity, such, as is seen in Figure 100,
representing an individual who was exhibited several years ago in Philadel-
phia, y^e have in English the expression, " pulling a long lip." Its origin
is said to date back to a semimythical hero of King Arthur's time, who,
" when sad at heart and melancholic," would let one of his lips drop below
his.waist, while he turned the other up like a cap on his head.

Blot« records a case of monstrous congenital hypertrophy of the superior

lip in an infant of eight months. Buck ^
successfully treated by surgical operations
a case of congenital hypertrophy of the
under lip, and Detmold ^ mentions a similar
result in a young lady with hypertrophy
of the lip and lower part of the nose.
Murray ^ reports an undescribed malforma-
tion of the lower lip occurring in one family.
Weiss has reported cases of exstrophy of the
lips.

Hare-lip may be unilateral or double,
and may or may not include the palatine
arch. In the worst cases it extends in
fissures on both sides to the orbit (Fig.

101) . In other cases the minimum degree of this deformity is seen (Yioi

102) . ' ^ ^*

Congenital absence of the tongue does not necessarilv 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 Nvithout a tongue who spoke, sang, and swallowed normally. Aur-
ran, Bartholinus, Louis, Parsons, Tulpius, and others mention speech with-
out the presence of a tongue.

a 476, 1876, i., 13. b 363, ]vi., 707. c Bull. Soc. de chir. de Par., 1873 ii 332
d 773, 1882, 171. e 594, 1844, iii., 38. f 222, 1860, xxvi.'' 502

g 107, vol. viii.. 185. h629, 1732-44, ix., 126. i 460, 1764 xx 3^8

Fig. 100.— Elephantiasis of tlie face, witla
hypertrophy of the upper lip.

ANOMALIES OF THE TONGUE.

255

Philib ^ reports a case in which mutism, almost simiihvting that of one con-
genitally deaf, was due to congenital adhesions of the tongue to the floor
of the buccal cavity. Speech was established after removal of the abnormal
adhesion. Routier speaks of ankylosis of the tongue of seventeen years

duration. .

Jurist b 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 Bancroft, in his journal, writ-
ten in the seventeenth century, says that he was born with two tongues and

Fig. 101.— Double hare-lip.

Fig. 102.— Slight hare-lip, with fissure of the
lower eyelid (Kraske).

passed through life so, one, however, gradually atrophying. In the poly-
clinic of Schuitzer in Vienna in 1892 Hajek observed in a lad of twelve an
accessory tongue 2.4 cm. in length and eight mm. in breadth, forming a tumor
at the base of the normal tongue. It was removed by scissors, and on histo-
logic examination proved to be a true tongue with the typical tissues and
constituents. Borellus, Ephemerides, Eschenbach, Mortimer,'' Penada, and
Schenck speak of double tongues, and Avicenna and Schenck have seen fis-
sured tongues. Dolaeus records an instance of double tongue in a paper
entitled " De puella bilingui," and Beaudry and Brothers ^ speak of cleft

a 454, 1829, xxxiii., 2()5.
c 629, 486.

d280, 1755, iii., 411.

b 538, xxviii., 539.
e 538, xxxiii., 109.

256

MINOR TERATA.

tongue. Braine " records a case in which there was a large hypertrophied
fold of membrane coming from each side of the upper lip.

In some cases there is marked augmentation of the volume of the
tongue. Fournier^' has seen a juggler with a tongue so long that he could
extrude it six inches from his mouth. He also refers to a woman in Berlin
with a long tongue, but it was thinner than that of a cat. When she laughed
it hung over lier teeth like a curtain, and was always extremely cold to the
touch. In the same article there is a description of a man with a very long
neck who could touch his tongue to his chest without reclining his head.
Congenital and acquired hypertrophy of the tongue will be discussed later.

Amatus Lusitanus « and Portal refer to the presence of hair on the
tongue, and later there was an account of a medical student « who com-
plained of dyspepsia and a sticky sensation in the mouth. On examination a
considerable growth of hair was found on the surface of the tongue. The
hairs would be detached in vomiting but would grow again, and when he
was last seen they were one inch long. Such are possibly nevoid in formation.

The ordinary anomalies of the palate are the fissures, unilateral, bilat-
eral, median, etc. : they are generally associated with hare-lip. The median
fissure commencing between the middle incisors is quite rare.

Many curious forms of obturator or artificial palate are employed to
remedy congenital defects. Sercombe ^ mentions a case in which destruction
of the entire palate was successfully relieved by mechanical means. In some
instances among the lower classes these obturators are simple pieces of wood,
so fashioned as to fit into the palatine cleft, and not infrequently the obturator
has been swallowed, causing obstruction of the air-passages or occluding the
esophagus.

Abnormalism of the Uvula.— Examples of double uvula are found in
the older writers, and Hagendorn speaks of a man who was born without a
uvula. The Ephemerides and Salmuth describe uvuIeb so defective as to be
hardly noticeable. Bolster, Delius, Hodges, Mackenzie of Baltimore, Orr,
Riedel, Schufeldt, and Tidy man are among observers reporting bifurcated
and double uvula, and they are quite common. Ogle s 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 with-
out interference with deglutition.^ Manifold ' speaks of a case of bifur-
cated epiglottis. Debloisj records an instance of congenital web of the

a Proc. M. Soc. Lond., 1874-5, ii., 21. b 302, iv., 149.

c 119, cent, vi., cur. 65. <i 639, iv., 507. e 611, Aug. 13, 1842.

f 550, xxxix., 91. g 548, 1865, ii., 414. h 230,' 1864, iv.', 353.

i 476, 1851, i., 10. j 597^ xxxix., 660.

DOUBLE VOICE. 257

vocal bands. Mackenzie'' removed a congenital papillomatous web
which had united the vocal cords until the age of twenty-throe, thus establish-
ing the voice. Poore also recorded a case of congenital web in the larynx.
Elsberg and Schetf mention occlusion of the rima glottidis by a membrane.

Instances of duplication of the epiglottis attended with a species of
double voice possess great interest. French ^ described a man of thirty, by
occupation a singer and contortionist, who became possessed of an extra voice
when he was sixteen. In high and falsetto tones he could run the scale from
A to F in an upper and lower range. The compass of the low voice was so
small that he could not reach the high notes of any song with it, and in sing-
ing he only used it to break in on the falsetto and produce a sensation. He
was supposed to possess a double epiglottis.'^

Roe describes a young lady who could whistle at will with the lower
part of her throat and without the aid of her lips. Laryngeal examination
showed that the fundamental tones were produced by vibrations of the edges
of the vocal cords, and the modifications were effected by a minute adjust-
ment of the ventricular bands, which regulated the laryngeal opening above
the cord, and pressing firmly down closed the ventricle and acted as a damper,
preventing the vibrations of the cords except in their middle third. Morgan
in the same journal mentions the case of a boy of nineteen, who seemed to
be affected with laryngeal catarrh, and who exhibited distinct diphthongia.
He was seen to have two glottic orifices with associate bands. The treatment
was directed to the catarrh and consequent paresis of the posterior bands,
and he soon lost his evidences of double voice.®

Complete absence of the eyes is a very rare anomaly. Wordsworth ^
describes a baby of seven weeks, otherwise well formed and healthy, which
had congenital absence of both eyes. The parents of this child were in every
respect healthy. There are some cases of monstrosities with closed, adherent
eyelids and absence of eyes.^ Holmes ^ reports a case of congenital absence of
both eyes, the child otherwise being strong and perfect. The child died of

« 224, 1874, i., 317. b Quoted 224, 1880, ii., .311.

c 148, vol. ii., 271. d Archives of Laryngology, Jan. 1, 1882.

e The foUowiag is a description of the laryngeal formation of a singer who has recently
ac<iuired 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 viliration and with
different degrees of rapidity the entire length of the vocal cords or only a part thereof. But
of greatest interest is her remarkable control over the muscles which regulate the division and
modification of the resonant cavities, the laryngeal, pharyngeal, oral, and nasal, and upon
this depends the quality of her voice. The uvula is bifurcated, and the two divisions some-
times act independently. The epiglottis during tlie production of the highest notes rises
upward and backward against the posterior pharyngeal wall in such a way as almost entirely
to separate the pharyngeal cavities, at the same time that it gives an unusual conformation
to those resonant chambers."

f 476, 1881, ii., 875.
17

g 240, 1828.

11268, 1869, xxvi., 163.

'258

MINOR TERATA.

cholera infantum. He also reports a case very similar in a female cliild of
American parents. In a girl of eight, of German parents, he reports defi-
ciency of the external walls of each orbit, in addition to great deformity of
the side of the head. He also gives an instance of congenital paralysis of the
levator palpebrse muscles in a child whose vision was perfect and who was
otherwise perfect. Holmes also reports a case of enormous congenital ex-
ophthalmos, in which the right eye protruded from the orbit and was no
longer covered by the cornea. Kinney'' has an account of a child born
without eyeballs. The delivery was normal, and there was no history of any
maternal impression ; the child was otherwise healthy and well formed.

Landes ^ reports the case of an infant in which both eyes were absent.
There were six fingers on each hand and six toes on each foot. The child
lived a few weeks. In some instances of supposed absence of the eyeball the
eye is present but diminutive and in the posterior portion of the orbit.
There are instances of a single orbit with no eyes and also a single orbit
containing two eyes.'' Again we may have two orbits with an absence of
eyes but the presence of the lacrimal glands, or the eyes may be present or
very imperfectly developed. Mackenzie mentions cases in which the orbit
was more or less completely wanting and a mass of cellular tissue in each eye.

Cases of living cyclopia, or individuals with one eye in the center of
the forehead after the manner of the mythical Cyclops, are quite rare. Val-
lentini in 1884*^ reports a case of a male cyclopic infant which lived for
seventy-three hours. There were median fissures of the upper lip, pre-
auricular appendages, oral deformity, and absence of the olfactory proboscis.
The fetus was therefore a cyclops arrhynchus, or cyclocephalus. Blok ^ de-
scribes a new-born infant which lived for six or seven hours, having but one
eye and an extremely small mouth.

The "Four-eyed Man of Cricklade'* was a celebrated English mon-
strositv 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, look-
ing backward with one and forward with another, upward with one and

a 218, 1854, li., 25. ^ 538, Nov. 3, 1894. « 418, 1751, 49.

d Atti deir Accad. med.-chir. di Perugia, vi., fasc. 3 & 4, 1894.

e Weekblad van het Nederlandsch Tijdschr. voor Geneeskunde, xxx., 2d part, 414,
Sept., 1894 ; also extracted in 759.

MULTIPLE PUPILS.

259

downward with another simultaneously.' He was of a savage, malignant
disposition, delighting in ugly tricks, teasing children, torturing helpless ani-
mals, uttering profane and blasphemous words, and acting altogether like the
monster, mental and physical, that he was. ' He could play the fiddle,
though in a silly sort, having his notes on the left side, while closing the
right pair of eyes. He also sang, but in a rough, screeching voice not to be
listened to without disgust.' "

There is a recent report of a child born in Paris with its eyes in the top
of its head. The inftint seemed to be doing well and crowds of people have
flocked to see it. Recent reports speak of a child born in Portland, Ore-
gon, which had a median rudimentary eye between two normal eyes. Four-
nier describes an infant born with perfectly formed eyes, but with adherent
eyelids and closed ocular aperture. Forlenze has seen the pupils adherent
to the conjunctiva, and by dissection has given sight to the subject.

Dubois cites an instance of supernumerary eyelid. At the external
angle of the eyelid was a fold of conjunctiva which extended 0.5 cm. in front
of the conjunctiva, to which it did not adhere, therefore constituting a fourth
eyelid. Fano presents a similar case in a child of four months, in whom no
other anomaly, either of organs or of vision, was observed. On the right
side, in front of the external half of the sclerotic, was observed a semilunar
fold with the concavity inward, and which projected much more when the
lower lid was depressed. When the eyelid rolled inward the fold rolled with
the globe, but never reached so far as the circumference of the cornea and
did not interfere with vision.

Total absence of both irides has been seen in a man of eighteen. ^
Dixon reports a case of total aniridia with excellent sight in a woman of
thirty-seven.® In Guy's Hospital there was seen a case of complete con-
genital absence of the iris.^^^ Hcntzschel ^ 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, I^awson,
Morison, Rculing, Samelson, and others also report congenital deficiency of
the irides in both eyes.

Jcalfreson *^'*'^ 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 tiie transparent cornea ; the sight was only
slightly impaired. No cause was traceable.

Multiple Pupils. — More than one pupil in tlie eye has often been
noticed, and as many as six have been seen. They may be congenital or due
to some pathologic disturbance after birth. Marcellus Donatus "^^^ speaks of
two pupils in one eye. Beer, Fritsche, and Heuermann are among the older
writers who have noticed supernumerary pupils. Higgens in 1885 described

a Amer. Med. Review, Dec, 1895. b 145^ vol. xxxiv. c 145^ jges, 1.

d 476, 1882, i., 265. e 543, 1858, ii., 35. f Quoted 476, 1830-1, i., 384.

260

MINOR TERATA.

a boy whose right iris was perforated by four pupils, — one above, one to the
inner side, one below, and a fourth to the outer side. The first three were
slit-shaped ; the fourth was the largest and had the appearance as of the
separation of the iris from its insertion. There were two pupils in the left
eye, both to the outer side of the iris, one being slit-like and the other resem-
bling the fourth pupil in the right eye. All six pupils commenced at the
periphery, extended inward, and were of different sizes. The fundus could
be clearly seen through all of the pupils, and there was no posterior staphy-
loma nor any choroidal changes. There was a rather high degree of myopia.
This peculiarity was evidently congenital, and no traces of a central pupil nor
marks of a past iritis could be found. Clinical Sketches * contains quite an
extensive article on and several illustrations of congenital anomalies of the
iris.

Double crystalline lenses are sometimes seen. Fritsch and Valisneri
have seen this anomaly and there are modern references to it. Wordsworth ^
presented to the Medical Society of London six members of one family, all
of whom had congenital displacement of the crystalline lens outward
and upward. The family consisted of a woman of fifty, two sous, 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. Tlie lenses moved freely through the pupil into the anterior cham-
bers. The condition remained unchanged for four years, when glaucoma
supervened.

Differences in Color of the Two Eyes. — It is not uncommon to see
people with different colored eyes. Anastasius I. had one black eye and the
other blue, from whence he derived his name " Dicore," by which this
Emperor of the Orient was generally known. Two distinct colors have been
seen in an iris. Berry gives a colored illustration of such a case.

The varieties of strabismus are so common that they will be passed with-
out mention. Kuhn ^ presents an exhaustive analysis of 73 cases of congeni-
tal defects of the movements of the eyes, considered clinically and didacti-
cally. Some or all of the muscles may be absent or two or more may be
amalgamated, with anomalies of insertion, false, double, or degenerated, etc.

The influence of heredity in the causation of congenital defects of
the eye is strikingly illustrated by De Beck.^ In three generations twelve
members of one family had either coloboma iridis or irideremia. He per-
formed two operations for the cure of cataract in two brothers. The opera-
tions were attended with difficulty in all four eyes and followed by cyclitis.
The result was good in one eye of each patient, the eye most recently blind.
Posey ^ had a case of coloboma in the macular region in a patient who had a

a 275, April, 1895. b 476, 1878, i., 86. c 765, 1894.

d Beit. z. Augenh., Heft xix., 1895. e Trans. 765, 1894. f 792, Nov., 1894.

ANOMALIES OF THE EARS.

261

supernumerary tooth. He believes the defects were inherited, as the patient's
mother also had a supernumerary tooth.

Nunnely^ reports cases of congenital malformation in tlirce children of
one family. The globes of t^vo 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 corneje
conical, the irides dull, thin, and tremulous ; the pupils were not in the axis
of vision, but were to the nasal side. The elder sister had the same congeni-
tal condition, but to a lesser degree. The other boy in the family had a total
absence of irides, but he could see fairly well with the left eye.

Anomalies of the Ears.— Bilateral absence of the external ears is quite
rare, although there is a species of sheep, native of China, called the " Yung-
ti," in which this anomaly is constant. Bartholinus, Lycosthenes, Pare,
Schenck, and Oberteuffer have remarked on deficient external ears. Guys,
the celebrated Marseilles litterateur of the eighteenth century, was born with
only one ear. Cliantreuil ^ mentions obliteration of the external auditory canal
in the new-born. Bannofont reports a case of congenital imperforation of
the left auditory canal existing near the tympanic membrane with total deaf-
ness in that ear. Lloyd « described a fetus showing absence of the external
auditory meatus on both sides. Munro ^ reports a case of congenital absence
of the external auditory meatus of the right ear ; and Richardson « speaks
of congenital malformation of the external auditory apparatus of the right
side. There is an instance ^ of absence of the auditory canal with but par-
tial loss of hearing. Mussey e reports several cases of congenitally deficient
or absent aural appendages. One case was that in which there was con-
genital absence of the external auditory meatus of both ears without much
impairment of hearing. In neither ear of N. W. Goddard, aged twenty-
seven, of Vermont, reported in 1834, was there a vestige of an opening or
passage in the external ear, and not even an indentation. The Eustachian
tube was closed. The integuments of the face and scalp were capable of
receiving acoustic impressions and of transmitting them to the organs of hear-
ing. The authors know of a student of a ])rorainent New York University
who is congenitally deficient in external ears, yet his hearing is acute. He
hides his deformity by wearing his hair long and combed over his ears.

The knowledge of anomalous auricles is lost in antiquity. Figure 103
represents the head of an ^gipan in the British Museum showing a super-
numerary auricle. As a rule, supernumerary auricles are preauricular
appendages. Warner, in a report of the examination of 50,000 children,
quoted by Ballantyne, describes 33 with supernumerary auricles, represented
by sessile or pedunculated outgrowths in front of the tragus. They are more
commonly unilateral, always congenital, and can be easily removed, giving rise

a 550, xlv., 43. ^ 242, 1867, xlii., 149. c 779^ 1846, i., 139.

d 476, 1869, ii., 41. e 476, 1882, i., 465. f 218, xi., 419. g 124, 1837, xxi., 378.

262

MINOR TERATA.

to no unpleasant symptoms. They have a soft and elastic consistency, and
are usually composed of a hyaline or reticular cartilaginous axis covered with
connective or adipose tissue and skin bearing fine hairs ; sometimes both

cartilage and fat are absent. They are
often associated with some form of de-
fective audition — harelip, ocular disturb-
ance, club-feet, congenital hernia, etc.
These supernumerary members vary from
one to five in number and are sometimes
hereditary. Reverdin describes a man
having a supernumerary nipple on the
right side of his chest, of whose five
children three had preauricular append-
ages. Figure 104 represents a girl with
a supernumerary auricle in the neck, de-
scribed in the Lancet, 1888.* A little
girl under Birkett's care in Guy's Hos-
pital more than answered to Macbeth's
requisition, " Had I three ears I'd hear
thee ! " since she possessed two super-
fluous ones at the sides of the neck, somewhat lower than the angle of
the jaw, which were well developed as to their external contour and made
up of fibrocartilage.'' There is mentioned the case of a boy of six months ^

Fig. 103.— -^gipan with supernumerary auricle
(British Museum).

Fig. 104. — Supernumerary auricle in the neck.

Fig. 105. — Supernumerary auricle.

on the left side of whose neck, over the middle anterior border of the sterno-
cleidomastoid muscle, was a nipple-like projection J inch in length ; a rod of
a 476, 1888, i., 312. b 543, 1858, 528. c 476, 1889, ii., 1003.

ABSENCE OE THE LIMBS.

263

cartilage was prolonged into it from a thin plate, which was freely ^movable
in the subcutaneous tissue, forming a striking analogue to an auricle (Fig. 105).
Moxhay ^ cites the instance of a mother who was frightened by the sight of a
boy with hideous contractions in the neck, and who gave birth to a child with
two perfect ears and three rudimentary auricles on the right side, and on the

left side two rudimentary auricles.

In some people there is an excessive development of the auricular
muscles, enabling them to move their ears in a manner similar to that of
the lower animals. Of the celebrated instances the Abb6 de 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. Prob-
ably 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 Mus6e Dupuy-
tren (Fig. 106). Flachsland ^ speaks of a woman who three times had borne
children without arms and legs. Hastings'" describes a living child born
without any traces of arms or legs (Fig. 107). Garlick s has seen a child
with neither upper nor lower extremities. In place of them were short
stumps three or four inches long, closely resembling the ordinary stumps after

a 224, 1870. b 302, iv., 148.

e Observat. patholog. Anat., p. 44.

c 401, vi., 142.
f 776, 1826, ii., 39.

d379, vi., 321.
g 656, 1849.

264

MINOR TEE ATA.

amputation. The head, chest, body, and male genitals were well formed, and

the child survived. Hutchinson * reports the
history of a child born without extremities,
probably the result of intrauterine amputa-
tion. The flaps were healed at the deltoid
insertion and just below the groin. Par6 ^
says he saw in Paris a man without arms, who
by means of his head and neck could crack a
whip or hold an axe. He ate by means of his
feet, dealt and played cards, and threw dice
with the same members, exhibiting such dex-
terity that flnally his companions refused to
play with him. He was proved to be a
thief and a murderer and was finally hanged
at Gucldres (Fig. 108). 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,

Fig. 106.— "P6pin" (Mus6e Dupuytren).

Fig. 107.— Limbless child.

as he could pick up a coin thrown to him. A monster of the same conforma-
a 779, 1853, 343. b 618, 1020. c 550, 1877. 65.

ABSENCE OF THE LIMBS.

265

tion was the celebrated painter, Ducornet (Fig. 109), who was born at Lille
on the 10th of January, 1806. He was completely deprived of arms, but the
rest of the body was well formed with
the exception of the feet, of which the
second toe was faulty. The deformity
of the feet, however, had the happiest
result, as the space between the great
toe and its neighbor was much larger
than ordinary and the toes mucli more
mobile. He became so skilful in his
adopted profession that he finally painted
a picture eleven feet in hciglit (repre-
senting Mary Magdalene at the feet of
Christ after the resurrection), Avhich was
purchased by the Government and given
to the city of Lille. Broca describes
James Leedgwood, who was deprived of
his arms and had only one leg. He ex-
hibited great dexterity with his single
foot, wrote, discharged a pistol, etc. ; he
was said to have been able to pick up a
sewing-needle on a slippery surface with
his eyes blindfolded. Capitan described
to the 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 " I'homme tronc." He was totally deprived of all his
members, Curran ^ describes a Hindoo, a prostitute of
forty, with congenital absence of both upper extremities.
A slight fleshy i)rotuberance depended from the cicatrix
of the humerus and shoulder-joint of the left side, and
until the age of ten there was one on the right side. She
performed many tricks with her toes (Fig. 110). Caldani
speaks of a monster without arms, Davis mentions one,
and Smith ^ describes a boy of four with his upper limbs
Breschet has seen a child of nine with only portions of the
upper arms and deformity of lower extremities and pelvis. Par6 says that
.1 536, 1887, i., 116. b 530, 1885, 338. c 767, 1873, 89. d 618, 1018.

Fig. 108. — Armless man (after Par6).

Fig. 109.— Csesar
Ducornet.

entirelv absent.

266

MINOE TERATA.

Fig. 110. — Hindoo armless
woman (Curran).

he saw in Paris in 1573, at the gate of St. Andrew des Arts, a boy of nine,
a native of a small village near Guise, who had no legs and whose left foot

was represented by a fleshy body hanging from the
trunk ; he had but two fingers hanging on his right
hand, and had between his legs what resembled a
virile penis. Par6 attributes this anomaly to a de-
fault in the quantity of semen.

The figure and skeleton of Harvey Leach, called
" Hervio Nono," is in the museum of the University
College in London. The pelvis was comparatively
weak, the femurs hardly to be recognized, and the
right tibia and foot defective ; the left foot was
better developed, although far from being in due
proportion to the trunk above. He was one of the
most remarkable gymnasts of his day, and not-
withstanding the distortion of his lower limbs had
marvelous power and agility in them. As an arena-
horseman, either standing or sitting, he was scarcely
excelled. He walked and even ran quite well, and
his power of leaping, partly with his feet and partly
with his hands, was unusual. His lower limbs
were so short that, erect, he touched the floor with
his fingers, but he earned his livelihood as much with his lower as with his
upper limbs. In his skeleton his left lower limb, between the hip and heel,
measured 16 inches, while the right, between the
same points, measured nine inches (Fig. 111).*
Hare ^ mentions a boy of five and a half whose head
and trunk were the same as in any other child of like
age. He was 22| inches high, had no spinal curva-
ture, but was absolutely devoid of lower extremities.
The right arm was two inches long and the left
Each contained the head and a small adjoining por-
tion of the humerus. The legs were represented by
masses of cellular tissue and fat covered by skin
which projected about an inch. He was intelligent,
had a good memory, and exhibited considerable
activity. He seemed to have had more than usual
mobility and power of flexion of the lower lumbar
region. AVhen on his back he was unable to rise
up, but resting on the lower part of the pelvis he
was able to maintain himself erect. He usually picked up objects with his
teeth, and could hold a coin in the axilla as he rolled from place to place.

a 476, 1864, ii., 60. b 779^ 1858-9, x., 308.

Fig. 111.— Harvey Leach.

ABSENCE OF THE LIMBS.

267

His rolling was accomplished by a peculiar twisting of the thorax and bend-
ing of the pelvis. There was no history of maternal imi)ression during preg-
nancy, no injury, and no hereditary disposition to anomalous members.
Figure 112 represents a boy with congenital deficiency of the lower extremi-
ties, who was exhibited a few years ago in Philadelphia. In Figure^ 113,
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 sig-
nifies abortive or imperfect for-
mation of the members. The
hands and feet were normally de-
veloped, but the arms, forearms,
and legs are much shortened (see
page 84).

The " turtle- woman " of
Demerara'^ (Fig. 114) was so
called because her mother when
pregnant was frightened by a
turtle, and also from the child's
fancied resemblance to a turtle.
The femur was six inches long ;
the woman had a foot of six
bones, four being toes, viz., the
first and second phalanges of the
first and second toes. She had
an acetabulum, capsule, and liga-
mentum teres, but no tibia or
fibula ; she also had a defective
right forearm. She was never

the victim of rachitis or like disease, but died of syphilis in the Colonial
Hospital. In her twenty-second year she was delivered of a full-grown child
free of deformity.

There was a woman living in Bavaria, under the observation of Buhl,
who had congenital absence of both femurs and both fibulas. Almost all the
muscles of the thigh existed, and the main attachment to the pelvis was by
a large capsular articulation. Charpentier gives the portrait of a woman in
whom there was a uniform diminution in the size of the limbs. Debout
portrays a young man with almost complete absence of the thigh and leg,

a International Med. Mag., Phila., June, 1892. b 476, 1867, ii., 578. c 368, 1861, No. 48.

Fig. 112.— Congenital deficiency of the lower extremities.

268

MINOR TEE ATA.

Fig. 113.— Congenital deficiency of the lower extremities with remedial apparatus.

S UPERNUMERA R Y LIMBS.

269

from whose right hip there depended a foot (Fig. 115). Accrell ^ deseribes
a peasant of twentv-six, born without a hip, thigh, or leg on the right side.
The external genital organs were in their usual place, but there was only one
testicle in the scrotum. The man was virile. The rectum instead of open-
ing outward and underneath was deflected to the right.

Supernumerary Limbs.— Haller reports several cases of supernumerary
extremities. Plancus*' speaks of an infant with a complete third leg, and
Dumeril « cites a similar instance. Geoffroy-Saint-Hilaire presented to the
Academic des Sciences in 1830 a child with four legs and feet who was in
good health. Amman saw a girl with a large thigh attached to her nates.
Below the thigh was a single leg made by the fusion of two legs. No patella
was found and the knee was anchylosed. One of the feet of the supernu-

Fig. 116.— Gustav Evrard (after Gufirin).

Fig. 117.— Eight-limbed monster (after Par6).

merary limb had six toes, while the other, which was merely an outgrowth,
had two toes on it.

According to Jules Guerin, the child named (justav Evrard w^as born
with a thigh ending in two legs and two imperfect feet depending from the
left nates (Fig. 116).

Tucker describes a baby born in the Sloane Maternity in New York,
October 1, 1894, who had a third leg hanging from a bony and fleshy union
attached to the dorsal spine. The supernumerary leg was well formed and
had a left foot attaclied to it. Larkin and Jones " mention the removal of a
meningocele and a supernumerary limb from an infant of four months. This

a Med, Chiiurg., Anat. Cases, London, 1758, 8°. ^ Do moustris, etc., Venetiis, 1749.
c Bull, de la soc. philom., iii., 3. d 125, Jan., 1895. e 224, 1889, ii., 310.

270

MINOR TERATA.

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

Pare ^ says that on tlie day the Venetians and the Genevois made peace
a monster was born in Italy which had four legs of equal proportions, and
besides had two supernumerary arms from the elbows of the normal limbs.
This creature lived and was baptized (Fig. 117).

Anomalies of the Feet. — Hatte ^ has seen a woman who bore a child
that had three feet. Bull " gives a description of a female infant with the
left foot double or cloven. There was only one heel, but the anterior portion
consisted of an anterior and a pos-
terior part. The anterior foot pre-
sented a great toe and four smaller
ones, but deformed like an example
of talipes equinovarus. Contin-
uous with the outer edge of the
anterior part and curving beneath
it was a posterior part, looking not
unlike a second foot, containing

Fig. 118. -Double foot (Bull).

Fig. 119.— Examples of " Sirens," showing fusion of the
lower extremities.

six well-formed toes situated directly beneath the other five. The eleven
toes were all perfect and none of them were webbed (Fig. 118).

There is a class of monsters called Sirens " on account of their resem-
blance to the fabulous creatures of mythology of that name. Under the
influence of compression exercised in the uterus during the early period of
gestation fusion of the inferior extremities is effected. The accompanying
illustration shows the appearance of these monsters (Fig. 119), which are
thought to resemble the enchantresses celebrated by Homer.

Anomalies of the Hand. — Blumenbach speaks of an officer who, having

a 618, 1017. b 462, T. ii., 229. c 218, 1875, xciii., 1293.

ABSENCE OF DIGITS.

271

lost his right hand, was subsequently presented by his wife with infants of
both sexes showing the same deformity. Murray^ cites the instance of a
woman of thirty-eight, well developed, healthy, and the mother of normal
children, who had a double
hand. The left arm was ab-
normal, the flexion of the elbow
imperfect, and the forearm ter-
minated in a double hand with
only rudimentary thumbs. In
working as a charwoman she
leaned on the back of the
flexed carpus. The double hand
could grasp firmly, though the
maximum power 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 web-
bed as far as the proximal joints,
and the movements of this hand
were stiff and imperfect. No
single finger of the two hands
could be extended while the

other seven were flexed (Fig. 120). Giraldes saw an infant in 1864 with
somewhat the same deformity, but in which the disposition of the muscles
and tendons permitted the ordinary movements (Fig. 121).

Absence of 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 (Fig. 122).

Figure 123 shows a man who was recently exhibited
He had but two fingers on each hand and two toes on each
foot, and resembles Kohler's case in the anomalous digital conformation.

Figure 124 represents an exhibitionist with congenital suppression of four
digits on each hand.

Fig. 120.— Double band (Murray).

Fig. 121.— Double hand
(Giraklfis).

in Philadelphia.

a 650, 1861-4, iv., 163 ; also 550, xlvi.

b Essai snr les monstres humaines, Diss, Iiiaug.

c 199, March 6, 1893.

272

MINOR TERATA.

Fig. 124.— Suppression of digits.

SUPERNUMERARY DIGITS. 273

Tubby has seen a boy of three in whom the first, second, and third toes
of each foot were suppressed, the great toe and the little toe being so over-
grown that they could be opposed. In this family for four generations 15 indi-
viduals out of 22 presented this defect of the lower extremity. The patient's
brothers and a sister had exactly the same deformity, which has been called
" lobster-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. F alia
also says that instances of intrauterine digital amputation are occasionally
seen.

According to Annandale, supernumerary digits may be classified as
follows : —

(1) A deficient organ, loosely attached by a narrow pedicle to the hand
or foot (or to another digit).

(2) A more or less developed organ, free at its extremity, and articu-
lating with the head or sides of a metacarpal, metatarsal, or phalangeal bone.

(3) A fully developed separate digit.

(4) A digit intimately united along its whole length with another digit,
and having either an additional metacarpal or metatarsal bone of its own, or
articulating with the head of one which is common to it and another digit.

Superstitions relative to supernumerary fingers have long been prevalent.
In the days of the ancient Chaldeans it was for those of royal birth especially
that divinations relative to extra digits were cast. Among the ancients we
also occasionally see illustrations emblematic of wisdom in an individual with
many fingers, or rather double hands, on each arm.

Hutchinson,^ in his comments on a short-limbed, polydactylous dwarf
(Fig. 125) which was dissected by Ruysch, the celebrated Amsterdam anat-
omist, writes as follows : —

" This quaint figure is copied from Theodore Kerckring's ' Spici-
legium Anatomicum,' published in Amsterdam in 1670. The description
states that the body was that of an infant found drowned in the river on
October IG, 1668. It was dissected by the renowned Ruysch. A detailed
description of the skeleton is given. My reason for now reproducing the
plate is that it offers an important item of evidence in reference to the develop-
ment of short-limbed dwarfs. Although we nmst not place too much reliance
on the accuracy of the draughtsman, since he has figured some superfluous
lumbar vertebrae, yet there can be no doubt that the limbs are much too
short for the trunk and head. This remark especially applies to the lower
limbs and pelvis. These are exactly like those of the Norwich dwarf and
of the skeleton in the Heidelberg Museum which I described in a recent
number of the ' Archives.' The point of extreme interest in the present case

a 476, Feb. 17, 1894. b 166, April, 1893.

18

274

MINOR TERATA.

is that this dwarfing of the limbs is associated with polydactylism. Both the
hands have seven digits. The right foot has eight and the left nine. The
conditions are not exactly symmetrical, since in some instances a metacarpal or

metatarsal bone is wanting ; or, to put it
otherwise, two are welded together. It will
be seen that the upper extremities are so
short that the tips of the digits will only
just touch the iliac crests.

" This occurrence of short limbs with
polydactylism seems to prove conclusively
that the condition may be due to a modi-
fication of develoj3ment 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 \qvj pos-
sible that it is still in existence in Amster-
dam, and if so it is very desirable that it should be more exactly described."

In Figure 126, A represents division of thumb after Guyot-Daub^s,
B shows a typical case of
supernumerary fingers,
and C pictures Morand's
case of duplication of
several toes.

Forster gives a sketch
of a hand with nine fin-
gers and a foot with nine
toes. Voight records an
instance of 13 fingers on
each hand and 12 toes on
each foot. Saviard saw
an infant at the Hotcl-Dieu in Paris in 1687 which had 40 digits, ten on
each member. Annandale relates the history of a woman who had six fingers
^nd two thumbs on each hand, and another who had eight toes on one foot.

Fig. 125. — Skeleton of a short-limbed,
polydactylous dwarf.

Fig. 126.— Supernumerary fingers and toes.

SUPERNUMERARY DIGITS.

275

Meckel tells of a case in which a man had 12 fingers and 12 toes, all well
formed, and whose children and grandchildren inherited the deformity.
Mason has seen nine toes on the left foot. There is recorded the account
of a child who had 12 toes and six fingers on each hand, one fractured.
Braid " describes talipes varus in a child of a few months who had ten toes.
There is also on record a collection of cases of from seven to ten fingers on
each hand and from seven to ten toes on each foot. Scherer*^ gives an illus-
tration of a female infant, otherwise normally formed, with seven fingers on
each hand, all united and bearing claw-like nails. On each foot there was
a double halux and five other digits, some of which were webbed.

The influence of heredity on this anomaly is well demonstrated. Reau-
mur was one of the first to prove this, as shown by the Kelleia family of
Malta, and there have been many corroboratory instances reported ; it is
shown to last for three, four, and even five generations ; intermarriage with
normal persons finally eradicates it.

It is particularly in places where consanguineous marriages are prevalent
that supernumerary digits persist in a family. The family of Foldi in the
tribe of Hyabites living in Arabia are very numerous and confine their
marriages to their tribe. They all have 24 digits, and infants born with the
normal number are sacrificed as being the offspring of adultery. The inhab-
itants of the village of Eycaux in France, at the end of the last century,
had nearly all supernumerary digits either on the hands or feet. Being
isolated in an inaccessible and mountainous region, they had for many years
intermarried and thus perpetuated the anomaly. Communication being opened,
they emigrated or married strangers and the sexdigitism vanished. Maujier-
tuis recalls the history of a family living in Berlin whose members had 24
digits for many generations. One of them being presented with a normal
infant refused to acknowledge it. There is an instance in the Western
United States in which supernumerary digits have lasted through five
generations. Cameron s speaks of two children in the same fiimily who
were polydactylic, though not having the same number of supernumerary
fingers.

Smith and Norwcll ^ report the case of a boy of fifteen both of whose
hands showed webbing of the middle and ring fingers and accessory nodules
of bone between the metacarpals, and six toes on each foot. The boy's father
showed similar malformations, and in five generations 21 out of 28 individ-
uals were thus malformed, ten females and 11 males. The deformity was
especially transmitted in the female lino.

Instances of supernumerary thumbs are cited by Panaroli,* Ephem-
erides, Munconys, as well as in numerous journals since. This anomaly is

a 705, 1879, n. s., ix., 37-42. b 476, 1832, ii., 673. c 225, 1848, i., 339.

d 562, 1870. c Archiv f. Kinderheilk., xvii., 1894, 244. f 130, No. 16.'

g Montreal Med. Jour., Dec, 1894. h 224, July 7, 1894. i 617,' iii., obs. 48.

276

MINOR TERATA.

not confined to man alone ; apes, dogs, and other lower animals possess it.
Bucephalus, the celebrated horse of Alexander, and the horse of 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 Sur-
geons in London.

Curling'^ quotes a most peculiar
instance of hypertrophy of the fingers
in a sickly girl (Fig. 127). The mid-
dle and ring fingers of the right hand
were of unusual size, the middle fin-
ger measuring inches in length and
four inches in circumference. On the
left hand the thumb and middle fin-
gers were hypertrophied and the in-
dex finger was as long as the middle
one of the right hand. The middle
finger had a lateral curvature out-
ward, due to a displacement of the
extensor tendon. This affection re-
sembled acromegaly. Curling cites
similar cases, one in a Spanish gentle-
man. Governor of Luzon, in the Philippine Islands, in 1850, who had an
extraordinary middle finger, which he concealed by carrying it in the breast
of his coat.

Hutchinson exhibited a photograph showing the absence of the
radius and thumb, with shortening of the forearm. Conditions more or less
approaching this had occurred in several members of the same family. In
some they were associated with defects of development in the lower extremi-
ties also.

The varieties of club-foot — talipes varus, valgus, equinus, equino-varus,
etc. — are so well known that they will be passed with mention only of a few
persons who have been noted for their activity despite their deformity.
Tyrt^e, Parini, Byron, and Scott are among the poets who were club-footed;

a Inter. Med. Mag., Phila., July, 1895. b 550, 1845, xxviii., 623.

Fig. 127. — Hypertrophied fingers.

HUMAN TAILS.

277

some

writers say that Shakespeare suffered in a sliglit degree from this de-
formity. Agesilas, Gens6rie, Kobert Duke of Normandy, Henry U.,
Emperor of the West, Otto IL, Duke of Brunswick, Charles II., King of
Naples, and Tamerlane were victims of deformed feet. Mile. ValliSre, 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 vertebrai have sometimes assumed the character of the
sacral vertebrte, the sacral vertebr{e presenting the aspect of lumbar vertebrse,
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 h 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 Weslevan mission-
ary, George Brown, in 1876 spoke of a formal breeding of a tailed race in
Kali, off the coast of New Britain. Tailless children were slain at once, as
they would be exposed to public ridicule. The tailed men of Borneo are

2T8 MINOR TERATA.

people afflicted with hereditary malformation analogous to sexdigitism. A
tailed race of princes have ruled Rajoopootana, and are fond of their ances-
tral mark.''^^^ There are fabulous stories told of canoes in the East Indies
which have holes in their benches made for the tails of the rowers. At one
time in the East the presence of tails was taken as a sign of brute force.

There was reported from Caracas^ the discovery of a tribe of Indians in
Paraguay who were provided with tails. The narrative reads somewhat after
this manner : One day a number of workmen belonging to Tacura Tuyn while
engaged in cutting grass had their mules attacked by some Guayacuyan In-
dians. The workmen pursued the Indians but only succeeded in capturing a
boy of eight. He was taken to the house of Seilor Francisco Galeochoa, at
Posedas, and was there discovered to have a tail ten inches long. On inter-
rogation the boy stated that he had a brother who had a tail as long as his
own, and that all the tribe had tails.

Aetius, Bartholinus, Falk, Harvey, Kolping, Hesse, Paulinus, Strauss, and

Wolff give descriptions of tails. Blanchard
says he saw a tail fully a span in length ; and
there is a description in 1690 of a man by
the name of Emanuel Konig, a son of a doctor
of laws,^^° who had a tail half a span long,
which grew directly downward from the coccyx
and was coiled on the perineum, causing much
discomfort. Jacob ^ describes a pouch of skin
resembling a tail which hung from the tij) of
the coccyx to the length of six inches. It was
removed and was found to be thicker than the
thumb, consisted of distinctly jointed portions
with synovial capsules. Gosselin saw at his
clinic a caudal appendix in an infant which measured about ten cm. (Fig. 128).
Lissner says that in 1872 he assisted in the delivery of a young girl who had
a tail consisting of a coccyx prolonged and covered with skin, and in 1884 he
saw the same girl, at this time the tail measuring nearly 13 cm.

Virchow received for examination a tail three inches long amputated from
a boy of eight weeks. Ornstein, chief physician of the Greelt army, describes
a Greek of twenty-six who had a hairless, conical tail, free only at the tip,
two inches long and containing three vertebrae. He also remarks that other
instances have been observed in recruits. Thirk of Broussa in 1820 de-
scril)ed the tail of a Kurd of twenty-two which contained four vertebrae.
Belinovski*^ gives an account of a hip-joint amputation and extirpation of a
fatty caudal extremity, the only one he had ever observed.

Before the Berlin Anthropological Society there were presented two adult
male Papuans, in good health and spirits, who had been brought from New
a 476, 1885, ii., 452. nil , 1827. c 270, 1892.

Fig. 128. — Caudal appendix observed in a
child in the clinic of M. Gosselin.

HUMAN TAILS.

279

Guinea ; their coccygeal bones projected li inches. Oliver Wendell Holmes
in the Atlantic Monthly, June, 1890, says that he saw in London a photo-
graph of a boy with a considerable tail. The "Moi Jioy" was a lad of
twelve, who was found in Cochin China, with a tail a foot long wliicli 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 ahvays gave him great dis-
tress, and the protuberance would often chafe until the skin was broken, tlie
blood trickling into his boots.

Bartels^' presents a very complete article in which he describes 21 per-
sons born with tails, most of the tails being merely fleshy protuberances.
Darwin speaks of a person with a fleshy tail and refers to a French arti-
cle on human tails.*^

Science*^ contains a description of a negro child born near Louisville,
eight weeks old, with a pedunculated tail 2| inches long, with a base 1^
inches in circumference. The tail resembled in shape a pig's tail and had
grown ^ inch since birth. It showed no signs of cartilage or bone, and had
its origin from a point slightly to the left of the median line and about an
inch above the end of the spinal column.

Dickinson^ recently reported the birth of a child with a tail (Fig. 129).
It was a well-developed female between 5J and six pounds in weight. The
coccyx was covered with the skin on both the anterior and posterior surfaces.
It thus formed a tail of the size of the nail of the little finger, with a length
of nearly inch on the inner surface and f inch on the rear surface. This
little tip could be raised from the body and it slowly sank back.

In addition to the familiar caudal projection of the human fetus, Dickin-
son mentions a group of other vestigial remains of a former state of things.
Briefly these are : —

(1) The plica semilunaris as a vestige of the nictitating membrane of
certain birds.

(2) The pointed ear, or the turned-down tip of the ears of many men.

(3) The atrophied muscles, such as those that move the ear, that are well
developed in certain people, or that shift the scalp, resembling the action of
a horse in ridding itself of flies.

(4) The supracondyloid foramen of the humerus.

(5) The vermiform appendix.

(6) The location and direction of the hair on the trunk and limbs.

(7) The dwindling wisdom-teeth.

(8) The feet of the fetus strongly deflected inward, as in the apes, and
persisting in the early months of life, together with great mobility and a dis-
tinct projection of the great toe at an angle from the side of the foot.

a 545, 1881, 165.
<i 727, Juue 6, 1884.

b 157, 1880.

c 669, 1867-8, p. 625.
e 227, viii., 568, 1894.

280

MINOR TERATA.

(9) The remarkable grasping power of the hand at birth and for a few
weeks thereafter, that permits young babies to suspend their whole weight on
a cane for a period varying from half a minute to two minutes.

Horrocks ^ ascribes to these anal tags a pathologic importance. He claims
that they may be productive of fistula in ano, superficial ulcerations, fecal con-
cretions, fissure in ano, and that they may hypertrophy and set up tenesmus
and other troubles. The presence of human tails has given rise to discussion
between friends and opponents of the Darwinian theory. By some it is

anus.

Fig. 129.— Skin-covered coccyx forming a rudimentary tail in a female child at birth: C, coccyx; A, anus

(Dickinson).

considered a reversion to the lower species, while others deny this and claim
it to be simply a pathologic appendix.

Anomalies of the Spinal Canal and Contents. — When there is a
default in the spinal column, the vice of conformation is called spina bifida.
Tliis 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
substa,nce. Figure 130 represents a large congenital sacral tumor.

Achard ^ speaks of partial duplication of the central canal of the spinal
cord. De Cecco reports a singular case of duplication of the lumbar seg-

a Quar. Med. Jour., July, 1894. ^ 242, 1888, 922. Morgagni, Napoli, 1857, i., 307.

CURVATURES OF THE SPINE.

281

Fig. i;su.— Sacral tu-
mor (Mutter Mus., Col.
of Phys.).

mcnt 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 tetus
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 wliich the curvature is posterior ; second, lor-
dosis, in which the curvature is anterior ; third, scoliosis,
in which it is lateral, to the right or left.

Kyphosis is the most common of the deviations in man
and is most often found in the dorsal region, althougli it
may be in the lumbar region. Congenital kyphosis is very
rare in man, is generally seen in monsters, and when it does
exist is usually accompanied by lordosis
or spina bifida. We sometimes observe a condition of
anterior curvature of the lumbar and sacral regions, which
midit be taken for a congenital lordosis, but this is really a
deformity produced after birth by the physiologic weight
of the body. Figure 131 represents a case of lordosis caused
by paralysis of the spinal muscles.

Analogous to this is what the accoucheurs call spondy-
lolisthesis. Scoliosis may be a cervicodorsal, dorso-
lumbar, or lumbosacral curve, and the inclination of the
vertebral column may be to the right or left (Figs. 132
and 133). The pathologists divide scoliosis into a myo-
pathic variety, in which the trouble is a physiologic an-
tagonism of the muscles ; or osteopathic, ordinarily asso-
ciated with rachitis, which latter variety is generally
accountable for congenital scoliosis. In some cases the
diameter of the chest is shortened to an almost incredible
degree, but may yet be compatible with life. Glover speaks
of an extraordinary deformity of the chest with lateral
curvature of the spine, in which the diameter from the
pit of the stomach to the spinal integument was only 5|
inches.

Supernumerary ribs are not at all uncommon in
man, nearly every medical museum having some examples.
Cervical ribs are not rare. Gordon ® describes a young man of seventeen

Fig. 131.— Lordosis,
— paralysis of spinal
muscle (Hirst).

a 536, Dublin, 1865, xi., 435.
d476, 1857, i., 263.

1 124, xxii., 253.

c 476, 1848, ii., 400.
e 355, Oct. 15, 1894.

282

MINOR TERATA.

in whom there was a pair of supernumerary ribs attached to the cervical
vertebrae. Bernhardt ^ mentions an instance in which cervical ribs caused
motor and sensory disturbances. Dumerin of Lyons showed an infant of
eight days which had an arrested development of the 2d, 3d, 4th, and 5th
ribs. Cases of deficient ribs are occasionally met. Wistar in 1818 gives
an account of a person in whom one side of the thorax was at rest while tlie
other performed the movements of breatliing in the usual manner.

In some cases we see fissure of the sternum, caused either by deficient
union or absence of one of its constituent parts. In the most exaggerated
cases these fissures permit the exit of the heart, and as a general rule ecto-

Fig. 132.— Non-rachitic scoliosis (Charpentier). Fig. 133.— Same woman, back view (Chari)entier).

pies of the heart are thus caused. Pavy ^ has given a most remarkable case
of sternal fissure in a young man of twenty-five, a native of Hamburg. He
exhibited himself in one medical clinic after another all over Europe, and
was always viewed with the greatest interest. In the median line, corre-
sponding to the absence of sternum, was a longitudinal groove bounded on
either side by a continuous hard ridge which articulated with the costal carti-
lages. The skin passed naturally over the chest from one side to another,
but was raised at one part of the groove by a pulsatile swelling which occu-
pied the position of the right auricle. The clavicle and the two margins of
the sternum had no connections whatever, and below the groove was a hard
a 199, 1894. b 548, 1857, ii., 522.

FISSUBE OF THE STERNUM.

283

substance corresponding to the ensiform cartilage, which, however, was very
elastic, and allowed the patient, under the influence of the pectoral muscles,
when the upper extremity was fixed, to open the groove to nearly the extent
of three inches, which was more than twice its natural width. By approxi-
mating his arms he made the ends of his clavicles overlap. When he coughed
the right lung suddenly protruded from the chest through the groove and
ascended a considerable distance above the clavicle into the neck. Between
the clavicles another pulsatile swelling was easily felt but hardly seen, which
was doubtless the arch of the aorta, as by putting the fingers on it one could
feel a double shock, synchronous with distention and recoil of a vessel or
opening and closing of the semilunar valves.

Madden pictures (Figs. 134 and 135) a Swede of forty with congenital

Fig. 134.— Congenital fissure of sternum
(Madden).

Fig. 135.— Congenital fissure of the sternum.

absence of osseous structure in the middle line of the sternum, leaving a fis-
sure 5f X If X 2 inches, the longest diameter being vertical. Madden also
mentions several analogous instances on record. Groux's case was in a person
of forty-five, and the fissure had the vertical length of four inches. Hodgen
of St. Louis reports a case in which there was exstrophy of the heart through
the fissure. Slocum ^ reports the occurrence of a sternal fissure 3 X 1^ inches
in an Irishman of twenty-five. Madden also cites the case of Abbott in an
adult negress and a mother. Obermeier mentions several cascs.*^ Gibson
and Malet ^ describe a presternal fissure uncovering the base of the heart.
Ziemssen, Wrany, and Williams also record congenital fissures of the sternum*

a 597, 188.5, 406. •> 133, Oct., 1878. c 7g8, 1860, iii., 310.

d 161, 1869, xlvi., 209. e 451^ xiv., 1.

284

MINOR TERATA.

Thomson'' has collected 86 cases of thoracic defects and summarizes his
paper by saying that the structures deficient are generally the hair in the
mannnary and axillary regions, the subcutaneous fat over the muscles, nip-
ples, and breasts, the pectorals and adjacent muscles, the costal cartilages
and anterior ends of ribs, the hand and forearm ; he also adds that there
may be a hernia of the lung, not hereditary, but probably due to the pressure
of the arm against the chest. De Marque gives a curious instance in which
the chin and chest were congenitally fastened together. Muirhead ^ cites an
instance in which a firm, broad strip of cartilage resembling sternomastoid
extended from below the left ear to the left upper corner of the sternum,
being entirely separate from the jaw.

Some preliminary knowledge of embryology is essential to understand the
formation of branchial fissures, and we refer the reader to any of the
standard works on embryology for this information. Dzondi was one of the
first to recognize and classify congenital fistulas of the neck. The proper
classification is into lateral and median fissures. In a case studied by Fev-
rier the exploration of a lateral pharyngeal fistula produced by the intro-
duction of the sound violent reflex phenomena, such as pallor of the face
and irregular, violent beating of the heart. The rarest of the lateral class is
the preauricular fissure, which has been observed by Fevrier, Le Dentu,
Marchand, Peyrot, and Rentier.

The median congenital fissures of the neck are probably caused by defec-
tive union of the branchial arches, although Arndt thinks that he sees in
these median fistulas a persistence of the hypobranchial furrow which exists
normally in the amphioxus. They are less frequent than the preceding
variety.

The most typical form of malformation of the esophagus is imperfora-
tion or obliteration. Van Cuyck of Brussels in 1824 delivered a child
which died on the third day from malnutrition. Postmortem it was found
that the inferior extremity of the esophagus to the extent of about two inches
was converted into a ligamentous cord. Porro ^ describes a case of con-
genital obliteration of the esophagus which ended in a cecal pouch about one
inch below the inferior portion of the glottidean aperture and from this
point to the stomach only measured an inch ; there was also tracheal com-
munication. The child was noticed to take to the breast with aviditv, but
after a little suckling it would cough, become livid, and reject most of the
milk through the nose, in this way almost suffocating at each paroxysm ; it
died on the third day.

In some cases the esophagus is divided, one portion opening into the
bronchial or other thoracic organs. Brentano*' describes an infant dying
ten days after birth whose esophagus was divided into two portions, one

a 759, Jan., 1855. b 224, 1887, 177.

c Soci6t6 de Chirurgie, 1892. d 151, 1871. e 242, 1894.

ANOMALIES OF THE LUNGS.

285

terminating in aculdesac, the other opening into the bronchi ; the left kidney
was also displaced downward. Blasius^^^ describes an anomalous case of
duplication of the esophagus. Grashuys, and subsequently Vicq d Azir,
saw a dilatation of the esophagus resembling the crop of a bird.

Anomalies of the Lungs.-Carper describes a fetus of thirty-seven
weeks in whose thorax he found a very voluminous thymus gland but no
lungs. These organs were simply represented by two little oval bodies hav-
ing no lobes, with the color of the tissue of the liver. The heart had only
one cavity but all the other organs were perfectly formed. This case seems
to be unique. Tichomirolf ^ records the case of a woman of twenty-four
who died of pneumonia in whom the left lung was entirely missing. No
traces of a left bronchus existed. The subject was very poorly developed

physically. Tichomiroff finds

four other cases in literature, in

all of which the left lung was

absent. Theremin and Tyson

record cases of the absence of

the left lung.

Supplementary pulmonary

lobes are occasionally seen in

man and are taken by some

authorities to be examples of

retrogressive anomalies tending

to prove that the derivation of

the human race is from the

quadrupeds which show analo-
gous pulmonary malformation.

Eckley reports an instance of

supernumerary lobe of the right

lung in close connection with

the vena azygos major (Fig.

136). Collins ^ mentions a similar case. Bonnet and Edwards speak of
instances of four lobes in the right lung. Testut and Marcond^s report a
description of a lung with six lobes.

Anomalies of the Diaphragm. — Dicinerbroeck is said to have dissected
a human subject in whom the diapliragm and mediastinum were apparently
missing, but such cases must be very rare, although we frequently find marked
deficiency of this organ. Bouchaud ° reports an instance of absence of the right
half of the diaphragm in an infant born at term. Lawrence ^ mentions con-
genital deficiency of the muscular fibers of the left half of the diaphragm with

a Inter-Monatschr. f. Anat. u. Physiol., 1895. ^ Chicago M. Times, June, 1895.
c 310, Iviii., 252. d Gaz. hebd. d. sc. m6d. de Bordeaux, 1880, i., 1045.

e 242, xxxviii., 344. f 476, 1852, ii., 327.

Fig 136.— Supernumerary lung: 1, upper lobe of right
lung; 2, middle or cuneate lobe; 3, lower lobe; 4, super-
numerary lobe; 5, vena azygos major; 6, descending vena
cava; 7, phrenic nerve (Eckley).

286

MINOR TERATA.

displacement of the stomacli. The patient died of double pneumonia. Car-
ruthers, McClintock, Polaillon, and van Geison also record instances of con-
genital deficiency of part of the diaphragm. Recently Dittel'"^ reported unilateral
defect in the diaphragm of an infant that died soon after birth. The stomach,
small intestines, and part of the large omentum lay in the left pleural cavity ;
both the phrenic nerves were normal. Many similar cases of diaphragmatic
hernia have been observed. In such cases the opening may be large enough
to allow a great part of the visceral constituents to pass into the thorax,
sometimes seriously interfering with respiration and circulation by the
pressure whicli 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 epij^loon. The most
extensive paper on this subject was contributed by Bodwitch,'^ wlio, 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 tlie thorax. Macnab ^ reports an instance in which three years after the
cure of empyema the whole stomach constituted the hernia. Recently
Joly 5 described a congenital hernia of the stomach in a man of thirty-
seven, who died from collapse following lymphangitis, persistent vomit-
ing, and diarrhea. At the postmortem there was found a defect in the
diaphragm on the left side, permitting herniation of the stomach and first
part of the duodenum into the left pleural cavity. There was no history of
traumatism to account for strangulation. Longworth cites an instance of
inversion of the diaphragm in a human subject. Bartholinus ^ mentions
coalition of the diaphragm and liver ; and similar cases are spoken of
by Morgagni and the Ephenierides. Hoffman '^-^ describes diaphragmatic
junction with the lung.

Anomalies of the Stomach. — The Ephemerides contains the account of
a dissection in which tlie stomach was found wanting, and also speaks of two
instances of duplex stomach. Bartholinus,^^" Heister, Hufeland, Morgagni,
Riolan, and Sandifort J cite examples of duplex stomach. Bonet speaks of a
case of vomiting which was caused by a double stomach. Struthers ^ reports
two cases in which there were two cavities to the stomach. Struthers also
mentions that Morgagni, Home, Monro, Palmer, Larry, Blasius, Hufeland,
and Walther also record instances in which there was contraction in the

a 261, May 19, 1894. b 476, 1858, ii., 396. c 363, xxxv., 447.

<i2.31, ix. e 476, 1861, i., 391 f 476. 1878, i., 11.

g 342, Jan., 1894. h 274, 1877, xii., 279. ' 190, cent, iv., n. 20.

j Observ. anat. path., L, iv., pp. 27, 45. k Month. J. M. Sc., Lend., 1851, xii., 121.

DILATATION OF THE COLON.

287

middle of the stomach, accounting for their instances of duplex stomach.
Musser * reports an instance of hour-glass contraction of the stomach. Hart ^
dissected the stomach of a woman of thirty which resembled the stomach
of a predaceous bird, with patches of tendon on its surface. The right
extremity instead of continuously contracting ended in a culdesac one-half as
large as the greater end of the stomach. The duodenum proceeded from the
depression marking the lesser arch of the organ midway between the cardiac
orifice and the right extremity. Crooks " speaks of a case in which the stomach
of an infant terminated in a culdesac.

Hernia of the stomach is not uncommon, especially in diaphragmatic or
umbilical deticiency. 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-detined round perforation at the cardiac
curvature the size of a sixpence.

Anomalies of the Intestines. — The
Ephemerides contains the account of an ex-
ample of double cecum, and Alexander ®
speaks of a double colon, and there are other
cases of duplication of the bowel recorded.
There is an instance of coalition of the
jejunum with the liver,^°^ and Treuner^

parallels this case. Aubery, Charrier, Poel- t.- u, .

1 >/ ' ' Fig. 13<. — Double stomach.

man, and others speak of congenital division

of the intestinal canal. Congenital occlusion is quite frequently reported.

Dilatation of the colon frequently occurs as a transient afiection, and by
its action in pushing up the diaphragm may so seriously interfere with the action
of the heart and lungs as to occasionally cause heart-failure. Fenwick has
mentioned an instance of this nature. According to Osier there is a chronic
form of dilatation of the colon in which the gut may reach an enormous
size. The coats may be hypertrophied without evidence of any special
organic change in the mucosa. The most remarkable instance has been
reported by Formad. The patient, known as the " balloon-man," aged
twenty-three at the time of his death, had had a distended abdomen from in-
fancy. Postmortem the colon was found as large as that of an ox, the cir-
cumference ranging from 15 to 30 inches. The \veight of the contents was
47 pounds. Cases are not uncommon in children. Osier s reports three well-
marked cases under his care. Chapman ^ mentions a case in which the liver

a 547, 18S3-1884, xiv., 331. b 311, iv., 326. c 776, 1826, ii., 38. d 381, 1854, ii., 26.
e 272, 1880, u. s., iv., 511. f 160, Band ii., 90. S 165, 1893. b 224, 1878', i., 566.

288

MINOR TERATA.

Fig. 138. — Anus absent ;
the rectum ends in the
bladder (after Ball).

was displaced by dilatation of the sigmoid flexure. Mya ^ reports two cases
of congenital dilatation and hypertrophy of the colon (megacolon congenito).
Hirschsprung, Genersich, Faralli, Walker, and Griffiths all record similar in-
stances, and in all these cases the clinical features were obstinate constipation
and marked meteorismus.

Imperforate Anus. — Cases in which the anus is imperforate or the
rectum ends in a blind pouch are occasionally seen. In
some instances the rectum is entirely absent, the colon
being the termination of the intestinal tract. There are
cases on record in which the rectum communicated with
the anus solely by a fibromuscular cord. Anorectal
atresia is the ordinary imperforation of the anus, in
which the rectum terminates in the middle of the sacral
cavity. The rectum may be deficient from the superior
third of the sacrum, and in this position is quite inacces-
sible for operation.

A compensatory coalition of the bowel with the
bladder or urethra is sometimes present, and in these
cases the feces are voided by the urinary passages. Huxham ^ mentions the
fusion of the rectum and colon with the bladder, and similar instances are
reported by Dumas and Baillie. Zacutus Lusitanus ^'^^ describes an infant
with an imperforate membrane over its anus who voided feces through the
urethra for three months. After puncture of the membrane, the discharge
came through the natural passage and the child lived ; Morgagni mentions a
somewhat similar case in a little girl living in Bologna,
and other modern instances have been reported. The
rectum may terminate in the vagina (Fig. 139).

Masters ^ has seen a cliild 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 ; h
the bladder ; c the point of communication ; g shows the
cellular tissue of the scrotum.

There is a description ^ of a girl of fourteen, other-
wise well constituted and healthy, who had neither external genital organs
nor anus. There was a plain dermal covering over the genital and anal
region. She ate regularly, but every three days she experienced pain in the
umbilicus and much intestinal irritation, followed by severe vomiting of
stercoraceous matter ; the pains then ceased and she cleansed her mouth with
aromatic washes, remaining well until the following third day. Some of the

Fig. 139. — Anus is absent;
rectum ends in the vagina
(after Ball).

a 747, An. 48, 1894, 215.
C1224, 1862, ii., 555.

b 629, n. 422.

c 664, T. iii., n. 55, p. 288.
e 463, viii.

I

IMPERFORATE ANUS.

289

urine was evacuated by the mammje. Tlic examiners displayed much desire
to see her after puberty to note the disposition of the menstrual flow, but no
fnrtlier observation of her case can be found.

Fournier « narrates that he was called by three students, who had been try-
ing to deliver a woman for five days. He found a well-constituted woman of
twenty-two in horrible agony, who they said had not had a passage of the
bowels for eight days, so he prescribed an enema. The student who was
directed to give the enema found to his surprise that there was no anus, but
by putting his finger in the vagina he could discern the floating end of the
rectum, which was full of feces. There was an opening in this suspended
rectum about the size of an undistended anus. Lavage was practised by a
cannula introduced through the opening, and a great number of cherry stones

Fig. 140. — Abnormal junction of the rectum and bladder.

agglutinated with feces followed the water, and labor 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 hydrone-
phrosis of a confluent kidney. There was a minute opening into the bladder,
which allowed the passage of meconium through the urethra. Burge ^ men-
tions the case of what he calls " sexless child," in which there was an imper-
forate anus and no pubic arch ; the ureters discharged upon a tumor the size
of a teacup extending from the umbilicus to the pubes. A postmortem
examination confirmed the diagnosis of sexless child.

a 302, iv., 155. b De morb. puer,, L. 1. c 597, 1878, xxviii., 516. d 597^ 1370 39.
19 ' '

290

MINOR TERATA.

The Liver. — The Ephemerides, Frankenau,* von Home, Moliiietti,
Schenck,'' and others speak of deficient or absent liver. Zacutns
Lusitanus ° says that he once found a mass of flesh in place of the liver.
Lieutaud ^ is quoted as describing a postmortem examination of an adult who
had died of hydropsy, in whom the liver and spleen were entirely missing.
The portal vein discharged immediately into the vena cava ; this case is
probably unique, as no authentic parallel could be found.

Laget reports an instance of supernumerary lobe in the liver. Van
Buren ^ describes a supernumerary liver. Sometimes there is rotation, real
or apparent, caused by transposition of the characteristics of the liver.
Handy s mentions such a case. Kirmisson ^ reports a singular anomaly
of the liver which he calls double displacement by inters^ersion and rota-
tion on the vertical axis. Actual displacements of the liver as well as what
is known as wandering liver are not uncommon. The operation for floating
liver will be spoken of later.

Hawkins ^ reports a case of congenital obliteration of the ductus com-
munis choledochus in a male infant which died at the age of four and a half
months. Jaundice appeared on the eighth day and lasted through the short
life. The hepatic and cystic ducts were pervious and the hepatic duct
obliterated. There were signs of hepatic cirrhosis and in addition an inguinal
hernia.

The Gall-Bladder. — Harle j mentions the case of a man of fifty, in whom
he could find no gall-bladder ; Patterson^ has seen a similar instance in a
man of twenty-five. Purser ^ describes a double gall-bladder.

The spleen has been found deficient or wanting by Lebby, Ramsay, and
others, but more frequently it is seen doubled. Cabrolius,^^'^ Morgagni, and
others have found two spleens in one subject ; Cheselden and Fallopius report
three ; Fantoni mentions four found in one subject ; Guy-Patin has seen
five, none as large as the ordinary organ ; 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 meso-
gastrium, peritoneum, on the mesentery and transverse mesocolon, in Douglas'
pouch, etc. There was a spleen " the size of a walnut " in the usual position,
with the splenic artery and vein in their normal position. Every one of these
spleens had a capsule, was covered by peritoneum, and exhibited the histo-
logic appearance of splenic tissue. According to the review of this article,
Toldt explains the case by assuming that other parts of the celomic epithelium,

a 350. n. 7. b 718, L. iii. c 831, L. ii., obs. 3. d 302, iv., 154.

e 242, 1874, 42. f N. York M. Times, 1853-1854, iii., 126. g 526, 1850, vi., 204.

h242, 1880, 112. i 476, April 6, 1895. J 476, 1856, ii., 304.

k 548, 1864, ii., 476. 1 476, 1886, ii., 1079. ^ 476, 1895, i., 1346.

TBANSPOSITION OF THE VISCERA.

291

besides that of the mesogastrium, are capable of forming splenic tissue. Jame-
son * reports a case of double spleen and kidneys. Bainbrigge ^ mentions a
case of supernumerary spleen causing death from the patient being placed in
the supine position in consequence of fracture of the thigh. Peevor " men-
tions an instance of second spleen. 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
M6ry described the instance later which was the subject of the following
quatrain : —

"La nature, peu sage et sans doute en d^bauche,
Pla§a le foie au cote gauche,
Et de meme, vice versa,
Le cceur ii le droite pla§a. ' '

Young ^ cites an example in a woman of eighty-five who died at Ham-
mersmith, London. She was found dead in bed, and in a postmortem exami-
nation, ordered to discover if possible the cause of death, there was seen
complete transposition of the viscera. The heart lay with its base toward
the left, its apex toward the right, reaching the lower border of the 4th rib,
under the right mamma. The vena cava was on the left side and passed
into the pulmonary cavity of the heart, which was also on the left side, the
aorta and systemic ventricle being on the right. The left splenic vein was
lying on the superior vena cava, the liver under the left ribs, and the spleen
on the right side underneath the heart. The esophagus was on the right of
the aorta, and the location of the two ends of the stomach was reversed ;
the sigmoid flexure was on the right side. Davis ^ describes a similar in-
stance in a man.

Herrick « 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.

a 435, 1874, ix., 11.
dHist. Anat. Med., i., 248.
g 538, July 28, 1894.

b 490, xxxviii., 1052. c 435^ 1885, xx., 216.

e 476, 1861, i., 630. f 476, 1879, i., 789.

Ann. de la m6d. physiol.. Par., xiii.,518.

292

MINOR TERATA.

Congenital extroversion or eventration is the result of some congenital
deficiency in the abdominal wall ; instances are not uncommon, and some
patients live as long as do cases of umbilical hernia proper. Ramsey* speaks
of entire want of development of the abdominal parietes. Robertson,
Rizzoli, Tait, Hamilton, Brodie, Denis, Dickie, Goyrand, and many others
mention extroversion of viscera from parietal defects. The different forms
of hernia will be considered in another chapter.

There seem to be no authentic cases of complete absence of the
kidney except in the lowest grades of monstrosities. Becker, Blasius,
Rhodius, Baillie, Portal, Sandifort, Meckel, Schenck, and StoU are among
the older writers who have observed the absence of one kidney. In a recent
paper Ballowitz has collected 213 cases, from which the following extract
has been made by the British Medical Journal : —

"Ballowitz (Virchow's Archiv, August 5, 1895) has collected as far as
possible all the recorded cases of congenital absence of one kidney. Exclud-
ing cases of fused kidney and of partial atrophy of one kidney, he finds
213 cases of complete absence of one kidney, upon which he bases the
following conclusions : Such deficiency occurs almost twice as often in males
as in females, a fact, however, which may be partly accounted for by the
greater frequency of necropsies on males. As to age, 23 occurred in the
fetus or newly born, most having some other congenital deformity, especially
imperforate anus ; the rest were about evenly distributed up to seventy years
of age, after which only seven cases occurred. Taking all cases together, the
deficiency is more common on the left than on the right side ; but while in
males the left kidney is far more commonly absent than the right, in females
the two sides show the defect equally. The renal vessels were generally
absent, as also the ureter, on the abnormal side (the latter in all except 15
cases) ; the suprarenal was missing in 31 cases. The solitary kidney
was almost always normal in shape and position, but much enlarged.
Microscopically the enlargement would seem to be due rather to hyperplasia
than to hypertrophy. The bladder, except for absence of the opening of
one ureter, was generally normal. In a large number of cases there were
associated deformities of the organs of generation, especially of the female
organs, and these were almost invariably on the side of the renal defect ; they
affected the conducting portion much more than the glandular portion — that
is, uterus, vagina, and Fallopian tubes in the female, and vas deferens or
vesiculie seminales in the male, rather tlian the ovaries or testicles. Finally,
he points out the practical bearing of the subject — for example, the proba-
bility of calculus causing sudden suppression of urine in such cases — and
also the danger of surgical interference, and suggests the possibility of
diagnosing the condition by ascertaining the absence of the opening of one
ureter in the bladder by means of the cystoscope, and also the likelihood
a Northwest Med. and Surg, Jour., Chicago, 1857, xiv., 450.

ANOMALIES OF THE KIDNEYS.

293

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 struc-
tures in their place. Guitems and Uiesman«« have noted the absence of the
right kidney, right ureter, and right adrenal in an old woman who had died of
chronic nephritis. The left kidney although cirrhotic was very much enlarged.

Tompsett^ describes a necropsy made on a coolie child of nearly twelve

Fig. 141.— Renal symphysis and supernumerary kidney (Rayer).

months, in which it was seen that in the place of a kidney there were two
left organs connected at the apices by a prolongation of the cortical substance
of each ; the child had died of neglected malarial fever. Sandiforf speaks
of a case of double kidneys and double ureters, and cases of supernume-
rary kidney are not uncommon, generally being segmentation of one of
the normal kidneys. Rayer has seen three kidneys united and formed like
a horseshoe (Fig. 141). We are quite familiar with the ordinary horse-
shoe kidney," in which two normal kidneys are connected.

a 224, Feb. 23, 1895. b 224, 1879, ii., 602. c 710, fasc. iii.

294

MINOR TERATA.

There are several forms of displacement of the kidneys, the most com-
mon being the "floating kidney," which is sometimes successfully re-
moved or 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 tlie 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 tlie
primitive iliacs. The right kidney was situated normally, and received from
the aorta two arteries, whose volume did not surpass the two arteries supply-
ing the left suprarenal capsule, which was in its ordinary place. Displace-
ments of the kidney anteriorly are very rare.

The ureters have been found multiple ; Griffon * reports the history of a
male subject in whom the ureter on the left side was double throughout its
whole length ; there were two vesical orifices on the left side one above the
other ; and Morestin, in the same journal, mentions ureters double on both
sides in a female subject. Molinetti speaks of six ureters in one person.
Littre in 1705 described a case of coalition of the ureters. Allen de-
scribes an elongated kidney witli two ureters. Coeyne ^ mentions duplica-
tion of the ureters on both sides. Lediberder ^ reports a case in which the
ureter had double origin. Tyson ® cites an instance of four ureters in an
infant. Penrose^ mentions the absence of the upper two-thirds of the left
ureter, with a small cystic kidney, and there are parallel cases on record.

The ureters sometimes have anomalous terminations either in the rectum,
vagina, or directly in the urethra. This latter disposition is realized nor-
mally in a number of animals and causes the incessant flow of urine, result-
ing in a serious inconvenience. Flajani speaks of the termination of the
ureters in the pelvis ; Nebel s has seen them appear just beneath the umbil-
icus ; and Lieutaud describes a man who died at thirty-five, from another
cause, whose ureters, as large as intestines, terminated in the urethral canal,
causing him to urinate frequently ; the bladder was absent. In the early
part of this century ^ there was a young girl examined in New York whose
ureters emptied into a reddish carnosity on the mons veneris. The urine
dribbled continuously, and if the child cried or made any exertion it came
in jets. The genital organs participated but little in the deformity, and with
the exception that the umbilicus was low and the anus more anterior than
natural, the child was wtII formed and its health good. Colzi^ reports a
case in which the left ureter opened externally at the left side of the hymen
a little below the normal meatus urinarius. There is a case described j of a
man who evidently suffered from a patent urachus, as the urine passed in jets

a 242, 1894. b 547^ 1873-4, iv., 220. c 242, 1874, xliii., 55.

<i242, 1834-5, ix., 187. e 629, Lond., 1731, iii., 146. f 779, xl., 161.

g Comment. Acad. Palat., vol. v., n. xii. h 302, iv., 159.

i 747, May, 1895. j M6m. de I'Acad. de Chir., vol. xxx.

ANOMALIES OF THE BLADDER.

295

in ix

Fig. 142.— Triple bladder (Scibelli).

as if controlled by a spliincter from his umbilicus. Littre mentions a patent
urachus in a boy of eighteen. Congenital dilatation of the ureters is occa-
sionally seen in the new-born. Shattuck describes a male fetus showing
reptilian characters in the sexual ducts. There was ectopia vesicae and pro-
lapse of the intestine at the umbilicus ; the right kidney was elongated ; the
right vas deferens opened into the ureter. There was persistence
separate condition of the
two Midlerian ducts which
opened externally inferior-
ly, and there were two
ducts near the openings
which represented anal
pouches. Both testicles
were in the abdomen.
Ord^' describes a man in
whom one of the Miillerian
ducts was persistent.

Anomalies of the
Bladder.— Blanchard, Blasius, Haller, Nebel, and Rhodius mention cases in
which the bladder has been found absent and we have already mentioned some
cases, but the instances in which the bladder has been duplex are much
more frequent. Bourienne, Oberteutfer, Ruysch, Bartholinus, Morgagni, and

Franck speak of vesical duplication. There
is a description'' of a man who had two blad-
ders, each receiving a ureter. Bussiere'^ de-
scribes a triple bladder, and Scibelli of
Naples® mentions an instance in a subject
who died at fifty-seven with symptoms of re-
tention of urine. In the illustration (Fig.
142), B represents the normal bladder, A and
C the supplementary bladders, with D and E
their respective points of entrance into B. As
will be noticed, the ureters terminate in the
supplementary bladders. Fantoni^-^'' and
Malgetti cite instances of quintuple blad-
ders.

The Ephemerides speaks of a case of coalition of the bladder with the os
pubis and another case of coalition with the omentum. Prochaska men-
tions vesical fusion with the uterus, and we have already described union
with the rectum and intestine.

Exstrophy of the bladder is not rare, and is often associated with hypo-

Fig. 143.— I 'iiauiuon of the fetal bladder.

a Jour, of Path, and Bacter., July, 1895.

c Jour, de Trevoux, 1702. ^629, u. 268.

b491, 1880, 109.
e 222, 1864, ii., 328.

296

MINOR TERATA.

spadias, epispadias, and other malformations of the genitourinary tract. It
consists of a deficiency of the abdominal wall in the hypogastric region, in
which is seen the denuded bladder. It is remedied by many different and
ingenious plastic operations.

In an occasional instance in wliich 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, Pauum, Behr, Paullini, Rhodius,
Winslow, and Zacutus Lusitanus.

The Ephemerides ® cites an instance of trij)le heart, and Johnston ^ has
seen a triple heart in a goose.

The phenomenon of " blue-disease," or congenital cyanosis, is due to the
patency of the foramen ovale, which, instead of closing at birth, persists
sometimes to adult life.

Perhaps the most unique collection of congenital malformations of the
heart from persons who have reached the age of puberty was to be seen in
London in 1895.^^^ In this collection there was an adult heart in which the
foramen ovale remained open until the age of thirty-seven ; there were but
two pulmonary valves ; there was another heart showing a large patent fora-
men ovale from a man of forty-six ; and there was a septum ventriculorum
of an adult heart from a woman of sixty-three, who died of carcinoma of the
breast, in which the foramen ovale was still open and would admit the fore-

a 302, xxxiv., 207. b 713, L. ii., obs. 184. c 473^ ohs. 469. d 778, vol. xii., 169.
e 104, dec. i., an. 9, obs. 108. "Med. Bemerk. und Untersucb.," Band ii., 103.

ANOMALIES OF THE BREASTS.

297

finger. This woman had shown no symptoms of the malformation. There
were also hearts in 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 liis 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 lieight, well proportioned and healthy, who was killed in a duel by
receiving a wound in the abdomen ; postmortem, the heart was found in the
position of the right lung ; the two lungs were joined and occupied the left
chest.

The anomalies of the vascular system are so numerous that we shall
dismiss them with a slight mention. Malacarne in Torino in 1784 de-
scribed a double aorta, and Hommelius^ mentions an analogous case. The
following case is quite an interesting anatomic anomaly : A woman since
infancy had difficulty in swallowing, which was augmented at the epoch of
menstruation and after exercise ; bleeding relieved her momentarily, but the
difficulty always returned. At last deglutition became impossible and the
patient died of malnutrition. A necropsy revealed the presence of the sub-
clavicular artery passing between the tracheal artery and the esophagus, com-
pressing this latter tube and opposing the passage of food.

Anomalies of the Breasts. — The first of the anomalies of the generative
apparatus to be discussed, although not distinctly belonging under this head,
will be those of the mammse.

Amazia, or complete absence of the breast, is seldom seen. Pilcher ^ de-
scribes an individual who passed for a female, but who was really a male, in
whom the breasts were absolutely wanting. Foerster, Froriep, and Ried cite
instances associated with thoracic malformation. Greenhow'' reports a case
in which the mammje 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, s
and others."^ Scanzoni has observed absence of the left mamma with ab-
sence of the left ovary.

a 462, tome xlix., p. 423. b 302, iv., 150. c 282, 1737.

<i476, 1878, i., 915. e 550, 1864, 195. f 548, 1858.

g 476, 1862, i., 648. h Thes6 de Paris, ann. x., No. 53, p. 15.

298

MINOR TERATA.

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. How-
ever, 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 Buslmian tribe nursing an infiint. 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 " be-
cause she had supernumerary breasts. Anne Boleyn, the unfortunate wife
of Heniy VIII. of England, was reputed to have had six toes, six fingers,

and three breasts. Lynoeus says that
in his time there existed a Roman
woman with four mammae, very beau-
tiful 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 mammae, 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 mar-

Fig. 144. — Bushwoman nursing her infant. ^

Leichtenstern, wdio 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 (l.o6 per cent.). Leichtenstern places the frequency at one in 500.
Both observers declare that men present the anomaly about twice as fre-
quently as women. It is impossible to account for the accessory glands on

a 792, May, 1896.

POLYMAZTA.

299

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 carti-
lages, above the umbilicus, in the axilla, in the groin, on the dorsal sur-
face, 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, Quinquaud, Whiteford, Eng-
strom, 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 grow-
ino- child. Figrure 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 form-
ing 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, exhibit-
ing 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 nii)plcs. She became a mother at
fourteen, and gave milk from all her breasts. In his " Dictionnaire Pliilo-
sophique" Voltaire gives the history of a woman with four well-formed
a 190, cent. iv. b 302, iv., 152.

Fig. 145.— statue of a poly mas-
tic Artemisia or Diana.

300

MINOR TERATA.

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.

Fig. 146. — Woman with two axillary mammae (Charpentier).

They all had an intense dark ring about them ; the fifth was situated
about five inches above the umbilicus. Percy injected the subject and dis-
sected 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
a 302, iv., 152. b 792, May, 1896.

POLYMAZIA.

301

axillary mamma) with nipples. They gave milk as the ordinary mammae
(Fig. 146). Robert saw a woman who nourished an infant by a mamma on
thelhigh. Until the time of pregnancy this mamma was taken for an ordi-
nary 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. Jcnner 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 axillie. Lee mentions a woman
of thirty-five with four mammte and four nipples; she suckled with the
pectoral and not the axillary breasts. McGillicudy describes a pair of rudi-
mentary abdominal mammie, and there is another similar case recorded.^ Har-
tung'^ mentions a woman of thirty
who while suckling had a manmia
on the left labium majus. It was
excised, and microscopic examina-
tion showed its structure to be that
of a rudimentary nipple and mam-
mary 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 func-
tionally 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
(Fig. 148). Sneddon,j who has collected quite a number of cases of poly-
mazia, quotes the case of a woman who had two swellings in each axilla in

Fig. 147.— Functional supernumerary mamma on the thigh.

a 476, 1860, ii., 405.
d Inaug. diss., Erlangen, 1872.
f Quart. Med. Jour., April, 1894.
i Archiv. fur Klinische Chirurgie, 1893

^550, xxi., 266.

g 476, xii., 618.

c 451, 1878, xiii., 425.
e 833, 1858, i., 52.
^ These de Paris,
j 381, 1879, p. 92.

302

MINOR TEE ATA.

which gland-stnicture was made out, but witli 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
m 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. Neuge-
bauer reports eight supernume-
rary nipples in one case. Hollerus
has seen a woman who had two
nipples on the same breast which
gave milk with the same regu-
larity and the same abundance as
the single nipple. The Ephem-
erides contains a description of
a triple nipple. Barth ^ describes
a " 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, Se-
verinus, and Werckardus.

Cases of functional male mam-
mae will be discussed in Chapter
IX.

Fig. 148.— Supernumerary breast (Martin). 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

a 778, ix., 50. b "Dissert, sur la lactation," Paris, 1802. p. 15.

c 161, 1888, 569. d " Annales d'hygiene publique et de medecine legale," 1877.

ABSENCE OE THE VAGINA.

303

biperforate hymen, which show very well that this disposition of the mem-
brane 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 dupli-
cated on either side. In her sister of nine the hymen was normally con-
formed. 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 conforma-
tion ; there were two oval orifices, their greatest diameter being in the ver-
tical 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 obstet-
rics. 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 con-
sidered together.

Complete absence of the vagina is quite rare. Baux * reports a case
of a girl of fourteen in whom " there was no trace of fundament or of genital
organs." Oberteulfer ^ 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. Men-
strual 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, Kluyskens, Debrou, Braid, Watson, and others are quoted by Churchill
as having mentioned the absence of the vagina. Amussat^ observed a Ger-
man girl who did not have a trace of a vagina and wlio menstruated regularly.
Griffiths 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 charac-
teristics of the male type. Matthews Duncan has observed a somewhat
similar case, the vagina not measuring more than an inch in length. Fer-
guson ^ describes a prostitute of eighteen who had never menstruated. The

a 460, 1758, viii., 59.
d 778, xxvii., 123.
g 778, xxvii., 123.

b 160, Band ii., 627.
e 476, 1872, ii., 225.

0 302, iv., 162.

f 368, Dec. 12, 1865.

h Planet, N. Y., 1883, 1.

304

MINOR TERATA.

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 congeni-
tal 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.

Az6ma ^ reports an instance of complete absence of the vagina and im-
permeability and probable absence of the col uterinus. The deficiencies
were remedied by operation. B6rard « mentions a smiilar deformity and
operation in a girl of eighteen. Gooding'^ cites an instance of absent va-
gina in a married woman, the uterus discharging the functions. Gosselin « re-
ports a case in which a voluminous tumor was formed by the retained men-
strual 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 M^moires in 1639 speaks of an instance.
The celebrated Madame R^camier was called by the younger Dumas an
involuntary virgin ; and in this connection could be cited the malicious
and piquant sonnet : —

Chateaubriand et Madaisie RficAMiER.

" Juliette et Kene s'aimaient d' amour si tendre
Que Dieu, sans les punir, a pu leur pardonner :
II n'avait pas voulu que Tune put donner
Ce que 1' 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.

a 548, 1852, 187. ^40, 193. TsBS ''''

. .^^ P QftQ oo^ I 125, XI., oyo.

d476, 1879, i., 430. ^ 363, xl., J,Zo. ■»■ j >

TRANSVERSE SEPTA OF THE VAGINA.

305

Robb ^ of Johns Hopkins Hospital reports a case of double vagina in a pa-
tient of twenty suifering from dyspareunia. The vaginal orifice was con-
tracted ; 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, Le-
maistre, 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 supernu-
merary 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 J 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 mem-
branous 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 If 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 inches from the
vaginal orifice and contained an opening which admitted a uterine sound.
It was very dense and tight and fully i 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 occ<asionally opens
abnormally into the rectum, into the bladder, the urethra, or upon the

a 446, April, 1895. 647, 1877. c 261, Sept. 22, 1894.

J 476, 1889, i., 726. e 218, May 30, 1895. f 476, 1888 ii 166

20 , , ., .

306

MINOB TERATA.

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 exammed
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 anes-
thetized the patient, applied the forceps, and extracted the fetus without
further accident. The wlva 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 alwavs 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. .111

Absence of the nymphae has also been observed, particularly by
Auvard and by Perchaux, and is generally associated with imperfect develop-
ment of the clitoris. Constantinedes « reports absence of the external
organs of generation, probably also of the uterus and its appendages, m 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 nympha3 ; Neubauer ni
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 hyper-
trophy, 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

a 789, Sept. 4, 1888. b 168, 1886, p. 854. c 250, 1870-1, iii., 77. d 685, L. ii., c. 35.

I

I

HOTTENTOT WOMEN.

307

the deficiency in development of the labia majora, mons veneris, and genital
hair. In this respect they present "an approximation to the genitals of tlie
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 w^as due to
abnormal hypertrophy of the labia and nymphse (PI. 5). According to John
Knott, the French traveler, Le V aillant, said that the more coquettish among
the Hottentot girls are excited by extreme vanity to practise artificial elongation
of the nymplia and labia. They are said to pull and rub these parts, and even
to stretch them by hanging weights to them. Some of them are said to spend
several hours a day at this process, which is considered one of the important
parts of the toilet of the Hottentot belle, this malformation being an attrac-
tion for the male members of the race. Merensky says that in Basuto-
land the elder women begin to practise labial manipulation on their female
children shortly after infancy, and Adams has found this custom to prevail
in Dahomey ; he says that the King's seraglio includes 3000 members, the
elect of his female subjects, all of whom have labia up to the standard of
recognized length. Cameron found an analogous practice among the women
of the shores of Lake Tanganyika. The females of this nation manipulated
the skin of the lower part of the abdomens of the female children from
infancy, and at puberty these women exhibit a cutaneous curtain over the
genitals which reaches half-way down the thighs.

A corresponding development of the preputian clitorides, attaining the
length of 18 mm. or even more, has been observed among the females of
Bechuanaland. The greatest elongation measured by Barrow was five inches,
but it is quite probable that it was not possible for him to examine the
longest, as the females so gifted generally occupied very high social positions.

Morgagni describes a supernumerary left nymplia, and Petit is accred-
ited with seeing a case which exhibited neither nymphte, clitoris, nor urinary
meatus. Mauriceau performed nymphotomy on a woman whose nvmphte were
so long as to render coitus difficult. Morand quotes a case of congenital
malformation of the nymphse, 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 whoi/he operated
which was the result of the fusion of the labia minora, and this with an en-
larged clitoris gave the exteral appearance of an hermaphrodite.

The absence of the clitoris coincides with epispadias in the male, and in
atrophy of the vulva it is common to find the clitoris rudimentary ; but a
more frequent anomalj is hypertrophy of the clitoris.

a 235, 1864, 26, tome xlv.

308

MINOR TERATA.

Among the older authorities quoting instances of enlarged clitorides are
Bartholinus, Schenck, Helhvig, Rhodiiis, Riolanus, and Zacchias. Albu-
casis"5 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 ^gean Sea who had a sentimental attachment for one
another which was called " Lesbian love," and which carried them to the
hio-hest degree of frenzy. The immortal effusions of Sappho contain refer-
ences to this passion. The solution of this peculiar ardor is found in the
fact that some of the females had enlarged clitorides, strong voices, robust
figures, and imitated men. Their manner was imperative and authoritative
to their sex, who worshiped them with perverted devotion. We find in
Martial mention of this perverted love, and in the time of the dissolute
Greeks and Romans ridiculous jealousies for unfaithfulness between these
women prevailed. Aetius said that the Egyptians practised amputation of
the clitoris, so that enlargement of this organ must have been a common vice
of conformation along the Nile. It was also said that the Egyptian women
practised circumcision on their females at the age of seven or eight, the time
chosen being when the Nile was in flood. Bertherand « cites examples of
enlarged clitorides in Arab women ; Bruce testifies to this circumstance in
Abyssinia, and Mungo Park has observed it in the Mandingos and the Ibbos.

Sonnini<i gays 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 I 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 nymphs; Gallienif found a similar operation cus-
tomarv on the upper banks of the Niger. v. • ii

Otto at Breslau in 1824 reports seeing a negress with a clitoris 4^
inches long and U inches in the transverse diameter ; it projected from the
vulva and when lupine formed a complete covering for the vaginal orifice.
The clitoris may at times become so large as to prevent coitus, and in France
has constituted a legitimate cause for divorce. This organ is very sensitive,
and it is said that in cases of supposed catalepsy a woman cannot bear titilla-
tion of the clitoris without some visible movement.

Columbus cites an example of a clitoris as long as a little finger ; Haller

n 683, 1695, 295. b 509, L. i., epigram 91. c M6d. et Hygiene des Arabes," p. 190.
.1 ' Voyage dans la Haute et la Basse-Egypt.," Paris, 1799. « 243, x.., 126.

f Bull, de la Soc. de Geog., iv., 1883, 573.

HYPERTROPHY OF THE CLITORIS.

309

mentions one whicli measured seven inches, and there is a record " of an
enhirgcd 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 \\\ih 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 ossifica-
tion of the clitoris is ob-
served. Fournier '^^^ speaks
of a public woman in Venice
who had an osseous clitoris ;
it was said that men having
connection with her invari-
ably suffered great pain, fol-
lowed by inflammation of
the penis.

There are a few instances
recorded of bifid clitoris,
and Arnaud'^ cites the his-
tory 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 whicli one of the ovaries is missing. Hunter, Vidal, and
Chaussier report in full cases of the absence of the ovaries, and Thudicuni
has collected 21 cases of this nature. Morgagni, Pears, ' and Cripps have
published observations in whicli 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 ;

« 302. v., 374. b 543, I860, i., 45. c 773, xii., 84. d " M6m. de Chinirg.," tome i.
e Soc. d. sc. nikl. de Gaunat., xxiii., 1868-9, 22. f 629, 1805, 225.

Fig. 149.— Hypertrophy of the clitoris.

310

MINOR TERATA.

on the other hand, Ruband describes a woman with only rudimentary
ovaries w ho 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 researclies of Beigel, Puech, Thudicum, Winckler, de Sin6ty, 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 por-
tions 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 f 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. Mund6,
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 Bla-
sius '''' reports an instance of deficient oviducts. Blot « reports a case of atro-
phy, or rather rudimentary state of one of the ovaries, with absence of the tube

(m that side, in a woman of forty. , t^. , . .

Doran f has an instance of multiple Fallopian tubes, and Richard, m
1851, says several varieties are noticed. These tubes are often found fused

a 061 1889 No 18

T-Les vices circonformation.les organs genitaux,'' etc. Par.,1892. di99, 1857, 345.
e "Compt. rend. Soc. de biol.," iii., 176. Par., 1857. 778, 1887.

DOUBLE UTERUS.

311

or adherent to the ovary or to the utcrns ; but Ful)ricius=«» describes tlie
symphysis of the Fallopian tube with the rectum.

Absence of the uterus is frequently reported. Lieutaud and Richer-
and^^o'-^ 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,^ Waltherj^i-i Le Fort, Calori, Pozzi, Munde, and Strauch. Balade
has reported a curious absence of the uterus and vagina in a girl of eighteen.
Azam, 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 in-
stance 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 vaginse. 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 (Fig. 151). Vallisneri ^ relates the history
of a woman who was poisoned by cantharides who had two uteruses, one open-
ing into the vagina, the other into the rectum. Morand, Bartholinus, Tiede-
mann, 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 8 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 con-
tained 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

a 462, iv., 128. ^ 565, ii., 19. c Jour, de Medicine de Bordeaux, Oct. 4, 1891.
1224, June 18, 1870. e 549, Juiy^ iges, 457. f " Esperienze d'osservaz.," etc
g 629, Ixiv., 474. h 261 , 1895, No. 4, p. 375.

312 MINOR TERATA.

c

Fig. 150— Bipartite uterus with double vagina. Fig. 151.— Didelphie uterus and divided vagina :

a, right segment; b, left segment; c, d, right ovary and
round ligament ; /, e, left ovary and round ligament ;
g,J, left cervix and vagina; k, vaginal septum; h, i,
right cervix and vagina.

Fig. 152.— Complete prolapse of the uterus, with eversion of vagina (Keen and White).

HERNIA OF THE UTERUS.

313

with its adnexa ; connected with this uterus was another one, anterior to it.
The two uteruscs had a common cervix ; the anterior of the two organs iiad
no adnexa, though there were lateral peritoneal ligaments ; it had become
pregnant." Hollander explains the anomaly by stating that probably the
Miillerian ducts or one of them had grown excessively, leading to a folding
off of a portion which developed into the anterior uterus.

Other cases of double uterus with pregnancy are mentioned on page 49.

AVhen 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 supcrfetation in a normal
uterus, or whether the uterus was
double, would immediately arise.
There would also be the possibility
that one of the children was of pro-
tracted gestation or that the other was
of premature birth. Article 312 of
the Civil Code of France accords a
minimum of one hundred and eighty
and a maximum of three hundred
days for the gestation of a viable
child. (See Protracted Gestation.)

Voight is accredited with having
seen a triple uterus, and there are
several older parallels on record.

Thilow mentions a uterus which was Fig. 153.-Inguinal hernia containing a gravid womb

(Winckel).

divided into three small portions.

Of the different anomalous positions of the uterus, most of whicli are
acquired, the only one that will be mentioned is that of complete prolapse of
the uterus (Fig. 152). In this instance the organ may hang entirely out of
the body and even forbid locomotion.

Of 19 cases of hernia of the uterus quoted by Debierre 13 have been ob-
served in the inguinal region (Fig. 153), five on the right and seven on the left
side. In the case of Roux in 1891 the hernia existed on both sides. The
uterus has been found twice only in crural hernia and three times in lunbilieal
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 ; Lcotaud, Murray, and Hagner
in an umbilical hernia. The accompanying illustration (Fig. 154) represents
a hernia of the gravid womb through the linea alba.

a 503, iii., 175.

314

MINOR TERATA.

Absence of the penis is an extremely rare anomaly, although it has
been noted by Schenck,--^ Borellus, Bouteiller, Nelaton, and others. Fortu-
natus Fidelis ^ and R^volat describe a newly born child with absence of
external genitals, with spina bifida and umbilical hernia. N6laton ^ 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 <i 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 scfotum was
present. Incisions were made into a small swelling just below the urinary

Fig. 154.— Hernia of the gravid womb through the linea alba.

opening in the abdomen which brought into view the penis, the glans being
normal but the body very small. The treatment consisted of pressing out
the glans daily until the wound healed ; the penis receded spontaneously. It
is stated that the organ would doubtless be equal to any requirements de-
manded of it. Demarquay quotes a somewhat similar case in an infant, but
it had no urinary opening until after operation.

Among the older writers speaking of deficient or absent penis are Bar-
tholinus,^^" Bauhinus, Cattierus, the Ephemerides, Frank, Panaroli,^!^ van
der Wiel, and others. Renauldin ^ describes a man with a small penis and
enormous mammse. Goschler,^ quoted by Jacobson, speaks of a well-de-
veloped man of twenty-two, with abundant hair on his chin and suprapubic

a 718 lib. iv., chap. 9. ^ De relationibus medicorum, no. 357. c 363, 1854.

d ' ' Dis. of Children, ' ' p. 53. e 224, 1885, ii. , 62. f 565, tome 1., p. 294. g 808, 1857.

RUDIMENTARY DEVELOPMENT OF THE PENIS. 315

region and tlie scrotum apparently perfect, with median raphe ; a careful
search failed to show any trace of a penis ; on the anterior wall of the
rectum four lines above the anus was an orifice which gave vent to urine ; the
right testicle and cord were normal, but there was an acute orchitis in the
left. Starting from just in front of the anal orifice was a fold of skin 1^
inches long and | inch high continuous with the raphe, which seemed to be
formed of erectile tissue and which swelled under excitement, the enlarge-
ment lasting several minutes with usually an emission from the rectum. It
was possible to pass a sound through the opening in the rectum to the blad-
der through a urethra 1^ inches wide ; the patient had control of the bladder
and urinated from every three to five hours.

Many instances of rudimentary development of the penis have been
recorded, most of them complicated with cryptorchism or other abnormality
of the sexual organs. In other instances the organ is present, but the
infantile type is present all through life ; sometimes the subjects are weak
in intellect and in a condition similar to cretinism. Kaufmann quotes a case
in a weakly boy of twelve whose penis was but f inch long, about as thick
as a goose-quill, and feeling as limp as a mere tube of skin ; the corpora
cavernosa were not entirely absent, but ran only from the ischium to the
junction of the fixed portion of the penis, suddenly terminating at this point.
Nothing indicative of a prostate could be found. The testicles were at the
entrance of the inguinal canal and the glans was only slightly developed.

Binet* speaks of a man of fifty-three whose external genitalia were of
the size of those of a boy of nine. The penis was of about the size of the
little finger, and contained on each side testicles not larger than a pea. There
was no hair on the pubes or the face, giving the man the aspect of an old
woman. The prostate was almost exterminated and the seminal vesicles were
verv^ 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
Avere 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,^35 gchenck,^ and Zacchias. The result in these cases was impotency.

In the Army and Medical Museum at Washington are two injected speci-
mens of the male organ divested of skin. From the meatus to the pubis
they measure ^ and 5i inches ; from the extremity to the termination of
either crus 9| and 8f inches, and the circumferences are 4| and 4i inches.
Between these two we can strike an average of the size of the normal penis.

"242,1883. b718,lib. iv.,obs. 12.

316

MINOR TERATA.

Ill some instances the penis is so large as to forbid coitus and even inconveni-
ence its possessor, measuring as much as ten or even more inches in length.
Extraordinary cases of large penis are reported by Albinus (who mentions
it as a cause for sterility), Bartholinus,i89 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 mture de la verge of the French, is the name given
to those examples of single cutaneous envelope for both the testicles and
penis ; the penis is adherent to the scrotum by its inferior face ; the glans only
is free and erection is impossible. Chretien cites an instance in a man of
twenty-five, and Schrumpf of Wesserling describes an example of this rare
anomaly. The penis and testes were inclosed in a common sac, a slight pro-
jection not over ^ inch long being seen from the upper part of this curious
scrotum. When the child was a year old a plastic operation was performed
on this anomalous member with, a very satisfactory result. Petit describes
an instance in which the penis was slightly fused with the scrotum.

There are many varieties of torsion of the penis. The glans itself may
be inclined laterally, the curvature may be total, or there may be a veritable
rotation, bringing the inferior face above and the superior face below. Gay «
describes a child Avith 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 e
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,4oi Petit, ^ Schurig, Tulpius,J and
Zacchias.^^*^

Zacutus Lusitanus ^ speaks of torsion of the penis from freezing. Paul-
lini ^ mentions a case the result of masturbation, and Hunter speaks of
torsion of the penis associated with arthritis.

Ossification of the Penis.— MacClellan " speaks of a man of fif^y-two
whose penis was curved and distorted in such a manner that urine could not
be passed without pain and coitus was impossible. A bony mass was dis-
covered in the septum between the corpora cavernosa ; this was dissected out
with much hemorrhage and the upward curvature was removed, but there

a " Spermatologia," p. 109. ^ " Lect. Memorab.," tome i., p. 34.

c " Menioires coucernaut les Arts, '» 1672, 27. d 369, 1882. ^ 779, xvi., 189.
f 789, 1862. g 476, Sept. 15, 1894. h 718, L. iv., no. 14.

i 625,' Supplement. J 842, L. iii., no. 39. ^ 831, L. iii., obs. 118.

I 620 cent, iv., obs. 92. m " References on Venereal Diseases," etc.

n Nouveau Journal des Sciences M6dicales, March, 1878.

ANOMALIES OF THE URETHRA.

317

resulted a slight inclination in the opposite direction. The formation of bone
and cartilage in the penis is quite rare. Velpeau, Kauffmaan, 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 develop-
ment is more frequent, but most common is excessive development of the pre-
puce, constituting phimosis, when there is abnormal adherence with the glans.
Instances of phimosis, being quite common, will be passed without special
mention. Deficient or absent prepuce has been observed by Blasius,^^^ Mar-
cellus Donatus/^"^ and Gilibert. Partial deficiency is described by Petit,
Severinus, and others.

There may be imperforation or congenital occlusion of some portion of the
urethra, causing enormous accumulation of urine in the bladder, but fortu-
nately there is generally in such cases some anomalous opening of the ure-
thra giving vent to the excretions. Tulpius ^ mentions a case of deficient
urethra. In the Ephemerides there is an account of a man who had a con-
stant flow of semen from an abnormal opening in the abdomen. La Pey-
ronia describes a case of impotence due to ejaculation of the spermatic ducts
into the bladder instead of into the urethra, but remarks that there was a
cicatrix of a wound of the neighboring parts. There are a number of
instances in which the urethra has terminated in the rectum. Congenital
dilatation of the urethral canal is very rare, and generally accompanied by
other malformation.

Duplication of the urethra or the existence of two permeable canals is
not accepted by all the authors, some of whom contend that one of the canals
either terminates in a culdesac or is not separate in itself Verneuil has pub-
lished an article clearly exposing a number of cases, showing that it is possi-
ble for the urethra to have two or more canals which are distinct and have
separate functions. Fabricius Hildanus ^ speaks of a double aperture to the
urethra ; Marcellus Donatus ^ describes duplicity of the urethra, one of the
apertures being in the testicle ; and there is another case on record in which
there was a urethral aperture in the groin. A case of double urethra in a
man of twenty-five living in Styria « who was under treatment for gonorrhea
is described, the supernumerary urethra opening above the natural one and
receiving a sound to the depth of 17 cm. There was purulent gonorrhea in
both urethrse. Vesalius has an account of a double urethral aperture, one of
which was supposed to give spermatic fluid and the other urine. Borellus,
Testa, and Cruveilhier have reported similar instances. Instances of double
penis have been discussed under the head of diphallic terata, page 194.

a 620, cent, i, obs. 72.
d334, cent, i., obs. 76.
g 536, 1887, vol. ii.

»>842, L. xliv., cap. 36.
e 306, L. vi., c. ii., 619.

c 563, i., 427.

<■ 524, vol. ii., 440.

1»804, L. v., c. 18.

318 MINOR TERATA.

Hypospadias and epispadias (Fig. 155) are names given to malforma-
tions of the urethra in which the wall of the canal is deficient either above
or below. These anomalies are particularly interesting, as they are nearly
always found in male hermaphrodites, the fissure giving the appearance of a
vulva, as the scrotum is sometimes included, and even the perineum may be
fissured in continuity with the other parts, thus exaggerating the deception.
There seems to be an element of heredity in this malformation, and this
allegation is exemplified by Sedgwick, who quotes a case from Heuremann in
which a family of females had for generations given birth to males with
hypospadias. Belloc " mentions a man whose urethra terminated at the base
of the frenum who had four sons with the same deformity. Picardat ^ men-
tions a father and son, both of whom
had double urethral orifices, one above
the other, from one of which issued
urine and from the other semen —
a fact that shows the possibility of
inheritance of this malformation.
Patients in whom the urethra opens
at the root of the penis, the meatus
being imperforate, are not necessarily
impotent ; as, for instance, Fournier
knew of a man whose urethra opened
posteriorly who was the father of four
children. Fournier supposed that
the semen ejaculated vigorously and
followed the fissure on the back of the
penis to the uterus, the membrane
of the vagina supplanting the deficient
wall of the urethra. The penis was
short, but about as thick as ordinary.
Gray ^ mentions a curious case in a man afflicted with hypospadias who,
suffering with delusions, was confined in the insane asylum at Utica. AVhen
he determined to get married, fully appreciating his physical defect, he re-
solved to imitate nature, and being of a very ingenious turn of mind, he
busied himself with the construction of an artificial penis. While so en-
gaged he had seized every opportunity to study the conformation of this
organ, and finally prepared a body formed of cotton, six inches in length, and
shaped like a penis, minus a prepuce. He sheathed it in pig's gut and gave
it a sliglit 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
firmlv wound. It was fastened to the waist-band by means of straps, a cen-
tral and an upper one being so arranged that the penis could be thrown into
a 302, xxiv. b Thes6 de Paris, 1858, No. 91. c 302, iv., 162. d 773, 1870

Fig. 155.— Complete epispadias.

ABSENCE OF THE TESTICLES.

319

an erect position and so maintained. He had constructed a flesh-colored cov-
ering which completely concealed the straps. With this artificial member he
was enabled to deceive his wife for fifteen months, and was only discovered when
she undressed him while he was in a state of intoxication. To further the
deception he had told his wife immediately after their marriage that it
was quite indecent for a husband to undress in the presence of his wife, and
therefore she liad 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,

a 476, 1828, ii., 182. b " Irenicum Numse," p. 133. c 445 p 406

d 124, Feb., 1839. e 553, Heft L, 1868.

320

MINOR TERATA.

1867, in whom the right half of the scrotum, the right testicle, epididymis,
and the scrotal and inguinal parts of the right vas deferens were absent.
Gruber examined the literature for thirty years up to the time of his report,
and found 30 recorded postmortem examinations in which there was absence
of the testicle, and in eight of these both testicles were missing. As a rule,
natural eunuchs have feeble bodies, are mentally dull, and live only a short time.
The penis is ordinarily defective and there is sometimes another associate mal-
formation. They are not always disinclined toward the opposite sex.

Polyorchids are persons who have more than two testicles. For a long
time the abnormality was not believed to exist, and some of the observers
denied the proof by postmortem examination of any of the cases so diagnosed ;
but there is at present no doubt of the fact,— three, four, and five testicles
having been found at autopsies. Russell, one of the older writers on the
testicle, mentions a monk who was a triorchid, and was so salacious that his
indomitable passion prevented him from keeping his vows of chastity. The
amorous propensities and generative faculties of polyorchids have always been
supposed greater than ordinary. Russell reports another case of a man with
a similar peculiarity, who was prescribed a concubine as a reasonable allow-
ance to a man thus endowed.

Morgagni and Meckel say that they never discovered a third testicle in
dissections of reputed triorchids, and though Haller ^ has collected records of
a great number of triorchids, he has never been able to verify the presence
of the third testicle on dissection. Some authors, including Haller, have
demonstrated heredity in examples of polyorchism. There is an old instance
in which two testicles, one above the other, were found on the right side and
one on the left. Macann « describes a recruit of twenty, 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 g discovered three fully
developed testicles, two on the right side placed one above the other. The
London Medical Record of 1884 quotes JdanofP of St. Petersburg in men-
tioning a soldier of twenty-one who had a supernumerary testicle erroneously
diagnosed as inguinal hernia. Quoted by the same reference, BulatolF men-
tions a soldier who had a third testicle, which diagnosis was confirmed by
several of his confreres. They recommended dismissal of the man from the
service, as the third testicle, usually resting in some portion of the inguinal
canal, caused extra exposure to traumatic influence.

a 400 L xxvii., 412. » 504, xviii., 362. c 656, 1842. ^ 654, 1842.

e 476; 1865, ii., 501. f 224, Dec. 1, 1894. ^ 812, 1882, 38, 642.

CB YPTOR CHIDS. 321

Venette gives an instance of four testicles, and Scharff, in the Ephe-
nierides, mentions five; Blasius'^^^ mentions more than three testicles, and,
without citing proof, Bulfon admits the possibility of such occurrence and
adds that such men are generally more vigorous.

RusselP 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 ab-
dominal and in the latter scrotal. Kerckring^ has a description of an indi-
vidual in whom the scrotum was absent.

In those cases in which the testicles are still in the abdominal cavity
the individuals are termed cryptorchids. Johnson*^ has collected the re-
sults of postmortem examinations of 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
crvptorchid child. Some of the cryptorchids were etfeminate, although
others were manly with good evidences of a beard. The morbid, hypochon-
driac, the voluptuous, and the imbecile all found a place in Johnson's statis-
tics ; and although there are evidences of the possession of the generative
function, still, we are compelled to say that the chances are against fecundity
of human cryptorchids. In this connection might be quoted the curious case
mentioned by Geoffroy-Saint-Hilaire, of a soldier who was hung for rape. It
was alleged that no traces of testicles were found externally or internally,
yet semen containing spermatozoa was found in the seminal vesicles. Sper-
matozoa have been found days and weeks after castration, and the individuals
during this period were capable of impregnation, but in these cases the reser-
voirs were not empty, although the spring had ceased to flow. Beigel, in
Virchow's Archives, mentions a cryptorchid of twenty-two who had noctur-
nal emissions containing spermatozoa and who indulged in sexual congress.
Partridge ^ describes a man of twenty-four who, notwithstanding his condi-
tion, gave evidences of virile seminal flow.

In some cases there is anomalous position of the testicle. Hough ^
mentions an instance in which, from the great pain and sudden appearance, a
small tumor lying against the right pubic bone was supposed to be a strangu-

a 215, an. ii., 38. b " Qbs. on Testicles," Edinburgh, 1833. c 473^ obs. xii.
d775, 1884. e 476, 1860, i., 66. f 545,' 1884.

21

322 MINOR TEE ATA.

lated hernia. There were hvo 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 burn-
ing pain near the internal aperture of the internal inguinal canal, succeeded
by a swelling until the tumor passed into the scrotum. It was found m
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. i ip 4.u

Marshall ^ mentions a boy of sixteen in whom the right half ot the
scrotum was empty, although the left was of normal size and contained a
testicle On close examination another testicle was found in the perineum ;
the boy said that while running he fell down, four years before, and on get-
ting up suifered 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 paintul
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. Hutehe-
son, quoted by Russell,<i has gi^en a curious case in an English seaman who,
as was the custom at that time, was impressed into service by H. M. b.
Druid in 1807 from a trading ship off the coast of Africa. The man said
he had been examined by dozens of ship-surgeons, but was invariably re-
iected on account of rupture in both groins. The scrotum was found to be
an emptv 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 dis-

*'°Tntht* connection Russell speaks of a man whose testicle was elevated
every time the east wind blew, which caused him a sense of languor and re-

a^9'^ 18^,6 ix 91 b 548, 1883.

1 «ai • ^dfi d - Obs. on Testicles." Edinb., 1833.

c 436, 1891, n., 546.

INVERSION OF THE TESTICLE. 323

luxation ; 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 Coojier, Boyer, Maisonneuve, Royet, and
other writers.

The anomalies of the vas deferens and seminal vesicles are of little in-
terest and will be passed with mention of the case of Weber,* who found
the seminal vesicles double; a similar conformation has been seen in
hermaphrodites.

a 559, May, 1811, 88.

CHAPTER VII.

ANOMALIES OF STATUKE, SIZE, AND

DEYELOPMENT.

Giants.— The fables of mythology contain accounts of horrible monsters,
terrible in ferocity, whose mission was the destruction of the life of the in-
dividuals unfortunate enough to come into their domains. The ogres known
as the Cyclops, and the fierce anthropophages, called Lestrygons, of Sicily, who
were neighbors of the Cyclops, are pictured in detail in the "Odyssey" of
Homer. Nearly all the nations of the earth have their fairy tales or super-
stitions of monstrous beings inhabiting some forest, mountain, or cave ; and
pages have been written in the heroic poems of all languages describing battles
between these monsters and men with superhuman courage, in which the giant
finally succumbs.

The word giant is derived indirectly from the old English word " geant,
which in its turn came from the French of the conquering Normans. It
is of Greek derivation, or the^^ Latin, " gigas." The Hebrew

parallel is " nophel," or plural, " nephilim."

Ancient Giants.— We are told in the Bible ^ that the bedstead of Og,
King of Basham, was 9 cubits long, which in English measure is IGJ feet.
Goliath of Gath, who was slain by David, stood 6 cubits and a span tail-
about 11 feet. The body of Orestes, according to the Greeks, was 111 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 re-
mains of Posio and Secundilla, found in the reign of Augustus Csesar in the
Sallustian Gardens, of which they were supposed to be the guardians, meas-
ured 10 feet 3 inches each. In common with Augustine, Pliny believed that
the stature of man has degenerated, but from the remains of the ancients so
far discovered it would appear that the modern stature is about the same as

a Deuteronomy iii., 11.
324*

DISCOVERIES OF " GIANTS' BONES."

325

the ancient. The beautiful alabaster sarcophagus discovered near Thebes in
1817 and now in Sir John Soane's Museum in Lincoln's Inn Fields in
London mea.sures 9 feet 4 inclies 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 1 1 feet high. Saxo, the
gmmmarian, mentions a giant 13| feet high and says he had 12 companions
who were double his height. Ferragus, the monster supposed to have been
slain by Roland, the nephew of Charlemagne, was said to have been nearly
1 1 feet high. It was said that there was a giant living in the twelfth century
under the rule of King Eugene II. of Scotland who was 11 J feet high.

There are fabulous stories told of the Emperor Maximilian. Some
accounts say that he was between 8| 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, Th^venot 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 tliat 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 vovagers 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 16 feet in
height.

Discoveries of - Giants' Bones. "_Riolan,««^ the celebrated anatomist
says that there M^as to be seen at one tim6 in the suburbs of Saint Germain
the tomb of the giant Isoret, who was reputed to be 20 feet tall • and that in

326 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT.

1509, in digging ditches at Rouen, near the Dominicans, they found a stone
tomb containing a monstrous skeleton, the skull of which would hold a bushel
of corn ; the shin-bone measured about 4 feet, which, taken as a guide, would
make his height over 17 feet. On the tomb was a copper plate which said
that the tomb contained the remains of " the noble and puissant lord, the
Chevalier Ri^on de Vallemont." Plater,^^^ the famous physician, declares
that he saw at Lucerne the true human bones of a subject that must have

been at least 19 feet high.

Valence in Dauphin6 boasted of possessing the bones of the giant Bucart,
the tyrant of the Yivarias, who was slain by his vassal. Count de Cabillon.
Tlie 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 221 feet high. They claimed to have an os frontis in the medical
school of Leyden measuring 9.1 X 12.2 X .5 inches, which they deduce
must have belonged to a man 11 or 12 feet high.

It is said that while digging in France in 1613 there was disinterred the
body of a giant bearing the title " Theutobochus Rex," and that the skeleton
measured 25 feet long, 10 feet across the shoulders, and 5 feet from breast
to back. The shin-bone was about 4 feet long, and the teeth as large
as those of oxen. This is likely another version of the finding of the

remains of Bucart.

Near Mezarino in Sicily in 1516 there was found the skeleton of a giant
whose height was at least 30 feet ; his head was the size of a hogshead, and
each tooth weighed 5 ounces; and in 1548 and in 1550 there were others
found of the height of 30 feet. The Athenians found near their city skele-
tons measuring 34 and 36 feet in height. In Bohemia in 758 it is recorded
that there was found a human skeleton 26 feet tall, and the leg-bones are still
kept in a medieval castle in that country. In September, 1691, there was
the skull of a giant found in Macedonia which held 210 pounds of corn.

General Opinions.— All the accounts of giants originating in the finding
of monstrous bones must of course be discredited, as the remains were likely
those of some animal. Comparative anatomy has only lately obtained a hold
in the public mind, and in the Middle Ages little was known of it. The pre-
tended giants' remains have been those of mastodons, elephants, and other
animals. From Suetonius we learn that Augustus Csesar pleased himself
by adorning his palaces with so-called giants' bones of incredible size, prefer-
ring these to pictures or images. From their enormous size we must be-
lieve they were mastodon bones, as no contemporary animals show such
measurements. Bartholinus ^ describes a large tooth for many years exhib-
ited as the canine of a giant which proved to be nothing but a tooth of a
spermaceti whale (Cetus dentatus), quite a common fish. Hand ^ described
an alleged giant's skeleton shown in London early in the eighteenth century,

4- • T,-o+ oa ^629, No. 168.

a 190, cent, i., nist. 98. '

GENERAL OPINIONS.

327

and which was composed of the bones of the fore-fin of a small whale or of
a porpoise.

The celebrated Sir Hans Sloane, who treated this subject very learnedly,
arrived at the conclusion that while in most instances the bones found were
those of mastodons, elephants, whales, etc., in some instances accounts were
given by connoisseurs who could not readily be deceived. However, modern
scientists will be loath to believe that any men ever existed who measured
over 9 feet ; in fact, such cases with authentic references are extremely rare.
Quetelet considers that the tallest man whose stature is authentically recorded
was the " Scottish Giant " of Frederick the Great's regiment of giants. This
person was not quite 8 feet 3 inches tall. Buffon, ordinarily a reliable au-
thority, comes to a loose conclusion that there is no doubt that men have
lived who were 10, 12, and even 15 feet tall ; but modern statisticians can-
not accept this deduction from the references offered.

From the original estimation of the height of Adam (Henrion once calcu-
lated that Adam's height was 123 feet and that of Eve 118) we gradually
come to 10 feet, which seemed to be about the favorite height for giants in
the Middle Ages. Approaching this century,we still have stories of men from
9 to 10 feet high, but no authentic cases. It was only in the latter part of
the last century that we began to have absolutely authentic heights of giants,
and to-day the men showing through the country as measuring 8 feet
generally exaggerate their height several inches, and exact measurement
would show that but few men commonly called giants are over 7^ 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 ac-
curately and scientifically measured the list is surprisingly small. Topinard
measured the tallest man in the Austrian army and found that he was 8 feet
41 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 4i 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, be'ing
always larger in proportion to the body, just as we find in infants. Indeed
the proportions of "General Tom Thumb" were those of an ordinary infant
of from thirteen to fifteen months old.

Figure 156 shows a portrait of two well-known exhibitionists of about the
same age, and illustrates the possible extremes of anomalies in stature

Recently, the association of acromegaly with gigantism has been

a 723, Feb., 1895.

328 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT.

noticed, and in these instances there seems to be an acquired uniform enlarge-
ment of all the bones of the bod v. Brissaud and Meige describe the case of a
male of forty-seven who presented nothing unusual before the age of sixteen,
when he begin to grow larger, until, having readied his majority, he measured i
feet 2 inches in height and weighed about 340 pounds. He remained well and
verv strong until the age of thirty-seven, when he overlifted, and following this
he developed an extreme deformity of the spine and trunk, the latter " tele-
scopiug into itself" until the nipples were on a level with the anterior superior
spines of the ilium. For two years he suffered with debility, fatigue, bron-
chitis, night-sweats, head-
ache, and great thirst.
Mentally he was dull ;
the bones of the face and
extremities showed the
hypertrophies character-
istic of acromegaly, the
soft parts not being in-
volved. The circumfer-
ence of the trunk at the
nipples was 62 inches,
and over the most promi-
nent portion of the ky-
phosis and pigeon-breast,
74 inches. The authors
agree with Dana and
others that there is an
intimate relation between
acromegaly and gigan-
tism, but they go further
and compare both to the
growth of the body. They
call attention to the strik-
ing resemblance to acromegaly of the disproportionate growth of the boy at
adolescence, which corresponds so well to Marie's terse description of this
disease • " The disease manifests itself by preference in the bones of the
extremities and in the extremities of the bones," and conclude with this
rather striking and aphoristic proposition : " Acromegaly is gigantism of the
adult • gigantism is acromegaly of adolescence."

The many theories of the cause of gigantism will not be discussed here,
the reader being referred to volumes exclusively devoted to this subject.

Celebrated Giants.— Mention of some of the most famous giants will
be made, together with any associate points of interest.

a Jour, de M6d. et de Chir. prat., Jan. 25, 1895.

Fig. 156.— Giantess and dwarf of the same age.

CELEBRATED GIANTS.

329

Becaniis, physician to Charles V., says that he saw a youth 9 feet high
and a man and a woman almost 10 feet. Ainsworth says that in 1553 the
Tower of London was guarded by three brothers claiming direct descent
from Henry VIII., and surnamed Og, Gog, and Magog, all of whom were
over 8 feet in height. In his "Chronicles of Holland" in 1557 Hadrianus
Barlandus said that in the time of John, Earl of Holland, the giant Nicho-
las was so large that men could stand under his arms, and his shoe held 3
ordinary feet. Among the yeoman of the guard of John Frederick, Duke
of Hanover, there was one Christopher Munster, 8i feet high, who died in
1676 in his forty-fifth year, The giant porter of the Duke of Wiirtemberg
was 71 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^
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
1D38 he saw m France a Flemish man over 9 feet. Keysler mentions see-
ing Hans Bran in Tyrol in 1550, and says that he was nearly 12 feet hi-h
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 a^e of
thirty-two there died in 1798 a clerk of the Bank of England who was said
to W been nearly 7^ feet high. The Daily Advertiser for Februarv
2S, 1740, says that there was a young colossus exhibited opposite the Man-
sion House in London who was 7 feet high, although but fifteen years old
In the same paper on January 31, 1753, is an account of MacGrath, whose
skeleton is still preserved in Dublin. In the reign of George I during the
time of the Rirtholomew Fair at Smithfield, ther! was exhibited In
man seventeen years old who was 8 feet tall.

a " Voyages physiques dans les Pyrenees."

330 AN03IALIES OF STATURE, SIZE, AND DEVELOPMENT

Nicephorus tells of Antoiiius of Syria, in the reign of Theodosius,
who died at the age of twenty-five with a height of 7 feet 7 inches
Artac^cas, 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 m 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 San-
tiago de los Santos, from the Island of Manilla,
thirty-five years old and 2 feet 2 inches high.
" The Annual Register " records the death of Peter
Tuchan at Posen on June 18, 1825, of dropsy of
the chest. He was twenty-nine years old and 8
feet 7 inches in height ; he began to grow at the
age of seven. This monster had no beard; his
voice was soft ; he was a moderate eater. There
was a giant exhibited in St. Petersburg, June, 1829,
8 feet 8 inches in height, who was very thin and
emaciated.

Dr. Adam Clarke, who died in 1832, measured
a man 8 feet 6 inches tall. Frank Buckland, in his
" Curiosities of Natural History," says that Brice,
the French giant, was 7 feet 7 inches. Early in
1837 there was exhibited at Parma a young man
formerly in the service of the King of the Nether-
lands who was 8 feet 10 inches high and weighed
401 pounds. Robert Hale, the "Norfolk Giant," who died in Yarmouth
in 1843 at the age of forty-three, was 7 feet 6 inches high and weighed_452
pounds The skeleton of Cornelius McGrath, now preserved in the Trinity
College Museum, Dublin, is a striking example of gigantism. At sixteen

years he measured 7 feet 10 inches. u o i- . a -

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

Fig. 157.— Skeleton of the
"Irish Giant" in the Royal Col-
lege of Surgeons, London.

CELEBRATED GIANTS.

331

was equally averse to being boiled in the distinguished scientist's kettle.
The giant was tormented all his life by the constant assertions of Hunter
and by his persistence in locating him. Finally, when, following the usual
early decline of his class of anomalies, O'Brien came to his death-bed, he
bribed some fishermen to take his body aftt^r his death to the middle of the
Irish Channel and sink it with leaden weights. Hunter, it is alleged, was
informed of this and overbribed the prospective undertakers and thus secured
the body. It has been estimated that it cost Hunter nearly 500 pounds
sterling to gain possession of the skeleton
of the " Irish Giant." The kettle in which
the body" was boiled, together with some
interesting literature relative to the cir-
cumstances, are preserved in the Museum
of the Royal College of Surgeons in Lon-
don, and were exhibited at the meeting
of the British Medical Association in
1895 with other Hunterian relics. The
skeleton, which is now one of the feat-
ures of the Museum, is reported to meas-
ure 92f inches in height, and is mounted
alongside that of Caroline Crachami, the
Sicilian dwarf, who was exhibited as an
Italian princess in London in 1824. She
did not grow after birth and died at the
age of nine (Fig. 157).

Patrick Cotter, the successor of
O'Brien, and who for awhile exhibited
under this name, claiming that he was a
lineal descendant of the famous Irish
King, Brian Boru, who he declared was 9
feet in height, was born in 1761, and
died in 1806 at the age of forty-five.
His shoe was 17 inches long, and he was
8 feet 4 inches tall at his death.

In the Museum of Madame Tussaud in Loudon there is a wax figure of
Loushkm, said to be the tallest man of his time. It measures 8 feet 5
inches, and is dressed in the military uniform of a drum-major of the Im-
perial Preobrajensky Regiment of Guards. To magnify his'height there is
a figure of the celebrated dwarf, " General Tom Thumb,"" in the palm of his
hand. Figure 158 represents a well-known American giant, Ben Hicks
who was called " the Denver Steeple." ' '

Buffoa refers *» a Swedish giantess wl,o ],e affirms was 8 feet 6 inches
tall. Chang, the " Chinese Giant," whose smiling fi.ce is familiar to nearly

Fig. 158.— Ben Hicks.

332 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT

all the modern world, was said to be 8 feet tall. In 1865, at the age of
nineteen, he measured 7 feet 8 inches. At Hawick, Scotland, in 1870, there
was an Irishman 7 feet 8 inches in height, 52 inches around the chest, and
who weighed 22 stone. Figure 159 shows an American giantess known as
« Leah, the Giantess." At the age of nineteen she was 7 feet 2 inches tall

and weighed 165 pounds.

On June 17, 1871, there were married at Saint-Martins-in-the-Field
iu London Captiiin Martin Van Buren Bates of Kentucky and Miss Anna

Swann of Nova Scotia, two
celebrated exhibitionists,
both of whom were over
7 feet. Captain Bates,
familiarly known as the
" Kentucky Giant," years
ago was a familiar figure
in many Northern cities,
where he exhibited him-
self in company with his
wife, the combined height
of the two being greater
than that of any couple
known to history. Captain
Bates was born in Whites-
burg, Letcher County, Ky.,
on November 9, 1845.
He enlisted in the South-
ern army in 1861, and
though only sixteen years
old was admitted to the
service because of his size.
At the close of the Avar
Captain Bates had attained
his great height of 7 feet
2i inches. His body was

Fig. 159.—" Leah, the Giantess."

well proportioned and his weight increased until it reached 450 pounds. He
traveled as a curiosity from 1866 to 1880, being connected with various
amusement organizations. He visited nearly all the large cities and towns in
the United States, Canada, Great Britain, France, Spain, Germany, Switzer-
land, Austria, and Russia. While in England in 1871 the Captain met Miss
Anna H. Swann, known as the " Nova Scotia Giantess," who was two years the
junior of her giant lover. Miss Swann was justly proud of her height, 7 feet
51 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.

D WAMFS.

333

Captain Bates' parents were of medium size. His father, a native of
Virginia, was 5 feet 10 inches high and weighed 160 jjounds. 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 Avere 42 cm,
(161 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
(961 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 IL; Pothier, the jurist; Bank, the English
naturalist ; Gall, Billat-Savarin, Benjamin Constant, the painter David Bel-
lart, the geographer Delamarche, and Care, the founder of the Gentleman's
Magazme, were all men of extraordinary stature.

Dwarfs.-The word "dwarf" is of Saxon origin (dwerg, dweorg) and
corresponds to the "pumilio" or "nanus" of the Romans. The Greeks
believed in the pygmy people of Thrace and Pliny speaks of the Spitha-
miens. In the "Iliad" Homer writes of the pygmies and Juvenal also de-
scribes them ; but the fentasies 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 a mentions that no dwarf can officiate at the
altar. Aristotle aiid Philostratus speak of pygmy people descended from
Pygmaaus, son of Dorus. In the seventeenth century van Helmont supposed
that there were pygmies in the Canai,^ Islands, and Abvssinia, Braz and
Japan in the older times were repeatedly said to contain pygm, ^.ees. ReHcs

* Lev. xxi., 20.

334 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT.

of what must have been a pygmy race have been found in the Hebrides, and
in this country in Kentucky and Tennessee.

Dr. Schweinfurth, the distinguished African traveler, confirms the state-
ments of Homer, Herodotus, and Aristotle that there was a race of pygmies
near the source of the Nile. Schweinfurth says that they live south of the
country occupied by the Niam-Niam, and that their stature varies from 4
feet to 4 feet 10 inches. These people are called the Akkas, and wonderful
tales are told of their agility and cunning, characteristics that seem to com-
pensate for their small stature.

In 1860 Paul DuChaillu speaks of the existence of an African people
called the Obongos, inhabiting the country of the Ashangos, a little to the
south of the equator, who were about 1.4 meters in height. There have been
people found in the Esquimaux region of very diminutive stature. Battel
discovered another pygmy people near the Obongo who are called the Dongos.
Kolle describes the Kenkobs, who are but 3 to 4 feet high, and another tribe
called the 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 myth-
ologic poems.

In the works of Humboldt and Burgoa there is allusion to the tradition
of a race of pygmies in the unexplored region of Chiapas near the Isthmus
of Tehuantepec in Central America. There is an expedition of anthropolo-
gists now on the way to discover this people. Professor Starr of Chicago
on his return from this region reported many colonies of undersized people,
but did not discover any pygmy tribes answering to the older legendary de-
scriptions. Figure 160 represents two dwarf Cottas measuring 3 feet 6
inches in height.

The African pygmies who were sent to the King of Italy and shown m
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 Livmg-
stone lost his life in African travel. These dwarfs had grown rapidly in
recent years and at the time of report measured 1.15 and 1.02 meters. In
1874 they were under the care of the Royal Geographical Society of Italy.
They were intelligent in their manner, but resented being lionized too much,
and were prone to scratch ladies who attempted to kiss them.'^

a 476, 1874, i., 896,

ARTIFICIAL PRODUCTION OF DWARFS.

335

The "Aztec Children" in 1851, at the ages of seven and six years, an-
other pair of alleged indigenous pygmies, measured 33f and 29| inches in
height and weighed 20| and 17 pounds respectively. The circumference of
their heads did not equal that of an ordinary infant at birth.

It is known that at one time the ancients artificially produced dwarfs

Fig. 160.-Dwarl Cottas.

by giving them an insufficient alimentation wlien very young Thev ,oon
became rachitic from tl.ir deprivation of lime-salts and a'great numbe
ponshed, bat those who survived were very highly prized by the Roma.
Emperors for the.r grotesque appearance. There were various recines for
dwarfing children. One of the most efficient in the olden ZZ::Za I

336 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT.

have been anointing the backbone with the grease of bats, moles, dormice,
and such animals ; it was also said that puppies were dwarfed by frequently
washing the feet and backbone, as the consequent drying and hardening of
the parts were alleged to hinder their extension. To-day the growth of boys
intended to be jockeys is kept down by excessive sweating.

Ancient Popularity of Dwarfs.— At one time a dwarf was a necessary
appendage of every noble family. The Roman Emperors all had their
dwarfs. Julia, the niece of Augustus, had a couple of dwarfs, Conopas
and Andromeda, each of whom was 2 feet 4 inches in height. It was the
fashion at one time to have dwarfs noted for their wit and wisdom. Philos
of Cos, tutor of Ptolemy Philadelphus, was a dwarf, as were Carachus, the
friend of Saladin ; Alypius of Alexandria, who was only 2 feet high ; Lucinus
Calvus, who was only 3 feet high, and ^.sop, the famous Greek fabulist.
Later in the Middle Ages and even to the last century dwarfs were seen at
every Court. Lady Montagu describes the dwarfs at the Viennese Court as
" devils bedaubed with diamonds." They had succeeded the Court Jester
and exercised some parts of this ancient office. At this time the English
ladies kept monkeys for their amusement. The Court dwarfs were allowed
unlimited freedom of speech, and in order to get at truths other men were
afraid to utter one of the Kings of Denmark made one of his dwarfs Prime
Minister.

Charles IX. in 1572 had nine dwarfs, of which four had been given to him
by King Sigismund-Augustus of Poland and three by Maximilian II. of
Germany. Catherine de 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 mar-
riage of his favorite, ValakofF, with the dwarf of the Princess Prescovie
Theodorovna. There were 72 dwarfs of both sexes present to form the
bridal party. Subsequently, on account of dangerous and difficult labor,
such marriages were forbidden in Russia.

In England and in Spain the nobles had the portraits of their dwarfs
painted by the celebrated artists of the day. Velasquez has represented Don
Antonio el Ingles, a dwarf of fine appearance, with a large dog, probably to
bring out the dwarf's inferior height. This artist also painted a great num-
ber of other dwarfs at the Court of Spain, and in one of his paintings he
portrays the Infanta Marguerite accompanied by her male and female dwarfs.
Reproductions of these portraits have been given by Gamier.^ In the pic-

a " Les Nains et les Geants." Paris, 1884.

INTELLECTUAL D WAEFS.

337

tares of Raphael, Paul Veronese, and Doniiniquin, 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, possi-
bly augmented by comparison. In a postmortem discussed at a meeting of
the Natural History Society at Bonn in 1868 it was demonstrated by
Schauf hausen that in a dwarf subject the brain weighed 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 M^ell convoluted.
This case was one of simple arrest of development, aflPecting all the organs
of the body ; he was not virile. He was a child of large parents ; had two
brothers and a sister of ordinary size and two brothers dwarfs, one 5 inches
higher and the other his size.

Several personages famous in history have been dwarfs. Attila, the his-
torian Procopius, Gregory of Tours, Pepin le Bref, Charles III., King of
Naples, and Albert the Grand were dwarfs. About the middle of the seven-
teenth century the French episcopacy possessed among its members a dwarf
renowned for his intelligence. This diminutive man, called Godeau, made
such a success in literature that by the grace of Richelieu he was named the
Archbishop of Grasse. He died in 1672. The Dutch painter Doos, the
English painter Gibson (who was about 3 feet in height and the father of
nine infants by a wife of about the same height). Prince Eugene, and the
Spanish Admiral Gravina were dwarfs. Fleury and Garry, the actors;
Hay, a member of Parliament from Sussex in the last century ; Hussein-
Pasha, celebrated for his reforms under Selim III. ; the Danish antiquarian
and voyager, Arendt, and Baron Denon were men far below the 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. Th6r§se Souvray, the dwarf fiancee of B6b6, 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
Ihe parents were of ordinary size, but had another child who was also a dwarf.

338 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT.

There are two species of dwarfs, the first coming into the world under
normal conditions, but who in their infiincy become afflicted with a sudden
arrest of development provoked by some malady ; the second are born very
small, develop little, and are really dwarfs from their birth ; as a rule they
are well conformed, robust, and intelligent. These two species can be dis-
tinguished by an important characteristic. The rachitic dwarfs of the first
class are incapable of perpetuating their species, while those of the second
category have proved more than once their virility. A certain number of
dwarfs have married with women of normal height and have had several
children, though this is not, it is true, an indisputable proof of their generative
faculties ; but we have instances in which dwarfs have married dwarfs and
had a family sometimes quite numerous. 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 pre-
sented to Henriette Marie, wife of Charles I., in a pie ; he afterward became
her favorite. Until he was thirty he was said to be not more than 18 inches
high, when he suddenly increased to about 45 inches. In his youth he
fought several duels, one with a turkey cock, which is celebrated in the verse
of Davenant. He became a popular and graceful courtier, and proved his
bravery and allegiance to his sovereign by assuming command of a royalist
company and doing good service therein. Both in'moral and physical capaci-
ties he showed his superiority. At one time he was sent to France to secure
a midwife for the Queen, who was a Frenchwoman. He afterward chal-
lenged a gentleman by the name of Croft to fight a duel, and would accept
only deadly weapons ; he shot his adversary in the chest ; the quarrel
grew out of his resentment of ridicule of his diminutive size. He was
accused of participation in the Papist Plot and imprisoned by his political
enemies in the Gate House at Westminster, where he died in 1682 at the
advanced age of sixty-three. In Scott's " Peveril of the Peak " Hudson
figures prominently. This author seemed fond of dwarfs.

About the same epoch Charles I. had a page in his court named Rich-
ard Gibson, who was remarkable for his diminutive size and his ability as a
miniature painter. This little artist espoused another of his class, Anne
Shepherd, a dwarf of Queen Henriette Marie, about his size (45 inches). Mis-
tress Gibson bore nine children, five of whom arrived at adult age and were
of ordinary proportions. She died at the age of eighty ; her husband after-

CELEBRATED DWARFS.

339

ward became the drawing master of Princesses Mary and Anne, daughters
of James II.; he died July 23, 1690, aged seventy-five years.

In 1730 there was born of poor fisher parents at Jelst a child named
Wybrand Lokes. He became a very skilful jeweler, and though he was of
diminutive stiiture he married a woman of medium height, by whom he had
several children. He was one of the smallest men ever exhibited, meas-
uring but 25| 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^
inches) long, weighed 14 ounces at birth, and was carried on a plate to
the church for baptism. At five Beb6 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 Beb6 became engaged to a female
dwarf named Ther&se Souvray, who at one time was exhibited in Paris at
the Theatre Conti, together with an older sister. Th6rese lived to be seventy-
three, and both she and her sister measured only 30 inches in height. She
died in 1819.

Aldrovandus gives a picture of a famous dwarf of the Due de Cr^qui
who was only 30 inches tall, though perfectly formed ; he also speaks of
some dwarfs who were not over 2 feet high.

There was a Polish gentleman named Joseph Borwilaski, born in 1739,
who was famed all over Europe. He became quite a scholar, speaking French
and German fairly well. In 1860, at the age of twenty-two, and 28 inches
in height, he married a woman of ordinary stature, who bore him two infants
well conformed. He was exhibited in many countries, and finally settled at
Durham, England, where he died in 1837 at the almost incredible age of
ninety-eight, and is buried by the side of the Falstaffian Stephen Kemble.
Mary Jones of Shropshire, a dwarf 32 inches tall and much deformed, died
in 1773 at the age of one hundred. These two instances are striking ex-
amples of great age in dwarfs and are therefore of much interest. Bor-
wilaski's parents were tall in stature and three of his brothers were small •
three of the other children measured 5 feet 6 inches. Diderot has written a
history of this family.

340 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT

Riclieborg,'524 d^y.^rf o^iy 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 ou the 4th
day of May, 1819, at the age of thirty-nine years, the smallest woman in the

kingdom, and one of the most
accomplished." She was born
in Krauma, in the north of
Austria, under normal con-
ditions. Her growth stopped
at the age of four, when she
was 33 inches tall. She was
shown in many villages and
cities over Europe and Great
Britain ; she was very gay,
played well on the piano, and
had divers other accomplish-
ments.

In 1742 there was shown
in London a dwarf by the
name of Robert Skinner, .63
meters in height, and his wife,
Judith, who was a little larger.
Their exhibition was a great
success and they amassed a
small fortune ; during twenty-
three years they had 14

Fig. I61.-Fen,ale dwarf with her husband and child. ^obust and Wcll-formed chil-

dren. Judith died in 1763,
and Robert grieved so much after her that he himself expired two years later.

Figure 161 shows a female dwarf with her husband and child, all of
whom were exhibited some years since in the Eastern United States. The
likeness of the child to the mother is already noticeable.

Buflfbn 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 1 8 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.

CELEBRATED DWARFS.

341

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, how-
ever, he had only increased four pounds. The arrest of development seemed
to be connected with hydrocephalus ; although the head was no larger than
that of a child of two, the anterior fontanelle was widely open, indicating
that there was pressure within. He was strong and muscular ; grave and
sedate in his manner ; cheer-
ful and affectionate ; his
manners were polite and en-
gaging ; he was expert in
many kinds of handicraft;
he possessed an ardent de-
sire for knowledge and apti-
tude for education.

Rawdon ^ described a
boy of five and a half, at
the Liverpool Infirmary for
Children, who weighed
pounds and whose height
was 28 or 29 inches. He
uttered no articulate sound,
but evidently possessed the
sense of hearing. His eyes
were large and well formed,
but he was apparently blind.
He suckled, cut his teeth
normally, but had tonic con-
tractions of the spine and
was an apparent idiot.

Hardie*^ mentions a girl
of sixteen and a half whose
height was 40 inches and
weight 35| pounds, includ-
ing her clothes. During intrauterine life her mother had good health and
both her parents had always been healthy. She seemed to stop growing at her
fourth year. Her intellect was on a par with the rest of her bodv Some-
times she would talk and again she would preserve rigid silenceVor a long
time. She had a shuffling walk with a tendencv to move on her toes Her
temporary teeth were shed in the usual manner and had been replaced bv
canines and right first molar and incisors on the right side. There was no

" 476, 1848, ii., 490. b 924 lR7q ^ q«r

' ' '^'^^^ 386. c 224, 1887, i., 730.

Fig. 1G2.-I)waif, lic-ight 34 iuehcs, weight. 309 pounds.

342 AN03IALIES OF STATURE, SIZE, AND DEVELOPMENT

indication of puberty except a slight development of the hips. She was almost
totally imbecile, but could tell her letters and spell short words. The cir-
cumference of the head was 19 inches, and Ross pointed out that the tendon-
reflexes were well marked, as well as the ankle-clonus ; he diagnosed the case
as one of parencephalus. Figure 162 represents a most curious case of a
dwarf named Carrie Akers, who, though only 34 inches tall, weighed 309

^'''''in'recent years several dwarfs have commanded the popular attention,
but none so much as - General Tom Thumb," the celebrated dwarf of Bar-
num's Circus. Charles Stratton, surnamed - Tom Thumb," was born at
Bridgeport, Conn., on January 11, 1832 ; he was above the normal weight
of the new-born. He ceased growing at about five months, when his height
was less than 21 inches. Barnum, hearing of this phenomenon in his city, en-
gaged him, and he was shown all over the world under his assumed name.
He was presented to Queen Victoria in 1844, and in the following year he
was received by the Royal Family in France. His success was wonderful,
and even the most conservative journals described and commented on him.
He gave concerts, in which he sang in a nasal voice ; but his " drawing feat
was embracing the women who visited him. It is said that m England
alone he kissed a million females; he prided himself on his success in this
function, although his features were anything but inviting. After he had
received numerous presents and had amassed a large fortune he returned to
America in 1864, bringing with him three other dwarfs, the " Sisters War-
ren " and " Commodore Nutt." He married one of the Warrens, and by
her had one child, Minnie, who died some months after birth of cerebral con-
gestion. In 1883 Tom Thumb and his wife, Lavinia, were still hving, but
after that they dropped from public view and have since died.

In 1895 the wife of a dwarf named Morris gave birth to twins at Blaen-
avon North Wales. Morris is only 35 inches in height and his wife is even
smaller. They were married at Bartholmey Church and have since been
traveling through England under the name of " General and Mrs. Small
being the smallest married couple in the world. At the latest reports the
mother and her twins Avere doing well.

The Rossow Brothers have been recently exhibited to the public. These
brothers, Franz and Carl, are twenty and eighteen years respectively
Franz is the eldest of 16 children and is said to weigh 24 pounds and
measure 21 inches in height ; Carl is said to weigh less than his brother but
is 29 inches tall. They give a clever gymnastic exhibition and are appa-
rently intelligent. They advertise that they were examined and still re-
main under the surveillance of the Faculty of Gottingen.

Next to the success of " Tom Thumb " probably no like attraction has
been so celel)rated as the " Lilliputians," whose antics and wit so many
Americans have in late years enjoyed. They were a troupe of smgers and

PRECOCIOUS DEVELOPMENT.

343

comedians composed entirely of dwarfs ; they exhibited much talent in all
their performances, which were given for several years and quite recently in
all the large cities of the United States. They showed themselves to be
worthy rivals for honors in the class of entertainments known as burlesques.
As near as could be ascertained, partly from the fact that they all spoi^e Ger-
man fluently and originally gave their performance entirely in German, they
were collected from the German and Austrian Empires.

The "Princess Topaze" was born near Paris in 1879. According to a
recent report she is perfectly formed and is intelligent and vivacious. She
is 23| inches tall and weighs 14 pounds. Her parents were of normal
stature.

Not long since the papers recorded the death of Lucia Zarete, a Mexican
girl, whose exact proportions were never definitely known ; but there is no
doubt that she was the smallest midget
ever exhibited in this country. Her
exhibitor made a fortune with her and
her salary was among the highest paid
to modern " freaks."

Miss H. Moritz, an American dwarf
(Fig. 163), at the age of twenty weighed
36 pounds and was only 22 inches
tall.

Precocious development is charac-
terized by a hasty growth of the subject,
who at an early period of life attains the
dimensions of an adult. In some of these
instances the anomaly is associated with
precocious puberty, and after acquiring
the adult growth at an early age there
is an apparent cessation of the devel-
opment. In adult life the individual shows no distinguishing characters.

The first to be considered will be those cases, sometimes called " man-
boys," characterized by early puberty and extraordinary development in
infancy. Histories of remarkable children have been transmitted from the
time of Vespasian. We read in the "Natural History" of Pliny that in
Salamis, Euthimedes had a son who grew to 3 Roman cubits (4i 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 m 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

» "DeMirab.," cap. 32.

Fig. 163.— Dwarf, 22 inches tali.

344 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT.

was crowned, in his tenth year he succeeded, in his fourteenth year he had a
complete beard, in his fifteenth he was married, in his eighteenth he had
gray hair, and in his twentieth he died, llhodiginus ^ speaks of a boy who
when he was ten years impregnated a female. In 1741 there was a boy
born at Willingham, near Cambridge,^ who had the external marks of
puberty at twelve months, and at the time of his death at five years he had
the appearance of an old man. He was called " prodigium Willinghamense."
The Ephemerides and some of the older journals record instances of penile
erection immediately after birth.

It was said that Philip Howarth, who was born at Quebec Mews, Port-
man Square, London, February 21, 1806, lost his infantile rotundity of
form and feature after the completion of his first year and became pale and
extremely ugly, appearing like a growing boy. His penis and testes increased
in size, his voice altered, and hair grew on the pubes. At the age of three
he was 3 feet 4i inches tall and weighed 51^ pounds. The length of his
penis when erect was 4i inches and the circumference 4 inches ; his thigh-
measure was 13| inches, his waist-measure 24 inches, and his biceps 7 inches.
He was reported to be clever, very strong, and muscular. An old chronicle
says that in Wisnang Parish, village of Tellurge, near Tygure, in Lordship
Kiburge, there was born on the 26th of May, 1548, a boy called Henry
Walker, who at five years was of the height of a boy of fourteen and pos-
sessed the genitals of a man. He carried burdens, did men's work, and in
every way assisted his parents, who were of usual size.

There is a case cited by the older authors^ of a child born in the
Jura region who at the age of four gave proof of his virility, at seven had a
beard and the height of a man. The same journal also speaks of a boy
of six, 1.62 meters tall, who was perfectly proportioned and had ex-
traordinary strength. His beard and general appearance, together with the
marks of puberty, gave him the appearance of a man of thirty.

In 1806 Dupuytren presented to the Medical Society in Paris a child 3^
feet high, weighing 57 pounds, who had attained puberty.

There are on record six modern cases of early puberty in hoys,^^^ 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 6f inches high, weighed 50 pounds, and had seminal dis-
charges. One of the cases was a child who at birth resembled an ordi-
nary infant of five months. From four to fifteen months his penis enlarged,
until at the age of three it measured when erect 3 inches. At this age he
was 3 feet 7 inches high and weighed 64 pounds. The last case mentioned
was an infant who experienced a change of voice at twelve months and
showed hair on the pubes. At three years he was 3 feet 41 inches tall and
weighed 51 1 pounds. Smith, in Brewster's Journal, 1829, records the
a 679, L. viii., cap. 8. t> 629, 1745. " Eecueil de I'Acad^mie des Sciences," 1668.

PRECOCIOUS PUBERTY.

346

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 gcnitids were as well developed
as those of an adult. He had a short, dark moustache but no hair on his
chin, although his pubic hair was thick, black, and curly. Ruelle '"^ describes
a child of three and a quarter years who was as strong and muscular as one
at eight. He had full-sized male organs and long black hair on the pubes.
Under excitement he discharged semen four or five times a day ; he had a
deep male voice, and dark, short hair on the cheek and upper lip.

Stone ^ gives an account of a boy of four who looked like a child of ten
and exhibited the sexual organs of a man with a luxuriant growth of hair on
the pubes. This child was said to have been of great beauty and a minia-
ture model of an athlete. His height was 4 feet I inch and weight 70
pounds ; the penis when semiflaccid was 4|^ inches long ; he Avas intelligent
and lively, and his back was covered with the acne of puberty. A peculiar
fiict as regjirds this case was the statement of the father that he himself had
had sexual indulgence at eight. Stone parallels this case by several others
that he has collected from medical literature. Breschet in 1821 reported
the case of a boy born October 20, 1817, who at three years and one
month was 3 feet 6f inches tall ; his penis when flaccid measured 4 inches
and when erect inches, but the testicles were not developed in propor-
tion. Lopez describes a mulatto boy of three years ten and a half months
whose height was 4 feet i inch and weight 82 pounds ; he measured about
the chest 27| inches and about the waist 27 inches ; his penis at rest was
4 inches long and had a circumference of 3^ inches, although the testes
were not descended. He had evidences of a beard and his axillse were very
hairy ; it is said he could with ease lift a man weighing 140 pounds. His
body was covered with acne simplex and had a strong spermatic odor, but
it was not known whether he had any venereal appetite.

Johnson^ mentions a boy of seven with severe gonorrhea complicated
with buboes which he had contracted from a servant girl with whom he
slept. At the Hopital des Enfans Malades children at the breast have
been observed to masturbate. Fournier and others assert having seen infan-
tile masturbators, and cite a case of a girl of four who was habitually
addicted to masturbation from her infancy but was not detected until her
fourth year ; she died shortly afterward in a frightful state of marasmus.
Vogel alludes to a girl of three in whom repeated attacks of epilepsy oc-
curred after six months' onanism. Van Bambeke mentions three children
from ten to twenty months old, two of them females, who masturbated.

Bidwell describes a boy of five years and two months who during the
year previous had erections and seminal emissions. His voice had changed
and he had a downy moustache on his upper lip and hair on the pubes ; liis
a 233, Feb. 28. 1843. b 124, 1852. c 124, 1843. d 476, 1860, i., Feb

346 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT.

height was 4 feet 3^ inches and his weight was 82i 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.

Pry or* 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 liis second year and when three years old he had hair on the
pubes. There is an instance ^ in which a boy of thirteen had intercourse with a
young woman at least a dozen times and succeeded in impregnating her. The
same journal mentions an instance in which a boy of fourteen succeeded in
impregnating a girl of the same age. Chevers '^^'^ speaks of a young boy in
India who was sentenced to one year's imprisonment for raping a girl of three.

Douglass ^ describes a boy of four years and three months who was 3 feet
10| inches tall and weighed 54 pounds ; his features were large and coarse, and
his penis and testes were of the size of those of an adult. He was unusually
dull, mentally, quite obstinate, and self-willed. It is said that he masturbated
on all opportunities and had vigorous erections, although no spermatozoa
were found in the semen issued. He showed no fondness for the opposite
sex. The history of this rapid growth says that he was not unlike other
children until the third year, when after wading in a small stream several
hours he was taken with a violent chill, after which his voice began to
change and his sexual organs to develop.

Blanc quotes the case described by Cozanet in 1875 of Louis Beran,
who was born on September 29, 1869, at Saint-Gervais, of normal size.
At the age of six months his dimensions and weight increased in an extra-
ordinary fashion. At the age of six years he was 1.28 meters high (4 feet 2^
inches) and weighed 80 pounds. His puberty was completely manifested in
every way ; he eschewed the society of children and helped his parents in
their labors. Campbell ^ showed a lad of fourteen who had been under his
observation for ten years. When fifteen months old this prodigy had ha^r
on his pubes and his external genitals were abnormally large, and at the age
of two years they were fully developed and had not materially changed in
the following years. At times he manifested great sexual excitement.
Between four and seven years he. had seminal discharges, but it was not
determined whether the semen contained spermatozoa. He had the muscular
development of a man of twenty-five. He had shaved several years. The
boy's education was defective from his failure to attend school.

a 778 xxii., 521. b 476, 1882, ii., 377. ^ 224, 1887, i., 918.

d .w' 1889. ^ 536, No. 2591, 551.

LARGE AND SMALL NEW-BORN INFANTS.

347

The accompanying illustration (Fig. 164) 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 Car-
luke, 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.
Linnseus saw a boy at the Amsterdam
Fair who at the age of three Aveighed
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 cir-
cumference, 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 ^ 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 extra-
ordinary instance of rapid growth in a
boy of eleven who grew 6 inches in fifteen
days.

Large and Small New-born In-
fants.— 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| ounces ; and on page 67 is an account of Eikam's five-
months' child, weighing 8 ounces. Of full-term children Sir Everard

a 224, Aug. 31, 1895.

Fig. 164.— Precocious development in a boy of
five years and three mouths.

348 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT

Home, in his Croonian Oration in 1824,^ speaks of one borne by a woman
who was traveling with the4)aggage 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
l.f pounds. In June, 1896, a baby weighing If pounds was born at the
Samaritan Hospital, Philadelphia.

Scott has recorded the birth of a child weighing 2^ pounds, and another
3| 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 22i 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 g 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|
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 13i pounds
and measured 26^ inches. Warren J 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; and Meadows^ has seen

a 629 1825. ^ Trans. Med. and Physical Soc. of Calcutta, 1825, i., 364.

e 124,' 1874. d 224, 1885, ii. ^ 224, 1886, i., 54. f 286, 1885-86, i., 543.
g " Comments de rupto in partu dolor," etc. ^ 800, L. ii., no. 12.

i 548, 1869, i., 618. 3 476, 1884, ii., 1029. ^ 616, 1875. l 548, 1860.

LARGE INFANTS.

349

a similar instance. Eddowes speaks of the birth of a child at Crewe, a male,
which weighed 20 pounds 2 ounces and was 23 inches long. It was 14| inches
about the chest, symmetrically developed, and likely to live. The mother,
who was a schoolmistress of thirty-three, had borne two previous children, both
of large size. In this instance the gestation had not been prolonged, the
delivery was spontaneous, and there was no laceration of the parts.

Chubb ^ says that on Christmas Day, 1852, there was a child delivered
weighing 21 pounds. The labor was not severe and the other children of
the family were exceptionally large. Dickinson describes a woman, a terti-
para, who had a most difficult labor and bore an extremely large child. She
had been thirty-six hours in parturition, and by evisceration and craniotomy
was delivered of a child weighing 16 pounds. Her first child weighed 9
pounds, her second 20, and her third, the one described, cost her her life soon
after delivery.

There is a history of a Swedish woman in Boston ^ who was delivered by
the forceps of her first child, which weighed 19| pounds and which was 25|
inches long. The circumference of the head was 16| inches, of the neck 9|,
and of the thigh lOf inches.

Rice « speaks of a child weighing 20| pounds at birth. Johnston de-
scribes a male infant who was born on November 26, 1848, weighing 20
pounds, and Smith s 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 f pounds. Its
mother ^Vas Mrs. Bates, formerly Anna Swann, the giantess who married
Captain Bates. Labor was rather slow, but she was successfully delivered
of a healthy child weighing 23f pounds and 30 inches long. The secun-
dines weighed ten pounds and there were nine quarts of amniotic fluid.

There is a recent record J 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 221 pounds!
Bumm"^ speaks of the birth of a premature male infant weighing 4320 gm.
m 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.

a 476, 1884, ii., 941. b 224, 1879, i., 143. c 227, 1894, 225. d 381 1879 i 255
c 218, 1876. f 124, 1881. g 545! 1878, 512. h 227 1894 228

k Sr' T' . .1 ""^P"'"" ^y^^^- May ^5, 1891.

^ Cor.-Bl. f. schweiz. Aerzte, p. 117, Feb. 15, 1895.

350 ANOMALIES OF STATUEE, SIZE, AND DEVELOPMENT.

Congenital asymmetry and hemihypertrophy of the body are most
peculiar anomalies and must not be confounded with acromegaly or myxe-
dema, in both of whicii 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 afPected with congenital unilateral
hypertrophy associated with patches of cutaneous congestion. Logan^ men-

Fig. 165.— Case of hem i hypertrophy (AUaius).

tions hypertrophy in the right half of the body in a child of four, first
noticed shortly after birth ; Langlet'' also speaks of a case of congenital
hypertrophy of the right side. Broca^ and Tr^lat « 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

a 381, 1884, xxi., 327. ^ N. Orl. J. M., 1868, xxi., 733.

c Union m6d. et scient. du nord-est, Reims, 1882, vi., 276.

d 368, 1859, xiv., 445. ^ 162, 1869, i., 536, 676.

HEMIHYPER TR OPHY.

351

and the reflexes showed no abnormality. The asymmetry was first observed
wlien 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 histpry, and the patient had
suffered from none of the diseases of childhood. Deformity was noticeable
at birth, but not to such a degree relatively as at a later period. The in-
creased growth affected the entire right half of the body, including the face,
but was most noticeable in the leg, thigh, and buttock. Numerous telangiec-

lilateral hypertrophy Fig. 167.-The Tompkins child, age thirteen months.

(Milne).

tatic spots were scattered irregularly over the body, but most thickly on the
right side, especially on the outer surface of the leg. The accompanying
illustration (Fig. 165) represents the child's appearance at the time of report
Jacobson ^ reports the history of a female child of three years with nearly
universal giant growth (Riesenwuchs). At first this case was erroneously
diagnosed as acromegaly. The hypertrophy affected the fiice, the genitals,
the left side of the trunk, and all the limbs.

Milne records a case of hemihypertrophy in a female child of one year
a 165, Dec, 1894. b lei, 1895, cxxxix., 104. c Quarterly Med. Jour., April, 1895.

352 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT

(Fig. 166). The only deviation from nniform 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 abnor-
mality of the adipose system,
causing in consequence an
augmentation of the natural
volume of the subject, should
be described with other ano-
malies of size and stature.
Obesity may be partial, as
seen in the mammae or in the
abdomen of both women and
men, or may be general ; and
it is of general obesity that
we shall chiefly deal. Lipomata, being distinctly pathologic formations, will
be left for another chapter.

The cases of obesity in infancy and childhood are of considerable
interest, and we sometimes see cases that have been termed examples of
" congenital corpulency." Figure 167 represents a baby of thirteen months
that weighed 75 pounds. Figure 168 shows another example of infantile
obesity, known as " Baby Chambers." Elliotson 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
a 476, March 23. 1895. ^ 629, No. 185. ^ 842, 283.

Fig. 168.— Baby Chambers.

OBESITY IN CHILDREN.

353

acquisition of fat did not commence until some time after birtli. Ebstein
reports an instance given to him by Fisher of Moscow of a child in Pomera-
nia who at the age of six weighed 137 pounds and was 46 inches tall ; her
girth was 4(3 inches and the circumference of her head was 24 inches. She
was the offs})ring of ordinarv-sized parents, and lived in narrow and some-
times needy circumstiinces. The child was intelligent and had an animated
expression of countenance.

Bartliolinus mentions a girl of eleven who Aveighed over 200 pounds.
There is an instance recorded of a young girl in Russia who weighed nearly
200 pounds when but twelve. Wulf, quoted by Ebstein, describes a child
which died at birth weighing 295 ounces. It was well proportioned and
looked like a child three months old, except that it had an enormous devel-
opment of fatty tissue. The parents were not excessively large, and the
mother stated that she had had children before of the same proportions.
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 Avaist ; 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 Allantv of Yorkshire ; althoindi
she was but thirteen she was 13 stone weight (182 pounds). At seven vears
she had AA^ighed 7 stone (98 pounds). Williams- mentions several instances
of fa children. The first Avas 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 Avas 3 feet 13 inches t.11. There Avas I
hild i.„.ed Everitt, exhibited in London in 1780, Avhoat eleven months was
3 feet 9 inches tall and measured around the loins over 3 feet. William
Abernethy- at the age of thirteen Aveighed 22 stone (308 pounds) and
measured 57 inches around the waist. He was 5 feet 6 LjZt \Zt

m T\ T "^'"'^ '''' ' ^-'-^^) 1-^1^ weighed

170 pounds. Her manners Avere infantile and her intellect.^1 development

a Jor^ungen Uber specielle Pathologie und Therapie, Deutsche Ausgahe," Leipzig.

1848

*> 599, 1829. c 548 i862 i -ia-i

23 ' 677, 1869, No. 2.

354 ANOMALIES OF STATURE, SIZE. AND DEVELOPMENT.

™s much retarded. She six,ke with difficulty in a deep voice ; she had a

most voracious appetite. i ^„ i iqq4 »

At a meetiug of the Physical Society of V.ennaon p«.e.uber 4 1894
there was showu a ,irl of five and a half who we.ghed 250 i»u„ds She
was just sheddin, her first teeth ; owing to the excess of fat - he-"
linJ she toddled like an infant. There was no tendency to obes ty m
family Up to the eleventh month she was nursed by her mother, and snb

Fig. 169. -Age nine, weight 201 pounds.

«eque„tly fed on cabbage, n.ilk, and vegetable sonp. This child, who was of
Russian descent, was said never to perspn-e j

Cameron describes a child who at b.rth weighed 14 P ™
months she weighed 69 pounds, and at seventeen months 98 PO»»d.- ^ «
was not weanecUmtil two years old and she then commenced to waU. The
parents were not remarkably large. There is an mstance of a boy of ri. rtcen
and a half who weighed 214 pounds." Kaestner speaks of a ch.ld of four

0 292, Ixvi.

a 476, 1875, i., 72.

b 778, xviii., 115.

GENERAL REMARKS ON OBESITY.

355

who weighed 82 pounds, and Benzenberg noted a cJiild 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. HilJairet knew of a
child of five which weighed 125 pounds. Botta cites several instances of
preternaturally stout children. One child died at the age of three weighing
90 pounds, another at the age of five weighed 100 pounds, and a third at
the age of two weighed 75 pounds.

Figure 170 represents Miss "Millie Josephine" of Chicago, a recent ex-

Fig. 170.— Age thirteen, weight 422 pounds.

wSTd ^I'lr^^^^ ' « i-Hes tan and

General Remarks.-It has been chiefly in Great Britain and in Hoi
land that the most remarkable instances of obesity have been seen eslklt
n the former country colossal weights have been recorded. In tme """^
tr es corpulency has been considered an adornment of the female Z

i^srtedtr^^^^^^^^^^^

where they are fed on farinaceous JZZ^:;^:^^
^, isei. . c,„c,n. Med. News, 18,7. 321.

356 ANOMALIES OF STATVRE, SIZE, AND DEVELOPMENT.

they are almost a shapeless mass of fat. According to Ebstein, the Moorish
women reach with astonishing rapidity the desired embonpomt on a diet ot

dates and a peculiar kind of meal.

In some nations and families obesity is hereditary, and gene.afons
come and go withont a change in the ordinary conformation of the ..presenta-
tives. In other people slenden.ess is equally persistent, and efforts to over-
come this peculiarity of nature are without avail.

Treatment of Obeslty.-Mauy persons, the most famous of whom was
Banting, have advanced theories to reduce corpulency and to improve s en-
derness • bnt they have been uniformly unreliable, and the whole subject of
ttrCdevelopment presents an almost unexplored field for "-.^10.
Recently, Leichtenstein,. observing in a case of myxedema treated with the
thyroid gland that the subcutaneous fat disappeared with the continuance of
he^reatment, was led to adopt this treatment for obesity itself and reports
striking results. Tlie diet of the patient remained the same, and as the
appe^ was not diminished by the treatment the loss of weight wa. evidently
Zt other causes than altered alimentation. He holds that » e obser^^^^^^^
in myxedema, in obesity, and psoriasis warrant the belief that he thy md
gland eliminates a material having a regulating '"A^-^."!'''" * ,
tution of the panniculns adiposus and upon the -^"tio;; !
in general. There were 25 patients in all; in 22 the e«ect was
rntMvltisfactory, the loss of weight amounting to as much as 9.-5 kilos
;lds) Of IL three cases in which the result was "Ot satisfac-y^^one
had nenhrit s with severe Graves' disease, and the third psoriasis. Charnn
rid the injections of thyroid extract with decided benefit So soon as
administ Jon of the remedy was stopped the loss of weight ceased, but
"e enewal of the remedy the loss of weight again ensued to a certain
;i,tey"nd which the extract seemed powerless to act. Ewald also reports
ffood 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 hav.
exhibZ themselves is incalculable. Nearly every crcijs and dime museum
has its example, and some of the most famous have in this way been able to

"Tthlnl^trwritten quite a long discourse on persons of note who in
thetlSHimes were distinguished for their obesity. He <V^^;;^
nf Denvs the tyrant of Heraclea, who was so enormous that he was in con
L^c" nget o -ff„,,aon ; most of the time he was in a stupor or as eep
a pecSy of very fat people. His doctors had needles put in the back
of'h "laS o keej him from falling asleep when sitting up and thus incur-
Ig tlJ danger of suffocation. In the same work Atlien.us^ speaks of

c" Banquet dessavante," edition of Lefebvre, etc. ^- •

REMARKABLE INSTANCES OF OBESITY.

357

several sovereigns noted for their obesity ; among others he says that Ptol-
emy VII., son of Alexander, was so fat that, according to Posidonius, when
he walked he had to be supported on both sides. Nevertheless, when he
was excited at a repast, he would mount the higJiest couch and execute with
agility his accustomed dance.

According to old chronicles the cavaliers at Rome who grew fat were
condemned to lose their horses and were placed in retirement. During the
Middle Ages, according to Guillaume in his " Vie de Suger," obesity was
considered a grace of God.

Among the prominent people in the olden time noted for their embonpoint
were Agesilas, the orator C. Licinius Calvus, who several times opposed Cicero,
the actor Lucius, and others. Among men of more modern times we can
mention William the Conqueror ; Charles le Gros ; Louis le Gros ; Humbert
II., Count of Maurienne ; Henry I., King of Navarre ; Henry III., Count
of Champagne ; Conan III., Duke of Brittany ; Sancho I., King of Leon ;
Alphonse II., King of Portugal ; the Italian poet Bruni, who died in 1635 •
\ ivonne, a general under Louis XIV. ; the celebrated German botanist Dil-
lenuis ; Haller ; Frederick I., King of Wiirtemberg, and Louis XVIII.

Probably the most famous of all the fat men was Daniel Lambert born
Mnrch 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
be leve 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
Bor^vl aski came to see him, he asked the little man how much cloth he
needed for a suit. AVhen told about | of a yard, he replied that one of hi
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 ex-
hibited in Holland who weighed 503 pounds

"Take heed, Ogood traveler ! and do not tread hard
For here lies Dr. Stafford, iu all this churchyard." '

Wadd has gathered some instances, a few of which will be cited. At

* 476, 1827, 361.

358 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT

Staunton, January 2, 1816, there died Samuel Sugars, Gent, who weighed
with a single wood coffin 50 stone (700 pounds). Jacob Powell died in 1754,
weighing 560 pounds. It took 16 men to carry him to his grave.* Mr.
Baker of Worcester, supposed to be larger than Bright, was interred m 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 (bib

pounds). . ^««r-

Mr. Spooner, an eminent farmer of Warwickshire, who died in 1775,
aged fifty-seven, weighed 569 pounds and measured over 4 feet across the
shoulders. The two brothers Stoneclift of Halifax, Yorkshire, together

weighed 980 pounds.^

Keysler in his travels speaks of a corpulent Englishman who in passing
through Savoy had to use 12 chairmen ; he says that the man weighed 550
pounds It is recorded on the tombstone of James Parsons, a fat man of Ted-
dington, who died March 7, 1743, that he had often eaten a whole shoulder of
mutton and a peck of hasty pudding. Keysler mentions a young English-
man living in Lincoln 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 ot
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 excitmg as-
tonishment. The fat of his legs overhung his shoes like the fat in the legs
of Lambert and Bright. Dr. Short mentions a lady who died of corpulency
in her twenty-fifth year weighing over 50 stone (700 pounds). Catesby
speaks of a man who weighed 500 pounds, « and Coe mentions another who
weio-hed 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 Fran9oise-Clay, who attained such
celebrity for her obesity. She was born in poverty, reached puberty at thir-
teen, and married at twenty-five, at which age she was already the stoutest
woman of her neighborhood notwithstanding her infirmity. She followed
her husband, who was an old-clothes dealer, afoot from town to town. She
bore six children, in whom nothing extraordinary was noticed. The last one
was born when she was thirty-five years old. Neither the births, her tmvels
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

a -^74 vol xxiv 483. ^ 629, vol. xliv., 100. « 629, No. 479.

: 629 v:l: ^1^:: 75. « 462, vol. xm., 65. ^ 730, 579. . 302, vol. .v.

REMARKABLE INSTANCES OF OBESITY.

359

hung as low as the umbilicus. Her arms were elevated and kept from her
body by the fat in her axilla?. 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 af-
flicted with organic heart disease.

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 meas-
ured. 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 ajBPable.^

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. Hutchi-
son f says that he saw in the Infirmary at Kensington, under Portei-'s care, a
remarkable example of obesity. The woman was only just able to wa'lk
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 Penn-

d ?S' ilon'''- 110 ' '''' ''''' ' 224, 1883, ii., 284.

536, 1890, u., 112. e 536, 1888, ii., 587. f igg, .^l. W., 358.

360 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT.

sylvania, 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 repre-
sents 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 pre-
viously been thin, gained 14 pounds
in his seventieth year and 14 pounds
each of seven succeeding years.

Simulation of Obesity. —
General dropsy, elephantiasis, lipo-
mata, myxedema, and various other
affections in which there is a hy-
pertrophic change of the connec-
tive tissues may be mistaken for
general obesity ; on the other hand,
a fatty, pendulous abdomen may
simulate the appearances of preg-
nancy or even of ovarian cyst (Fig.
172).

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 com-
plained 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 myxe-
dema because there is no peculiar pliysiognomy, no spade-like hands nor infil-
trated 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 (Fig. 173) was a widow of Irish birth, who died

a 124, Nov.. 1892.

Fig. 171.— Au example of obesity with hirsuties.

SIMULATION OF OBESITY.

361

Fig. 172.— Fatty abdominal wall simulating ovarian cyst (Baldy).

362 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT.

both alcoholic and syphilitic. When forty-eight or forty-nine her arms
began to enlarge. In June, 1887, the enlargement affected the shoulders.

Fig. 174.— " Adiposis dolorosa" fDercum).

arms, ba(;k, 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 ap-
peared 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. Cu-
taneous 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 English-
woman of sixty-four (Fig. 174). The
enlarged tissue was very unevenly dis-
tributed, 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

Fig. 175.-J. w. Coffey, the " living skeleton." biccps, ovcr the outcr and posterior aspect

of either arm, and two large masses over
the belly; there was excessive prominence of the mons veneris. At the

ABNORMAL LEANNESS.

363

autopsy the heart weighed 8^ ounces, aud the fat below the umbilicus was
seven inches tliick.

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

Fig. 176.— Rosa Lee Plemons.

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.

Fig. 177.— Muscular atropliy a.ssociated with non development.

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

364 ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT.

than 12 pounds. His parents still had six children left, all of whom were nor-
mal 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 be-
numbed. 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 201 indies 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 (Fig. 176) 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.

a 374, vol. xxiv., 191. ^ 476, 1873, ii., 903.

CHAPTER yill.

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 in-
variably 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. Corne-
wall 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. Lon-
gevity 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 "En-
cyclopedia of Insurance " says that in England the " Royal Exchange " for
a period of one hundred and thirty-five years had insured no life which sur-
vived 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 liundred 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

365

366

LONGEVITY.

in recent years that the middle and lower classes of people have taken insur-
ance 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 record-
ing 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 Massa-
chusetts, 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 cen-
tenarians 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

a 638, Oct., 1894.

EFFECT OF CLASS-INFLUENCES, OCCUPATION, ETC. 367

have been published, show that there are now aHve in this country 213 persons
who are over one hundred years okl. 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 prepon-
derance 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 un-
impassioned 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 cen-
tenarians, of whom 143 were men and 235 were women. A Avriter 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
60 " " " " 110 to 120
29 " " " " 120 to 130

15 persons who lived from 130 to 140
6 " " " " 140 to 150
1 person " " to 169

Effect of Class-Influences, Occupation, etc. — Unfortunately for the
sake of authenticity, all the instances of extreme age iu this countrv have been
from persons in the lower walks of life or from obscure parts of the countr)^,
where little else than hearsay could be procured to verify them. It must also

368

LONGEVITY.

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 inhabi-
tants of the higher stations of life, the popidation of thickly settled communi-
ties, 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 prema-
ture decay.

Those who object to the reliability of reports of postcentcnarianism 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, Buifon, 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 astonish-
ing 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 Butfon, Hufeland, and Flourens be-
lieved ])ossible.

Alchemy and the Elixir of Life." — The desire for long life and the
acfpiisitionof wealtli have indirectly been the stimulus to medical and physical
investigation, eventually evolving science as we have it now. The funda-
mental principles of nearly every branch of modern science were the gradual
metamorphoses of the investigations of the old searchers after the " philoso-
pher's stone " and " elixir of life." The long hours of study and experiment

REMARKABLE INSTANCES OF LONGEVITY.

369

in the chase for this will-o'-the-wisp were of vast benefit to the corning genera-
tions ; and to these dehided 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
discover}-' 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 1555 the celebrated Doctor Dee appeared on the scene and
had victims by the score. Then came the Rosicrucians. Count Saintr-Gerniain
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 w'ho claimed possession of the secret of perpetual life was
Joseph Balsamo, w'ho 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 wdth 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 pos-
sibility, 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 w^arrior, 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 war-
like and ever-active Joshua lived to one himdred and ten. Lcjoucourt* gives
the following striking parallels : John Gower lived to one hundred and sev-
enty-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,

a " Galerie des Centeuaires. "

24

370

LONGEVITY.

to one hundred and twenty-seven. The eldest son of the Gower couple was
one hundred a nil 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 in-
complete 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 lon-
gevity 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
stationarv 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 teaclier,
lived to one hundred and eight ; Democritus, a naturalist, attained one hun-
dred 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 liim, 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 Em-
peror 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 Pla-
centia there was a man of one hundred and thirty and at Faventia a woman
of one hundred and thirty-two. According to Hufeland,427 ^\^^ ^ills of mor-
tality 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 sup-
posed 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 hun-
dred and four ; Saint Epithanius lived to one hundred and fifteen ; Simeon
Stylites to one hundred and twelve ; Saint Mungo was accredited with one

INFLUENCE OF MENTAL CULTURE.

371

hundred and eighty-five years (Spottiswood), and Saint David attained one
hundred and fortv-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 ; Xeno-
philus, 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 at-
tained advanced age. Kant, Buffon, Goethe, Fontenelle, and Newton were
all over eighty. Michael Angelo and Titian lived to eighty-nine and ninetv-
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 Lyndliurst at eighty-eight could pour forth words
of eloquence and sagacity for hours at a time. Landor wrote his " Im-
aginary Conversations " M^hen 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 exemplifv vigor in age.
In the Senate of the United States, Senators Edmunds, Sherman, Hoar, Mor-
rill, and other elderly statesmen display as much vigor as their youthful col-
leagues. 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 Englisli Naturalists, Lord Kelvin announced that during the
last year 26 members had died at an average age of seventy-six and a\alf
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

372

LONGEVITY.

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. Tlie Austrian General
Melas was still in tlie 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 Constantinoi)le. 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 tar 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 useful-
ness 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 ani-
mating liis troops from the deck of his galley, and the brave old blind King
of Bohemia falling in the thickest of the fray at Cr^cy, it would seem as if
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 octogena-
riansj Tiberius was eighty-eight at his death, and Augustus C^sar was
ciglity-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 excep-
tion.

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

GREATEST RECORDED AGE.

373

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 sixtv^-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 im-
pression 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,i84 Petratsh Zartan, was
also born in Hungary at a village four miles from Teneswaer in 1537. He

a 629, 1731, iii., 306, 4th ed.

374

LONGEVITY.

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 liair were white. He was accustomed to eat a little
cake the Hungarians call kalatschcii, witli 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 Nalior, sixteen more than
Henrv Jenkins, and thirtv-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 setatis 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 fol-
lowed 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 Avhich 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.

Hufeland 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. * Butfon 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 ao-e of one hundred and sixtv.

There was a woman living in Moscow in 1848 who was said to be one hun-
dred 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 Rocquefort ^ speaks of two cases at one hundred and fifty.

a Quoted in "Practical Medicine." N. Y., 1895. b 629, No. 233. c 302, xxix. d 503, i., 141.
e "Voyages dans I'Amerique Meridian," ii., 142. f "Hist, des Antilles," i., 431.

SUNDRY INSTANCES OF GEE AT AGE.

375

There are stories of an EngHshman 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 be-
tween 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 venera-
ble 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 physi-
cal. 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 New-
man 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 himdred 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 Frod-
sam in 1591 at the age of one hundred and fortv-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 re-
lated by the lips of an eye-witness to that event ; nevertheless, in this case it

' 708, 1724, 636. b ns, 1803, 57 ; 1805, 264 ; 1807, 384.

376

LONGEVITY.

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 jjreat-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. 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 be-
tween 1630 and 1896, and that there is at present living a lady who person-
ally knew Miss C, wlu) had nursed a relative born in 1630. Tlie 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 liad
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 eight}^-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 in-
stances of longevity ranging from one hundred and tAventy to one hundred and
forty. Lieutenant Gibbons found in a village in Peru one hundred inhabi-
tants 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 nnich
longer this man who was cradled by an earthquake lived is not as yet re-
ported. In tlie 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 con-
sisting 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 genera-
tive 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

a 218, 1869, 432.

GENERATIVE ABILITY IN OLD AGE.

377

sixty, and oontinuod in single blessedness nntil 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 hun-
dred 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 eightv-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 '^3' 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 hun-
dred 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, per-
formed a whole centur}'^, 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 attrib-
uted 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 liirn to allay hunger while shepherding in
the mountains. John de la Somet of Virginia died in 1766 aged one hun-
dred and thirty. He was a great smoker, and according to Eaton the hal)it
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

378

LONGEVITY.

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 re-
tained 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 Avas always a healthy, vigorous
man, and celebrated mass live days before his death. Mr. Evans of Spital
Street, Spitallields, London, died in 1780 aged one hundred and tliirty-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
aud 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 hun-
dred 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 renova-
tion 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, Avho 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 ap-
peared, 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 pro-
cess 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.

HEREDITAR Y L ONGE VITY.

379

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 " 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 hun-
dred 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 Avho have reached an old age
have lived on the smallest diet and the most frugal fare. Many of the in-
stances of longevity were in people of Scotcli origin wlio 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 luin-
dred 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 motlier 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 in-
fluences 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,

a Essay on " Longevity.' b 302, iv., 176. c 222, 1867, ii., 470.

380

LONGEVITY.

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
sliot 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 1 790, 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 practising 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 ^vater, 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 reclin-
ing 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 practised 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 Col-
lege 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 practising physician
of Market Wickham, Suffolk, England, and there is in the possession of his
two sur\'iving relatives, who cared for his household for many years, his
mother's diaiy, in which is inscribed in the handwriting of a lady of the
eighteenth century, under the date, Tuesday, March 16, 1790, a prayer of

LONGEVITY IN PHYSICIANS.

381

thankfulness to God that she had passed her ' tiyall/ and that a son was
born, wlio 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 authori-
ties of the Freemasons, who thereupon enshrined his portrait in their gallery
as the oldest living Freemason. The Salmon family moved to Cowbridge
in 179G, sothat the doctor had lived exactly a century in the lovely and
poetic Vale of Glamorgan, in the very heart of which Penllyn Court is situ-
ated. 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
nuich 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 uncom})lainingly in his old-fashioned mansion, surrounded by the beau-
tiful 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 conclu-
sively 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."

a Nat. Pop. Review, Aug., 1895.

382

LONGEVITY.

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 extra-
ordinary 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 re-
cently died after an active life in chemical investigation. Sir Moses Monte-
fiore 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 " Brandy wine," U. S. N., eighty-three years ago. He
relates having heard George AVashington speak at Washington and at Ports-
mouth 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 Arm^e 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.

a Siglo Med., Madrid, 1851.

CHAPTER IX.

PHYSIOLOGIC AND FUlsTCTIONAL 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 Don-
atus ^ 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 everv
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 ; PauUini * 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 Philadel-
phia 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

a 428, iii., 12 and 14. b 306, L. i., cap. 9. c " Diss, de Ictero." Lips* 1696
^ "7^9, 1884. e 462, T. viii., 59. f 620, cent, i., obs. 79.

g 796, iii., 338. h jour. Universal des Sciences, 1829. i 768 i

383

384 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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 con-
tinued for more than three years; during this time if her urine was not drawn
olf with the catheter she frequently voided it by vomiting ; for the last twenty
months she passed nuich gravel by the catheter ; when the use of the instru-
ment 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 tlie
thyroid gland. A^omiting 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 vicari-
ous secretion of the urinary constituents from the skin.

Instances of the anomalous exit of urine caused by congenital malforma-
tion or fistulous connections are mentioned in another chapter. Black urine
is generally caused by the ingestion of pigmented food or drugs, such as car-
bolic acid and the anilines. Amatus Lusitanus, Bartholinus, and the Ephe-
merides speak of black urine after eating grapes or damson plums. The
Ephemerides speaks of black urine being a precursor of death, but Piso, Rho-
dius, 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 Col-
lege 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 sliedding of tears.
Salomons 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 espe-

a Allgem. Medic. Annal., Jan., 1815.

c 768, 1793, i., 96. d 476, 1832-1833, ii., 704.

f 548, 1860, ii., 80. g 175, 1854.

b222, 1860, i., 27.
e 476, 1857, ii., 519.
h 476, 1891, i., 21.

CHROMTDROSIS.

385

cially supposed to be the case in satyriasis, in wliicli the preternatural exit was
(hie 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 Holfman 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 Eph-
emerides and PauUini also mention it. Chromidrosis, or colored sweat, is
an interesting anomaly exemplified in numerous reports. Black sweat has
been mentioned by Bartliolinus,^ who remarked that the secretion resembled
ink ; in other cases Galcazzi ^ and Zacutus Lusitanus * said the perspiration
resembled sooty water. Phosphorescent sweat has been recorded, j Paul-
lini ^ and the Ephemerides mention perspiration which was of a leek-green
color, and Borellus ^ has observed deep green perspiration. Marcard men-
tions green perspiration of the feet, possibly due to stains from colored foot-
gear. The Ephemerides and Paullini speak of violet perspiration, and
Barthol inus " 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 p describes an Irish married woman of forty, the subject of rheu-
matic fever, Avho occasionally had a blue serous discharge or perspiration that
literally flowed from her legs and body, and accompanied by a miliary erup-
tion. It was on the posterior portions, and twelve hours previous was usually

a Sperraatologia, " 22. b <' Qp. Med. et Chirnrg," T ii

c Med. Obs. and Inquiries, ii., No. 22. d 363, xxxviii., 217 ; 374

e 349, quoted in 476, i., 1878, 248. f 680, cent, iii., obs. 68. g lio' i., obs 70
h "Comment. Bonou.," vi., 60. i 831, L. iii., obs. 73. j los' x' obs 95

k 620, cent, i., obs. 38. 1 841, cent, ii., obs. 54. m 62o', cent, i.', obs 21

n 190, cent, iv., 62. o 550, 1845, 611. p Jour. Cutan. Med., London, 1868, ii., 247.'

386 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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 catamcnia
there was a discharge reddish-green in color. The patient denied having
taken any coloring matter or chemicals to influence the color of her perspira-
tion, 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 pop-
liteal 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 Sliadwell in a woman of forty-seven of naturally dark complexion.
The bowels were habitually sluggish, going three or four days at least with-
out 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 emi-
nence 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 alkaUes 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 distinctlv fatty, evidently seborrheic and of a sepia-tint. The girl suf-
fered 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 AVhite of Harvard, a case of unilateral yellow cliromi-
drosis 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, orgamc and
functional, and its presence is oft^n difficult of explanation. The following
a 767, Ixvi. b 455, ii., Nov. 10, 1884. « 657, 1863, ii., 387.

HYPERIDROSIS.

387

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 examina-
tion. The author olfered 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 deliv-
ered of an infixnt, which she nursed herself According to Dupont, this hyperi-
drosis was independent of any other affection, and after having been combated
fruitlessly by various remedies, yielded at last to fluid extract of aconitin.

IMyrtle ^ 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. Latterlv 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 paral-
ysis of the insane. Ramskill f reports a case of sweating on one side of the face
in a patient who was subject to epileptic convulsions. Takdcs g describes a

a 458, 1807, T. XXX., 33. b 536, Feb. 25, 1885. c 173 jgas iqi

dSoc. deBioIog., Jan., 1894. e 4«r ... /J'^' ^^l.

o48, 1866, 1., 367. g ^^j^ ^^^^

388

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

case of unilateral sweating with proportionate nervous prostration. Bartho-
low and Brj-an report unilateral sweating of the head. Cason speaks of uni-
lateral 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° 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,—
Teburo, Marcellus Donatus, Paullini, and Hartmann ^ discussing it. Hyperi-
drosis 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, c. 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 hemor-
rhage, substituting the menses or periodic hemorrhoids, hemoptysis, epis-
taxiX etc., or possibly purpura. Extreme rehgious 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, faUing 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 PelUson describes a scar which periodi-
cally 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 otficer 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 ' men-
tions that the detestable Charles IX. of France, being under constant agitation
and emotion, sank under a disorder which was accompanied by an exudation

a 548, 1857, 291. b 809, 1878-79, 284.

c 462 T Ixxiii. 49. d "Diss, sudore nnius latens." Hal., 1751.

e " p'aradigniata," 193. ^ " Histoire de France," iii., 306.

INSTANCES OF BLOODY SWEAT AND "STIGMATA." 389

of blood from every pore of his body. This was taken as an attempt of na-
ture to cure by bleeding according to the theory of the venesectionists. Fabri-
cius 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 wag, 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 relig-
ious 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, wliilst a
similar oval surface on the palm of each hand became of the same hue, and
on the upper surfajce of each foot a pinkish-white square appeared. Exam-
ined 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
a 638, 1854, 357 et seq. b St. Luke, xxii., 44.

390 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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 be-
fore her, and the successive scenes of the crucifixion were panoramically pro-
gressive. She saw Christ in person — His clothing, His wounds. His crown of
thorns. His cross — as well as the Apostles, the holy Avomen, 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 nourish-
ment, 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 ordi-
nary 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
l)ains in the tliighs, groins, legs, and penis. The veins of these parts became en-
gorged, 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, Avhich 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 ap-
pearance 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 infre-
quent, the bone being replaced by cartilaginous substance. There Avas no
pain, discoloration, swelling, or soreness, and after this strange anomaly dis-
appeared menstruation regularly commenced. Van Swieten^ mentions a
young lady who from her twelfth year at her menstrual periods had hem-
orrhages from pustules in the skin, the pustules disappearing in the interval.

a 302, iv., 189. Philadelphia Jour, of Med. and Physical Sciences, 1825. c 755^ xii., 86.

ANOMALIES IN LACTATION.

391

Schmidt's Jahrbiicher for 1836 gives an account of a woman who had dis-
eased ovaries and a recto vesicovaginal fistula, and though sometimes cata-
menia appeared at the proper place it was generally arrested and hemorrhage
appeared on the face. Chambers mentions a woman of twenty-seven who
suifered 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-hem-
orrhages 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.g Green milk has been observed by Lanzonius, Riverius,*^"^ and
Paullini.*52o -pj^g 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 sub-
stance 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 per-
spiration, and there are numerous varieties of milk-metastasis recorded.
Dolseus and Nuck ' mention the appearance of milk in the saliva. Auten-
reith mentions metastasis of milk through an abdominal abscess to the thio-h

* 476, 1861. b 747, Nov. , 1884. c 504, xviii

•1809,1879-80. e 4O6, iii., 44. f 189, Epis. i., 718

g 462, T. xxxii., 222, and T. xxv., 62. h 463, xii., 455. i " Sialographia, " 49

392

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

and Balthazaar also mentions excretion of milk from the thigh. Bourdon *™
mentions milk from the thigh, labia, and vulva. Klein ^ speaks of the
metastasis of the milk to the lochia. Gardane speaks of metastasis to the
lungs, and there is another case on record in which this phenomenon caused
asphyxia. Schenck ^ describes excretion of milk from the bladder and uterus.
Jaeger in 1770 at Tubingen describes the metastasis of milk to the umbili-
cus, Haen to the back, and Schurig '^^ to a wound in the foot. Knack-
stedt has seen an abscess of the thigh which contained eight pounds of milk.
Hauser*' gives the history of a case in which the kidneys secreted milk vicari-
ously.

There is the liistory of a woman who suiFered from metastasis of milk to
the stomach, and who, with convulsive action of the chest and abdomen,
vomited it daily.** A peculiar instance of milk in a tumor is that of a Mrs.
Reed, who, when pregnant with twins, developed an abdominal tumor from
which 25 pounds of milk was drawn off.®

There is a French report ^ of secretion of milk in the scrotum of a man
of twenty-one. The scrotum was tumefied, and to the touch gave the sensa-
tion of a human breast, and the parts were pigmented similar to an engorged
breast. Analysis showed the secretion to have been true human milk.

Cases of lactation in the new-born are not infrequent. Bartholinus,
Baricelli, Muraltus, Deusingius, Rhodius, Schenck, and Schurig mention
instances of it. Cardanus describes an infant of one month whose breasts
were swollen and gave milk copiously. Battersby ^ cites a description of a
male child three weeks old whose breasts were full of a fluid, analysis proving
it to have been human milk ; Darby, in the same journal, mentions a child
of eight days whose breasts were so engorged that the nurse had to milk it.
Faye ^ gives an interesting paper in which he has collected many instances of
milk in the breasts of the new-born. Jonston ^ details a description of lacta-
tion in an infant. VariotJ 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.
Yariot 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-

a 490, L. v., 202. ^ 718, L. ii., No. 285.

c Oglethorpe, Med. and Surg. Jour., Savannah, Ga., 1859-60, 11., 408.
d Allgem. Medic. Annal., Jan., 1815. e 218, 1833, vii., 13. ^ 368, 1835.

g 312, 1850. b602, 1876, viii., 1-10. i 447, 461. J" 237, July 25, 1890.

k 476, 1859. 1536,1877,348. m 233, 1839, iv., 77. n 363, 1878.

LACTATION IN THE AGED.

393

shaped, with a rosy areola, in the center of which was a iiii)ple. These pre-
cocious breasts increased in size at the beginning of the menstrual epoch (which
was also present) and remained enlarged while the menses lasted. The vulva
was covered with thick hair and the external genitalia were well developed.
The child was reticent, and with a doll was inclined to play the role of
mother.

Baudelocque mentions a girl of eight who suckled her brother with her
extraordinarily developed breasts. In 1783 this child milked her breasts in
the presence of the Royal Academy at Paris. Belloc spoke of a similar case.
There is another of a young negress who was able to nourish an infant and
among the older writers we read accounts of young virgins who induced lacta-
tion by applying infants to their breasts. Bartholinus, Benedictus, Hippocrates,
Lentilius, Salmuth, and Schenck mention lactation in virgins.

De la Coide describes a case in which lactation was present, though
menstruation had always been deficient. Dix, at the Derby Infirmary,*' has
observed two females in whom there was continued lactation, although they
had never been pregnant. The first was a chaste female of twenty-five, who
for two years had abundant and spontaneous discharge of milk that wetted the
linen ; and the other was in a prostitute of twenty, who had never been preg-
nant, but who had, nevertheless, for several months an abundant secretion of
healthy milk. Zoologists know that a nonpregnant bitch may secrete milk
in abundance. Delafond and de Sinnety have cited instances.

Lactation in the aged has been frequently noticed. Amatus Lusi-
tanus"^ and Schenck have observed lactation in old women ; in recent years
Dunglison has collected some instances. Semple relates the history of an
elderly woman who took charge of an infant the mother of 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 1 8 10. Not having enough milk for both, and being too poor to
secure the assistance of a midwife, in her desperation she sought an old woman
named Laverge, a widow of sixty-five, whose husband had been dead twenty-
nine years. This old woman gave the breast to one of the children, and in a
few days an abundant flow of milk was present. For twenty-two months she
nursed the infant, and it thrived as well as its brother, who was nursed by
their common mother — in fact, it was even the stronger of the two.

Dargan ^ tells of a case of remarkable rejuvenated lactation in a woman of
a 302, XXX., 386. b 548, 1856, i., 89. c 629, ix., 1674. d 264, 1874.

394 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

sixty, who, in play, placed the child to her breast, and to her surprise after
three weeks' nursing of this kind there appeared an abundant supply of milk,
even exceeding in amount that of the young mother.

Blanchard mentions milk in the breasts of a woman of sixty, and Krane^
cites a similar instance. In the Philosophical Transactions there is an in-
stance of a woman of sixty-eight having abundant lactation.

Warren, Boring, Buzzi, Stack, Durston, Egan, Scalzi, Fitzpatrick, and
Gillespie mention rejuvenation and renewed lactation in aged women. Ford*
has collected several cases in which lactation was artificially induced by women
who, though for some time not having been pregnant themselves, nursed for
others.

Prolonged lactation and galactorrhea may extend through several
pregnancies. Green ^ reports the case of a woman of forty-seven, the mother
of four children, who after each weaning had so much milk constantly in her
breasts that it had to be drawn until the next birth. At the time of report
the milk was still secreting in abundance. A similar and oft-quoted case was
that of Gomez Pamo,^ who described a woman in whom lactation seemed in-
definitely prolonged ; she married at sixteen, two years after the establishment
of menstruation. She became pregnant shortly after marriage, and after de-
livery had continued lactation for a year without any sign of returning men-
struation. Again becoming pregnant, she weaned her first child and nursed the
other without delay or complication. This occurrence took place fourteen
times. She nursed all 14 of her children up to the time that she found her-
self pregnant again, and during the pregnancies after the first the flow of
milk never entirely ceased ; always after the birth of an infant she was able
to nurse it. The milk was of good quality and always abundant, and during
the period between her first pregnancy to seven years after the birth of her
last child the menses had never reappeared. She weaned her last child five
years before the time of report, and since then the milk had still persisted in
spite of all treatment. It was sometimes so abundant as to necessitate draw-
ing it from the breast to relieve painful tension.

Kennedy s describes a woman of eighty-one who persistently menstruated
through lactation, and for forty-seven years had uninterruptedly nursed many
children, some of which were not her own. Three years of this time she was
a widow. At the last reports she had a moderate but regular secretion of
milk in her eighty-first year.

In regard to profuse lacteal flow, Remy is quoted ^ as having seen a young
woman in Japan from whom was taken 12^ pints of milk each day, which is
possibly one of the most extreme instance of continued galactorrhea on
record.

Galen refers to gynecomastia or gynecomazia ; Aristotle says he has

a 213, cent, ii., No. 83. b 4.52, L. v., 243. c 629, No. 453. ^ 579, 1869, 39.
e 594, 1844, 188. f Quoted 494, Aug. 4, 1883. g 549, 1832. ^ 548, 1883 ii., 581.

GYNECOMAZIA.

395

seen men with mammae ^ which were as well developed as those of a woman,
and Paulus ^Egineta recognized the fact in the ancient Greeks. Subsequently
Albucasis discusses it in his writings. Bartholinus, Behr, Benedictus, Borel-
lus, Bdnet, the Ephemerides, Marcellus Donatus, Schenck, Vesalius, Schacher,
Martineau, and Buifon all discuss the anomalous presence of milk in the male
breast. Puech says that tliis condition is found in one out of 13,000 con-
scripts.

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 dic-
tionary.^'^^ gj^^e then many observations have been made on this subject, and
quite recently Laurent "^'^ has
published a most exhaustive
treatise upon it.

Robert ^ describes an old man
who suckled a child, and Meyer
discusses the case of a castrated
man who was said to suckle chil-
dren. It is said that a Bishop
of Cork, who gave one-half crown
to an old Frenchman of seventy,
was rewarded by an exhibition of
his breasts, which were larger than
the Bishop had ever seen in a
woman. 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 cir-
cumference at the base, and hung
like those of a nursing woman
(Fig. 178).

In some instances whole families with supernumerary breasts are seen.
Handyside gives two instances of quadruple breasts in brothers. Blanchard ^
speaks of a father who had a supernumerary nipple on each breast and his
seven sons had the same deformities ; it was not noticed in the daughters. The
youngest son transmitted this anomaly to his four sons. 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 circum-

a 169, "Hist, animal.," lib. ill., chap. xx. h 451, Oct., 1812. c 629, No. 461.
d 243, 1886, 485. e 368, 1837, 195. f 703, Feb., 1894.

Fig. 178.— Man with fully-developed mammae (Laurent).

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

ference and 15 cm. from the nipple to the base of the gland ; they resembled
normal female mammae in all respects. The penis and the other genitalia
were normal, but the man had a female voice and absence of facial hair. There
was an abundance of subcutaneous fat and a rather broad pelvis.

A\ iltshire * said that he knew a gynecomast in the person of a distinguished
naturalist who since the age of puberty observed activity in his breasts, accom-
panied with secretion of milky fluid which lasted for a period of six weeks and
occurred every spring. This authority also mentions that the French call
husbands who have well-developed 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 propor-
tion to the size of ' the breast and the manners
became effeminate. Cameron, quoted by Sned-
den, speaks of a fellow-student who had a super-
numerary nipple, and also says he saw a case in
a little boy who had an extra pair of nipples much
wider than the ordinary ones. Ansiaux, surgeon
of Li^ge, saw a conscript of thirteen whose left
mamma was well developed like that of a M^oman,
and whose nipple was surrounded by a large are-
ola. He said that this breast had always been
larger than the other, but since puberty had
grown greatly ; the genital organs were well
formed. Morgan ^ examined a seaman of twenty-
one, admitted to the Royal Naval Hospital at
Hong Kong, whose right mamma, in size and
conformation, had the appearance of the well-
Fig. 179.-Ahnormal development dcVclopcd brcast of a full-grOWU WOmaU. It

of right breast in a young man was lobulatcd and had a large, brown-colored

areola ; the nipple, however, was of the same
size as that on the left breast (Fig. 179). The man stated that he first ob-
served the breast to enlarge at sixteen and a half years ; since that 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.

a 224, 1884, i., 654. ^ J 66, iii., 326. c 476, 1875, ii., 767. d Quoted 224, 1886, ii., 172.

3IEN SUCKLING INFANTS.

397

The same journal quotes an instance (possibly Morgan's case) in a young man
of twenty-one with a deep voice, excellent health, and genitals well developed,
and who cohabited with his wife regularly. When sixteen his right breast be-
gan to enlarge, a fact that he attributed to the pressure of a rope. Glandular
substance could be distinctly felt, but there was no milk-secretion. The left
breast was normal. Schuchardt has collected 272 cases of gynecomazia.

Instances of Men Suckling Infants.— These instances of gynecomazia
are particularly interesting when the individuals display ability to suckle in-
fants. Hunter refers to a man of fifty who shared equally with his wife the
suckling of their children. There is an instance of a sailor who, having lost
his wife, took his son to his own breast to quiet him, and after three or four
days was able to nourish him.^ Humboldt describes a South American peasant
of thirty-two who, when his wife fell sick immediately after delivery, sustained
the child with his own milk, which came soon after the application to the breast ;
for five months the child took no other nourishment. In Franklin's " Voyages
to the Polar Seas " he quotes the instance of an old Chippewa who, on losing his
wife in childbirth, had put his infant to his breast and earnestly prayed that
milk might flow ; he was fortunate enough to eventually produce enough milk
to rear the child. The left breast, with which he nursed, afterward retained its
unusual size. According to Mehliss some missionaries in Brazil in the six-
teenth centur}^ 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 mammte 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 neces-
sary to milk every other day of the year.

Ford ^ mentions the case of a captain who in order to soothe a child's
cries put it to his breast, and who subsequently developed a full supply of
milk. He also quotes an instance of a man suckling his own children, and
mentions a negro boy of fourteen who secreted milk in one breast. Hornor
and Pulido y Fernandez ^ also mention similar instances of gynecomazia.

Human Odors. — Curious as it may seem, each individual as well as each
species is in life enveloped with an odor peculiarly its own, due to its exhaled
breath, its excretions, and principally to its insensible perspiration. The fac-
ulty of recognizing an odor in different individuals, although more developed
in savage tribes, is by no means unknown in civilized society. Fournier
quotes the instance of a young man who, like a dog, could smell the enemy by
scent, and who by smell alone recognized his own wife from other persons. ^

a 302, XXX., 384. b 579^ 169, 39.

c Independ. m6d., Barcel., xi., 274, 297, 309. d302, iv.

PHYSIOLOGIC Am FUNCTIONAL ANOMALIES.

Fournier also ^ mentions a French woman, an inhabitant of Naples, who had
an extreme supersensitiveness of smell. The slightest odor was to her intoler-
able ; sometimes she could not tolerate the presence of certain individuals.
She could tell in a numerous circle which women were menstruating. This
woman could not sleep in a bed which any one else had made, and for this
reason discharged her maid, preparing her own toilet and her sleeping apart-
ments. Cadet de Gassicourt witnessed this peculiar instance, and in con-
sultation with several of the physicians of Paris attributed this excessive
sensitiveness to the climate. There is a tale told of a Hungarian monk^^^
who affirmed that he was able to decide the chastity of females by the sense
of smell alone. It is well known that some savage tribes with their large,
open nostrils not only recognize their enemies but also track game the same as
hounds.

Individual Odors. — Many individuals are said to have exhaled particu-
larly strong odors, and history is full of such instances. We are told by
Plutarch that Alexander the Great exhaled an odor similar to that of violet
flowers, and his undergarments always smelled of this natural perfume. It
is said that Cujas otfered a particular analogy to this. On the contraiy, there
are certain persons spoken of who exhaled a sulphurous odor. Martial said
that Thais was an example of the class of people whose odor was insupportable.
Schmidt has inserted in the Ephemerides an account of a journeyman sad-
dler, twenty-three years of age, of rather robust constitution, whose hands
exhaled a smell of sulphur so powerful and penetrating as to rapidly fill any
room in which he happened to be. Rayer was once consulted by a valet-de-
chambre who could never keep a place in consequence of the odor he left
behind him in the rooms in which he worked.

Hammond ^' is quoted with saying that when the blessed Venturni of Ber-
gamons officiated at the altar people struggled to come near him in order to
enjoy the odor he exhaled. It was said that St. Francis de Paul, after he had
subjected himself to frequent disciplinary inflictions, including a fast of thirty-
eight to forty days, exhaled a most sensible and delicious odor. Hammond
attributes the peculiar odors of the saints of earlier days to neglect of washing
and, in a measure, to affections of the nervous system. It may be added that
these odors were augmented by aromatics, incense, etc., artifically applied. In
more modern times Malherbe and Haller were said to diffuse from their bodies
the agreeable odor of musk. These " human flowers," to use Goethe's expres-
sion, are more highly perfumed in Southern latitudes.

Modifying Causes. — According to Brieude, sex, age, climate, habits, ail-
ments, the passions, the emotions, and the occupations modify the difference in the
humors exhaled, resulting in necessarily 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

a 302, iv., 96. b 491^ 1378, 279.

HUMAN ODORS.

399

babies become less decided. Boys when they reach puberty exliibit peculiar
odors which are similar to those of animals when in heat. These odors are
leading symptoms of what Borden calls "seminal fever" and are more
strongly marked in those of a voluptuous nature. They are said to be caused
by the absorption of spermatic fluid into the circulation and its subsequent
elimination by the skin. This peculiar circumstance, however, is not seen
in girls, in whom menstruation is sometimes to be distinguished by an odor
somewhat similar to that of leather. Old age produces an odor similar to that
of dry leaves, and there have been persons who declared that they could tell
approximately the age of individuals by the sense of smell.

Certain tribes and races of people have characteristic odors. Ne-
groes have a rank anuuoniacal odor, unmitigated by cleanliness ; according
to Pruner-Bey it is due to a volatile oil set free by the sebaceous follicles.
The Esquimaux and Greenlanders have the odors of their greasy and oily
foods, and it is said that the Cossacks, who live much with their horses, and
who are principally vegetarians, will leave the atmosphere charged with odors
several hours after their passage in numbers through a neighborhood. The
lower race of Chinamen are distinguished by a peculiar musty odor, which
may be noticed in the laundry shops of this country. Some people, such as
the low grade of Indians, have odors, not distinctive, and solely due to the
filth of their persons. Food and drink, as have been mentioned, markedly
influence the odor of an individual, and those perpetually addicted to a special
diet or drink have a particular odor.

Odor after Coitus. — Preismann in 1877 makes the statement that for
six hours after coitus there is a peculiar odor noticeable in the breath, owing
to a peculiar secretion of the buccal glands. He says that this odor is most
perceptible in men of about thirty-five, and can be discerned at a distance of
from four to six feet. He also adds that this fact would be of great medico-
legal value in the early arrest of those charged with rape. In this connection
the analogy of the breath immediately after coitus to the odor of chloroform
has been mentioned.^ The same article states that after coitus naturally foul
breath becomes sweet.

The emotions are said to have a decided influence on the odor of an
individual. Gambrini, quoted by Monin,** mentions a young man, unfortunate
in love and violently jealous, whose whole body exhaled a sickening, pernicious,
and fetid odor. Orteschi met a young lady who, without any possibility of
fraud, exhaled the strong odor of vanilla from the commissures of her fingers.

Eayer 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

a 536, 1883, i., 374. b "gur les Odeurs du Corps Humain." Paris, 1885.

400 PHYSIOLOGIC AXD FUNCTIONAL ANOMALIES.

kind of perfume about her and that her clothes had been frequently changed.
The odor of musk in this case was very perceptible on the arms and other
portions of the body, but did not become more powerful by friction. After
continuing for about eight days it grew fainter and nearly vanished before the
patient's death. Speranza* relates a similar case.

Complexion.— Par6«i8 gtates that persons of red hair and freckled com-
plexion have a noxious exhalation ; the odor of prussic acid is said to come
from dark individuals, while blondes exhale a secretion resembling musk. Fat
persons frequently have an oleaginous smell.

The disorders of the nervous system are said to be associated with
peculiar odors. 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. Bur-
rows declares that in the absence of further evidence he would not hesitate to
pronounce a person insane if he could perceive certain associate odors. Sir
William Gull and others are credited with asserting that they could detect
syphilis by smell. Weir Mitchell has observed that in lesions of nerves the
corresponding cutaneous area exhaled the odor of stagnant water. Hammond
refers to three cases under his notice in which specific odors were the results
of affections of the nervous system. One of these cases was a young woman
of hysterical tendencies who exhaled the odor of violets, which pervaded her
apartments. This odor was given oif the left half of the chest only and
could be obtained concentrated by collecting the perspiration on a handker-
chief, heating it with four ounces of spirit, and distilling the remaining
mixture. The administration of the sahcylate 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 mfluence
upon the breath. It has been remarked that the breath of individuals who
have recentlv performed a prolonged necropsy smells for some hours of the
odor of the "cadaver. Such things as copaiba, cubebs, sandalwood, alcohol,
coffee, etc., have their recognizable fragrance. There is an instance of a

a 162, T. XXX., 399.

ODORS OF DISEASES.

401

young woman taking Fowler's solution who had periodic offensive axillary
sweats that ceased when the medicine was discontinued.

Henry of Navarre was a victim of bromidrosis ; proximity to him was
insufferable to his courtiers and mistresses, who said that his odor was like
that of carrion. Tallemant says that when his wife, Marie de 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 axillte diffuses an aromatic odor
similar to that of acids or chloroform, and in suppression of menses, according
to the Epliemerides, 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
Yetlianka diffused an odor of honey. In diabetes there is a marked odor of
apples. The sweat in dysentery unmistakably bears the odor of the dejecta.
Behier calls the odor of typhoid that of the blood, and Berard says that it
attracts flies even before death. Typhus has a mouse-like odor, and the fol-
lowing diseases have at different times been described as having peculiar
odors,— measles, the smell of freshly plucked feathers ; scarlatina, of bread
hot from the oven ; eczema and impetigo, the smell of mold ; and rupia, a
decidedly offensive odor.

The hair has peculiar odors, differing in individuals. The hair of the
Chinese is known to have the odor of musk, which cannot be washed away by the
strongest of chemicals. Often the distinctive odor of a female is really due
to the odor of great masses of hair. It is said that wig-makers simply by
the sense of smell can tell whether hair has been cut from the living head or
from combings, as hair loses its odor when it falls out. In the paroxysms of
hysteroepilepsy the hair sometimes has a specific odor of ozone. T«nia 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 " fetich-
ism," in which the subject displays a perverted taste for the odors of hand-
kerchiefs, shoes, underclothing, and other articles of raiment worn by the
opposite sex. Binet maintains that these articles play the part of the " fetich "
in early tiieology. It is said that the favors given by the ladies to the knights

402

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

in the Middle Ages were not only tokens of remembrance and appreciation,
but sexual excitants as well. In his remarkable " Osphresiologie," Cloquet
€alls 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
eftect of odors.

Krafl't-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 con-
ceived such a passion for her that he could not resist it, and, as history shows,
made her very unhappy. An analogous instance is related of Henry IV.,
whose passion for the beautiful Gabrielle is said to have originated at the instant
when, at a ball, he wiped his brow with her handkerchief."

Kraffi-Ebing also says that " one learns from reading the work of Ploss
Das Weib ') that attempts to attract a person of the opposite sex by means
of the perspiration may be discerned in many forms in popular psychology.
In reference to this a custom is remarkable which holds among the natives of
the Philippine Islands when they become engaged. When it becomes neces-
sary for the engaged pair to separate they exchange articles of wearing apparel,
by means of which each becomes assured of faithfulness. These objects arc
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. Hesclil 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 aiii-
a - Psycbopathia Sexualis." ^ " Les Fetichistes," etc. Paris, 1896.

BULIMIA.

403

mals of opposite sexes are drawn to each other by means of olfactory percep-
tions, and that almost all animals at the time of rutting emit a very strong
odor from their genitals. It is said that the dog is attracted in this way to the
bitch several miles aM^ay. An experiment by Schiff' is confirmatory. He extir-
pated the olfactory nerves of puppies, and found that as they grew the male
was unable to distinguish the female. Certain animals, such as the musk-ox,
civet-cat, and beaver, possess glands on their sexual organs that secrete mate-
rials having a very strong odor. Musk, a substance possessing the most pene-
trating odor and' used in therapeutics, is obtained from the preputial follicles
of the musk-deer of Thibet ; and castor, a substance less penetrating, is ob-
tained from the preputial sacs of the beaver. Virgin moths (Bombyx) carried
m 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 d 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 d-iv
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

^^1- « 545, 1880, xlii., 385.

404 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

was 105 pounds, but when last seen he weighed 284 pounds and was increas-
ing a half pound daily. Despite his continuous eating, this boy constantly
complained of hunger.

Polydipsia is an abnormal thirst ; it may be seen in persons otherwise
normal, or it may be associated with diseases — such as diabetes mellitus or
diabetes insipidus. Mackenzie ^ quotes a case from Trousseau, in which an
individual afflicted with diabetes insipidus passed 32 liters of urine daily and
drank enormous quantities of water. This patient subjected himself to severe
regimen for eight months, — although one day, in his agonies, he seized the
chamber-pot and drank its contents at once. Mackenzie also mentions an
infant of three who had polydipsia from birth and drank daily nearly two
pailfuls of water. At the age of twenty-two she married a cobbler, unaware
of her propensity, who found that his earnings did not suffice to keep her in
water alone, and he was compelled to melt ice and 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 aifecting 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 notliing but excessive thirst. He
was active, industrious, enjoyed good health, and was not addicted to
alcoholics. His daily ration of water was from eight to twelve gallons. He
always placed a tub of water by his bed at night, but this sometimes proved
insufficient. He had frequently driven hogs from mudholes to slake his
thirst with the water. He married in 1829 and moved into Western Ten-
nessee, and in 1854 he was still drinking the accustomed amount ; and at this
time he had grown-up children. Ware « mentions a young man of twenty
who drank six gallons of water daily. He was tormented with thirst, and if
he abstained he became weak, sick, and dizzy. Throughout a long life he
continued his habit, sometimes drinking a gallon at one draught ; he never
used spirits. There are three cases of polydipsia reported from London in
1792.^

Field describes a boy with bilious remittent fever who would drink until

a 548, 1878, ii., 268. 218, 1856. « 589, 1815.

d528, 1792. ^ Western Jour. Med., 1869, iv., 714.

PERVERTED APPETITES.

405

his stomach was compk^tely distended and then call for more. Emesis was
followed by cries for more water. Becoming frantic, he would jump from his
bed and struggle for the water bucket ; failing in this, he ran to the kitchen
and drank soapsuds, dish-water, and any other liquid he could find. He had
swallowed a mass of mackerel which he had not properly masticated, a fact
proved later by ejection of the whole mass. There is a case on record * in
which there was intolerable thirst after retiring, lasting for a year. There
was apparently no polydipsia during the daytime.

The amount of water drunk by glass-blowers in a day is almost incredi-
ble. McElroy ^ has made observations in the glass-factories in his neighbor-
hood, and estimates that in the nine working hours of each day a glass-blower
drinks from 50 to 60 pints of water. In addition to this many are addicted
to the use of beer and spirits after working hours and at lun(!h-time. Tlie
excreta and urine never seem to be perceptibly increased. When not Avorking
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 perspira-
tion ceases, the man becomes utterly helpless, has to be carried out, and is
disabled until the sweating process is restored by vigorously applied friction.
There is little deleterious change noticed in these men ; in fact, they are rarely
invalids.

Hydroadipsia is a lack of thirst or absence of the normal desire for water.
In some of these cases there is a central lesion which accounts for the symp-
toms. McElroy, among other cases, speaks of one in a patient who was con-
tinually dull and listless, eating little, and complaining of much pain after the
least food. This, too, will be mentioned under abstinence.

Perverted appetites are of great variety and present many interesting as
well as disgusting examples of anomalies. In some cases the tastes of people
dilfer 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, sala-
manders, snakes, earth, wood, the dung of deer, and many other things." «
Gomara, in his " Historia de les Indias," says this loathsome diet was particu-
lar to one tribe, the Yaguaces of Florida. It is said that a Russian peasant
prefers a rotten egg to a fresh one ; and there are persons who prefer game
partly spoiled.

a 476, 1869, i., 285, etc. b 272, 1877, 9 et seq. c " De Vaca in Ternaux," vu., 144.

406

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

Bourke * recalls that the drinking of human urine has often been a re-
ligious rite, and describes the urine-dance of the Zufiis of New Mexico, in
which the participants drink freely of their urine ; he draws an analogy to the
Feast of the Fools, a religious custom of Pagan origin which did not disap-
pear in Europe until the time of the Reformation. It is still a practice in
some parts of the United States to give children fresh urine for certain dis-
eases. It is said that the ordure of the Grand Lama of Thibet was at one
time so venerated that it was collected and worn as anuilets.

The disgusting habit of eating human excrement is mentioned by Schurig,*^
who gives numerous examples in epileptics, maniacs, chlorotic young women,
pregnant women, children who have soiled their beds and, dreading detection,
have swallowed their ejecta, and finally among men and women with abnormal
appetites. The Indians of North America consider a broth made from the
dung of the hare and caribou a dainty dish, and according to Abbe Dome-
nech, as a means of imparting a flavor, the bands near Lake Superior mix their
rice with the excrement of rabbits. De Bry mentions that the negroes of
Guinea ate filthy, stinking elephant-meat and buifalo-flesh infested with thou-
sands of maggots, and says that they ravenously devoured dogs' guts raw.
Spencer, in his " Descriptive Sociology," describes a " Snake savage " of Aus-
tralia 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 Rev-
erend J. Owen Dorsey reports that while among the Ponkas he saw a woman
and child devour the entrails of a beef with their contents. Bourke also cites
instances in which human ordure was eaten by East Indian fanatics. Nu-
merous authorities are quoted by 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-hon-
ored custom among some of the tribes of Africa. This custom is often prac-
tised more in the spirit of vengeance than of real desire for food. Prisoners
of war were killed and eaten, sometimes cooked, and among some tribes raw.
In their religious frenzy the Aztecs ate the remains of the human beings who
were sacrificed to their idols. At other times cannibalism has been a neces-
sity. In a famine in Egypt, as pictured by the Arab Abdallatif, the putrefy-
ing debris of animals, as well as their excrement, was used as food, and finally
the human dead were used ; then infants were killed and devoured, so great
was the distress. In many sieges, shipwrecks, etc., cannibalism has been

a ' ' Scatologic Eites of All Nations. " l> " Chylologia. ' ' Dresden, 1725.

c "Scatologic Rites of All Nations."

ANTHROPOPHAGY OB CANNIBALISM.

407

practised as a last resort for sustaining life. When supplies have given out
several Arctic explorers have had to resort to eating the bodies of their com-
rades. In the famous Wiertz Museum in Brussels is a painting by this ec-
centric artist in which he has graphically portrayed a woman driven to insanity
by hunger, who has actually destroyed her child with a view to cannibalism.
At the siege of Rochelle it is related that, urged by starvation, a father and
mother dug up the scarcely cold body of their daughter and ate it. At the
siege of Paris by Henry IV. the cemeteries furnished food for the starving.
One mother in imitation of what occurred at the siege of Jerusalem roasted
the limbs of her dead child and died of grief under this revolting nourishment.

St. Jerome states that he saw Scotchmen in the Roman armies in Gaul
whose regular diet was human flesh, and who had " double teeth all around."

Cannibalism, according to a prominent New York journal, has been
recently made a special study by the Bureau of Ethnology at Washington,
D. C. Data on the subject have been gathered from all parts of the world,
which are particularly interesting in view of discoveries pointing to the con-
clusion that this horrible practice is far more widespread than was imagined.
Stanley claims that 30,000,000 cannibals dwell in the basin of the Congo
to-day — people who relish human flesh above all other meat. Perah, the
most peculiar form of cannibalism, is found in certain mountainous districts of
northeast Burmah, where there are tribes that follow a life in all important
respects like that of wild beasts. These people eat the congealed blood of
their enemies. The blood is poured into bamboo reeds, and in the course of
time, being corked up, it hardens. The filled reeds are hung under the roofs
of the huts, and when a person desires to treat his friends very hospitably
the reeds are broken and the contents devoured.

" The black natives of Australia are all professed cannibals. Dr. Carl Lum-
holtz, a Norwegian scientist, spent many months in studying them in the wilds
of the interior. He was alone among these savages, who are extremely treach-
erous. Wearing no clothing whatever, and living in nearly every respect as
monkeys do, they know no such thing as gratitude, and have no feeling that
can be properly termed human. Only fear of the traveler's weapons pre-
vented them from slaying him, and more than once he had a narrow escape.
One of the first of them whom he employed looked more like a brute than a
man. ' When he talked,' says the doctor, ' he rubbed his belly with com-
placency, as if the sight of me made his mouth water.' This individual was
regarded with much respect by his fellows because of his success in procuring
human flesh to eat. These aborigines say that the white man's flesh is salt
and occasions nausea. A Chinaman they consider as good for eating as a
black man, his food being chiefly vegetable.

"The most horrible development of cannibalism among the Australian
blacks is the eating of defunct relatives. When a person dies there follows an
elaborate ceremony, wliich terminates with the lowering of the corpse into the

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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 bv 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 moutli. 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 motlier. 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 redoubt-
able enemy they dried his head as a trophy and made flutes of his thigh bones.

"Among the Monbuttos of Africa human fat is commonly employed for a
variety of purposes. The explorer Schweinfurth speaks of writing out in the
evenings his memomnda respecting these people by the light of a little oil-lamp
contrived by himself, which was supplied with some questionable-looking
grease furnished by the natives. The smell of this grease, he says, could not
fail to arouse one's worst suspicions against the negroes. According to his
account the Monbuttos are the most confirmed cannibals in Africa. Sur-
rounded as they are by a number of peoples who are blacker than themselves,
and who, being inferior to them in culture, are held in contempt, they carry
on expeditions of war and plunder which result in the acquisition of a booty
especially coveted by them — namely, human flesh. The bodies of all foes who
fall in battle are distributed on the field among the victors, and are prepared
by drying for transportation. The savages drive their prisoners before them,
and these are reserved for killing at a later time. During Schweinfurth's
residence at the Court of Munza it was generally understood that nearly every
day a little child was sacrificed to supply a meal for the ogre potentate. For
centuries past the slave trade in the Congo Basin has been conducted largely
for the purpose of furnishing human flesh to consumers. Slaves are sold and
bought in great numbers for market, and are fattened for slaughter.

" The Mundurucus of the Upper Amazon, who are exceedingly ferocious,
have been accused of cannibalism. It is they who preserve human heads in
such a remarkable way. When one of their warriors has killed an enemy he
cuts off the head with his bamboo knife, removes the brain, soaks the head in
a vegetable oil, takes out bones of the skull, and dries the remaining parts by
putting hot pebbles inside of it. At the same time care is taken to preserve
all the features and the hair intact. By repeating the process with the hot
pebbles many times the head finally becomes shrunken to that of a small doll,

ANCIENT CUSTOMS.

409

though still retaining its human aspect, so that the effect produced is very
weird and uncanny. Lastly, the head is decorated with brilliant feathers,
and the lips are fostened together with a string, by which the head is suspended
from the rafters of the council-house."

Ancient Customs. — According to Herodotus the ancient Lydians and
Medes, and according to Plato the islanders in the Atlantic, cemented friend-
ship by drinking human blood. Tacitus speaks of Asian princes swearing
allegiance with their own blood, which they drank. Juvenal says that the
Scythians drank the blood of their enemies to quench their thirst.

Occasionally a religious ceremony has given sanction to cannibalism. It
is said that in the Island of Chios there was a rite by way of sacrifice to
Dionysius in which a man was torn limb from limb, and Faber tells us that
the Cretans had an annual festival in which they tore a living bull with their
teeth. Spencer quotes that among the Bacchic orgies of many of the tribes of
North America, at the inauguration of one of the Clallum chiefs on the north-
west coast of British America, the chief seized a small dog and began to devour
it alive, and also bit the shoulders of bystanders. In speaking of these cere-
monies. Boas, quoted by Bourke, says that members of the tribes practising
Hamatsa ceremonies show remarkable scars produced by biting, and at cer-
tain festivals ritualistic cannibalism is practised, it being the duty of the Ha-
matsa to bite portions of flesh out of the arms, legs, or breast of a man.

Another cause of cannibalism, and the one which deserves discussion here,
is genuine perversion or depravity of the appetite for human flesh among civil-
ized persons, — the desire sometimes being so strong as to lead to actual murder.
Several examples of this anomaly are on record. Gruner of Jena speaks of a
man by the name of Goldschmidt, in the environs of Weimar, who developed
a depraved appetite for human flesh. He was married at twenty-seven,
and for twenty-eight years exercised his calling as a cow-herd. Nothing
extraordinary was noticed in him, except his rudeness of manner and his chol-
eric and gross disposition. In 1771, at the age of fifty-five, he met a young
traveler in the woods, and accused him of frightening his cows ; a discussion
arose, and subsequently a quarrel, in which Goldschmidt killed his antagonist
by a blow with a stick which he used. To avoid detection he dragged the
body to the bushes, cut it up, and took it home in sections. He then washed,
boiled, and ate each piece. Subsequently, he developed a further taste for
human flesh, and was finally detected in eating a child which he had enticed
into his house and killed. He acknowledged his appetite before his trial.

Hector Boetius says that a Scotch brigand and his wife and children were'
condemned to death on proof that they killed and ate their prisoners. The
extreme youth of one of the girls excused her from capital punishment ; but at
twelve years she was found guilty of the same crime as her father and suffered
capital punishment. This child had been brought up in good surroundings, yet
her inherited appetite developed. Gall tells of an individual who, insttglted

410 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

by an irresistible desire to eat human flesh, assassinated many persons ; and
his daughter, though educated away from him, yielded to the same craving.

At Bicetre^ there was an individual who had a horribly depraved appetite
for decaying human flesh. He would liaunt the graveyards and eat the putre-
fying remains of the recently buried, preferring the intestines. Having re-
galed himself in a midnight prowl, he would fill his pockets for future use.
When interrogated on the subject of his depravity he said it had existed since
childhood. He acknowledged the greatest desire to devour children he would
meet playing ; but he did not possess the courage to kill them.

Prochaska quotes the case of a woman of Milan who attracted children to
her home in order that she might slay, salt, and eat them. About 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 Cas-
tro-^^ tells of a pregnant woman who so strongly desired to eat the shoulder
of a baker that she killed him, salted his body, and devoured it at intervals.

There is a record of a woman who in July, 1817, was discovered in cooking
an amputated leg of her little child. Gorget in 1827 reported the celebrated
case of Leger the vine dresser, who at the age of twenty-four wandered about a
forest for eight days during an attack of depression. Coming across a girl of
twelve, he violated her, and then mutilated her genitals, and tore out her
heart, eating of it, and drinking the blood. He finally confessed his crime
with cahn indifference. After Leger^s execution Esquirol found morbid adhe-
sions between the brain and the cerebral membranes. Mascha relates a simi-
lar instance in a man of fifty-five who violated and killed a young girl, eating
of her genitals and 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 Menes-
clou, who was examined by Brouardel, Motet, and others, and declared to be
mentally sound ; he was convicted. Tliis miscreant was arrested with the fore-
arm of a missing child in his pocket, and in his stove were found the head and
entrails in a half-burnt condition. Parts of the body were found in the water-
closet, but the genitals were missing ; he was executed, although he made no
confession, saying the deed was an accident. Morbid changes were found in
his brain. 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 men-
a 162, March, 1825. ^ " La Vie du Sang," note 7.

FURTHER EXAMPLES OF DEPRAVED APPETITES. 411

tioned that patients in hospitals have been detected in drinking the blood of
patients after venesections, and in other instances frequenting dead-houses
and sucking the blood of the recently deceased. Du Saulle" quotes the case
of a chlorotic girl of fourteen who eagerly drank human blood. She preferred
that flowing fresh from a recent wound.

Further Examples of Depraved Appetites. — Bijoux ^ speaks of a por-
ter or garfon at the Jaixlin des Plantes in Paris who was a prodigious glutton.
He had eaten the body of a lion that had died of disease at the menagerie.
He ate with avidity the most disgusting things to satiate his depraved appe-
tite. He showed further signs of a perverted mind by classifying the animals
of the menagerie according to the form of their excrement, of which he had a col-
lection. He died of indigestion following a meal of eight pounds of hot bread.

Percy saw the famous Tarrare, who died at Versailles, at about twenty-
six years of age. At seventeen he weighed 100 pounds. He ate a quarter
of beef in twenty-four hours. He was fond of the most revolting things. He
particularly relished the flesh of serpents and would quickly devour the largest.
In the presence of Lorenze he seized a live cat with his teeth, eventrated it,
sucked its blood, and ate it, leaving the bare skeleton only. In about thirty
minutes he rejected the hairs in the manner of birds of prey and carnivorous
animals. He also ate dogs in the same manner. On one occasion it was said
that he swallowed a living eel without chewing it ; but he had first bitten otf
its head. He ate almost instantly a dinner that had been prepared for 15
vigorous workmen and drank the accompanying water and took their aggre-
gate allowance of salt at the same time. After this meal his abdomen was so
swollen that it resembled a balloon. He was seen by Courville, a surgeon-
major in a military hospital, where he had swallowed a wooden box wrapped
in plain white paper. This he passed the next day with the paper intact.
The General-in-chief had seen him devour thirty pounds of raw liver and lungs.
Nothing seemed to diminish his appetite. He Avaited around butcher-shops
to eat what was discarded for the dogs. He drank the bleedings of the hos-
pital and ate the dead from the dead-houses. He was suspected of eating a
child of fourteen months, but no proof could be produced of this. He was
of middle height and was always heated and sweating. He died of a puru-
lent diarrhea, all his intestines and peritoneum being in a suppurating condi-
tion.

F ulton d mentions a girl of six who exhibited a marked taste for feeding
on slugs, beetles, cockroaches, spiders, and repulsive insects. This child
had been carefully brought up and was one of 13 children, none of whom
displayed any similar depravity of appetite. The child was of good dispo-
sition and slightly below the normal mental standard for her age. At the
age of fourteen her appetite became normal.

In the older writings many curious instances of abnormal appetite are
^ Med. Critic, 1862, ii., 711. b 302, iv., 199. c 302, iv., 200 d isQ, 1879.

412 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

seen. Borellus speaks of individuals swallowing stones, horns, serpents, and
toads. Plater * mentions snail-eating and eel-eating, two customs still extant.
Rliodius is accredited with seeing persons who swallowed spiders and scor-
pions. Jonston**' says that Avicenna, Rufus, and Gentilis relate instances
of young girls who acquired a taste for poisonous animals and substances, who
could ingest them with impunity. Colonia Agrippina was supposed to have
eaten spiders with impunity. Van 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 Ephcmerides contains mention of it ; Hunter
speaks of the blacks who eat potters' clay ; Bartholinus^^^ describes dirt-eating
as does also tl 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 he said in-
variably relieved his gastric irritation. In the twenty-five years of the habit
he had used over | ton of chalk ; but notwithstanding this he always enjoyed
good health. The Ephcmerides contains a similar instance, and Verzascha
mentions a lime-eater. Adams ^ mentions a child of three who had an in-
stinctive desire to eat mortar. This baby was rickety and had carious teeth.
It would pick its preferred diet out of the wall, and if prevented would cry
loudly. When deprived of the mortar it would vomit its food until this
sul)stance 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 635, L. i. and L. ii. b 105, 1748, viii., 62-64. c 257, L. iii., 399.

d 629, 1700. e 218, 1868, 101. f 476, 1885, i., 235.

FASTING.

413

a piece of mortar. The quantity consumed in twenty-four hours was about
I 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 quanti-
ties taken habitually are quite sufficient to produce immediate death ordi-
narily. But the same might be easily said of those addicted to opium and
chloral, a subject that will be considered later. Perverted appetites during
pregnancy have been discussed on pages 80 and 81.

Glass-eaters, penknife-swallowers, and sword-swal lowers, being exhibi-
tionists and jugglers, and not individuals with perverted appetites, will be con-
sidered in Chapter XII.

Fasting. — The length of time which a person can live 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 pen-
ance and to gain the approbation of Heaven.

In many religions fasting has become a part of worship or religious cere-
mony, and from the earliest times certain sects have carried this custom to
extremes. It is well known that some of the priests and anchorites of the
East now subsist on the minimum amount of food, and from the earliest
times before the advent of Christianity we find instances of prolonged fasting
associated with religious worship. The Assyrians, the Hebrews, the Egyp-
tians, and other Eastern nations, and also the Greeks and Romans, as well as
feasting days, had their times of fasting, and some of these were quite pro-
longed.

At the present day religious fervor accounts for but few of our remark-
able instances of abstinence, most of them being due to some form of nervous
disorder, varying from hysteria and melancholia to absolute insanity. The
ability seen in the Middle Ages to live on the Holy Sacrament and to resist
starvation may possibly have its analogy in some of the fasting girls of the
present day. In the older times these persons were said to have been nour-
ished by angels or devils ; but according to Hammond many cases both of
diabolical abstinence from food and of holy fasting exhibited manifest signs
of hysteric symptoms. Hammond, in his exhaustive treatise on the subject
of " Fasting Girls," also remarks that some of the chronicles detail the exact
symptoms of hysteria and without hesitation ascribe them to a devilish agency.
For instance, he speaks of a young girl in the valley of Calepino who had all
her limbs twisted and contracted and had a sensation in her esophagus as if a

414

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

ball was sometimes rising in her throat or falling into the stomach— a rather
lay description of the characteristic hysteric "lump in the throat/' a frequent
sign of nervous abstinence.

Abstinence, or rather anorexia, is naturally associated with numerous dis-
eases, particularly of the febrile type ; but in all of these the patient is main-
tained by the use of nutrient enemata or by other means, and the abstinence
is never complete.

A peculiar type of anorexia is that striking and remarkable digestive dis-
turbance of hysteria which Sir William Gull has called anorexia nervosa.
In 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 de-
gree of muscular restlessness, so that the patients wander about until exhausted.
According to Osier, who reports a fatal case in a girl who, at her death, only
weighed 49 pounds, nothing more pitiable is to be seen in medical practice
than an advanced case of this malady. The emaciation and exhaustion are
extreme, and the patient is as miserable as one with carcinoma of the esopha-
gus, food either not being taken at all or only upon urgent compulsion. ^

Gull ^ mentions a girl of fourteen, of healthy, plump appearance, who in the
beginning of February, 1887, without apparent cause evinced a great repug-
nance to food and soon afterward declined to take anything but a half cup of
tea or coffee. Gull saw her in April, when she was much emaciated ; she
persisted in walking through the streets, where she was the object of remark
of passers-by. At this time her height was five feet four inches, her weight
63 pounds, her temperature 97° F., her pulse 46, and her respiration from 12
to 14. She had a persistent wish to be moving all the time, despite her
emaciation and the exhaustion of the nutritive functions.

There is another class of abstainers from food exemplified in the exhibi-
tionists who either for notoriety or for wages demonstrate their ability to
forego eating, and sometimes drinking, for long periods. Some have been
clever frauds, who by means of artifices have carried on skilful deceptions ;
others have been really interesting physiologic anomalies.

Older Instances.— Democritus in 323 B. C. is said to have lived forty
days by simply smelling honey and hot bread. Hippocrates remarks that
most of those who endeavored to abstain five days died within that period, and
even if they were prevailed upon to eat and drink before the termination of
their fast they still perished. There is a possibility that some of these cases
of Hippocrates were instances of pyloric carcinoma or of stenosis of the
pylorus. In the older writings there are instances reported in which the
period of abstinence has varied from a short time to endurance beyond the

a 476, 1888, i., 321.

OLDER INSTANCES OF FASTING.

415

bounds of credulity. Hufeland mentions total abstinence from food for
seventeen days, and there is a contemporary case of abstinence for forty days
in a maniac who subsisted solely on water and tobacco. Bolsot * speaks
of abstinence for fourteen months, and Consbruch ^ mentions a girl who
fasted eighteen months. Miiller'' mentions an old man of forty-five who
lived six weeks on cold water. There is an instance of a person living
in a cave twenty-four days without food or drink, and another of a man
who survived five weeks' burial under ruins.® Ramazzini speaks of fasting
sixty-six days ; AVillian, sixty days (resulting in deatli) ; von Wocher,
thirty-seven days (associated with tetanus) ; Lantana, sixty days ; Hobbes, ^
forty days ; Marcardier,^ six months ; Cruikshank,'' two months ; the Ephe-
merides, thirteen months ; Gerard,i 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 Grani6 died in the prison of
Toulouse in 1831, after a voluntary suicidal abstinence of sixty-three days.

Haller' cites a number of examples of long abstinence, but most ex-
traordinary' was that of a girl of Confolens, described by Citois of Poitiers,
who published a history of the case in the beginning of the seventeenth cen-
tury. This girl is said to have passed three entire years, from eleven to four-
teen, without taking any kind of aliment. In the " Harleian Miscellanies " is
a copy of a paper humbly offered to the Royal Society by John Reynolds,
containing a discourse upon prodigious abstinence, occasioned by the twelve
months' fasting of a woman named Martha Taylor, a damsel of Derbyshire.
Plot gives a great variety of curious anecdotes of prolonged abstinence.
Ames ™ refers to " the true and admirable history of the maiden of Con-
folens," mentioned by Haller. In the Annual Register, vol. i., is an
account of three persons who were buried five weeks in the snow ; and in
the same journal, in 1762, is the history of a girl who is said to have sub-
sisted nearly four years on water. In 1684 four miners were buried in a
coal-pit in Horstel, a half mile from 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 over-
come by the cold while on the way to her house ; she recovered despite her
exposure." Somis, physician to the King of Sardinia, gives an account of
three women of Piedmont, Italy, who were saved from the ruins of a stable

a 470, 1685. b 452^ l. ix., 115. c 452, L. xxiv. d 609 153

e 586, XV. , 45. f 629, 1668. g 402! T xxiii

"Anat. of the Absorbent Vessels," 101. i 46'^ T \" 147

j 708, 1722. k 789, 1880, xxx., 350. 1 400,' T.' vi" 171 sea

m Topographical Antiquities." n 629, 1684. o 629, 1700-20, v., 358.'

416 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

where they had been buried by an avalanche of snow, March 19, 1755,
thirty-seven days before. Thirty houses and 22 inhabitants were buried in
this catastrophe, and these three women, together with a child of two, were
sheltered in a stable over which the snow lodged 42 feet deep. They were
in a manger 20 inches broad and upheld by a strong arch. Their enforced
position was with their backs to the wall and their knees to their faces. One
woman had 15 chestnuts, and, fortunately, there were two goats near by, and
within reach some hay, sufficient to feed them for a short time. By milking
one of the goats which had a kid, they obtained about two pints daily, upon
which they subsisted for a time. They quenched their thirst with melted
snow liquefied by the heat of their hands. Their sufferings were greatly in-
creased by the filth, extreme cold, and their uncomfortable positions ; their
clothes had rotted. When they were taken out their eyes were unable to
endure the light, and their stomachs at first rejected all food.

While returning from Cambridge, February 2, 1799, Elizabeth Wood-
cock dismounted from her horse, which ran away, leaving her in a violent snow-
storm. She was soon overwhelmed by an enormous drift six feet high. The
sensation of hunger ceased after the first day and that of thirst predominated,
which she quenched by sucking snow. She was discovered on the 10th of
February, and although suffering from extensive gangrene of the toes, she
recovered. Hamilton" says that at a barracks near Oppido, celebrated for its
earthquakes, there were rescued two girls, one sixteen and the other eleven ;
the former had remained under the ruins without food for eleven days.
This poor creature had counted the days by a light coming through a small
opening. The other girl remained six days under the ruin in a confined
and distressing posture, her hands pressing her cheek until they had almost
made a hole in it. Two persons were buried under earthquake ruins at
Messina for twenty-three and twenty-two days each.

Thomas Creaser Ogives the history of Joseph Lockier of Bath, who, while
going through a woods between 6 and 7 p. m., on the 18th of August,
was struck insensible by a violent thunderbolt. His senses gradually re-
turned and he felt excessively cold. His clothes were wet, and his feet so
swollen that the power of the lower extremities was totally gone and that of
the arms was much impaired. For a long time he was unable to articulate
or to summon assistance. Early in September he heard some persons in the
wood and, having managed to summon them in a feeble voice, told them his
story. They declared him to be an impostor and left him. On the
evening of the same day his late master came to his assistance and removed
him to Swan Inn. He affirmed that during his exposure in the woods he
had nothing to eat ; though distressing at first, hunger soon subsided and
yielded to thirst, which he appeased by chewing grass having beads of water
thereon. He slept during the warmth of the day, but the cold kept him
a 629, Ixxiii. ^ " Case Joseph Lockier." 8°, Bath, 1806.

OLDER INSTANCES OF FASTING.

417

awake at night. During his sleep he dreamt of eating and drinking. On
November 17, 1806, several surgeons of Bath made an affidavit, in which
they stated that this man was admitted to the Bath City Dispensary on
September 15th, almost a month after his reputed stroke, in an extremely
emaciated condition, with his legs and thighs shriveled as well as motionless.
There were several livid spots on his legs and one toe was grangrenous.
After some time they amputated the toe. The power in the lower extremities
soon returned.

In relating his travels in the Levant, Hasselquist mentions 1000 Abyssini-
ans who became destitute of provisions while en route to Cairo, and who lived
two months on gum 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. Gower of Chelmsford had a patient who lived ten years on a
pint of tea daily, only now or then chewing a half dozen raisins or almonds,
but not swallowing them. Once in long intervals she took a little bread.

Brassavolus describes a younger daughter of Frederick King of Naples,
who 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, and cheese. In 1806 one of them at the age of one hundred and twenty
was healthy.

Sometimes in the older writings we find records of incredible abstinence.
Jonston" speaks of a man in 1460 who, after an unfortunate matrimonial
experience, lived alone for fifteen years, taking neither food nor drink. Petrus
Aponensis cites the instance of a girl fasting for eight years. According to
Jonston, Hermolus lived forty years on air alone. This same author has
also collected cases of abstinence lasting eleven, twenty-two, and thirty years,
and cites Aristotle as an authority in substantiating his instances of fasting
girls.

Wadd, the celebrated authority on corpulence, quotes Pennant in mentioning
a woman in Rosshire who lived one and three-quarters years without meat or
drink. Granger had under observation a woman by the name of Ann Moore,
fifty-eight years of age, who fasted for two years. Fabricius Hildanus=^34
lates 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 Avithout meat or drink. According to the Rev. Thos!
Steill, Janet Young fasted sixteen years and partially prolonged her absti-
nence for fifty years. The Edinburgh Medical and Surgical Journal,i> which
contains a mention of the foregoing case, also describes the case of Janet
Macleod, who fasted for four years, showing no signs of emaciation. Benja-

a 447 444 ,

y ^318, 1813, ix., 157.

418 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

mill 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 earth-
quake, at which time a girl of eighteen was buried under ruins for six
days. The edge of a barrel fell on her ankle and partly separated it, the dust
and mortar effectually stopping the hemorrhage. The foot dropped off and
the wound healed without medical assistance, the girl making a complete re-
covery. There is an account taken from a document in the Vatican of a
man living in 1306, in the reign of Pope Clement V., who fasted for two
years.<= McNaughton mentions Rubin Kelsey, a medical student afflicted
with melancholia, who voluntarily fasted for 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 sup-
posed to have taken no food for fourteen years, was fraudulent. He says that
Ann Moore was fed by her daughter in several ways ; when washing her
mother's face she used towels wet with gravy, milk, or strong arrow-root meal.
She also conveyed food to her mother by means of kisses. One of the " fast-
ing girls," Margaret Weiss, although only ten years old, had such powers of
deception that after being watched by the priest of the parish, Dr. Bucol-
dianus, she was considered free from juggling, and, to everybody's astonish-
ment, she grew, walked, and talked like other 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 fast-
ing girl who attained such celebrity among the laity, was ttikcn 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,

a 527, 1774, v., part ii., 471 et seq. ^ 328, 1790, 124.

c Journal de Pharmacia, etc., de Lisboa. d 763, 1830, i., 113. e 151, 1828.

MODERN INSTANCES OF FASTING.

419

revealed remarkable intestinal changes. The serous membranes were all
callous and thickened, and the canal of the sigmoid flexure was totally obliter-
ated. The mucous membranes were all soft and friable, and presented the
appearance of incipient gangrene.

Modern Cases. — Turning now to modern litemture, we have cases of mar-
velous 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. Kichardson*^ mentions a
case, happening in 1848, of a man of thirty-three who voluntarily fasted for
fifty-five days. His reason for fiisting, which it was impossible to combat,
was that he had no gastric juice and that it was utterly useless for him to
take any nutrition, as he had no means of digesting it. He lived on water
until the day of his death. Richardson gives an interesting account of the
changes noticed at the necropsy. There is an account of a religious mendi-
cant of the Jain caste " who as a means of penance fasted for ninety-one days.
The previous year he had fiisted eighty-six days. He had spent his life in
strict asceticism, and during his fasting he was always engrossed in prayer.

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

Grants describes the " Market Harborough fasting-girl," a maiden of
nineteen, who abstained from food from April, 1874, until December,
1877, although continually using morphia. Throughout her fast she had
periodic convulsions, and voided no urine or feces for twelve months before
her death. There was a middle-aged woman in England in 1860 who for two
years lived on opium, gin, and water. Her chief symptoms were almost
daily sickness and epileptic fits three times a week. She was absolutely
constipated, and at her death her abdomen was so distended as to present the
appearance of ascites. After death, the distention of the abdomen was found
to be due to a coating of fat, four inches thick, in the parietes. There was
no obstruction to the intestinal canal and no fecal or other accumulation
within it.

- 476, 1853, i., 512. b 173, iggo. c 536, 1882, i., 11. d 224 1880 ii 9ld

g 224', 1878, i::'i52

420

FHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

Christina Marshall/' a girl of fourteen, went fifteen and one-half months
without taking solid nourishment. She slept very little, seldom spoke, but
occasionally asked the time of day. She took sweets and water, with beef
tea at intervals, and occasionally a small piece of orange. She died April
18, 1882, after having been confined to her bed for a long while.

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

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

Among the modern exhibitionists may be mentioned Merlatti, the fast-
ing Italian, and Succi, both of whom fasted in Paris; Alexander Jacques,
who fasted fifty days ; and the American, Dr. Tanner, who achieved great
notoriety by a fast of forty days, during which time he exhibited progressive
emaciation. Merlatti, who fasted in Paris in 1886, lost 22 pounds in a

a 224, 1882, i., 631. b 124, April, 1878. 476, 1878, ii.. 646.

d 556, 1861, i., 67. « 476, 1890, i., 978.

ANOMALIES OF TEMPERATURE.

421

month ; during his fast of fifty days he drank only pure filtered water. Prior
to the fast his farewell meal consisted of a whole fat goose, including the bones,
two pounds of roast beef, vegetables for two, and a plate of walnuts, the lat-
ter eaten whole. Alexander Jacques ^ fasted fifty days and Succi fasted forty
days. Jacques lost 28 pounds and 4 ounces (from 142 pounds, 8 ounces to
114 pounds, 4 ounces), while Succi's loss was 34 pounds and 3 ounces.
Succi diminished in height from 65| to 64| inches, while Jacques increased
from 641 to 65| 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 fiister and helped him deceive the others. The result of the Vienna ex-
periment is bound to cast suspicion on all previous fasting accomplishments
of Signer Succi, if not upon those of his predecessors."

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

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

Mackenzie ^ reports the temperature-range of a woman of forty-two who
suffered with eiysipelatous inflammation of a stump of the leg. Throughout
a somewhat protracted illness, lasting from February 20 to April 22, 1879,
the temperature many times registered between 108° and 111° F. About a
year later she was again troubled with the stump, and this time the terapera-

a 224, 1890, i., 1444. b 475, 1881, ii., 796.

422 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

ture reached as high as 114°. Altliough under the circumstances, as any
rational physician would, Mackenzie suspected fraud, he could not detect
any method of deception. Finally the woman confessed that she had pro-
duced the temperature artificially by means of hot-water bottles, poultices, etc.

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

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

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

Philipson ' gives an account of a female servant of twenty-three who
suffered from a neurosis which influenced the vasomotor nervous system, and
caused hysteria associated with abnormal temperatures. On the evening of
July 9th her temperature was 112° F. ; on the 16th, it was 111° ; on the
18th, 112° ; on the 24th, 117° (axilla); on the 28th, in the left axilla it

a 476, 1873, ii., 341. b 476, 1875, ii., 107. c 476, 1879, i., 868.

d476, 1876, i., 28. e 543, 1880, i., 585. f 476, 1878, ii., 658.

g 199, 1867. h 476, 1879, i., 609, i 476, 1880, 1., 641.

REMARKABLE HYPERTHERMY.

423

was 117°, in the right Jixilla, 114°, and in the mouth, 112°; on the 29th, it
was 115° in the right axilla, 110° in the left axilla, and 116° 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°.
Mahomed b 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 1 30° 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° F. with
the large thermometer. In INIarch of the following year she died, and the
necropsy revealed nothing indicative of a cause for these enormous tempera-
tures. She was suspected of fraud, and was closely watched in Guy's Hos-
pital, 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 tem-
perature cannot be registered by an ordinary thermometer. Any one who
has been resident at a hospital in which heat-cases are received in the sum-
mer will substantiate this. At the Emergency Hospital in Washington, dur-
ing 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° 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 com-
plained of various pains, bloody expectoration, and had convulsions at vaiy-
ing intervals, with loss of consciousness, rapid respiration, unaccelerated
pulse, and excessively high temperature, the last on one occasion reaching
the height of 148° F. The temperature was taken carefully in the presence
of a number of persons, and all possible precautions were observed to pre-
vent 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° and 125° 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° F. These extraordinary elevations of temperature, he said,
appear physically impossible when they are long continued, as they are flital
to the life of the animal cell.

a 476, 1881, ii., 790. b 476, I88I, ii., 790.

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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

J acobi closed the discussion by insisting that his observations had been
made with the greatest care and precautions and under many different cir-
cumstances. He had at tirst viewed the case witli 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° 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 ex-
treme north at times endure a temperature of — 60° F., while some of the
people living in equatorial regions are apparently healthy at a temperature as
high as 130° 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° 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 tempera-
tures, 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° 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 exhibi-
tions 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° 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 ther-
mometer generally varying from 250° F. upward. Chamouni was the cele-
brated " Russian Salamander," assuming the title of " The Incombustible." ^
His great feat was to enter an oven with a raw leg of mutton, not retiring

a 681, 1874, vii., 365. ^ 226, 1827, 276. c 476, 1827-8, 585.

HUMAN SALAMANDERS."

425

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 contempo-
raneous 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° F.; for ten minutes, 279° F.;
and for several minutes, 364° 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° F. Chantrey, the sculptor, and his work-
man are said to have entered with impunity a furnace of over 320° F.

In some of the savage ceremonies of fire worship the degree of heat en-
dured by the participants is really remarkable, and even if the rites are per-
formed 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 practised 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 accom-
plished 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 efl^ect of it is both Aveird 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. Rush-
ing 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.

426

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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 com-
bustible 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 speak-
ing 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 suffo-
cated, have been burned to charcoal without awaking. Drunkenness or great
exhaustion may also explain certain cases. In substantiation of the possi-
bility 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.

a 593, 1870.

SPONTANEOUS HUMAN COMBUSTION.

427

The theories advanced by the advocates of spontaneous human combus-
tion 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 com-
bustion, 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
wlio, opening a diseased beef, was burned by a flame which issued from
the maw of the animal ; tiiere was first an explosion which rose to a
height of five feet and continued to blaze several minutes with a highly offen-
sive 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 exag-
geration 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 par-
ticularly 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 him-
self 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 ; Sinibaldus,'=" Borellus,^^^
and Bierling have also written on this subject, and the Ephemerides con-
tains 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

a 774, 1835, 9 et seq. b 476, 1842, ii., 2, 374.

c 462, T. Ixviii., 436. d "Observat. rar.," fasc. i.. No. 10.

e "Chylologia," 524. f " Mem. di Matem. e di Fisica della di Modena," x.

428

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

said that the fire was caused in the entrails by the inflamed efiluvia 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 noble-
men 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 com-
bustion 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
]iale flame about the size of a ten-cent piece issuing therefrom. As recent
as March, 1850, in a Coui-t 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 emi-
nent 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 nos-
trils and he was soon a corpse. Flowers states that the body remained ex-
tremely warm for a much longer period than usual.

Statistics. — From an examination of 28 cases of spontaneous combus-
tion, 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 eoml)ustion was rapid and was finished in from one to seven hours.

a 476, 1845, ii., 274 ; 1845, i., 11. b 124, xvii., 266.

c 789, 1870. d 235, May 15 and 30, 1841.

MAGNETIC, PHOSPHORESCENT, ELECTRIC ANOMALIES. 429

(9) The room where the combustion took phice 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) AVith 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 mstance,
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 skil-
fully ari-anged 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 cer-
tain 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. Raster
mentions an instance in which light was seen in the perspiration and on the
body linen after violent exertion. After exertion Jurine,*' Guyton, and Dries-
sen observed luminous urine passed by healthy persons, and Nasse mentions
the same phenomenon in a phthisical patient, Percy and Stokes have ob-
served 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.

a 124, Jan., 1838.
c 458, 1813, 48.

b Casper's Wochenschrift, No. 15, 1849.
^536, 1882, ii., 360.

430

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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 inspec-
tion 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 audi-
ence 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 cele-
brated 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° 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 pefese 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, with-
out any visible after-effect, in January, even, when the temperature was — 4°
F., ran into the snow and gleefully rubbed his body with ice. In the French

a 634, 1888, ii., 5.

PSYCHOLOGIC EFFECTS OF COLD.

431

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 nuich 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 ex-
perienced 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 trans-
portation 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 Currv 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 Lap-

a 513, ii., 348. b 475, 1843, i., 70.

432

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

landers 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° 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, Avithout
very bad effects on the men, Messrs. Sooysmith &, Company had an experi-
ence 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 pres-
sure. 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| atmospheres, and it was impossible to whistle. Perspiration was very pro-
fuse. Those who had to work a long time lost their appetites, became
emaciated, and congestion of the lung and brain was observed. The move-
ments 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 acute-
ness 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 ^vhich we find throughout nature.

a Scientific American, May, 18, 1885, 307.

COMPENSATORY SUBSTITUTION OF THE SENSES.

Jonstou ^ 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 natura; 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. AVe 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 shufflmg
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, wlio 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 de-
veloped and are practised 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 botli sight and hearing, and some-
times 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 illus-
trated 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.

* 447, 469. b ' ' Trait6 des Sens. »

28

434 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

Laura Dewey Bridgman" was born December 21, 1829, at Hanover, N.
H. Her parents were farmers and healthy people. They were of average
height, reguhir 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 infirmi-
ties, 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 pro-
gress, that it was deemed advisable by the authorities to hold her back. By
her peculiar sensibility to vibration she could distinguish the difference be-
tween 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 devel-
oped 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 intel-
lectual 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 move-
ments. Like most mutes, she articulated a number of noises, — 50 or more,

a "Anatomy and Observations on the Brain and Several Sense Organs of the Blind
Deaf-mute, Laura Dewey Bridgman," by H. H. Donaldson.

HELEN KELLAR.

435

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 orienta-
tion, 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 ani-
mals, 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 depart-
ure 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 suscepti-
bility 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, bur-
dened 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 ob-
server, in speaking of her mental development, although she was eccentric she
was not defective. She necessarily lacked certain data of thought, but even
this fact 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 develop-
ment. This girl, Helen Kellar, 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 Kellar, 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 de-
ceived 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. Bv
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 M^ords of
one of her lay observers, " her sense of touch is developed to such an exquis-
ite 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." Accordino-

436

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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 Eadclilfe 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 Kellar, as follows : —

" Helen Kellar'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 Sul-
livan 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.
Kellar came with her. They visited Miss Fuller's school. Miss Sullivan
had taught the child the manual alphabet, and she had obtained much infor-
mation 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 at-
tempt 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,

EDITH THOMAS.

437

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 let-
ting 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 per-
fectly.

" 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
practising 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 con-
nected 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 after-
ward, 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 intentuess and brightening as she catches the meaning. Any-
body can understand her answers."

In a beautiful eulogy of Helen Kellar 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 Kellar, 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 mus-
cular 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

438 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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.
Heading, 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 short-
hand 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 Motte-Houdart are among other blind poets. Asconius Pedianus, a gram-
marian 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 English-
man, 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 col-
lection of old Roman medals, all of which, without mistake, he could distin-
guish by their impressions. He also seemed to have the ability to judge dis-

FEATS OF MEMORY.

439

tance, 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 astron-
omer, 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 longtime
Professor of Mathematics at the College of Brianyon.

In the sev entccnth century the sculptor, Jean Gonnelli, born in Tuscany,
became blind at twenty years ; but in spite of his infirmity he afterward exe-
cuted 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 aftersvard known as the
" old blind dog," but, nevertheless, led his troops to many victories. Frois-
sart 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 inter-
fere 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 Pied-
montese, 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 accom-
plished his task in less than ten minutes, and without the aid of pencil and
paper, solving the whole problem mentally. Although not looking intelli-
gent, 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 wonder-
ful abilities was his high forehead.

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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. Y. 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 there-
after 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 hear-
ing, taste, and smell are acute, and the tactile development surpasses in re-
finement. 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 re-
quired 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 prin-
cipal 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.

FEATS OF MEMORY.

441

" 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 occipito-
parietal portion, which is noticeably very wide. The occiput protrudes back-
ward, causing a forward sweep of the back of the neck. From the nose-root
to the nucha over the head he measures 13| inches, and between upper ear-
tips across and over the head 1 1 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 Ameri-
can 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 mothei^'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 condi-
tions 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 re-
markable memory-increase before death, mainly in adults, and during fever
and insanit}\ 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 extraordinar}^ memory. He calls attention to the fact that the
scrofulous and rachitic diatheses in childhood are sometimes accompanied bv
this disorder. Winslow notes that in the incipient state of the brain disease
of early life connected with fevers, disturbed conditions of the cerebral cir-
culation and vessels, and in alfections 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 twent}^-
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.

442

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

" 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 liis 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 liis apparently perfect
mental and physical health, leaves no reason to suppose that Oscar^s extrava-
gant memory depends upon disease any more than we can suspect all giants
of being sickly, though the anomaly is doubtless due to pathologic condi-
tions. 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 mem-
ory-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 Dan-
ish historian, was remarkable for his acuteness of memory. Sir James Mack-
intosh, 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 phe-
nomenal Oscar it cannot be predicted that he will not develop, as he now

FEATS OF MEMORY.

443

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 menioi-v 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 assist-
ance of the owners, he invariably returned the right articles to the right per-
sons 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 won-
derful 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. J ust 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

444

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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 coknnns 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. Calcu-
lations 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 reach-
ing 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."

WOLF CHILDREN.

445

Saxo Granimaticus speaks of a bear that kidnapped a child and kept it a
long time in his den. The talc 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 oif 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 has 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 in-
offensive, except when teased, and then he growled surlily. He would eat
anything thrown to him, but preferred meat, which he devoured with canine

a "Zoological Sketches," Philadelphia, 1883, p. 195. b 475, I888, i., 593.

446

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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 great-
est 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 tlic night for hours together he would give v^ent 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 authen-
ticity 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

wo LF- CHILDREN.

447

staying at an up-country place called Sluiporeooundie, in East Bengal, it was
my fortune to meet an Anglo-Indian gentleman aVIio 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 gmss 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 wdth some native vege-
table 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.

448 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

" 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 snap-
ping 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 fear-
ful 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 abso-
lute 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 cliild 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 " pa-
riah " 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 legiti-
mate 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 kid-
nap 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 ren-
dered 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 " ex-
hibited 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 decapi-

a "Arch, per I'Antrop.," Firenze, 1882, xii.,49. b J.Anthrop. Soc, Bombay, 1893, iii., 107.
c " Verhandl. d. Berl. Gesselsch. f. Anthrop.," 1891, 817. d 616, 1893, viii., 34.

EQUILIBRISTS.

449

tated on the spot. Macgowan says that parasitic monsters are manufactured
in China by a similar process of transplantation. He adds that the depriva-
tion of light for several years renders the child a great curiosity, if in conjunc-
tion 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 discov-
ered 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 in-
credible 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," " ori-
bates," and " staenobatcs." Blondin would have been one of the latter. An-
tique 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 execut-
ing 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 dif-
ferent pantomimes. It is said that under Charles YI. 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-Pr6vost. 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 extraordinaiy skill in rope-walking. Her specialty

450

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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 Hippo-
drome of Paris.

In 1814 there was a woman called "La Malaga," who, in the presence
of the allied sovereigns at A ersailles, 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 18G0 he traversed the Niagara Falls on a cable at
an elevation of nearly 200 feet. Blondin introduced many novelties in his per-
formances. 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 per-
fection.

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 inspec-
tion 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 gym-
nastic 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 tlu^ir 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.

JUGGLERS.

451

The equihbrists 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 tliat 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 witli 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 din-
ner " Un d^euner en tMe-cl-tMe" Some other persons perform wonderful
feats of a similar nature on an oscillating trapeze, and many simihir per-
formances have been witnessed by the spectators of our large circuses.

The human pyramids" are interesting, combining, as they do, won-
derful 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" exem])lify 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 tlie air with unerring precision. Another
man called " Paul Cinquevalli," well known in tins country, does not hesi-
tate to juggle with liglited lamps or pointed knives. The tricks of the cloAvns
with tlieir traditional jwinted felt hats are well known. Recentlv 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 Colum-
bus, 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-juggh

lers.

452 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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 male
and female, will with their feet juggle substances and articles that it requires
several assistantjs to raise.

A curious trick is given by Rousselet in his magnificent work entitled
^^L'lnde des Rajahx," and quoted by Guyot-Daub6s. 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 hav-
ing 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 genuine-
ness. 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 revolu-
tion 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 inditFerent 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, cer-
tainly 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 butter-
flies 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 buttei^ies, without allowing one
to fiill 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

YENTRIL 0 Q UISTS.

453

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 genera-
tion. 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 country-
man 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
pliysiologic 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 If 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 tlie
present day ; it is common to see a person who possesses the power of speak-
ing with a voice apparently from the epigastrium. Some acquire this faculty,
while with others it is due to a natural resonance, formed, accordino- 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 pos-
sible 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."

454 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

He was always noticed to place the inanimate objects with which he held con-
versations near his nnibilicus.

Ventrilo(|iiists 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 succes-
sion, and thus seem to make their i)uppets talk in many different voices.
After having accpiired the ability to suddenly change the tone of their voice,
they practise 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 ])erformance 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 hesi-
tate to imitate a conglomeration of familiar sounds and noises in such a man-
ner 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
liad 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 begin-
ning to make a noise. The father scolded it, while the baby continued cry-
ing. 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 M^as so true to life that every one rose to his feet and was start-
ing 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 ven-
triloquist, his table, his chair, and his ruler."

ATHLETIC FEATS.

455

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 Olympiiui, the Pythian, the Nemean, and
the Isthmean games. On these occasions every one stop[)ed labor, truce was
declared between the States, and the whole country paid tribute to the con-
testants 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 van-
quished, 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, Avere 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 Hippo-
crates, was anterior to his time ; for in Book V. of the " Epidemics " we
read of Bias, who, " suapte natura vorax, in choleram-morbum incidit ex
carnium esu, prsecipueque suillarum crudarum, etc."

From the time of the well-known fable of the hero who, by practising
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 shortenino- 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 con-
test ; but gradually the " dialos," in which the course was double that of the

456

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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, wlio 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 extraordinarj^ feats of the cour-
iers 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 tra-
verse 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 veiy 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 d^p^che 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 noble-
man 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 Cliarles 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 carrjdng a letter to a London physician returned
with the potion prescribed within twenty-four hours, having traversed 148

FEATS OF EUNNINO.

457

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-dis-
tance 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 ndles of as rough, mountainous road as ever tried a moun-
taineer'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 practising, 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 Catta-
raugus 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 Eup-land,
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 remark-
able 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

458 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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-car-
riers 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.

Fig. 180.— Japanese porters. ^ _

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 tAvo
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 fixvorably with the older, and presum-
ably mythical, feats of this nature. In California, C. A. Harriman of

LONG-DISTANCE RUNNERS.

459

Truckec 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 Yanh.-n seconds, made by Edward Donavan, at Natick, Mass., September 2, 1895.
m YarcU—2H seconds, made by Harry Jewett, at Montreal, September 24, 1892.
QHarfer-M!le.—in seconds, made by W. Baker, at Boston, Mass., July 1, 188b.
Half-Mile.-\ minute 53| seconds, made by C. J. Kirkpatrick, at Manhattan l^ield, P^ew

York, September 21, 1895. i j a

1 Mile.-A minutes 12| seconds, made by W. George, at London, England, August

23, 1886.

5 .Miles.— 2i minutes 40 seconds, made by J. White, in England, May 11, 1863.

10 Miles.— 51 minutes 6| seconds, made by William Cummings, at London, England,

September 18, 1895. i j

25 Miles.— 1 houi-s 33 minutes 44 seconds, made by G. A. Dunning, at London, England,

December 26, 1881.

50 Miles.— 5 hours 55 minutes 4^ seconds, made by George Cartwright, at London, Eng-
land, February 21, 1887.

75 Miles.—S hours 48 minutes 30 seconds, made by George Littlewood, at London, Eng-
land, November 24, 1884.

100 Miles.— \Z 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
M^eeks 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
muscularlv. He was in good health during his feat ; his diet for the twenty-
four hours was 1 J 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 com-
pound 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 tempemture
was 97.25° 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 walk-
ing 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 A¥eston walked
5000 miles in one hundred days, but Snyder was said to have traveled

a 224, 1881, i., 63. b 224, 1887, 321.

460

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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 liis 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 •dnd eighteen hours. His performances all over Europe were so mar-
velous 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 start-
ing 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 Home 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 per-
formance equals the 200 miles in the shorter time about an English race
track and on thoroughbreds. It is said that this wonderful horseman lost

a 548, 1868, i., 515.

t

LONG DISTANCE SWIMMING.

461

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
cimiel from Bombay to Allygur (perhaps 800 miles) in eight days.

As regards the physiology of the runners and walkers, it is quite in-
teresting 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 anciient days the Greeks, living on their various islands and
being in a mild climate, were celebrated for their prowess as swimmers. Soc-
rates 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 water-
ways are found possessed of remarkable dexterity and endurance in swim-
ming.

In 1875 the celelebrated Captain Webb swam from Dover to Calais.'' On

a 476, 1875, ii., 359.

462

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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° F. and his pulse normal.
In five hours he was feverish, his temperature rising to 101° 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 de-
lirious, 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 per-
formances 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 Eus-
tache 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 thev 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 mar-
velous, 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 physi-
cal development.

In September, 1895, M. F. Sweeney, an American amateur, at Manhattan
Field in New York jumped six feet 5| inches high in the running high jump
without weights. With weights, J. H. Fitzpatrick at Oak Island, Mass.,

a 302, vol. 1., 69.

EXTRAORDINARY STRENGTH.

463

jumped six feet six inches high. Tlie record for the running high kick is
nine feet eight inches, ii 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 van-
quished. 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, lie 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 sup-
posed to be the son of Jupiter and Alcmena, He was endowed with pro-
digious 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 Avas 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 equiva-
lent 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

464 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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 igno-
rant 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-Daubds (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 " Dumndal " 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, Chris-
topher, 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 lift-
ing 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
Scverus, 16 of the most vigorous wrestlers, and accomplished this feat with-
out stopping for breath. It is said that this feat was the origin of his for-
tune. 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. ; Sciinderbeg ; 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 Eckc'berg, born in Anhalt, and who traveled under the name of
Samson." He was exhibited in I^ondon, 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

MODERN HERCULES.

465

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 Desaouliers 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 mus-
cles 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. Accord-
ing to Ddsaguliers, 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 main-
tain 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 Avheat, 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
30

466 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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.

Fig. I81.-Extreme muscular deTelopment. Fig. 182.-Sandow (after a photograph by Falk).

Guyot-Daubes considers that one of the most remarkable of all the men
noted ioY their strength was a butcher living in the mountains of Margeride,
known as Lapiada (the extraordinary). This man, whose strength was leg-
endary 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.

MODERN HERCULES.

467

One of Lapiada's great feats was to get under a cart loaded witli hay and, form-
ing an arcli with liis body, raise it from the ground, then little by little he
would mount to his haunches, still holding the cart and hay. ^ Lapiada ter-
minated 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
jNIillcr, whose specialty
was wrestling and stone-
breaking ; Samson, a re-
cent English exhibition-
ist, Louis Cyr, and San-
dow, who, in addition to
his remarkable strength
and control over his mus-
cles, is a very clever gym-
nast. Sandow gives an
excellent exposition of
the so-called " checker-
board " arrangement of
the muscular fibers of the
lower thoracic and ab-
dominal regions, and in
a brilliant light demon-
strates 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 fort-
ress 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 use-
less 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

Fig. 183.— Marked development of the muscles of the back.

468 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

large carpenter's bench with liis 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 com-
bination 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 sujij^orting 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 Sclig Whitman, known as " Ajax," a New York police-
man, has lifted 2000
pounds with his hands
and has maintained 450
pounds with his teeth.
This man is five feet 8^
inches tall and weighs 162
pounds. His chest meas-
urement is 40 inches, the
biceps 17 inches, tliat of
his neck 16| inches, the
forearm 11, the wrist 9|,
the thigh 23, and the calf
17.

One of the strongest
of the strong women "
is Madame Elise, a French-
woman, 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 ordinaiy 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 whWc supporting possibly half a ton.

Strength of the Jaws. — There are some persons who exhibit extra-
ordinary power of the jaw. In the curious experiments of Regnard and

Fig. 184.— Sandow (after a photograph by Sarony).

STRENGTH OF THE JAWS.

469

Blanchard at the Sorbonne, it was found that a crocodile weigh in^r about 120
pounds exerted a force between its jaws at a point corrcspontling 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 cocoa-
nut with their teeth, and Guyot-Daubos 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 nuich
as 100 pounds. In Buffon's
experiments he onco 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 be-
tween 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-Daub6s, at fipernay 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 s{)ectators.

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, ac-
cording to the size of his audience, at the same time keeping his hands occu-
pied with other weights. Figure 185 represents a well-known modern
exhibitionist lifting with his teeth a cask on which are seated four men.

Fig. 185.— Signor Lawoiida, '• the iron-jawed man."

470

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

The celebrated jMIIc. Gauthier, an actress of the Corned ie-Fran9ais, 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 liand 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 wonderfidly 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 Thuo-s 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
witli 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 hanmier would break it. Again, there are many instances in which the
stone has been found already separated and fixed quite firmly together, plac-
ing 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 perfi)rmances. By skilfully arranging stout twine on the
liands, 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 of&cially recorded feats of strength that stand unequaled
in the last decade are as follows : —

Wdght-h'ft!ng.—Yl?indi^ alone, 15711 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.

Ihmih-heMs.— H. Pcnnock, 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

PLATE 6.

Feats of contortion.

CONTORTIONISTS.

473

shoulder, and then using one hand alone, li. 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.

Throioing 16-pound Hammer— 5. S. Mitchell, at Ti-avers Island, N. Y., October 8,
1892, made a record-throw of 145 feet | inch.

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

Thromng 56-pound Weight — 3. 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 J 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 up-
right 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 perpen-
dicular 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 Avith 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 com-
pletely 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
acotabula, but reduction was always easy. When eight years old he joined
a company of acrobats and strolling performers, and was called by the eupho-
nious title of " the Yankee dish-rag." His muscular system was well-devel-
oped, and, like Sandow, he could make muscles act in concert or separately.

a 224, 1882, i., 650, and 476, 1882, i., 576.

474 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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 sliows 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 disloca-

Charles Warren, the celebrated dislocationist.

tions. 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 (Fig. 187). 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" (Fig. 188) 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 (Fig. 186). 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

ENDURANCE OF PAIN. 475

the various forms of talipes, in such a way as to deceive an expert. He dis-
located 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 1880 there was shown a man who was called " I'homme
prot^e," 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 mus-
cles he could give himself diiferent 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 bodv, 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 ex-
hibited 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 sensa-
tion 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 ex-
amples of persons who in religious enthusiasm inflict pain on themselves. In

476

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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 tliis position without the least visible show of pain.
In a similar manner they pierce the lips and cheeks with long jmus 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 tliey are
rendered insensible to pain by self-induced hypnotism.

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

"The center of the court was given up to the Aissaoui. These were 12
hollow-cheeked 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 tam-
bours, 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. Sud-
denly 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 ft)rward, almost touching the ground in his fearful contortions, and w^ag-
ging 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, whicli sent a shiver down one's back, held it up before his eyes.

ENDURANCE OF PAIN.

477

Mdfc 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 glow-
ing 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

478

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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, hav-
ing 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 instru-
ment 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, wliere 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 tliis subject, will be dis-
cussed 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 Mucins Scsevola 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 some-
what 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,

ENDURANCE OF PAIN

and the case was finally referred to his —""^if^;';^^^

The impostor was carried to a field hos^.tal m a '^'f^^^'^^ZTu^^^^^

and watched for a couple of weeks, during which he h^ ^^^^^^^

moving his feet in his sleep. Still, the witnesses were not prepared to s w ai

Thai thL changes of position might not have been effe^^^^

whole body. The suspect stuck to his assertion, and Conoredo n ^ ^^^^"^^^

tion, finally summoned a surgeon, who actually placed the feet of tli professed

paralvtic in ''aqua fortis," but even this rigorous method avai ed the cruel

s^ ge.! nothing!and he was compelled to advise dismissal from the service

u 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 con-
fession 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 Thev 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
seetliing oil, but Damiens never uttered a sound till his dying groan an-
nounced 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 wav the heroic General instructed them to amputate it, again remain-
ing 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 with-
out an anesthetic, making no show of pain, and only remarking that he
thouo-ht 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.

a 392, 1887, 143.

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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 i^ain 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 M^ho 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 him-
self 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 Charity Hospital a number
of hysteric women with a morbid desire for operation without an anes-
thetic. 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 pleas-
ure 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 Stefanow-
ski, 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 tlie enjoyment and frenzy of flagellation are well known, its

IDIOSYNCRASIES.

481

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 fan-
cies, 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, Bartliolinus, 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 emphy-
sema, 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 de-
fines idiosyncrasy as the predominance of an organ, of a viscus, or a system
of organs. This definition does not entirely grasp the subject. An idiosyn-
crasy 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 tem-
perament, 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.

a Monthly Journal of Medical Sciences, London, 1846. b 543, I853,

c "Physiologic Pathologique." Paris, 1828.

31

482 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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

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

The first examples of idiosyncrasies to be noticed will be those manifested
through the sense of smell.^ On the authority of Spigelius, whose name
still survives in the nomenclature of the anatomy of the liver, Mackenzie
quotes an extraordinary case in a 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 re-
lates that so obnoxious was a rose to Lady Heneage, that she blistered her
cheek while accidentally lying on one while she slept. Ledelius ^' records
the description of a woman who fiiinted 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 esophagiis, the
stomach, the diaphragm, the intestines, the organs of generation, etc. Odor-
ous substances have occasioned syncope, stupor, nausea, vomiting, and some-
times death. It is said that the Hindoos, and some classes who eat nothing
but vegetables, are intensely nauseated by the odors of European tables, and
for this reason they are incapable of serving as dining-room servants,
a " Hieroglyphica." Francofurti, 1678. b 104, dec, ii., and ann. x., obs. 8.

iniO^YNCBASY TO ODORS.

483

Fabricius Hildaims mentions a person who fainted from the odor of vine-
gar. The Ephemerides contains an instance of a soldier who fell insensible
from the odor of a peony. Wagner knew a man who was made ill by the
odor of bouillon of crabs. The odors of blood, meat, and fat are repugnant
to herbivorous annuals. 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
aifected with aphonia whenever exposed to the odor of musk, but who im-
mediately recovered after taking a cold bath. Dejean has mentioned a man
who could not tolerate an atmosphere of cherries. Highmore knew a man
in whom the slightest smell of musk caused headache followed by epistaxis.
Lanzonius ^'^ gives an account of a 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
w^ould detect by its odor. She lived almost entirely on milk. Bierling ^'o
mentions an antipathy to the smell of musk, and there is a case on record in
which it caused convulsions. Boerhaave bears witness that the odor of
cheese caused nasal hemorrhage. Whytt mentions an instance in which to-
bacco became repugnant to a woman each time she conceived, but after
delivery this aversion changed to almost an appetite for tobacco fumes.
Panaroli mentions an instance of sickness caused by the smell of sassa-
fras, and there is also a record of a person who fell helpless at the smell of
cinnamon. Wagner had a patient who detested the odor of citron. Ignorant
of this repugnance, he prescribed a potion in which there was water of balm-
mint, of an odor resembling citron. As soon as the patient took the first
dose he became greatly agitated and much nauseated, and this did not cease
until Wagner repressed the balm-mint. There is reported ^ the case of a
young woman, rather robust, otherwise normal, who always experienced a
desire to go to stool after being subjected to any nasal irritation sufficient
to excite sneezing.

It has already been remarked that individuals and animals have their
special odors, certain of which are very agreeable to some people and ex-
tremely unpleasant to others. Many persons are not able to endure the
emanations from cats, rats, mice, etc., and the mere fact of one of these ani
ma s being in their vicinity is enough to provoke distressing symptoms
Mile. Contat, the celebrated French actress, was not able to endure the odor

a"Deossecribriformi," 367. . b 302, xxiii., 501.

484 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

of a hare. Stanislaus, King of Poland and Duke of Lorraine, found it im-
possible to tolerate the smell of a cat. The Ephemerides mentions the
odor of a little garden-frog as causing epilepsy. Ab Heers^o"' mentions a
similar anomaly, fainting caused by the smell of eels. Habit had rendered
Haller insensible to the odor of putrefying cadavers, but according to Zim-
merman the odor of the perspiration of old people, not perceptible to others,
was intolerable to him at a distance of ten or twelve paces. He also had an
extreme aversion for cheese. According to Dt^an, 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 tiie other.
Everard Home has cited several examples, and Heidmann of Vienna has
treated two musicians, one of whom always perceived in the affected ear,
during damp weather, tones an octave lower than in the other ear. The
other musician perceived tones an octave higher in the affected ear. Cheyne ^
is quoted as mentioning a case in which, when the subject heard the noise of
a drum, blood jetted from the veins with considerable force. Sauvages^ has
seen a young man in whom intense headache and febrile paroxysm were only
relieved by the noise from a beaten drum. Esparron has mentioned an
infant in whom an ataxic fever was established by the noise of this instru-
ment. Ephemerides contains an account of a young man who became nerv-
ous and had the sense of suffocation when he heard the noise made by sweep-
ing. Zimmerman speaks of a young girl who had convulsions when she
heard the rustling of oiled silk. Boyle, the father of chemistry, could not
conquer an aversion he had to the sound of water running through pipes. A
gentleman of the Court of the Emperor Ferdinand suffered epistaxis when he
heard a cat mew. La Mothe Le Vayer could not endure the sounds of
musical instruments, although he experienced pleasurable sensations when he
heard a clap of thunder. It is said that a chaplain in England always
had a sensation of cold at the top of his head when he read the r33d chapter
of Isaiah and certain verses of the Kings. There was an unhappy wight
who could not hear his own name pronounced without being thrown into
convulsions.^ Marguerite of Valois, sister of Francis I., could never utter
the words " mort " or " petite verole," such a horrible aversion had she to
death and small-pox. According to Campani, the Chevalier Alcantara
could never say " lana," or words pertaining to woolen clothing. Hippo-
a 302, xxiii., 503. b "Nosol. Method." Paris, 1771. ^ HO v., obs. 15, 60.

THERAPEUTIC VALUE OF MUSIC.

485

I

crates says that a certain Nicaiior had tlie greatest horror of the sound of the
flute at night, although it delighted him in the daytime. Rousseau reports a
Gascon in whom incontinence of urine was produced by the sound of a bag-
pipe. Frisch, Managetta, and Rousse speak of a man in whom the same
effect was produced by the sound of a hurdy-gurdy. Even Shakespeare alludes
to the effects of the sound of bagpipes. Tissot mentions a case in which
music caused epileptic convulsions, and Forestus mentions a beggar who had
convulsions at the sound of a wooden trumpet similar to those used by chil-
dren in play. Rousseau mentions music as causing convulsive laughter in a
woman. Bayle mentions a woman who fainted at the sound of a bell.
Paullini cites an instance of vomiting caused by music, and Marcellus Dona-
tus mentions swooning from the same cause. Many people are unable to bear
the noise caused by the grating of a pencil on a slate, the filing of a saw, the
squeak of a wheel turning about an axle, the rubbing of pieces of paper
together, and certain similar sounds. Some persons find the tones of music
very disagreeable, and some animals, particularly dogs, are unable to endure
it. In Albinus the younger the slightest perceptible tones were 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 har-
monica has been noticed to produce fainting in females. Fischer ^ says that
music provokes sexual frenzy in elephants. Gutfeldt*^ speaks of a peculiar
idiosyncrasy of sleep produced by hearing music. Delisle ® mentions a young
person who during a whole year passed pieces of ascarides and tenia, during
which time he could not endure music.

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

The therapeutic value of music has long been known. For ages war-
riors have been led to battle to the sounds of martial strains. David
charmed away Saul's evil spirit with his harp. Horace in his 3 2d Ode,
Book 1, concludes his address to the lyre :

" 0 laborum,
Dulce lenimen, mihicuruque salve,
Rite vocanti ;"

a " Diet, de Mnsique." b 302, xxiii. c sr^o lonQ 7

^ 159, 1806. e 476, 1828-9, 720. f ^q^^ ^^^^

486 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

or, as Kiessling of Berlin interprets : —

' ' 0 laborum,
Dulce lenimen medicumque, salve,
Rite vocanti. ' '

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

According to the American Medico-Surgical Bulletin, " Professor Tarch-
anoff of Saint Petersburg has been investigating the influence of music upon
man and other animals. The subject is by no means a new one. In recent
times Dagiel and Fere have investigated the effect of music upon the respira-
tions, 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 voluntarj^ efforts or by electric excitation, to the point of
being incapable of making any mark except a straight line on the registering
cylinder, music had the power of making the fatigue disappear, and the fin-
ger placed in the ergograph again commenced to mark lines of different
heights, according to the amount of excitation. It was also found that
music of a sad and lugubrious character had the opposite effect, and could
check or entirely inhibit the contractions. Professor Tarchanoff does not
profess to give any positive explanation of these facts, but he inclines to
the view that ' the voluntary muscles, being furnished with excitomotor and
depressant fibers, act in relation to the music similarly to the heart— that is
to say, that joyful music resounds along the excitomotor fibers, and sad
music along the depressant or inhibitory fibers.' Experiments on dogs
showed that music was capable of increasing the elimination of carbonic acid
by 16.7 per cent., and of increasing the consumption of oxygen by 20.1 per
cent. It was also found that music increased the functional activity of the
skin. Professor Tarchanoff claims as the result of these experiments that
music may fairly be regarded as a serious therapeutic agent, and that it exer-

a 476, 1828-9, 720.

IDIOSYNCRASIES OF THE VISUAL ORGANS.

487

cises a genuine and considerable influence over the functions of the body.
Facts of this kind are in no way surprising, and are chiefly of interest as pre-
senting some physiologic basis for phenomena tliat 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
diflerence between mind and body, and the principles of their interaction, it is
obviously impossible to controvert this view successfully. From the im-
mediately practical point of view we should not ignore the possible value of
music in some states of disease. In melancholia and hysteria it is probably
capable of being used with benefit, and it is worth bearing in mind in deal-
ing with insomnia. Classical scholars will not forget that the singing of
birds was tried as a remedy to overcome the insomnia of Mtecenas. Music
is certiiinly a good antidote to the pernicious habit of introspection and self-
analysis, which is often a curse both of the hysteric and of the highly
cultured. It would seem obviously preferable to have recourse to music of
a lively and cheerful character,"

Idiosyncrasies of the visual organs are generally quite rare. It is well-
known that among some of the lower animals, e. g., the turkey-cocks, buffaloes,
and elephants, the color red is unendurable. Buchner'^ and Tissot^' mention
a young boy who had a paroxysm if he viewed anything red. Certain in-
dividuals become nauseated when they look for a long time on irregular lines
or curves, as, for examples, in caricatures. Many of the older examples of
idiosyncrasies of color are nothing more than instances of color-blindness,
which in those times was unrecognized. Prochaska« knew a woman who in
her youth became unconscious at the sight of beet-root, although in her later
years she managed to conquer this antipathy, but was never able to eat the
vegetable in question. One of the most remarkable forms of idiosyncrasy on
record is that of a student who was deprived of his senses by the very sight
of an old woman. On one occasion he was carried out from a party in a
dying state, caused, presumably, 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 arc the individuals
who feel nausea in an hospital ward.

^ All Robert Boyle's philosophy could not make him endure the sight of
spider, although he had no such aversion to toads, venomous snakes, etc.
Par6 mentions a man who fainted at the sight of an eel, and another'who
had convulsions at the sight of a carp. There is a record of a young lady
a"Derachitiaeperlecta/' 1754. b " j)^ p . j^j^^^^g.^ „ c " Anuot. Acad. " d302,xxiii.

a

488

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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

As to idiosyncrasies of the sense of touch, it is well known that some
people cannot handle velvet or touch the velvety skin of a peach without

a ''Curiosities of Medical Experience," London, 1837, ii., 246.

b " De Subtilat. Exercit." Hanover, 1634. " Exercit," 142.

d570, dec. i., ann. iii., obs. 46.

IDIOSYNCRASIES TO FOODS

489

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

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

Amatus Lusitanus speaks of vomiting and diarrhea occurring each time
a certain Spaniard ate meat. Haller knew a person who was purged violently
by syrup of roses. The son of one of the friends of Wagner would vomit
immediately after the ingestion of any substance containing honey. Bayle *
has mentioned a person so susceptible to honey that by a plaster of this sub-
stance placed upon the skin this untoward effect was produced. Whvtt 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. Kitte "^^'^ mentions a similar instance. Roose has seen
vomiting produced in a woman by the slightest dose of distilled water of
linden. There is also mentioned a person in whom orange-flower water pro-
duced the same effect. Dejean cites a case in which honey taken internally
or applied externally acted like poison. It is said that the celebrated Haen ^
would always liave convulsions after eating half a dozen strawberries. Earle
and Halifax attended a child for kidney-irritation produced by strawberries
and this was the invariable result of the ingestion of this fruit. The authors
personally know of a family the male members of which for several genera-
tions could not eat strawberries without symptoms of poisoning. The female
members were exempt from the idiosyncrasy. A little boy of this family was
killed by eating a single berry. Whytt mentions a woman of delicate con-
stitution and great sensibility of the digestive tract in whom foods difficult

a - De utilitat. physic, experiment." b "Maladies des Nerfs "

^ Ueber die Krankheiten der Gesnndeu." d 302, xxiii 499

490

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

of digestion provoked spasms, which were often followed by syncopes. Bayle
describes a man who vomited violently after taking coifee. Wagner mentions
a person in whom a most insignificant dose of manna had the same effect.
Preslin speaks of a woman who invariably had a hemorrhage after swallow-
ing a small quantity of vinegar. According to Zimmerman, some people are
unable to wash their fiices on account of untoward symptoms. According to
Gaubius, the juice of a citron applied to the skin of one of his acquaintances
produced violent rigoi"S.

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 Avithout convulsions and
vomiting. It is said that Erasmus was made ill by the ingestion of fish ; but
this same philosopher, who was cured of a malady by laughter, expressed his
appreciation by an elegy on the folly. There is a record of a person who
could not eat almonds without a scarlet rash immediately appearing upon the
face. Marcellus Donatus knew a young man who could not eat an egg with-
out his lips swelling and purple spots appearing on his face. Smetius men-
tions a person in whom the ingestion of fried eggs was often followed by
syncope. Brunton ^ has seen a case of violent vomiting and purging after
the slightest bit of egg. On one occasion this person was induced to eat a
small morsel of cake on the statement that it contained no egg, and, although
fully believing the words of his host, he subsequently developed prominent
symptoms, due to the trace of egg that was really in the cake. A letter
from a distinguished 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-
elfects which the eating of eggs has upon her, upon me, and upon my father
before us. I believe my grandfather, as well as my father, could not eat
eggs with impunity. As to my father himself, he is nearly eighty years old ;
he has not touched an egg since he was a young man ; he can, therefore, give
no precise or reliable account of the symptoms the eating of eggs produce in
him. But it was not the mere ' stomach-ache ' that ensued, but much more
immediate and alarming disturbances. As for me, the peculiarity was dis-
covered when I was a spoon-fed child. On several occasions it was noticed
(that is my mother's account) that I felt ill without apparent cause ; after-
ward it was recollected that a small part of a yolk of an egg had been given
to rae. 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 try-
a "Miscellan.," etc., 566. b 643, 1885, ii., 113.

IDIOSYNCRASIES TO FOODS

491

ing it again, but always with the same result — a feeling that I had been
poisoned ; and yet all the while I liked eggs. Then I never touched them
for years. Later I tried again, and I find the ill-effects are gradually wear-
ing off. With my daughter it is different ; she, I think, becomes more sus-
ceptible as time goes on, and the effect upon her is more violent than in my
case at any time. Sometimes an egg has been put with coffee unknown to
her, and she has been seen immediately afterward with her face alarmingly
changed — eyes swollen and wild, the face crimson, the look of apoplexy.
This is her own account : ' An egg in any form causes within a few minutes
great uneasiness and restlessness, the throat becomes contracted and painful,
the face crimson, and the veins swollen. These symptoms have been so
severe as to suggest that serious consequences might follow.' To this I may
add that in her experience and my own, the newer the egg, the worse the
consequences."

Hutchinson * speaks of a Member of Parliament who had an idiosyncrasy
as regards parsley. After the ingestion of this herb in food he always had
alarming attacks of sickness and pain in the abdomen, attended by swelling
of the tongue and lips and lividity of the face. This same man could not
take the smallest quantity of honey, and certain kinds of fruit always pois-
oned him. There was a collection of instances of idiosyncra.sy in the British
Medical Journal, 1859, which will be briefly given in the following lines :
One patient could not eat rice in any shape without extreme distress. From
the description given of his symptoms, spasmodic asthma seemed to be the
cause of his discomfort. On one occasion when at a dinner-party he felt the
symptoms of rice-poisoning come on, and, although he had partaken of no dish
ostensibly containing rice, was, as usual, obliged to retire from the table. Upon
investigation it appeared that some white soup with which he had com-
menced his meal had been thickened with ground rice. As in the preceding
case there was another gentleman who could not eat rice without a sense of
suffocation. On one occasion he took lunch with a friend in chambers, partak-
ing only of simple bread and cheese and bottled beer. On being seized with
the usual symptoms of rice-poisoning he informed his friend of his peculiar-
ity of constitution, and the symptoms were explained by the fact that a few
grains of rice had been put into each bottle of beer for the purpose of excit-
ing a secondary fermentation. The same author speaks of a gentleman
under treatment for stricture who could not eat figs without experiencing the
most unpleasant formication of the palate and fauces. The fine dust from
split peas caused the same sensation, accompanied witli running at the nose •
it was found that the father of the patient suffered from hay-fever in certain
seasons. He also says a certain young lady after eating eggs suffered from
swelling of the tongue and throat, accompanied by " alarming illness," and
there is recorded in the same paragraph a history of another young girl in

a 166, iv., 78.

492 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

whom the ingestion of honey, and especially honey-comb, produced swelling
of the tongue, frothing of the mouth, and blueness of the fingers. The authors
know of a gentleman in whom sneezing is provoked on the ingestion of
chocolate in any form. There was another instance — in a member of the
medical profession — who suffered from urticaria after eating veal. Veal
has the reputation of being particularly indigestible, and the foregoing
instance of the production of urticaria from its use is doubtless not an uncom-
mon one.

Overton * cites a striking case of constitutional peculiarity or idiosyn-
crasy in which wheat flour in any form, the staff of life, an article hourly
prayed for by all Christian nations as the first and most indispensable of
earthly blessings, proved to one unfortunate individual a prompt and dreadful
poison. The patient's name was David Waller, and he was born in Pittsyl-
vania County, Ya., about the year 1780. He was the eighth child of his
parents, and, together with all his brothers and sisters, was stout and healthy.
At the time of observation AYaller was about fifty years of age. He had
dark hair, gray eyes, dark complexion, was of bilious and irascible tempera-
ment, Avell 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 healtli
of his ancestry, nothing could be found which could establish the fact of
heredity in his peculiar disposition. Despite every advantage of stature,
constitution, and heredity, David Waller was through life, from his cradle to
his grave, the victim of what is possibly a unique idiosyncrasy of constitu-
tion. In his own words he declared : " Of two equal quantities of tartar
and wheat flour, not more than a dose of the former, he would rather
swallow the tartar than the wheat flour." If he ate flour in any form or
however combined, in the smallest quantity, in two minutes or less he would
have painful itching over the whole body, accompanied by severe colic and
tormina in the bowels, great sickness in the stomach, and continued vomiting,
which he declared was ten times as distressing as the symptoms caused by
the ingestion of tartar emetic. In about ten minutes after eating the flour
the itching would be greatly intensified, especially about the head, face, and
eyes, but tormenting all parts of the body, and not to be appeased. These
symptoms continued for two days with intolerable violence, and only declined
on the third day and ceased on the tenth. In the convalescence, the lungs
were affected, he coughed, and in expectoration raised great quantities of
phlegm, and really resembled a phthisical patient. At this time he was con-
fined to his room with great weakness, similar to that of a person recovering
from an asthmatic attack. The mere smell of wheat produced distressing
symptoms in a minor degree, and for this reason he could not, without suf-
a Southern Journal of Medical aud Physical Sciences, iii., 1855.

FOOD-SUPERSTITIONS. 493

fering, go into a mill or house where the smallest quantity of wheat flour
was kept. His condition was the same from the earliest times, and he was
laid out for dead when an infant at the breast, after being fed with " pap "
thickened with wheat flour. Overton remarks that a case of constitutional
peculiarity so little in harmony with the condition of other men could not be
received upon vague or feeble evidence, and it is therefore stated that AValler
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 Avhim, put a small quantity of flour in the soup which she gave him
to eat at her table, stating that it contained no flour, and as a consequence
of the deception he was bed-ridden for ten days with his usual symptoms.
It was also stated that Waller was never subjected to militia duty because it
was found on full examination of his infirmity that he could not live upon
the rations of a soldier, into which wheat flour enters as a necessary ingredient.
In explanation of this strange departure from the condition of other men,
Waller himself gave a reason which was deemed equivalent in value to any
of the others offered. It was as follows : His father being a man in humble
circumstances in life, at the time of his birth had no wheat with which to
make flour, although his mother during gestation " longed " for wheat-
bread. The father, being a kind husband and responsive to the duty
imposed by the condition of his wife, procured from one of his opulent
neighbors a bag of wheat and sent it to the mill to be ground. The mother
was given much uneasiness by an unexpected delay at the mill, and by the
time the flour arrived her strong appetite for wheat-bread had in a great
degree subsided. Notwithstanding this, she caused some flour to be imme-
mediately baked into bread and ate it, but not so freely as she had expected.
The bread thus taken caused intense vomiting and made her violently
and painfully ill, after which for a considerable time she loathed bread.
These facts have been ascribed as the cause of the lamentable infirmity
under which the man labored, as no other peculiarity or impression in her.
gestation was noticed. In addition it may be stated that for the purpose of
avoiding the smell of flour Waller was in the habit of carrying camphor
in his pocket and using snuff, for if he did not smell the flour, however
much might be near him, it was as harmless to him as to other men.

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

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

From the days of Adam and Eve to the present time there has been not
only forbidden fruit, but forbidden meats and vegetables. For one reason or

494 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

another people have resolutely refused to eat any and all kinds of flesh, fish,
fowl, fruits, and plants. Thus, the apple, the pear, the strawberry, the
quince, the bean, the onion, the leek, the asparagus, the woodpecker, the
pigeon, the goose, the deer, the bear, the turtle, and the eel — these, to name
only a few eatables, have been avoided as if unwholesome or positively in-
jurious to health and digestion.

"As we all know, the Jews have long had an hereditary antipathy to
pork. On the other hand, swine's flesh was highly esteemed by the ancient
Greeks and 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 De-
meter, roast pig was the ^i^ce 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 Thesmo-
phoria ) and had eaten freely of roast pig. Those who took part in another
Greek mystery or festival ( known as the Eleusinia ) abstained from certain
food, and above all from beans.

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

" But people have abstained from eating kinds of flesh which could not be
called unclean. For example, the people of Thebes, as Herodotus tells us, ab-
stained from sheep. Then, the ancients used to abstain from certain vegetables.
In his ' Roman Questions ' 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 buflalo,
the woodpecker, the asparagus, and so forth. No member of the bear family
would dare to eat bear-meat, but he has no objection to eating buffalo steak.
Even the marriage law is based on this belief, and no man whose family
name is Wolf may marry a woman whose family name is also Wolf.

" In a general way it may be said that almost all our food prohibitions
spring from the extraordinary custom generally called totemism. Mr.
Swan, who was missionary for many years in the Congo Free State, thus de-

I

FO OD-S UPERS TITIONS. 4yD

scribes the custom : 'If I were to ask the Ycke people why they do not eat
zebra flesh, they would reply, 'CMjila,' i.e., ' It is a thing to which we have an
antipathy ; ' or better, ' It is one of the things which our fathers tauglit 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 ' Bashilanzcfu,' ' those who have an antipathy to the ele-
phant.' In other words, the members of these stocks refuse to eat their
totems, the zebra, the leopard, or the elephant, from which they take tlieir
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 Avhose flesh was forbidden might be drawn up. For example, in
Old Egypt the sheep could not be eaten in Thebes, nor the goat in Mendes,
nor the cat in Bubastis, nor the crocodile at Ombos, nor the rat, which was
sacred to Ra, the sun-god. However, the people of one place had no scruples
about eating the forbidden food of another place. And this often led to re-
ligious disputes.

" Among the vegetables avoided as food by the Egyptians may be men-
tioned the onion, the garlic, and the leek. Lucian says that the inhabitants
of Pelusium adored the onion. According to Pliny the Egyptians relished
the leek and the onion. Juvenal exclaims : ' Surely a very religious
nation, and a blessed place, where every garden is overrun with gods ! '
The survivals of toteraism among the ancient Greeks are very interesting.
Families named after animals and plants were not uncommon. One Athe-
nian gens, the loxidse, had for its ancestral plant the asparagus. One Roman
ffens, 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 ani-
mal. Thus when the people of dog-town were feeding on the fish called
oxyrrhyncus, the citizens of the town which revered the oxyrrhyncus began
to eat dogs. Hence arose a riot.' The antipathy of the Jews to pork has
given rise to quite difl'erent 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

I

i

I

496 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

the apple to health/ says Mr. Conway, ' is traceable to Arabia. Sometimes
it is regarded as a bane. In Hessia it is said an apple must not be eaten on
New Year's Day, as it will produce an abscess. But generally it is curative.
In Pomerania it is eaten on Easter morning against fevers ; in Westphalia
(mixed with saffron) against jaundice ; while in Silesia an apple is scraped
from top to stalk to cure diarrhea, and upward to cure costiveness.'
According to an old English fancy, if any one who is suffering from a
wound in the head should eat strawberries it will lead to fatal results. In
the South of England the folk say that the devil puts his cloven foot upon
the blackberries on Michaelmas Day, and hence none should be gathered or
eaten after that day. On the other hand, in Scotland the peasants say that
the devil throws his cloak over the blackberries and makes them unwhole-
some after that day, while in Ireland he is said to stamp on the berries.
Even that humble plant, the cabbage, has been invested with some mystery.
It was said that the fairies were fond of its leaves, and rode to their
midnight dances on cabbage-stalks. The German women used to say
that 'Babies come out of the cabbage-heads.' The Irish peasant ties a
cabbage-leaf around the neck for sore throat. According to Gerarde, the
Spartans ate watercress with their bread, 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 ' His-
tory of Civilization' took this view, and tried to prove that the character of
a people depends on their diet."

Idiosyncrasies to Drugs. — In the absorption and the assimilation of
drugs idiosyncrasies are often noted ; in fact, they are so common that we
can almost say that no one drug acts in the same degree or manner on differ-
ent individuals. In some instances the untoward action assumes such a
serious aspect as to render extreme caution necessary in the administration of
the most inert substances. A medicine ordinarily so bland as cod-liver oil
may give rise to disagreeable eruptions. Christison speaks of a boy ten years
old who was said to have been killed by the ingestion of two ounces of Epsom
salts without inducing purgation ; yet this common purge is universally used
without the slightest fear or caution. On the other hand, the extreme toler-
ance exhibited by certain individuals to certain drugs offers a new phase of
this subject. There are well-authenticated cases on record in which death

IDIOSYNCRASIES TO DRUGS. 497

has been caused in children by the ingestion of a small fraction of a grain of
opium. While exhibiting especial tolerance from peculiar disposition and long
habit, Thomas DeQuincey, the celebrated English litterateur, makes a state-
ment in his " Confessions " that with impunity he took as much as 320 grains
of opium a day, and was accustomed at one period of his life to call every
day for " a glass of laudanum negus, warm, and without sugar," to use his
own expression, after the manner a toper would call for a " hot-Scotch."

The individuality noted in the assimilation and the ingestion of drugs is
functional as well as anatomic. Numerous cases have been seen by all physi-
cians. The severe toxic symptoms from a whiif 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 physio-
logic capability of individual organs of similar nature in the same body ; the
degree of human vitality influencing absorption and resistance ; the peculiar
epochs of life ; the element of habituation, and the grade and strength of the
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 inter-
ested reader is referred for further information. In the following lines
examples of idiosyncrasy to the most common remedial substances will be
cited, taking the drugs up alphabetically.

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

" Die Nebenwirkungen der Arzneiraittel. "
I' "The Untoward Effect of Drugs." Detroit, 1884. c 704, 1881, No. 42. d 720, ccii. 38.

498 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

ment of 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 sulfering 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 in-
gested, and in three minutes was dead. There is recorded an account of a man
of sixty-four who was killed by a solution containing slightly over a dram
of phenol. A half ounce has frequently caused death ; smaller quantities
have been followed by distressing symptoms, such as intoxication (^vhich
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 c^ase which may be mentioned as characteristic of the symptoms of carbol-
ism. A boy, suffering from abscess under the trochanter, was operated on
for its relief. During the few minutes occupied by the operation he was kept
under a two per cent, carbolic spray, and the wound was afterward dressed
with carbolic gauze. The day following the operation he was seized with
vomiting, which was attributed to the chloroform used as an anesthetic. On
the following morning the bandages were removed under the carbolic spray ;
during the day there was nausea, in the evening there was collapse, and car-
bolic acid was detected in the urine. The pulse became small and frequent
and the temperature sank to 35.5° C. The frequent vomiting made it im-
possible to administer remedies by the stomach, and, in spite of hypodermic
injections and external application of analeptics, the boy died fifty hours
after operation.

Recovery has followed the ingestion of an ounce of officinal hydrochloric
acid.'' Black f mentions a man of thirty-nine who recovered after swallow-

a 199, 1878, No. 48. 720, civ., 276. « 476, 1884, i., 659.

d 548, 1875, ii., 597. « 218, xv. f 476, 1886, ii., 14.

ANTIMONY.

499

ing 1| ounces of commercial hydrochloric acid. Jolinson* reports a case of
poisoning from a dram of hydrochloric acid. Tracheotomy was performed,
but death resulted.

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

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

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

According to Taylor, the smallest quantity of oxalic acid causing death
is one dram. Ellis " describes a woman of fifty who 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 J 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 i
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 | grain of tartar emetic has caused
death in a child and two grains in an adult. Falot^ reports three cases in
which after small doses of tartar emetic there occurred vomiting, delirium,
spasms, and such depression of vitality that only the energetic use of stimu-
lants saved life. Beau s mentions death following the administration of two
doses of 1| gr. of tartar emetic. Preparations of antimony in an ointment
applied locally have caused necrosis, particularly of the cranium, and
Hebra^oy jj^s long since denounced the use of tartar emetic ointment in
affections of the scalp. Carjienter ^ mentions recovery after ingestion of two

^ 224, 1871, i., 221. ^ 476, 1854, i., 39. c 476, 1864, 265. d 548 1864 ii 386
e 548, 1861, i., 295. f 789, 1852, 245. g 548, 1857, i., 320. h 491,' 1893^ 514.

500

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

drams of tartar emetic. Behrends * describes a case of catalepsy witb
mania, in which a dose of 40 gr. of tartar emetic was tolerated, and Mor-
gagni speaks of a man who swallowed two drams, immediately vomited,,
and recovered. Instances like the last, in which an excessive amount of
a poison by its sudden emetic action induces vomiting before there is absorp-
tion of a sufficient quantity to cause death, are sometimes noticed. McCreery ^
mentions a case of accidental poisoning with half an ounce of tartar emetic
successfully treated with green tea and tannin. Mason " reports recovery
after taking 80 gr. of tartar emetic.

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

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

In speaking of the tolerance of belladonna, in 1859 Fuller mentioned a.

a 587, ix., 199. ^ 124, 1853. « 224, 1877, i., 674.

e 536, 1889, i., 287. ^ 224, 1880, ii., 240.

h 476, 1875, ii., 758. ^ 224, 1879, ii., 630.

k476, 1884, i., 408. ^ 548, 1868.

n AnnaMst, N. Y., 1849, 136.

d 491, 1883, 526.
g 548, 1862, i., 137.
j 224, 1879, ii., 746.
ml24, July, 1858.,
o 435, 1872.

BELLADONNA.

501

■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 live 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 \ grain of the alkaloid. In some cases the idiosyn-
crasy to belladonna is so marked that violent symptoms follow the application
of the ordinary belladonna plaster. Maddox describes a case of poisoning
in a music teacher by the belladonna plaster of a reputable maker. She had
obscure eye-symptoms, and her color-sensations were abnormal. Locomotor
equilibration was also affected. Golden^ mentions two cases in which the
application of belladonna ointment to the breasts caused suppression of the
secretion of milk. Goodwin relates the history of a case in which an in-
fant was poisoned by a belladonna plaster applied to its mother's breast and
died within twenty-four hours after the first application of the plaster. In
1881 Betancourt spoke of an instance of inherited susceptibility to belladonna,
in which the external application of the ointment produced all the symptoms
of belladonna poisoning. Cooper ^ mentions the symptoms of poisoning fol-
lowing the application of extract of belladonna to the scrotum. Davison
reports poisoning by the application of belladonna liniment, Jenner and
Lyman also record belladonna poisoning from external applications.

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

There is an instance mentioned ^ of a robust youth of twenty who by a
mistake took a half ounce of cantharides. He was almost immediately

a 124, 1893. b 476, 1856. c 545, 1871, 346.

d224, 1877, i., 164. e Therap. Gaz., July 16, 1894. f 475, 1825, 233.

502 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

seized with violent heat in the throat and stomach, pain in the head, and
intense burning on urination. These symptoms progressively increased, were
followed by intense sickness and almost continual vomiting. In the evening
he passed great quantities of blood from the urethra with excessive pain in
the urinary tract. On the third day all the symptoms were less violent and
the vomiting had ceased. Recovery was complete on the fifteenth day.

Digitalis has been frequently observed to produce dizziness, fainting,
disturbances of vision, vomiting, diarrliea, weakness of the pulse, and depres-
sion of temperature. These phenomena, however, are generally noticed
after continued administration in repeated doses, the result being doubtless
due to cumulative action caused by abnormally slow elimination by the kid-
neys. Traube * observed the presence of skin-affection after the use of digi-
talis in a case of pericarditis. Tardieu has seen a fluid-dram of the tincture
of digitalis cause alarming symptoms in a young woman who was pregnant.
He also quotes cases of death on the tenth day from ingestion of 20 grains
of the extract, and on the fifth day from 2i grams of the infusion. Kohnhorn ^
mentions a death from what might be called chronic digitalis poisoning.

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

Epidemics of ergotism have been recorded from time to time since the
days of Galen, and were due to poverty, wretchedness, and famine, resulting
in the feeding upon ergotized bread. According to Wood,829 gangrenous er-
gotism, or ''Ignis Sacer" of the Middle Ages, killed 40,000 persons in
Southwestern France in 922 A. D., and in 1128-29, in Paris alone, 14,000
persons perished from this malady. It is described as commencing with
itchings and formications in the feet, severe pain in the back, contractions in
the muscles, nausea, giddiness, apathy, with abortion in pregnant women, in
suckling women drying of milk, and in maidens with amenorrhea. After
some time, deep, heavy aching in the limbs, intense feeling of coldness, with
real coldness of the surfaces, profound apathy, and a sense of utter weari-
ness develop ; then a dark spot appears on the nose or one of the extremi-
ties, all sensibility is lost in the affected part, the skin assumes a livid red
hue, and adynamic symptoms in severe cases deepen as the gangrene spreads,
until finally death ensues. Very generally the appetite and digestion are
preserved to the last, and not rarely there is a most ferocious hunger. Wood
also mentions a species of ergotism characterized by epileptic paroxysms,
which he calls " spasmodic ergotism." Prentiss ' mentions a brunette of forty-
two, under the influence of ergot, who exhibited a peculiar depression of
a 263, i., 622. ^ 476, 1876, i., 583. « 450, 1889, No. 26, 912.

LEAD-POISONING.

503

spirits with hysteric phenomena, although deriving much benefit from the
administration of the drug from the hemorrhage caused by ut^^rmc fibroids.
After taking ergot for three days she felt like crying all the time, became
irritable, and stayed in bed, being all day in tears. The natural disposition
of the patient was entirely opposed to these manifestations, as she was even-
tempered and exceptionally pleasant.

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

lodin Preparations.— The eruptions following the administration of
small doses of potassium iodid are frequently noticed (Fig. 189), and at
the same time large quantities
of albumin liave been seen in
the urine. Potassium iodid, al-
though generally spoken of as a
poisonous drug, by gradually in-
creasing the dose can be given in
such enormous quantities as to
be almost beyond the bounds of
credence, several drams being
given at a dose. On the other
hand, eight grains have produced
alarming symptoms.^ In the
extensive use of iodoform as a
dressing instances of untoward

effects, and even fatal ones, have been noticed, the majority of them being
due to careless and injudicious application. In a French journal there is
mentioned the history of a man of twenty-five, suspected of urethral ulcer-
ation, who submitted to the local application of one gram of iodoform. Deep
narcosis and anesthesia were induced, and two hours after awakening his
breath smelled strongly of iodoform. There are two similar instances
recorded in England.''

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

Fig. 189. — A somewhat rare form of eruption from the in-
gestion of iodin compounds (after J. C. McGuire).

a 476, 1891.
476, May 31, 1879.

l> 133, xxvi., 197.
e 224, 1893.

c Le Practicien, Mar. 17, 1879.
f 653, 1877, 349.

504 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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

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

Castor oil is usually considered a harmless drug, but the castor bean,
from which it is derived, contains a poisonous acrid principle, three such
beans having sufficed to produce death in a man. Doubtless some of the in-

a 491, 1887, 120.
d476, Sept. 16, 1871.
g 363, 1869, 290.

b224, 1888, ii., 720.
e 261, 1887, No. 47.
11218, 1868, i., 294.

c 124, 1863, 340.
f 476, 1830, 767.
i 548, 1870, i.

OPIUM.

505

stances in which castor oil has produced symptoms similar to cholera are the
results of the administration of contaminated oil.

The untoward effects of opium and its derivatives are quite numerous.
Gaubius treated an old woman in whom, after three days, a single grain of
opium produced a general desquamation of the epidermis ; this peculiarity was
not accidental, as it was verified on several otlier occasions. Hargens''^^
speaks of a woman in whom the slightest bit of opium in any form produced
considerable salivation. Gastric disturbances are quite common, severe
vomiting being produced by minimum doses; not infrequently, intense
mental confusion, vertigo, and headache, lasting hours and even days, some-
times referable to the frontal region and sometimes to the occipital, are seen
in certain nervous individuals after a dose of from i to f 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 pon-
derosissimum caput circumgestasse." Convulsions are said to be observed after
medicinal doses of opium. Albers * states that twitching in the tendons,
tremors of the hands, and even paralysis, have been noticed after the inges-
tion of opium in even ordinary doses. The " pruritus opii," so familiar to
physicians, is spoken of in the older writings. Dioscorides, Paulus Aegineta,
and nearly all the writers of the last century describe this symptom as an
annoying and unbearable affection. In some instances the ingestion of opium
provokes an eruption in the form of small, isolated red spots, which, in their
general character, resemble roseola. Rieken ^ remarks that when these spots
spread over all the body they present a scarlatiniform appearance, and he
adds that even the mucous membranes of the mouth and throat may be
attacked with erethematous inflammation, Behrend ^ observed an opium
exanthem, which was attended by intolerable itching, after the exhibition of
a quarter of a grain. It was seen on the chest, on the inner surfaces of the
arms, on the flexor surfaces of the forearms and wrists, on the thighs, and
posterior and inner surfaces of the legs, terminating at the ankles in a stripe-
like discoloration about the breadth of three fingers. It consisted of closely
disposed papules of the size of a pin-head, and several days after the dis-
appearance of the eruption a fine, bran-like desquamation of the epidermis
ensued. Brand has also seen an eruption on the trunk and flexor surfaces,
accompanied with fever, from the ingestion of opium. Billroth ^ mentions
the case of a lady in whom appeared a feeling of anxiety, nausea, and vomit-
ing after ingestion of a small fraction of a grain of opium ; she would
rather endure her intense pain than suffer the untoward action of the
drug. According to Lewin, Brochin ^ reported a case in which the idiosyn-
crasy to morphin was so great that ^ of a grain of the drug administered

a 161, xxvi., 225. b 720, cvii., 22. c 199, 1379, 626.

d 199, 1879, 718. e 611, 1868, 763. f 363, 1877, 226.

506

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

hypodermically caused irregularity of the respiration, suspension of the
heart-beat, and profound narcosis. According to the same authority, 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 suifered from prolonged inanition. These effects are prob-
ably due to a central excitation of a similar nature to that produced by san-
tonin. Persons thus attacked complain, shortly after the injection, of an
intensely sour or bitter taste, which for the most part ceases after elimination
of the morphin. Von Graefe and Sommerfrodt speak of a spasm of accom-
modation occurring after ingestion of medicinal doses of morphin. There
are several cases on record °- in which death has been produced in an adult
by the use of \ to ^ grain of morphin. According to Wood, the maximum
doses from which recovery has occurred without emesis are 55 grains of
solid opium, and six ounces of laudanum. According to the same authority, in
1854 there was a case in which a babe one day old was killed by one minim
of laudanum, and in another case a few drops of paregoric proved fatal to a
child of nine months. Doubtful instances of death from opium are given,
one in an adult female ^ after 30 grains of Dover's powder given in divided
doses, and another after a dose of ^ 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 J ounce of laudanum. After this she slept
a few hours, and awoke complaining of being ill. Yavorski saw her about
an hour later, and by producing emesis, and giving coffee, atropin, and tincture
of musk, he saved her life. Pyle ® describes a pugilist of twenty-two who,
in a fit of despondency after a debauch (in which he had taken repeated doses
of morphin sulphate), took with suicidal intent three teaspoonfuls of morphin ;
after rigorous treatment he revived and was discharged on the next day per-
fectly well. Potassium permanganate was used in this case. Chaffee ^ speaks
of recovery after the ingestion of 18 grains of morphin without vomiting.

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

' That moveth altogether, if it move at all. '

a 829, 168. t> 269, July, 1882. c 218, Jan. 3, 1885.

d 812, 1885. e 533, May 12, 1894. f 545, 1882, xlvii.,697.

CHRONIC OPIUM EATING.

507

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

508 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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

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

A peculiar feature of phosphorus-poisoning is necrosis of the jaw. This
affection was first noticed in 1838, soon after the introduction of the manu-
facture of phosphorous matches. In late years, owing to the introduction of
precautions in their manufacture, the disease has become much less common.
The tipping of the match sticks is accomplished by dipping their ends in a
warm solution of a composition of phosphorus, chlorate of potassium, with
particles of ground flint to assist friction, some coloring agent, and Irish
glue. From the contents of the dipping-pans fumes constantly arise into the
faces of the workmen and dippers, and in cutting the sticks and packing
the matches the hands are constantly in contact with phosphorus. The
region chiefly affected in this poisoning is the jaw-bone, but the inflammation
may spread to the adjoining bones and involve the vomer, the zygoma, the
body of the sphenoid bone, and the basilar process of the occipital bone. It
is supposed that conditions in which the periosteum is exposed are favorable
to the progress of the disease, and, according to Hirt, workmen with diseased
teeth are affected three times as readily as those 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 Decem-
ber 16, 1880, and February 22, 1881, the patient had 22 sweats from pilo-
carpin. The action usually lasted from two to six hours, and quite a large
dose was at length necessary. The idiosyncrasy noted was found in the hair,
which at first was quite light, afterward chestnut-brown, and May 1, 1881,
almost pure black. The growth of the hair became more vigorous and
thicker than formerly, and as its color darkened it became coarser in propor-
tion. In March, 1889, Prentiss saw his patient, and at that time her hair was

a 547, July 2, 1881.

QUINIK

dark brown, having returned to that color from black. Prentiss also reported
the following case ^ as adding another to the evidence that jaborandi will
produce the effect mentioned under favorable circumstances : Mrs. L., aged
seventy-two years, was suffering from Bright's disease (contracted kidney).
Her hair and eyebrows had been snow-wliite for twenty years. She suf-
fered greatly from itching of the skin, due to the uremia of the kidney-
disease ; the skin was harsh and dry. For this symptom fluid extract of
jaborandi was prescribed with the effect of relieving the itching. It was
taken in doses of 20 or 30 drops several times a day, from October, 1886, to
February, 1888. During the fall of 1887 it was noticed by the nurse that
the eyebrows were growing darker, and that the hair of the head was darker
in patches. These patches and the eyebrows continued to become darker,
until at the time of her death they were quite black, the black tufts on the
head presenting a very curious appearance among the silver-white hairs sur-
rounding them.

Quiniu being such a universally used drug, numerous instances of idio-
syncrasy and intolerance have been recorded. Chevalier ^ mentions that
through contact of the drug workmen in the manufacture of quinin are liable
to an affection of the skin which manifests itself in a vesicular, papular, or
pustular eruption on different parts of the body. V6pan mentions a lady
who took 1| grains and afterward 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 pe-
techise were profusely spread over the entire body, and they disappeared after
the suspension of the drug. Dauboeuf, Garraway,*^ Hemming," Skinner,^
and Cobner s mention roseola and scarlatiniform erythema after minute doses
of quinin. In nearly all these cases the accompanying symptoms were differ-
ent. Heusinger ^ speaks of a lady who, after taking | grain of quinin, ex-
perienced headache, nausea, intense burning, and edema, together with nodular
erythema on the eyelids, cheeks, and portion of the forehead. At another
time 1| grains of the drug gave rise to herpetic vesicles on the cheeks, fol-
lowed by branny desquamation on elimination of the drug. In other patients
intense itching is experienced after the ingestion of quinin. Peters^ cites
an instance of a woman of sixty-five who, after taking one grain of quinin,
invariably exhibited after an hour a temperature of from 104° to 105° F.,
accelerated pulse, rigors, slight delirium, thirst, and all the appearances of

a 727, Oct. 3, 1890. ^ 141, 1851, T. Ixviii., 5. c 359, 1865.

<l 224, 1869, ii., 388. e 224, 1869, ii., 533. f 224, 1870, i., 103.

g 199, 1877, 305. h 199, 1877, 361. i 476', 1889*, ii'., 727.

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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 perma-
nent. 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 ex-
amination 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 disturb-
ances of the functions of the ear range from tinnitus aurium to congestion causing
complete deafness. The gastro-intestinal and genito-urinary tracts are espe-
cially 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 urina-
rius 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. Hemojitysis
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 atone dose ;
the only symptoms noticed were a stuporous condition and complete deaf-
ness. 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 grain of strychnin, which, however, disappeared with
the discontinuance of the drug. There was a man in London in 1865 ^ who
died in twenty minutes after the ingestion of J grain of strychnin. Wood
speaks of a case in which the administration of 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 posi-
tion for about thirty minutes, and about thirty hours afterward a painful
stinging sensation commenced in the back of the neck, followed by violent

a 363, Jan., 1861. b 543, 1864, i., 461. c 224, 1870, i., 303.

d 392, 1865, xi., 208. e 224, 1880, i., 476.

IDIOSYNCRASIES IN COITUS

511

twitching of the muscles of the face, arms, and legs, which contmued 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 strychnm had
been taken, but surely, from the symptoms, such must have been the case.

Tobacco.— O'Neill gives the history of a farmer's wife, aged forty, who
wounded her leg against a sewing-machine, and by lay advice applied a hand-
ful 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 fol-
lowing case may be mentioned here : Ramadge ^ speaks of a young French-
man, 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 playmg Avith and
burning the toy called " Pharaoh's serpent egg."

The idiosyncrasies noticed in some persons during coitus are quite
interesting. The Epheraerides mentions a person in w^hom 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 inmiediately 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, w'ho called at the doctor's
office, saying that in coitus her partner had no difficulty until the point of
culmination or orgasm, w^ien he was seized with complete numbness and
lost all pleasurable sensation in the penis. The numbness was follow^ed by a
sensation of pain, which was intensified on the slightest motion, and wdiich
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 obfciin-
ing suggestions from the physicians over the country. In response, one

a 476, 1879, i., 296. 475, 1829-30, i., 415. c 331^ i867.

d 703, 1873, X., 318. e 569,' 1879, ii., 225.

512 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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 inflamma-
tory 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 Hendrich-
sen mentions that Marion Sims, Beigel, and Budin describe spasmodic con-
tractions of the levator ani, constricting the vagina ; he also cites an instance
under his personal observ^ation in which this spasm was excited by both
vaginal and rectal examination, although on the following day no such con-
dition could be produced. In this connection, among the older writers, Bor-
ellus^^ gives the history of a man w^ho 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 quanti-
ties 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 throAving cold water on the persons was prac-
tised. 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, Par^, 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 pro-
cess 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 ° 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 dur-
ing a single night had intercourse with 103 men.

a 839, Band xxiii., Heft i. ^ 664, T. vii., 113.

SUSPENDED ANIMATION.

613

Among the older writers there are instances reported in which erection
and ejaculation took place without the slightest pleasurable sen,sation. Clau-
dius exemplifies this fact in his report of a Venetian merchant who had vig-
orous erections and ejaculations of thick and abundant semen without either
tingling or pleasure.

Attila, King of the Huns, and one of the most celebrated lejiders 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 dis-
orders, 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 fatid issue to excessive sexual indulgence, not considering
the possibility of the associate direct aiuse, 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 sus-
pension 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. Gu6rard
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 ; Po vail 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 submer-
sion for six minutes was followed by subsequent recovery.

There have been individuals who gave exhibitions of prolonged submer-
sion 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 exhibi-
tionists 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

a 124, 1853, 348. b 141^ 1850, ii., 306. c 629, 1732-44. d 490 1340 i 443
e 425, 1868. f 819, 1828. g 789, 1871,' 3 s. xii.",' 293!

33

614 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

was a performer who accomplished the feat of remaining under water foai-
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 " I'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 porce-
lain 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 Decem-
ber 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 centur}^
whose feats are recorded in the writings of Alexander ab Alexandro, Pon-
tanus, and Father Kircher, the Jesuit savant. This man's name was Nicolas,
born of poor parents at Catania. From his infancy he showed an extraordi-
nary 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

DIVERS.

515

Mediterranean, the Indian Seas, and the Gulf of Mexico invite the attention
of those interested in the anomalies of suspended animation. There arc many
marvelous tales of their ability to remain under water for long periods. It
is probable tliat 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. Orduiarily 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 minuie vessels m
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-
Daubds,^^^ 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 divmg. Speaking of the inhabi-
tants 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 prac-
tice of this occupation. These divers are generally Cmgalese, who practise
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 appa-
ratus. 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 sub-
marine 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 £90,000 in specie from the
steamer Alphonso XII., a Spanish mail boat belonging to the Lopez line,
which sank off Point Gando, Grand Canary, in 261 fathoms of water. For
nearly six months the salvage party, despatched by the underwriters in May,

516 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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 dimin-
ished. 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 pur-
pose. 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 asso-
ciates 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, al-
though the pulse ceased for an extended period, the patient made an ultimate
recovery. In reviewing the older literature we find that Ballonius^^^ men-
tions 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'^i^ details the history of a case in Avhich 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 move-
ment 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 with-
out any consciousness or volition on the man's part. The longest period in

a 282, 1732, 287.

HUMAN HIBERNATION.

517

which he remained in this death-like condition was about thirty minutes. A
postmortem examhiatiou 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 knexv of a priest named Rutilut who had the power of
voluntarily simulating death. Both the pulsation and respiration was appar-
ently abolished when he was in his lifeless condition. Burning and pricking
left visible effects on the skin after his recovery, but liad no apparent effect
on his lethargy. ChaiUe ^ reports an instance of voluntary suspension of the
pulse.

Relative to hibernation, it is well-known that mice, snakes, and some rep-
tiles, as well as bees, sometimes seem to entirely suspend animation for an ex-
tended period, and especially in the cold weather. In Russia fish are trans-
ported 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 con-
vinced of their genuineness. Furthermore, these persons are extremely
scarce and are indifferent to money ; none has been enticed out of his OM^n
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.

a 593, xvi., 388.

518

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

To the fakir, who neither visibly breathes nor shows circulatory movements,
and who never moves from his place of confinement, fasting should be com-
paratively easy, when we consider the number of men whose minds were ac-
tively 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 pul-
sation 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.

Honigbergcr,^ 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 pro-
cesses the man recovered and lived many years after. Sir Henry Law-
rence 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,

a 548, 1881, ii., 733.
c 548, 1870, i., 21.

b "Treatise on Human Hibernation," 1850.
d Calcutta Med. Jour., 1835.

RECOVERY AFTER HANGING.

519

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 Avife.

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,!^^ Blcgny^^^ Camerarius,^'^^ Mor-
gagni,576 Pechlin,«2i Schcnck/i« Stoll^^^ and Wepfer " all mention recovery
after hanging. Forestus =^-^8 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° F., but six hours after it rose to 101.6° F., and he sub-
sequently recovered. Taylor'^ cites the instance of a stout woman of forty-
four who recovered from hanging. When the woman was found by her hus-
band 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 follow-
ing day. Chevers mentions a most curious case, in which cerebral con-
gestion 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 un-
doubtedly 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 execu-
tion 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

a "Exeroit. in Apoplex.," 181. b 200, x., 242.

c 476, 1870, i., 446. d 381, 1880, ii., 387.

520 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

are true of persons buried alive and returning to life, only to find themselves
hopelessly lost in a narrow coffin many feet below the surface of the earth.
Among the lower classes the dread of being buried before life is extinct is
quite generally felt, and for generations the medical profession have been de-
nounced 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 pre-
vention 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 -^sculapius,
saw during the time of Pompey the Great a crowd of mourners about to start
a fire on a funeral pile. It is said that by his superior knowledge he per-
ceived indications of life in the corpse and ordered the pile destroyed, subse-
quently 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 im-
mediately subsequent to death having their own special ceremonies. The

PREMATURE BURIAL.

521

Turks were also fearful of premature interment and subjected the defunct to
every test ; among others, one was to examine the contractility of the sphmcter
ani, which shows their keen observation of a well-known modern medical fact.

According to the Memoirs of Amelot de la Houssaye, Cardinal Espinola,
Prime Minister to Philip II., put his hand to the embalmer's knife with
which he was about to be opened. It is said that Vesalius, sometimes called
the " Father of Anatomy," having been sent for to perform an autopsy on a
woman subject to hysteric convulsions, and who was supposed to be dead,
on making the first incision perceived by her motion and cries that she was
still alive. This circumstance, becoming known, rendered him so odious that
he had to leave the community in which he practised, and it is believed that
he never entirely recovered from the shock it gave him. The Abb6 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 sur-
geon 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 w^ore. This instance has been
cited in nearly every language. There is another more recent instance, com-
ing from Poitiers, of the wife of a goldsmith named Mernache who was
buried with all her jewels. During the night a beggar attempted to steal her
jewelry, and made such exertion in extracting one ring that the woman re-
covered and was saved. After this resurrection she is said to have had sev-
eral children. This case is also often quoted. Zacchias mentions an in-
stance which, from all appearances, is authentic. It was that of a young
man, pest-stricken and thought to be dead, who was placed with the other
dead for burial. He exhibited signs of life, and was taken back to the pest-
hospital. Two days later he entered a lethargic condition simulating death,
and was again on his way to the sepulcher, when he once more recovered.

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

a 536, 1887, i., 586. b 548, 1866, i., 287.

522 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

ding-ring, which was quite tightly on her finger. In the effort to do this she
was aroused^ recovered, and arrived in England perfectly well.

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

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

Postmortem Anomalies. — Among the older writers startling move-
ments of a corpse have given rise to much discussion, and possibly often
led to suspicion of premature burial. Bartholinus describes motion in a
cadaver. Barlow ^ says that movements were noticed after death in the vic-
tims of Asiatic cholera. The bodies were cold and expressions were death-
like, but there were movements simulating natural life. The most common
was flexion of the right leg, which would also be drawn up toward the body
and resting on the left leg. In some cases the hand was moved, and in one
or two instances a substance was grasped as if by reflex action. Some
observers have stated that reflex movements of the face were quite noticeable.
Tliese movements continued sometimes for upward of an hour, occurring
mostly in muscular subjects who died very suddenly, and in whom the mus-
cular irritability or nervous stimulus or both had not become exhausted at
the moment of dissolution. Richardson ^"^^ doubts the existence of postmortem
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-like 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 sur-
charged with carbon dioxid. The moist tissues suffuse carbonized blood, and
there occurs an osmotic interchange between the carbon dioxid and the oxygen
of the air resulting in an oxygenation of the blood, and modification of the
color from dark venous to arterial red.

a 548, 1866, i., 287. ^ 173, 1889, 5. c Richardson, 173, 1889.

POSTMORTEM ANOMALIES.

523

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

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

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

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

Postmortem Growth of Hair and Nails. — The hair and beard
may grow after death, and even change color. Bartholinus recalls a case
of a man who had short, black hair and beard at the time of interment,
but who, some time after death, was found to possess long and yellowish hair.
Aristotle discusses postmortem growth of the hair, and Garmanus cites an
instance in which the beard and hair were cut several times from the cadaver.
"We occasionally see evidences of this in the dissecting-rooms. Caldwell ^ men-
tions a body buried four years, the hair from which protruded at the points
where the joints of the coffin had given away. The hair of the head measured
18 inches, that of the beard eight inches, and that on the breast from four to six
inches. Kosse 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

a 476, 1890, i., 1105. b 538, 1877.

524

PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

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

Galen mentions death from joy, and in comment upon it he says that the
emotion of joy is much more dangerous than that of anger. In discussing
this subject, Haller says that the blood is probably sent with such violence to
the 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,306 Martini, and Struthius all mention death
from joy.

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

Powerfully depressing emotions, which are called by Kant "asthenic,"
such as great and sudden sorrow, grief, or fright, have a pronounced effect
on the vital functions, at times even causing death. Throughout litemture
and histoiy 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 throAvn 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 \\'\th saying that
agony of the mind produces rupture of the heart. It is quite conunon to
hear the expression, " Died of a broken heart ; " and, strange to say, in some
cases postmortem examination has proved the actual truth of the saying.
Bartholinus, Fabricius Hildanus, Pliny, Rhodius, Schenck, Marcellus Dona-
tus, Riedlin, and Garengeot speak of death from fright and fear, and the

a "Anecdotes de Medecine," 117. ^ 462, 1812, Oct., 199.

c "Theatre vitae human," 2656. ^ " Es.sais historique.s sur Paris," T. v., 54.

c "Treatise on the Physical Cause of the Death o5f Christ."

DEATH FROM FEAR.

525

Ephemerides describes a death the direct cause of which was intense shame.
Deleau,'^ a celebrated doctor of Paris, while embracing his favorite daiigliter,
who was in the last throes of consumption, was so overcome by mtense 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.
Eveiy region of the body was examined with minutest care by an eminent
physician, but no signs indicative of the cause of death were found. Mor-
dret cites a similar instance of death from fear of labor. Morgagni^^e nien-
tions a woman who died from the disappointment of bearing a girl baby when
she was extremely desirous of a boy.

The following case, quoted from Lauder Brunton,** shows the extent of
shock which may be produced by fear : Many years ago a janitor of a college
had rendered liimself obnoxious to the students, and they determined to punish
him. Accordingly they prepared a block and an axe, which they conveyed to
a lonely place, and having appropriately dressed themselves, some of them
prepared to act as judges, and sent others of their company to bring him be-
fore them. He first affected to treat the whole affair as a joke, but was
solemnly assured by the students that they meant it in real earnest. He was
told to prepare for immediate death. The trembling janitor looked all 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 laieel
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

a 224, 1878, ii., 381. b 846, 292. c 475, 1884, i., 916.

526 PHYSIOLOGIC AND FUNCTIONAL ANOMALIES.

which, however, was as severe as the first blow. The man fell unconscious
and died. -At the autopsy there were no signs indicative of death, which must
have been due to the shock following the blow on the epigastrium.

As illustrative of the sensitiveness of the epigastric region, Vincent relates
the following case : " A man received a blow by a stick upon the epigastrium.
He had an anxious expression and suffered from oppression. Irregular heart-
action and shivering were symptoms that gmdually 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 otliers have discussed it. By some it is maintained that
the momentum acquired by a cannon-ball generates enough force in the neigh-
boring air to prostrate a person in the immediate vicinity of its path of flight.

a 187, 1834, ii., 151.

CHAPTER X.

SURGICAL ANOMALIES OF THE HEAD AND

NECK.

Injuries of such a delicate organ as the eye, in which the slightest acci-
dent can produce such disastrous consequences, naturally elicit the interest of
all. Examples of exophthalmos, or protrusion of the eye from the orbit
from bizarre causes, are of particular interest. Among the older writers we
find 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 i
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 m 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. Haniill s

a 452, 1809, xi., 63. b 334, cent, i., obs. i. c 693 1866

d 363, 1859, No. 65. e 312, 1854. f 145, xxvi., 99. g 224' 1878 i 894

527

I

i

\
I

528 SURGICAL ANOMALIES OF THE HEAD AND NECK

describes the case of a young girl whose conjunctiva was pierced by one of
the rests of an ordinary gas-bracket. Being hooked at one of its extremities
the iron became entangled in either the inferior oblique or external rectus
muscles, and completely avnlsed the eyeball upon the cheek. The real dam-
age could not be estimated, as the patient never returned after the muscle was
clipped off close to its conjunctival insertion. Calhoun ^ mentions an instance
of a little Esquimaux dog whose head was seized between the jaws of a large
Newfoundland with such force as to press the left eyeball from the socket.
The ball rested on the cheek, held by the taut optic nerve ; the cornea was
opaque. The ball was carefully and gently replaced, and sight soon returned
to the eye.

In former days there was an old-fashioned manner of fighting called
"gouging." In this brutal contest the combatant was successful who
could, with his thumb, press his opponent's eyeball out. Strange to sjiy, 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 liid
the organ from view, but when it was pulled aside the eyeball was exposed,
and in its remote position still possessed the power of vision. In some cases
in which exophthalmos has been seemingly spontaneous, extreme laxity of the
lids may serve as an explanation. There is an instance on record in which
a Polish Jew appeared in a Continental hospital, saying that while turning in
bed, without any apparent cause, his eyeball was completely extruded.
There have been people who prided themselves on their ability to produce
partial exophthalmos.

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

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

Serious Sequelae of Orbital Injuries. — In some instances injuries pri-
marily to the orbit either by extension or implication of the cerebral contents
provoke the most serious issues. Pointed instruments thrust into the orbital
cavity may by this route reach the brain. There is a record « of death

a 176, 1876. l> Wien. Med. Woch., No. 6, 1895. c 476, 1831.

GUNSHOT INJURIES OF THE ORBIT.

529

caused by a wound of a cavernous sinus through the orbit by the stem of a
tobacco-i)ipe. Bower saw a woman at the Gloucester Infirmary who had
been stabbed in the eye by the end of an umbrella. There was profuse
hemorrhage from the nostrils and left eye, but no signs indicative of its
origin. Death shortly ensued, and at the necropsy a fracture through the
roof of the orbit was revealed, the umbrella point having completely severed
the optic nerve and divided the ophthalmic artery. The internal carotid
artery was wounded in one-half of its circumference at its bend, just before
it passes up between the anterior clinoid process and the optic nerve. The
cavernous sinus was also opened. In this rare injury, although there was a
considerable quantity of clotted blood at the base of the brain, there was no
wound to the eyeball nor to the brain itself.

Pepper records a case in which a knife was thrust through the sphenoidal
fissure, wounding a large meningeal vein, causing death from intracranial
hemorrhage. N6laton 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 ; en-
trance being thus effected, the dura was incised, and some blood and cerebro-
spinal fluid escaped. Five splinters were removed and a portion of the
damaged brain-substance, and a small artery was tied with catgut. The
debris of the eyeball was enucleated and a drain was placed in the frontal
wound, coming out through the orbit. The patient soon regained conscious-
ness and experienced no bad symptoms afterward. The drains were gradu-
ally withdrawn, the process of healing advanced rapidly, and recovery soon
ensued.

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

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

Buchanan ^ recites the case of a private in the army who was shot at a

a 47fi, 1879, i, 547. b 233, Aug., 1891. c 318, 1877, xii

d779, 1848-50, i., 188. e 616, 1874-5, 444. f 545, 1862-3, ix., 274.

530 SURGICAL ANOMALIES OF THE HEAD AND NECK.

distance of three feet away, the ball entering the inner canthiis of the right
eye and lodging under the skin of the opposite side. The eye was not lost,
and opacity of the lower part of the cornea alone resulted. Cold water and
purging constituted the treatment.

It is said '■^ that an old soldier of one of Napoleon's armies had a 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 ex-
tract ^ of a report by Wenyon of Fatshan, South China : —

" Tang Shan, Chinese farmer, thirty-one years of age, was injured in the
face by the bursting of a shot-gun. After being for upward of two months
under the treatment of native practitioners, he came to me on December 4,
1891. I observed a cicatrix on the right side of his nose, and above this a
sinus, still unhealed, the orifice of which involved the inner canthus of the
right eye, and extended downward and inward for about a centimeter. The
sight of the right eye was entirely lost, and the anterior surface of the globe
was so uniformly red that the cornea could hardly be distinguished from the
surrounding conjunctiva. There was no perceptible enlargement or protrusion
of the eyeball, and it did not appear to have sustained any mechanical injury
or loss of tissue. The ophthalmia and keratitis were possibly caused by the
irritating substances applied to the wound by the Chinese doctors. The
sinus on the side of the nose gave exit to a continuous discharge of slightly
putrid pus, and the patient complained of continuous headache and occasional
dizziness, which interfered with his 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 informa-
tion as to the probable size or shape of the object, I cautiously made several
attempts to remove it through a slightly enlarged opening, but without success.
I therefore continued the incision along the side of the nose to the nostril,

a 222, 1846. ^ 224, Oct. 12, 1895.

FOREIGN BODIES IN THE ORBIT.

531

thus laying open the right nasal cavity ; then, seizing the foreign body with
a pair of strong forceps, I with difficulty removed the complete breech-pin
of a Chinese gun. Its size and shape are accurately represented by the
accompanying drawing (Fig. 190). The breech-pin measures a little over
three inches in length, and weighs 2| 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 iiealed 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 Sy^^- inches long and about |
inch in diameter (upon one end of which was a knob nearly i inch in diame-
ter) was impacted in the orbit for from ten to twenty days, and during this

Fig. 190. — Breech-pin removed from the orbit. (Actual size.)

time the patient was not aware of the fact. Recovery followed its extraction,
the vision and movements of the eye being unimpaired.

According to the Philosophical Transactions ^ a laborer thrust a long lath
with great violence into the inner cantlius of the left eye of his fellow work-
man, Edward Roberts. The lath broke off short, leaving a piece two inches
long, J inch wide, and J inch thick, in situ. Roberts rode about a mile
to the surgery of Mr. Justinian Morse, who extracted it with much difficulty ;
recovery followed, together with restoration of the sight and muscular action.
The lath was supposed to have passed behind the eyeball. CoUette^ speaks of
an instance in which 186 pieces of glass were extracted from the left orbit,
the whole mass weighing 186 Belgian grains. They were blown in by a gust
of wind that broke a pane of glass ; after extraction no affection of the brain
or eye occurred. Watson ^ speaks of a case in which a chip of steel f inch
long was imbedded in cellular tissue of the orbit for four days, and was re-
moved without injury to the eye. Wordsworth*^ reports a case in which a
foreign body was deeply imbedded in the orbit for six weeks, and was re-

a Ophtb. Eev., No. 4, p. 337. b 629, 1743, 945. c 145 igSO 217

<i224, 1876, i., 506. « 548, 1861 ! ii., 452.

632 SURGICAL ANOMALIES OF THE HEAD AND NECK

moved with subsequent recovery. Chisholm* has seen a case in which for
five weeks a flv was imbedded in the culdesac between the lower lid and the
eyeball.

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

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

Taylor ^ reports the removal of a piece of bone which had remained qui-
escent in the eye for fourteen years ; after the removal of the eye the bone
was found adherent to the inner tunics. It resembled the lens in size and
shape. Williams ^ mentions continual tolerance of foreign bodies in the eye-
ball for fifteen and twenty-two years; and ChisholmS reports the lodgment
of a fragment of metal in the iris for twenty-three years. Liebreich ex-
tracted a piece of steel from the interior of the eye where it had been lodged
twenty-two years. Barkar^ speaks of a piece of steel which penetrated
through the cornea and lens, and which, five months later, was successfully
removed by the extraction of the cataractous lens. Critchettj gives an in-
stance of a foreign body being loose in the anterior chamber for sixteen years.
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 inthecanthus for thirty years. Jacob " re-
ports a case in which a chip of iron remained in the eyeball twenty-eight years

a 186, 1870. b 548, 1880, i., 280. c 476, 1880, i., 749. d 476, 1880, i., 749.

e 809, 1878. f 218, 1881, 84. g 476, April 3, 1880. h 224, 1873, ii., 651.

i Archiv. of Opthal. and Otol., N. Y., 1874, iv., 231. i 693, 1857-8, i., 264.

k 773, 1872, 160. 1 188, iv., obs. 64. ^ 476, 1880, i., 667.

RARE ACCIDENTS TO THE EYE.

533

without giving indications for removal. It was clearly visible, protruding
into the anterior surface of the iris, and although it was rusted by its long
lodgment, sight in the eye was fairly good, and there was no sign of irritation.

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

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

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

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

Injury of the Eyeball by Birds. — There are several instances in which
birds have pierced the eyeball with their bills, completely destroying vision.
Not long since a prominent taxidermist winged a crane, picked it up, and
started to examine it, when it made one thrust with its bill and totally de-
stroyed his eyeball. In another instance a man was going from the railroad
station to his hotel in a gale of wind, when, as he turned the corner of the
street, an English sparrow was blown into his face. Its bill penetrated his
eyeball and completely ruined his siglit. 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 gatf while preparing in a cock-pit.

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

" Mr. S. B. A., while attending to his bees, was stung by one upon the
right upper eyelid near its center. An employee, who was assisting in the
work, immediately discovered the sting driven in the lid and cautiously ex-

a 693, ix., part iii. b 310, 1876, 181. c 591 1^59 303

d 476, 1882, ii., 448. e 476, 1861, i., 530. f 784, 98. g 533, May 27,' 1893.

534 SURGICAL ANOMALIES OF THE HEAD AND NECK.

tracted it, stating that he made sufficient traction to lift the lid well away
from the globe. In a few hours the lid became much swollen, but the pain
experienced at first had disappeared. Before retiring for the night he began
gentle massage of the lid, stroking it horizontally with his finger. The
edematous condition was by this means much reduced in a short time. While
thus engaged in stroking the lid he suddenly experienced intense pain in the
eye as if it liad 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 incli 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 M^decine Moderne * of a seamstress of Berlin
who was in the habit of allowing her dog to lick her face. She was attacked
with a severe inflammation of the right eye, which had to be enucleated, and
was found full of tenia echinococcus, evidently derived from the dog's tongue.

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

" Dr. T. L. Wilson of Bellwood, Pa., relates the case of an old lady of
seventy-eight whom he found with the blood gushing from the nostrils.
After plugging the narcs 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.

a 545, June 6, 1896. b 224, 1883, i., 715.

LATE RESTORATION OF SIGHT. 535

In a short time the woman complained that she could scarcely see, owing to
the welling up of blood in the eyes and trickling down her face. The bleedmg
only ceased when the posterior nares also were plugged."

''Dr. T. G. Wright of PlainviUe, Conn., narrates the case of a young
man whom he found in the night, bleeding profusely, and having already
lost a large amount of blood. Shortly after plugging both anterior and pos-
terior nares the blood found its way through the lacrimal ducts to the eyes
and trickled down the cheeks."

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

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

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

a 476, 1888, i., 14. b 179^ Qct. 15, 1869.

c " Experience metaphysique ou Developpement de la lumifere et des sensations."

302, iv.

536 SURGICAL ANOMALIES OF THE HEAD AND NECK.

thoughts, of an educated and matured mind experiencing its first sensations
of sight.

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

Sight is popularly supposed to be occasionally restored without the aid of
art, atler long years of bhndness. 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 con-
dition in which one sees better by night, relatively speaking, than by day is
due to some lesion of the macular region, rendering it blind. At night the
pupil dilates more than in the day-time, and hence vision with the extramac-
ular or peripheral portions of the retina is correspondingly better. It is,
therefore, a symptom of serious retinal disease. All night-prowling animals
have widely dilatable pupils, and in addition to this they have in the retina a
special organ called the tapdum 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 mean-
ing day-vision or night-blindness) is a symptom of a peculiar degenerative
disease of the retina, called rdinitis pigmentosa. It also occurs in some cases
of extreme denutrition, numerous cases having been reported among those who
make the prolonged fasts customary in the Russian church. In retinitis pig-
mentosa the peripheral or extramacular portions of the retina are subject to a
pigmentary degeneration that renders them insensitive to light, and patients so
afflicted are consequently incapable of seeing at night as well as others. They
stiunble and run against objects easily seen by the normal eye.

a Beit, zur Augenh., Heft xvi., 1894.

INJURIES TO THE EAR.

537

Snow-blindness occurs from prolonged exposure of the eyes to snow upon
which the sun is shining. Some years ago, some seventy laborers, who were
clearing away snow-drifts in the Caucasus, were seized, and thirty of them
could not find their way home, so great was the photophobia, conjunctivitis,
and lacrimatiou. 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, 2e5 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.s

Dalby ,^ in a paper citing many different causes of rupture of the tympanic
membrane, mentions the following : A blow in sparring ; violent sneezing ;
blowing the nose ; forcible dilatation of the Eustacliian canal ; a thorn or twig
of a tree accidentally thrust into the head ; picking the ear with a toothpick.
In time of battle soldiers sometimes have their tympanums ruptured by the
concussion caused by the firing of cannon. Dalby mentions an instance of an
officer who was discharged for deafness acquired in this manner during the
Crimean War. He was standing beside a mortar which, unexpectedly to
him, was fired, causing rupture of the tympanic membrane, followed by
hemorrhage from the ear. Similar cases were reported in the recent naval
engagements between the Chinese and Japanese. Wilson' reports two

a 124, 1887. ^ Graefe's Archiv. 1887. c Arch. f. Augenheilk 1887

d 533, Dec. 8, 1888. e 476, 1889, i., 574. f 476, 1879, i., 23.

g Archives of Otology, 1880, ix., 16. h 475, 1875, i., 752. i '533, xli., 173.

538 SURGICAL ANOMALIES OF THE HEAD AND NECK.

cases of rupture of the membrana tympani caused by diving. Roosa ^
divides the causes into traumatic, hemorrhagic, and inflammatory, and primary
lesions of the labyrinth, exemplifying each by numerous instances. Under
traumatic causes he mentions severe falls, blows about the head or face, con-
stant listening to a telegraphic instrument, cannonading, and finally eight cases
of boiler-makers' deafness. Roosa cites a curious case of sudden and pro-
found deafness in a young man in perfect health, while calling upon the
parents of his lady-love to ask her hand in marriage. Strange to say that
after he had had a favorable reply he gradually recovered his hearing ! In
the 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 practised as a last resort. There is an
account ^ of a provision-dealer's agent who fell asleep at a public house at
Tottenham. In sport an attendant tickled his ear with a wooden article used
as a pipe light. A quick, unconscious movement forced the wooden point
through the tympanum, causing cerebral inflammation and subsequent death.
There is a record « of death, in a child of nine, caused by the passage of a
knitting-needle into the auditory meatus.

KaufPmann ^ 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

a 124, Oct., 1874, 376. ^ 548, 1859, 002. « 47fi, 1889, i., 574.

<l 566, Jan. 20, 1829. e 476, 1875, i., 535. f 476, 1895, ii., 222.

g 224, 1869, ii., 470. ^ Deutsche Med. Zeitung, Jan. 6, 1896.

FOREIGN BODIES IN THE EAR.

539

the arch of the palate. Kauffmann expresses the opinion that the noises were
due to clonic spasm of the tensor velum palati, and states that under appro-
priate treatment the tinnitus gradually subsided.

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

D'Aguanno ^ gives an account of two instances of living larvse of the
musca sarcophaga in the ears of children. In one of the cases the 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 knowl-
edge of an instance in which three small centipedes were taken from the ear
of a policeman after remaining there three days ; during this time they caused
excruciating pain, but there was no permanent injury. The Ephemerides con-
tains instances in which, while yet living, worms, crickets, ants, and beetles
have all been taken from the ear. In one case the entrance of a cricket in the
auditory canal was the cause of death. Martin gives an instance in w^hich
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

a 176, 1873, X., 665. b 843, 836. c ibid. d 462, T. xxxi., 179.

540 SURGICAL ANOMALIES OF THE HEAD AND NECK.

the habit of using a tampon of cotton in the meatus to mistake the deep
entrance of this substance for functional derangement, and many cases of
temporary deafness are simply due to forgetfulness of the cause. A strange
case is reported in a girl of fourteen, who lost her tympanum from a profuse
otorrhea, and who substituted an artificial tympanum which was, in its turn,
lost by deep penetration, causing augmentation of the symptoms, of the
cause of which the patient herself seemed unaware.* Sometimes artificial
otoliths are produced by the insufflation of various powders which become
agglutinated, and are veritable foreign bodies. Holman^ tells of a negro, aged
thirty-five, whose wife poured molten pewter in his ear while asleep. It was
removed, but total deafness was the result.

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

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

A boy of six introduced a carob-nut kernel into each ear. On the next
day incompetent persons attempted to extract the kernel from the left side,
but only caused pain and hemorrhage. The nut issued spontaneously from
the right side. In the afternoon the auditory canal was found excoriated and
red, and deep in the meatus the kernel was found, covered with blood. The
patient had been so excited and pained by the bungling attempts at extraction
that the employment of instruments was impossible ; prolonged employment
of injections was substituted. Discharge from the ear commenced, intense
fever and delirium ensued, and the patient had to be chloroformed to facili-
tate the operation of extraction. The nut, when taken out, was found to have
a consistency much larger than originally, caused by the agglutination of wax
and blood. Unfortunately the symptoms of meningitis increased ; three days

a 720, 1877, 210. b 744, 1888. c 124, April, 1852, 377.

d 310, 1836, ix., 99. e 554, 1842, No. 32.

FOREIGN BODIES IN THE EAR.

541

after the operation coma followed, and on the next day death ensued.* In
75 cases collected by Mayer, and cited by Poulet^^i (whose work on " Foreign
Bodies" is the most extensive in existence), death as a consequence of menin-
gitis was found in three.

Fleury de Clermont mentions a woman of twenty-five who consulted him
for removal of a 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 membrana tym-
panum. The mere touching of the pin caused the woman intense pain ; even
after etherization it was necessary to construct a special instrument to extract
it. She suffered intense cephalalgia and other signs of meningitis ; despite
vigorous treatment she lost consciousness and died shortly after the operation.

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

Albucasius, Fabricius Hildanus, Par6, and others, have mentioned the fact
that seeds and beans have been frequently seen to increase in volume while
lodged in the auditory canal. Tulpius speaks of an infant, playing with his
comrades, who put a cherry-seed in his ear which he was not able to extract.
The seed increased in volume to such an extent that it was only by surgical
interference that it could be extracted, and then such serious consequences
followed that death resulted. Albers® reports an instance in which a pin
introduced into the ear issued from the pharynx.

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

In the external ear of a child Tansley observed a diamond which he

a 720, 1800, 230. b 363, 1870, 58. c 543, 1866, ii., 496. d 641, 695. e 456, i., 151.

542 SURGICAL ANOMALIES OF THE HEAD AND NECK.

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
dav.

Barclay*' reports a rare case of ensnared aural foreign body in a lady,
aged about forty years, who, while " picking " her left ear Avith 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 re-
mained 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 im-
bedded 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 | inch from the flaccid portion of the drumhead, and, to-
gether 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, wlien 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

a 165, Aug., 1894. b 843, 836. « 533, Jan. 11, 1896. d 174, 324.

SCALP-INJURIES.

543

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 horse-
shoe flap. The linear extent of the wound was 14 inches, the distance be-
tween 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 2i bv 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 oyer
the scalp, covered with oiled silk and with a recurrent bandage. A consid-
erable portion of the wound healed by adhesions, and the patient was dis-
charged, cured, in fifty-four days. No exfoliation of bone occurred. Rever-
din, 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 cir-
cumference. 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 symp-
toms 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 re-
moved from within three mm. of their edges. The lower margin of the wound

a Deutsche Zeitschrift fiir Chirurg., Feb., 1876. b 476, 1879, ii., 421.

c 782, 1887, iii., 166 et seq.

544 SURGICAL ANOMALIES OF THE HEAD AND NECK.

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 occipi-
tal 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 baclv 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 ac-
cident, 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 Avound 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

CEREBRAL INJURIES.

545

aid by simply cicatrizing over. Gross mentions such a case in a young
lady, who, in 18G9, 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-surgeiy have, in a
measure, diminished the interest and wonder of some of the older instances of

Fig. 191.— Scalp-injury and skin-graft (Scliaeffer).

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 descrip-
tion 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

a 544, surgical portion, part i., 315. b 473 iggj jj 345

35 '

546 SURGICAL ANOMALIES OF THE HEAD AND NECK

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 extrac-
tion was due to rust on the steel, and by the serrated edges of the wound in
the bone.

\Yarren describes a case of epilepsy of seven months' standing, from de-
pression 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 difiaculty 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 for^vard. 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 move-
ments 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

b 224, No. 1781, 356.
a 779, XXV., 13. ' '

PENETRATION OF THE BRAIN.

547

roso to 102° ; the pupils became contracted, the riglit 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 con-
junctiva 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 memoiy 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 hemi-

Fig. 192 — Diagram indicating the probable course of
the spout; the direction was not vertical, but inclined
backward (Abel and Colman).

Fig. 193.— Exact outline of spout after re-
moval ; the dotted line represents position of
cheek-wound ; from A to B, natural size, meas-
ured 6>g inches.

plegia 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 sphenoid bone and penetrating

548 SURGICAL ANOMALIES OF THE HEAD AND NECK.

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 sphenoidal 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 memorv.

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 A^^ere inelfectual.
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 diflPerent times, at a point above the ear,
he inserted into his brain five pieces of No. 20 broom wire from 2^ to
6| inches in length, a fourpenny nail 2^ inches long, and a needle If inches
long. Despite these desperate attempts at suicide he lived several months,
finally accomplishing his purpose by taking an overdose of morphin. Mac-
Queen ^ 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 tliird into his
vertex an inch in front and i 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 dis-
charged 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 appear-
ing inexplicable. A postmortem examination revealed the fact that an ordi-
nary knife-blade had been driven into his brain on the right side, just above

a 476, 1862. i., 626. b 265, i. ^ 124, 1876, 426.

d 476, 1890, ii., 721. ' ^47, Nov. 1, 1871.

GUNSHOT INJURIES OF THE BRAIN

549

I

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 New-
castle, 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 ex-
ternal 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
\ 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 look-
ing 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 sutfer with a troublesome cough, with bloody expecto-
ration ; 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 pidmonarv trouble.

Ford f quotes the case of a lad of fift(>en who was shot in the head, f
inch anterior to the summit of the right ear, the ball escaping through the left
OS frontis, 1^ inch above the center of the brow. Recovery ensued, with a
cicatrix on the foreliead, 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 i 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

a 536, 1884, ii., 419. b 520, Oct. 20, 1891.

dHosp. Gaz., London, 1879, 39.

f Monthly Jour. Med. Sciences, 1845, v., 653.

c 224, 1887, ii., 278.
« 224, Feb. 7, 1891.
g 593, 1866-67, xix., 52.

I

550 SURGICAL ANOMALIES OF THE HEAD AND NECK.

suppuration with discharges of fragments of skull and broken-down sub-
stance 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 mis-
take. 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 pro-
duce unconsciousness or death than in the case of a bullet of low velocity,
especially if it w^ere light in weight. Thus I have recorded elsewhere an

a Sau Fraucisco Med. Jour., 1856, i., 10. ^ 218, 1849, 323. « 533, 1895, ii., 478.

-AMERICAN CROW-BAR CASEr 551

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 mch 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 suf-
ficient 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 practised, 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 sub-
stance destroyed or lost, and yet recovery ensue. Possibly the most noted injury
of this class was that reported by Harlow^ and commonly known as " Bige-
low'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^
inches in diameter, weighing 13J 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 sphenoid 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

a 218, 1848.

552 SUBGICAL ANOMALIES OF THE HEAD AND NECK

the extremities. He was taken to a hotel | mile distant, and during the
transportation seemed slightly dazed, but not at all unconscious. Upon arriv-
ing 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, leav-
ing an opening 3J 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 facul-
ties 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 pro-
cess of the inferior maxilla there was removed a fragment measuring about f
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 (Fig. 194) to his paper. In the illustration
the parts are as follows : —

a 124, July, 1850.

LOSS OF BRAIN-SUBSTANCE.

553

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

(2) Front view of same.

(3) Plan of the base seen from within. In these three figures tlie 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 unim-

Fig. 194. — Dr. Harlow's case of recovery after the passage of an iron bar through the head.

paired. 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. Fran-
ciscus Arcseus 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 frac-
tured ; fragments of bone were driven into the brain. For three days the
patient was unconscious and almost lifeless. After the eighth day a cranial
a Trans. Detroit Med. and Library Assoc., 1879, i., 4.

554 SURGICAL ANOMALIES OF THE HEAD AND NECK.

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 foramen magnum. Bontius asserts that the patient was per-
fectly 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 yet 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 on 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 after-
ward 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^ 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 consid-
ered 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 545 of extreme injury to the cra-
nium and its contents. AVhile sleeping on the deck of a canal boat, a man at
Highspire was seriously injured by striking his head against a bridge. AVhen
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 occip-
a 124, 1869. ^ Medical Press of Western New York, 1888, 317.

LOSS OF BRAIN-SUBSTANCE.

555

ital bone, and, though full of clots, the Avound 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 ak)ng
the sagittal 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| inches in the longitudinal diameter, and 5| inches
in the short oval diameter. The dressing occupied an hour, at the end of
which tlie patient arose to his feet and changed his clothes as tliough nothing
had happened. Twenty-six years after the accident there was slight unsteadi-
ness 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
thougli a slice of the skull were cut out (Fig.
195). The depressed area measured five by
six inches. In 1 8 8 7 the man left the hospital
in Butfalo with the paralysis improved, but
his mental equilibrium could be easily dis-
turbed. He became hysteric and sobbed when
scolded.

Buchanan * mentions the history of a case
in a woman of twenty-one, who, while work-
ing 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-

a 381, 1879. b 476, 1889, i., 1083. c 124, April, 1859.

Fig. 195.— Skull injury with extensive loss
of cranial and cerebral substance.

556 SURGICAL ANOMALIES OF THE HEAD AND NECK.

substance. In five weeks tlie 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, jjrotruding
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 respira-
tion were undisturbed. On the following day a fragment of the cerebral
substance, about the size of a hazel-nut, together with some blood-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 mus-
cular sense. The patient, a work-
man of twenty-nine, while cut-
ting down a gum-tree, was struck
by a brancli as thick as a man's
arm, which fell from 100 feet
overhead, inflicting a compound
comminuted fracture of the cran-
ium. The right eye was con-
tused 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

Fig. 1!»6. — Skull injui y with extensive destruction of brain- x o ./

suhstiiTice around the Holandic area (Cooke and Laycock). inches. The base of the skull

was fractured behind the orbits ;
a fissure \ inch wide was discernible, and the right frontal bone could be easily
moved. The lacerated and contused brain-substance was removed. Con-
sciousness returned six days after the operation. The accompanying illustra-
tions (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 pos-
terior end of the upper convolution, and the base of the corresponding por-
tion 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.

a 180, July 13, 1893.

LO^S OF BRAIN-SUBSTANCE.

557

Morton mentions a patient of forty-seven, who was injured in a railroad
accident near Phoenix ville, Pa.; there was a compound conmiinuted fracture
of the skull involving the left temporal, sphenoid, 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 dura 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 com-
minuted 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 interfer-
ence. Ballon,^ Bartlett,^ Buckner, Ca-
pon,s Carmichael,'' Corban,^ Maunder, j
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 fore-
head in the frontal suture, crushing the os frontis, destroying If 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

Fig. 197. — Diagrammatic sketch of injury seen in
figure 196.

a 547, Oct. 3, 1874.
e 298, 1883.
i 535, 1825.

b 130, 1861, 165. c 124, 1865, 552.
f 647, 1878. g 548, 1879.

j 548, 1870.

d 548, 1852, 268.

312, 1841.
k 703, 1870, 131.

558 SURGICAL ANOMALIES OF THE HEAD AND NECK.

in length, the patient, ahnost 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 mem-
ory was remarkable, and, up to within two weeks of his death, the patient
was able to memorize poems. The amount of involvement discovered post-
mortem in cases similar to the preceding is astonishing. At a recent patho-
logic 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
(Fig. 198). 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 his care a most dreadful case of a girl of eleven or twelve

years, who received 18 or 19 cut-
lass 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 perios-
teum and cutting the cranium.

Fig. 198. -Cranial fracture (14 fragments) (Jennings). During a debaucll the night be-

fore 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 warmtli and stimulants were applied, after
whicli she completely reacted. Slie 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

? 124, May, 1891.

FRACTURES OF THE BASE OF THE SKULL.

559

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 con-
crete 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. Par6 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 sub-
sequently 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 in-
jury, 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 •

96 18 Total, 114.

In a paper on nonmortal fractures of the base of the skull, Lidcll 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 suflFercd 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

a 476, 1886, ii., .579. b 817, 1844. c 476, 1890, ii , 1.

d 124, Ixxxi., 1881, 335. e 475, 1886, ii., 209.

560 SURGICAL ANOMALIES OF THE HEAD AND NECK.

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 dis-
commoded, 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 diiferent accident. Fabricius Hildanus re-
lates the history of an injuiy, 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 appear-
ances 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 peri-
tonitis following a bullet-wound of the intestines, he found postmortem a knife-
blade ^ inch in width projecting into the brain to the depth of one inch.
The blade was ensheathed in a strong fibrous capsule | 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
fi)rehead 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.

a 545, Nov. 1, 1884. b 533^ July 25, 1891. c 224, 1869. d 554, 1799.

INJURIES OF THE NOSE.

561

Hnppert 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 s has compiled
elaborate statistics on this subject, commenting on 316 cases in wliich foreign
bodies were lodged in the brain, and furnishing all the
necessary information to persons interested in this sub-
ject.

Injuries of the nose, with marked deformity, are
in a measure combated by devices invented for restor-
ing the missing portions of the injured member.
Tahacotius, 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 Fig. 199. -warren's appar-
it is supposed that it can be severed, and further trim- ^tus for resorting to the meth-

^ _ ' od of Taliacotius.

ming and paring of the nose is then practised. A

column is subsequently made from the upper lip. In the olden days there was
a humorous legend representing Taliacotius maldng 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
Taliacotian method have been made (Fig. 199); but in recent years the
Indian method, introduced by Carpue into England in 1816, is generally
preferred. Syme of Edinburgh, "Wood, and Oilier 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

155, 1875. b 133^ 1370, ii.

« 681, 1873. d Trans. Med. Soc. W. Va., 1877.

e 230, 1871-2, xi., 194. f South. Med. Rec, Atlanta, 1878, 323.

« 547, 1879, ix., 493. h International Med. Mag., Phila.' Feb., 1894.
36

562 SURGICAL ANOMALIES OF THE HEAD AND NECK.

illustration (Fig. 200) 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
skilflil 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

Fig. 200.— Case of rhinophyma before and after operation (Olimann-Dumesnil).

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 con-
sider 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.

a 536, 1890, ii., 240. ^ 246, 1869.

FOREIGN BODIES IN THE NOSE.

563

Deformities of the nose causing enormous development, or the condition
called double-nose " by Bartholinus, Borellus, Bidault, and others, are ordi-
narily 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 mto un-
equally sized tumors, covering nearly his entire face. Similar instances have
been observed in recent years. Hey mentions a case in which the tumor ex-
tended 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. Im-
bert 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 pro-
gressively 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 astrin-
gent 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 wliich medicinal leeches were removed from the mouth and pos-
terior nares of persons who had, for some days previously, been drinking turbid
water. Sinclair mentions the removal of a leech from the posterior nares.

a 302, iv., 209. b 662, 1st series, T. x., 406.

c Trans. Med. and Phys. Soc, Calcutta, 1842. d 224, 1885, i., 1246.

564 SURGICAL ANOMALIES OF THE HEAD AND NECK.

In some regions, more particularly tropical ones, there are certain flies
that crawl into the nostrils of the inhabitants and deposit eggs in the cavi-
ties. 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 com-
plications. 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 acci-
dental 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 irrita-
ting, 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 nos-
tril ; in three days it had swollen to such an extent as to fill the whole pas-
sage. 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 for-
eign 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 s men-
tions 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 naso-
pharyngeal fossa of a child. It was detected by the rhinoscope and was re-
moved. Parker j speaks of a gunbreech bolt which "was removed from the

a 434, 1836, i., 449. ^ 500, 1842, iv., 345.

d272, 1872. e 545, xxix., 100. ^ 548, 1876, ii., 717.
h Trans. Path. Soc, Phila., 1874, 25. i 224, 1867, ii., 266.

c 594, 1847, ix., 315.

g 224, 1893.

j 476, 1885, i., 378.

INJURIES TO THE TONGUE.

665

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. J^Iolinier<i an observation on the extrac-
tion of a fragment of a knife-blade which had rested four years in the nasal
fossEe, where the blade had broken off during a quarrel.

A peculiar habit, sometimes seen in nervous individuals, is that of " swal-
lowing the tongue." Cohen claims that in some cases of supposed laryn-
geal 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 suck-
ing." Morris s mentions a young lady of fifteen who spontaneously dislo-
cated 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 suck-
ing " 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 A^an 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.

a 252, XV. b 612, 1852-3, v., 215. c 435^ xviii., 341.

d 662, 1854, xiv., 291. e 252, 1884-5, 611. f 401, v.

g 224, 1872, ii., 242. ^ 536, 1887, 78. i Arch. Beiges de M6d. Milt., 1851.

566 SURGICAL ANOMALIES OF THE HEAD AND NECK

There is au 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 thir-
teen 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, driv-
ing 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 li 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 struc-
tures were normal, and articulation, which was at first lost, became fairly dis-
tinct, 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 under-
stood 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,^ Kodtorifer, 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 abnor-
mally 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 J 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

a 47fi, 1846, i., 17.T
<1 312, 1864, iii., 60.
g 548, 1853, i., 202.

b 224, 1883, i., 457. « 224, 1890, ii., 205.

e 735, i., 665. ^ 735, i., 651.

h Am. Med. Gaz. and Jour. Health, N. Y., 1856, 1.

LIVING FISH IN TEE PHARYNX.

six weeks later the common carotid artery. Chalk ^ mentions partial
tion of the lower jaw from an enlarged tongue. Lyford speaks ot
ment of the tongue causing
death.

The above conditions are
known as macroglossia, which
is a congenital hypertrophy of
the tongue analogous to elephan-
tiasis. 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 (Fig. 201).

The great enlargement may
cause deformities of ^ the teeth
and lower jaw, and even present
itself as an enormous tumor in
the neck (Fig. 202). The pro-
truding tongue itself may ulcer-

567

disloca-
enlarge-

Fig. 201.— Macroglossia in a girl eleven years old
(after Humphrey).

ate, possibly bleed, and there is con-
stant dribbling of saliva. The dis-
ease is probably due to congenital
defect aggravated by frequent attacks
of glossitis, and the treatment consists
in the removal of the protruding por-
tions by the knife, ligation, the cau-
tery, or 6craseiu",

Living Fish in the Pharynx. —
Probably the most interesting cases
of foreign bodies are those in which
living fish enter the pharynx and eso-
phagus. Chevers "^^^ has collected five
cases in which death was caused by
living fish entering the mouth and occluding the air-passages. He has men-
tioned a case in which a large catfish jumped into the mouth of a Madras
a 779, viii., 305. b 476, 1827-8, i., 16.

Fig. 202.— Macroglossia (Keen and White).

568 SURGICAL ANOMALIES OF THE HEAD AND NECK.

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 respira-
tion 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 draw-
ing 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 as-
phyxiated 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 be-
cause 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 distress-
ing 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. Immedi-
ately ensued suffocation, nausea, vomiting, together with the expectoration of
blood and mucus. There was emphysema of the face, neck, and chest. The
a 548, 1863, i., 333. ^ 476, Sept. 25, 1868. 476, 1873.

A LEECH m THE PHARYNX.

569

I

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 em-
physema had extended to the scrotum. There was much expectoration ot
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. Exami-
nation 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 oftending 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 fel-
lows he attempted to kill the eel by bitting ofl" its head ; in the attempt the
fish slipped into his gullet, and owing to its sharp fins could not be with-
drawn. 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 wait-
ing 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 adlierent
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

a 548, 1878, ii., 504. b 224, 1895, ii., 695.

570 SURGICAL ANOMALIES OF THE READ AND NECK.

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| and three
inches in length, and with a body of the size of a Lee-]\Ietford 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 wdiere the water is perfectly clear and pure.
Though I have not met with another case of leeches being taken with drink-
ing 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 tlieir endeavors to prevent the Sepoys of a regi-
ment from drinking water from condemned or doubtful sources during a
cholera or typhoid epidemic."

Foreign Bodies in the Pharynx and Esophagus. — Aylesbury men-
tions 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 ingeni-
ously 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, f x | inch, which
subsequently penetrated the esophagus, and in its course irritated the recur-
rent laryngeal and vagi, giving rise to the most serious phlegmonous inflam-
mation 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 71 ounces,
was taken from the stomach after death.

Evans relates the history of a girl of twenty-one who swallowed four arti-
ficial 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

a 374, 1738, viii., 380. ^ 604, 1887. « 178, 1882.

d 629, 1756, part ii. e 476, 1879, ii., 75. 663, T., xxxiv., 13.

FOREIGN BODIES IN THE ESOPHAGUS. 571

bone was dislodged, and, althongh 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 m this position,
during which the young man was never without acute pain and often had con-
vulsions. He vomited material, sometimes alimentary, sometimes mucus,
pus, or blood, and went into the last stage of marasmus. At last, after this
long-continued suftering, 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 re-
peatedly 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. H6vin 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 calcu-
lated 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

a 458, T. xxiii., 147. 641, 113. c Acad, tie Medecine, 1824.

A 538, 1870. « 458, T. xiii., 1807. f 641, 119.

572 SURGICAL ANOMALIES OF THE HEAD AND NECK

mouth. The chestnut became lodged in the throat and caused death on the
nineteenth day. At the autopsy it was found that an abscess connnunicatiug
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. Colics'^ mentions a man of fifty-six who, while eating, perceived a
sensation as of a rent in the chest. The pain was augmented during degluti-
tion, 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 | inch long, and a cor-
responding 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 sud-
denly 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 frequence was as follows : aorta, 17 ;
carotids, four ; vena cava, two ; and one case each of perforation of the in-
ferior thyroid artery, right coronary vein, demi-azygos vein, the right sub-
clavicular artery (abnormal), and the esophageal artery. In three of the
cases collected there was no autopsy and the vessel aifected was not known.

In a child of three years that had swallowed a half-penny, Atkins'^ re-
ports 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 | 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 pro-
truded into the same cavity about the bifurcation of the vessel.

Denonvillicrs has described a perforation of the esophagus and aorta by a
five-franc piece. A preserved preparation of this case, showing the coin in
f5itu, is in the Musee Dupuytren (Fig. 203). 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

a 313, 1855, T. xix., 25. b 476, 1877, ii., 789. « 641, 122.

d 224, May 4, 1895. ^ 490, 1847, iv., 647.

PERFORATION OF THE ESOPHAGUS.

573

(Fig. 204). 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 ver-
tehvve, with vomiting, delirium, and death on the fifth day. At t le
autopsy it was found that a foreign body, seven cm. long had perforated the

Fig. 203.— Perforation of esophagus and aorta by a
five-franc piece (coin in situ) (after Poulet).

Fig. 204.— Perforation of aorta by a piece of bone
(after Poulet).

pericardium, causing a suppurative pericarditis. Dagron^''^ reports a unique
instance of death by purulent infection arising from perforation of the esoph-
agus 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 supraclavic-
ular 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

a 648, 1858. ^ 264, 1858.

574 SURGICAL ANOMALIES OF THE HEAD AND NECK

to remark that Ashhurst * has collected 129 cases of esophagotomy for the
removal of foreign bodies, resulting in 95 recoveries and 34 deaths. Gau-
dolphe*' collected 14*2 cas§s with 110 recoveries.

Injuries of the neck are usually inflicted with suicidal intent or in bat-
tle. Cornelius Nepos says that while figliting against the Lacedemonians,
Epaminondas was sensible of having received a mortal wound, and appre-
hending 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 Boe-
otians had conquered, exclaiming " I die unconquered," he drew out the lance
and perished. Petrus de Largenta speaks of a man Avith an arrow in one of
his carotids, who was but sliglitly affected before its extraction, but who died
immediately after the removal of the arrow. Among the remarkable recov-
eries 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. Bene-
dictus, 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 con-
tinuous hemorrhage for a time, and subsequently a false aneurysm developed,
which ruptured in about three riionths, 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.

a 174, 385. b 497, Jan. 20, 1895. c 218, 1862, Ixvi., 389.

d 124, 1879, 281. 490, 1832, x., 183.

WOUNDS OF THE TRACHEA AND ESOPHAGUS. 575

Cholmeley reports the instance of a Captain of the First Madras Fi^sil-
eers, who was wounded at Pegu by a nuisket.ball penetrating his neck Ihe
common carotid was divided and for five minutes there was profuse hemor-
rhage 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 foct that the artery has been ligated in 228 instances, with 94 recoveries.
Ellis b mentions ligature of both carotids in four and a half days, as a treat-
ment for a gunshot wound, with subsequent recovery. Lewtas« reports a
case of ligation of the innominate and carotid arteries for traumatic aneurysm
(likelv a hematoma due to a gunshot injury of the subclavian artery). The
patient was iu 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 oxtery.

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 Par6 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 sterno-
cleido-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 epi-
glottis, 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 esopha-
geal tube was removed and recovery was virtually complete. Little men-
tions an extraordinary case of a woman of thirty-six who was discharged

a 548, 1855, 538. ^ 594, 1845. c 224, 1889.

d 476, 1882. e 436, May 16, 1894. f 476, 1889, ii., 91.

576 SURGICAL ANOMALIES OF THE HEAD AND NECK.

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 tlie
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 ^ 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 epi-
glottis 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 supra-
scapular 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 hemor-
rhage, but had expectorated and swallowed much blood. He had a
constant desire to swallow, which continued several days. The treat-
ment 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.

Bramand 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 raphe 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.

a 476, June 30, 1894. b 476, 1864, i., 94. c 847, 23. d 847, 90.

CASES OF CUTTHROAT.

577

Thomas =' has reported the case of a man sixty-five years okl who in
an attempt at suicide with a penknife, had made a deep wound m the left
side of the neck. The sternohyoid and omoliyoid nuiscles were divided ;
the internal jugular vein was cut through, and its cut ends were collapsed
and I 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 ves-
sels 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 live 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 ^vith 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
|)roceeded rapidly until the twenty-second day, when violent hemorrhage oc-
curred, 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 suifer 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 re-
covered.

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

a 224, No. 1823, p. 1420. ^ 476, 1850, i., 691). c 476, 1889, ii., 608. "

37

578 SURGICAL ANOMALIES OF THE HEAD AND NECK

front of the cervical vertebrje. On postmortem examination, a sharp piece of
wood about two inches long, corresponding to the missing portion of the
broken mirror handk>, was found lying between the posterior wall of the
esophagus and the spine. Hennig'^ mentions a case of gunshot wound of the
neck iu wliicli the nuisket ball was lodged in the posterior portion of the
neck and was subsequeutiy disciiarged 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
bv death or permanently bad results. BarwelP' mentions a man of sixty-
three who, iu a tit of despondency, threw liimself 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 Belle-
vue Hospital, X. Y.,^' describes a fracture of the odontoid jirocess caused by
a fall on the back of the head ; death, however, did not ensue until six months
later. According to Ashluu-st,« Philips, the elder Cliue, A\'iilard Parker,
Bayard, Stephen Smith, ]May, and several other surgeons, have recorded com-
])lete 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 l)ody of the third cervical vertebra, from
which it was cxtract(>d six weeks later. Tlie paralysis, ^vhicll, up to the time
of extraction, liad affected all four limbs, rapidly diminished. In about five
weeks after the removal of the bullet nearly the entire body of the 3d cer-
vical vertebra, includiug the anterior half of the transverse process and ver-
tebral foramen, was spontaneously discharged. Nearly eight years afterNvard
Keen saw the man still living, but with his right shoulder and arm dimin-
ished iu 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 road-
side appar(>ntlv dead. Physicians ^vho were (juiekly summoned from the
immediate neighborhood detected faint signs of life ; they also found a defor-
mity of the neck, which led them to suspect dislocation. An ambulance was
called, and without any effort being made to relieve the deformi1:y the niau
was placed in it and driven to his home about a mile distant. The jolting

a 316 1817 b 224, 1882, 369. ^ 318, 181:5, ix., 165.

d Archives of Clinical Surgery, N. Y, 1877, ii, 116. e 174, 353. f 231, Jan., 1896.

INJURIES OF THE CERVICAL VERTEBRA.

579

over the vou^h roads greatly aggravated his co.uliticm. Wlien Doyle saNV the
patient, his general appearance presented a iioj^'less condition, hut benig
satisHed that a dislocation existed, Doyle immediately prepared to rediice 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 t.nK> the pli) -
sician placed his right hand against the neck just over the pomuni Adami, aiu
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
iiead was returned to its normal position. The manipulation was acc(»mpanied
by a clicking sensation, caused by the replacement of the dislocated vertebra.
The patient immediately showed
signs of relief and improved ra])idly.
Perceptible but feeble movements
were made by all the limbs except
the right arm. The patient re-
mained in a comatose condition for
eight or nine days, during which
he had enuresis and intestinal tor-
por. He suftered from severe con-
cussion of the brain, which ac(!0unt-
ed for his prolonged coma. De-
lirium was present, but he was
carefully watched and not allowed
to injure himself His recovery
was tedious and N\as delayed l)y
several relapses. His tirst com-
plaint after consciousness returned
(on the tenth day) was of a sense
of constriction about the neck, as
if he were being choked. This
gradually passed oflP, and his im-
provement went on without devel-
opment of any serious symptoms. At the time of rci)ort he aj)[)caivd in the
best of health and was (piite able to attend to his daily avocations. Doyle
appends to his report the statement that among .394 cases embraced in Ash-
hurst'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 liouisville and Nashville Railroad, wh<j, after recovery from cervical dis-
location, exhil)ited himself about the country, never appearing without his
suspensory apparatus.

Fig. 205. — B. Baldwin, " tlie switchiiKui witli tlie
l)rokeii iR'ck."

580 SURGICAL ANOMALIES OF THE HEAD AND NECK.

Achesou ^ records a case of luxation of the cervical spine with recovery
after the use of a jury-mast. The patient tvas 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. AMion 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 sulfered 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 descrip-
tion, 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 oscil-
lation forvvard and backward, was practised, and the abnormal appearance sub-
sided 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 d^ys 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 evi-
dence of paralysis was in the fingers, which, when applied to anything, ex-
perienced 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 vertebra.
Shaw is accredited with a case in which the patient lived fifteen months, the
fnicture 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 rujXured abscesses entered
the trachea and caused subsequent asphyxiation. A curious instance is
a 124, March, 1890. 224, Oct. 27, 1894. 641, 365.

FOREIGN BODIES IN THE LARYNX AND TRACHEA.

reported by Gaujot of Val-dt-Gifice 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
Cliarit6 Hospital, in Paris, who, full of wine, had started to vomit ; he per-
ceived 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, M6rat, and many other writers have mentioned death caused by the
entrance of vomited inatekals into the air-passages. Parrot*^ has obserNcd 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 \voman of twenty-six, who was anesthetized for the extraction
of the right second inferior molar. The crown broke off during the opera-
tion, 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

a 789, 1885, ii., 167. b 272, 1867. c og^^ i873.

d Thhse de Strasbourg, 1856. e 476, 1886, i., 758.

582 SURGICAL ANOMALIES OF THE HEAD AND NECK.

drawn tlic rubbor of the balloon into the oj)ening of tlie glottis, causing death.
Aronsohn, who has already been cjuoted, 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 lie sud-
denly ins})ired the nut into the air-passages, causing inmiediate 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 o])pression, and no cough-
ing, 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''^ trans-
mits 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 sutlbcated. 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, Brunei, 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 lY. 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 * re-
jiorts the history of a woman who was supposed to have either laryngeal car-
cinoma 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, remem-
bered havinir been awakened in the night bv a violent attack of vomiting, and
finding her teeth were missing assumed they were thrown away with the ejec-
tions. From that time on she had suffered pain and distress in breathing and
swallowing, and became the subjecf of progressive emaciation. After the re-
moval of the impacted plate and teeth she soon regained her health. Paget''
speaks of a gentleman who for three months, unconsciously, carried at the
l)ase 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-])late. From the symptoms
and history it was suspected that he had swallowed his set of false teeth, l)iit,
in order to j^revent 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

a 536, 1860, ii., 588. I' 548, 1862, i., 59. <^ 476, 1880, i., 71.

FOKEIGX 110 DIES IN THE LARYNX AND TRACHEA.

583

„,„v ,„,Kl,u,. sv,u,,.o,u. si,nukti,ig tlx,.. «nli,u„-ily «,uso,l by l.o «val .«.ng
nfialse t«.th. • This man awoke one morning with hi. nos,. and throat full o
|,loo,l, and notiml that his lalso tooth, whioh he seklon. removed at n,ght,
were n.issing. He rapidly develo|«l great pain and tumor n, he larynx,
to.^ther with diffieultv in deglutition and speeoh. After a fru.tlesB seareh,

with instrunu.ntal and larvngosc^opi^' "i'L '"i^'^'-'S '"""''7','' "

ehest of drawers; the sympton.s imn.ediately subsided when UK'ntal din-

sion was relieved. a a fi

There is a curious ease of a nuui drowned near Portsmouth." Aiter the

rec(n'erv of his body it was seen that his false teeth were impacted at the ante-
rior openincr of thJ glottis, and it was presumed that the shock caused by tlie

pluncre into the cold water had induced a violent and deep inspn-ation whicli

carried the teetli to the place of

impa(^tion.

Perrin reports a case of an

old man of citjhty-two who lost

liis Hfc from the impaction of a

small piece of meat in the tracliea

and ijlottis. In the Musee A^al-

de-(irace is a prepared specimen

of this case showing the foreign

body in situ (Fig. 206). In the

same museum Perrin has also de-

])osited a ])rcparation from the

body of a man of sixty-two, who

died from the entrance of a morsel

of b(>ef into th(> respiratory j>ass- • , ,

^ Fig. 206.— Foreign body m 1-ig. 207.— I'oreign body

ages. At the postmortem a mo- traclu-a and glottis. in trachea.

bile mass of food about the size

of a hazel-nut was found at tlie base of the larynx at the glossoe])iglottic fossa.
About the 5th ring of the tracliea the caliber of this organ >vas obstructed by a
cvlindric alimentary bolus about six inches long, extending almost to the
bronchial divisiou (Fig. 207). Ashhurst shows a fibrinous cast, similar to that
found in croup, caused by a foreign body removed by Wharton, together
with a shawl-])in, fnmi a ])atient at the Childnni's Hospital seven hours after
the performance of tracheotomy. Search for the foreign body at the time of
the ()])eratiou was prevented by i)rofuse iieuiorrliage.

The ordinary instances of foreign bodies in the laryn.x and trachea are so
conmion that thev will not be mentioned here. Their variety is innumerable
and it is quite possible for more than two to be in the same location sinnd-
taneou.sly. In his treatise on this subject Gross says that he lias seen two,
three, and even four substances simultaneously or successively penetrate the

a 47fi, 1882, i., 964. ^' 641, 403.

584 SURGICAL ANOMALIES OF THE HEAD AND NECK.

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'' tinds in an Indian contemi)orary some
curious instances of misapplied ingenuity on the part of certain liabitual crimi-
nals in that country. The discovery on a prisoner of a heavy leaden bullet
about I 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. Tlie 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 nuy 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 eni])loyed 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 treat-
ment. Armv surgeons are nOt altogether unfomiliar 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, polypi, tuberculosis, enchondroma, stenosis, and
necrosis. Whatever the procedure chosen for the operation, preliminary
tracheotomv 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 (39 cases of either total or partial extir-
pation 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 ex-
haustion. 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 1 80 laryngectomies for carcinoma prior to
January 1, 1892, 72, or 40 per cent., died as a result of the operation ; 51 of

a 242, 1833, viii, 60. b 536, 1889, ii., 189. ^ 538, March 23, 1895.

INJURIES OF. THE FACE AND JAW.

585

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 opera-
tion. 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. t. ^ +

Injuries destroying great portions of the face or jaw, but not caus-
ing death, are seldom seen, except on the battle-field, and it is to nnlitary
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, re-
ceived 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 hemor-
rhage and suppuration, in two months recovered. At the time of report the
wounded man presented no trace of the inferior maxillary bone, but by car-
rying 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 liyoid 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 (Fig. 208). The same
author quotes the instance of a man of fifty, who, during the siege of Alex-
andria in 1801, was struck in the middle of his face, obliquely, by a cannon-
ball, from below upward and from right to left. A part of the right malar
bone, the two su])ori()r maxilhiry bones, the nasal bones, the cartilage, the
vomer, tlie middle himiua of the ethmoid, the left maxillary bone, a portion
of the left zygomatic arcli, and a great portion of the inferior maxilla were
carried away, or comminuted, and all the soft parts correspondingly lacer-
ated. Several hours afterward this soldier was counted among the number
of dead, but Larrey, the surgeon-in-chief of the army, with his typical vigi-
lance 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 splin-
ters of bone taken out, showing an enormous wound. Three months were

a 302, xxix., 424.

586 SURGICAL ANOMALIES OF THE HEAD AND NECK.

necessary for cicatrization, but it was not until tlie capitulation of Marabou,
at which jilacc lie 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
fossti 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 ])rc-
sented an enormous triangular opening in the center of the face, as shown by
the accompanying illustration (Fig. 209). The tongue and larynx were se-
verely involved, and the sight in the left eye was lost. This ])atient contiiui-
ally wore a gikled silver mask, which covered liis deformity and rendered
articulati(Mi a little less dithcult. The saliva continually dribbled from the
moutii and from the inferior internal portion of his mask, comj^elling him
to carry some substance to receive the dribblings. A\'hymper" mentions an

Fig. 208.— (iiiushot injury of tlie lower jaw. Fig. 209.— Giinsliot injury of the face.

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 maslc for remedying the loss of the parts. Steiner^' mentions a wound
from a eanuon-ball, which carried away the left half of the inferior maxilla,
strip])iug the soft parts as high as the malar, and on the left side of the neck
to within U inches of the clavicle, laying bare the transverse processes of the
2d and 3d vertebrse, and 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 ren\oval.
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 Frascr cites an analogous instance in which the breech

a 490, 1833. 52G, 1849. ^ 548, 1858, 416. 218, 1863, 470.

A CURIOUS ACCIDENT.

587

was imbedtlod in the bones of the lace Ibr eiglit years. Smith records an
instance in which a broken piece of tobacco-pii>e penetrated tlie cheek, re-
mained there for seven months, but nvus successfull)- extracted.

l^efore leaving accidents to the head and neck, a nu,st curious case, cited
bN- ( )'NcMl V will be briefly reviewed. A boy of twelve was entrusted to carry
a" new iron pot to the destination of its purchaser. Probably to fl.cdit.tte
transportation, the bov removed his hat and placed the pot obhquely 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 i\w jmt from his head, but m vam, and he
continued all the night greatly })rostrated by fright, hunger, and thirst, together
with the efforts at removal." The next morning he was taken to a neighbor-
ing 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 (juick, heavy tap with a hamm(>r,
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 situa-
tion much longer.

a 476, 1864, i., 490. b 476, 1889, i., 156.

CHAPTER XI.

SUHGICAI. ANOMALIES OF THE EXTREMITIES.

Reunion of Digits. — An intcrcstin^i- plu'iiomenoii noticed in relation to
severed digits is tlieir w onderful (.rapacity tor reunion. Restitution of a severed
part, particularly if one of considerable funcrtion, naturally excited the interest
of the okler writers. Locher=' has cited an instance of avulsion of the finger
with restitution of the avulsed portion; and Brulet,'^ Van Esh, Farmer,
Ponteau. Reo-nault, and Rosenberg cite instances of reunion of a digit after
amputation or severance. Eve's " Remarkable Cases in Surgeiy" contanis
many instances of reunion of both lingers and thumbs, and in more recent
vears 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 hnger 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 bv 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 ])halanx. Staton has described a case in which the hand
was sevennl 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 i)ortion
of the skin below the articulation, with the ulna, remained intact. After an
unavoidal)le delay of an hour, Staton proceeded to replace the hand with silver
sutures, adhesive plaster, and splints. On the third day pulsation wa.s 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 inter-
esting. 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
Orman9ey ^ have related instances of similar growths oji the 2d phalanx

a 456 ii., 405. ^ 297, No. 223. 313, Aug., 1865 ; 224, Jan., 1862.

d 6O4' 1880. e 462, T. xxvii., 177. f 461, March, 1809.

588

AVULSION OF THE DIGITS.

589

after the loss of the 1st. For several months a woman had suttered rom
an ulcer of the middle finger of the right hand, in conseciuence ol a whitlow ;
there was loss of the U phalanx, and the whole of the articular surface
and part of the compact bony structure of the 2d. On examining the
sore, Ormanyey saw a bony sequestrum which appeared to keep it open. He
extracted this, and, until cicatrization was complete, he dressed the stump w.th
saturnine cerate. Some months afterward Orman^ey saw with astonishment
that the nail had been reproduced ; instead of following the ordinary direc-
tion, however, it lay directly over the face of the stump, growing from the
back toward the palmar 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 Charit6, 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 termin-
ated bv a small, blackish nail, like a grain of spur rye. It is probable that
in thJse 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 move-
ment 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 sev-
erance complete.

It occasionally happens that in avulsion of the finger an entire tendon is
stripped up and torn off with the detached member. Yogel*' 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 simultane-
ously. 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 neigh-
boring 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

a " Anatomie Topographique," p. 558, Paris. ^ Quoted 476, 1886, ii., 641.

c Med.-Cliir. Beobachtuugen, 353. d 779^ 1859. e 124^ 1854.

590 SURGICAL ANOMALIES OF THE EXTREMITIES.

be generally overlooked bv 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 iirmly 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 dro})pcd 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 ])halanx
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 fiexor muscle twisted from its origin. The authors know
of an unreported case in which a man i-unning 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 fidl 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 Hunczoysky observed complete avulsion of the arm by a
cannon-ball, without tlie slightest hemorrhage. The Ephemerides contains
an account of the avulsion of the hand without any bleeding, and A\'oolcond)
has observed a huge wound of the arm from which hemorrliage was sinn'larly
absent. Later observations have shown that in this accident al)S('ncc of hem-
orrhage 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 ustially separates at the highest point and the nuiscles
protrude, appearing to be tightly embraced and almost strangulated by the
skin, and also bv the tendons, vessels, and nerves which, crushed and twisted
with the fragments of bone, form a conical stumj). Cheselden re])orts 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, draw-
ing him from the ground and violently throwing liis 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
a 381, 1887, 43. ^ 701, 187:9. c 564, iii. ^ 629, Ix.

wafi

A VVLSION OF THE ARM.

and th- num was ins,.,sibk. to pain; l.eins s„ <la«..l and «u,-pri»cd he really
, „aco«scio»s of the nature of lu.s injury until he .aw his arm n, the wheel
AeeonliuK to Billroth the avulsion of an arn. is usually loUowed by taUi
sho,.k. Kiseher, however, relates the ease of a lio,.-tanier whose whole left
,n.,n was torn fron, the shoulder by a lion; the loss of blcKX beu.g very
slight and the patient so little atleeted by shoek that he was able to walk to

the liospital. ^ i i i i

MussoN-' describes a bov of sixtoon wlu, had his lelt arm and shoidder-
bh.dc coiupk'telv torn from his body by machinery. The patient became
s.. involved in thc> bands that his body was securely fastened to a drum,
while his le^s hnno- danglino-. In this position he made about 15 revolutions
around the drum before the motion of the machinery could be ettcctually
stopped bv euttino- „ff the water to the great wheel. When he was disentan-
gled froni the bands and taken down from the drum a huge wound was seen
at the shoulder, but there was not more than a ])int of blood lost. The collar-
bone projected from the wound about half an inch, and hmiging 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 ceil-
ing and the drum in which the revolutions of the body had taken place Avas
scarcelv 7^ inches wide. Horsbeck's case was of a negro of thirty-five who,
whik> pounding resin on a 12-inch leather band, had his hand caught between
tile wheel and band. His hand, forearm, arm, etc., were rai)idly drawn in,
and lie was carried around until his shoulder came to a large beam, where the
bodv was stopped by resistance against the beam, fell to the floor, and the arm
and scapula were comi)letely 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
tweiitv-three who had both arms caught l)etweeii a belt and the shaft while
working in a wook^n factory, and while the machinery was in full operation.
He was carried around the shaft witli great velocity until his arms M ere torn
off at a point about four inches bek)W the shoulder-joint on each side. The
patient landed on his feet, tlie l)lood spurting fn^n each brachial artery in a
large stream. His fellow-workmen, Avithout delay, wound a piece of rope
around each bleeding member, and the man recovered after primary amputa-
tion of each stunij). W'ilk' gives an excellent instance of avulsion of the right
arm and scapula in a girl of eighteen, who w'as caught in flax-spinning ma-
chinery. The axillary artery was seen lying in the wound, ]^ulsating feebly,
but had been efficiently closed by the torsion of the machiner}'. The girl re-
covered.

Additional cases of avulsion of the u])per extremity are reported l)y
a 124, 1837, xxi., 385. b 632, 1880. c 224, 1884, i., 1135.

592 SURGICAL ANOMALIES OF THE EXTREMITIES

Aubiiiais,'^ Bleyuie,'' Cliarles,*^ George,^ James/ Joiie.s/ Marcano/ Bel-
chier,575 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. HorlbeckJ quotes
Benoraont'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 al)Out the punishment he expected to receive at home for disobedi-
ence 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 fol-
lowing almost to the thigh. The whole left leg and thigh, together with the
left side of the scrotum, were torn off ; th(> boy died as a result of his
injuries.

Ashhurst 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 Avas the ra[)id
cooling of the body after the accident and prolongation of the coolness with
slight variations until death ensued. Ashhurst 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, Kiister^ 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 Kiister 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, Kiister 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 ru])ture of the sciatic nerve caused by a
patient giving a violent lurch during an ojjeration at the hip-joint.

The instances occasionally observed of recovery of an injured leg after

a Soc. Acad. Loire inf., 1862. ^ 673, 1867-8, i., 11. c 476, 1872, i., 216.

d 315, 1879, xxxix., 69. e 180, 1868, xiii., 117. f 224, 1870, i., 545.

g 242, 1875, 228. ^490, 1832. > 299, 1875. 3 264, 1859, 433.

k 528, 1792, ii., 17. 1 199, March 26, 1883. m 450, 1884, 323.

«

RUPTURE OF THE QUADRICEPS TENDON.

593

extensive severance and loss of substance are most marvo ous Morto
^uentions a boy of sixteen, who was struck by one of the bla<^s of a r^u .
n.achiue, and had his left leg eut through about U uiches above the ank -
joint. The foot was hangiug by tlie portion of skui corresponding to the
posterior qnarU.- of the eireuniferenee of the leg, together with the posterioi
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 ot
the wound were dmwn together by wire sutures, and the cut surfaces ot tlie
tibia were placed in as good apposition as possible, although the lower frag-
ment 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 wa.s
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 cor-
responding 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 liml) was saved with a shorten-
ing of but 1| 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 depres-
sion immediately above the upper margin of the patella, and the other dis-
tinctive 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, iu
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

a 47(5, 1873. ^ 124, 1877, i., 332. e 597^ 1884.

597, Dec. 29, 1884. e 548, 1868, i., 175.

38

594 SURGICAL ANOMALIES OF THE EXTREMITIES.

strong and healthy man, of niptnre of the tendon of the left triceps cnbiti,
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 ex-
isting in medical literature in abundance.

Marshall had uniler 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 a])plication of a caus-
tic, 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 vio-
lently 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, inflam-
mation 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 por-
tion 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 M-as 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
uHMuber 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 humenis backward on
the scapula. It conld not be reduced because the tendon of the biceps lay
between the head of the humenis and a piece of the bone which was chipped off.

a 224, 1870, ii., 116. ^ 656, 1843. c 224, 1877, i., 544.

CONG ENITAL DISL 0 CA TI ONS.

595

Baxtor-Tyrie«^ reports a dislocation of the shoukler-joint, f^^f
orWm, in a man who was riding a horse that ran away u,> a steep lu I. Attei
goiiiP- a few hundred yards the animal abated its speed, when tlie nder ra.sc.l
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 giveai way
at his shoulder. He did not fall off, but rode a little further and was helped
to dismount. On examination a snbcoracoid dislocation of the head of tlie
humerus was found. The explanation is that as the weight of the whip was
inconsiderable (fonr ounces) the inertia of the arm converted it into a lever ol
the first order. Instead of fulfilling its normal function of i)reventing dis-
placement, the coraco-acro-
mial 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
ru])tured capsular ligament
and displacement of the head
of the bone would represent
the work done.

Congenital Disloca-
tions.— The extent and ac-
curacy of the knowledge pos-
sessed by Hippocrates on the
subject of congenital disloca-
tions have excited the admir-
ation 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.

Amono- couirenital dislocations, those of the hips are most conmion — 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 develop-
ments 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

a 476, No. 3767, 1165.

Fig. 210.— Case of congenital Ui.Katiou of Iho rciuoru (Hirst).

596 SURGICAL ANOMALIES OF THE EXTREMITIES

can be done is to diminish the deformity and functional disabiHty 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 hyperexten-
sion, the foot sometimes resting on the abdomen. Congenital luxation of the
femora, when it appears in adult women (Fig. 210) 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 re-
covery is fast becoming an ordinary operation ; at Westminster Hospital in
London, there is preserved the right humerus and scapula, presenting an enor-
mous 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. Champenois'' 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. Jack-
son, quoted by Ashhurst,'' had a patient from whom he simultaneously ampu-
tated all four limbs for frost-bite.

MuUer'^ 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 con-
tinued 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 condi-
tion 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 alse 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,

a 662, 1869, 507. ^ 174, 107. ^ 847, 216.

MULTIPLE AMPUTATIONS. 597

a„d a. the patient suffered from singultus and eonstant pain oy<^^^i^
region, a light eathartio was given, which, in twenty-tour hours gave relK^i
The four teen li„>bs were enveloped in a solution of .n,e cW<"- J;
frozen ears and eheeks healed in due time, and f^^'^ZlT:^ ^
nose separated and soon healed, with the loss of the tip and pa ts of ^e ate,
leavin. the septunr somewtot exposed. On January 10th the hues of demar-
leciviu^ tuc F 1 thoudi the patient, seconded

cation were distnict and deep on all lour hmbs, tnou^ f j t,„,,^,,„
by his wife, at first obstinately opposed operative mterference ; on Jam a^y
13th, after a little hesitancy, the man consented to an amputation of the anr^s
This was successfully carried out on both forearms, at the middle tliird, the
patient losing hardly any blood and complaining of little pain. The grea
relief afforded bv this operation so changed his aversion to being operated
upon that on the next day he begged to have both legs amputated in the sanie
manner, which was done, three days afterward, with the same favorable result.
After some minor complications the patient left for his home, perfectly recov-

ered, June 9, 1866.

Beo-g of Dundee* successfully performed quadruple amputation on a
woman, the victim of idiopathic gangrene. With artificial limbs she nn^s
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 (Fig. 211). 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 Ley den, whose axillary artery was divided

a 224, 1886, i., 81. ^ 476, 1889, i., 730. c 533^ March 31, 1894.

598 SURGICAL ANOMALIES OF THE EXTREMITIES.

Fig. 211.— Synchronous triple amputation (Wharton).

with a knife, causing great effii.sion 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
spontiineously, and the arm decayed,
shrunk, and dried into a mummified
stump, whicli 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, devel-
oped ; but on account of the increas-
ing 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 expos-
ing the acromion process and involving the pec-
toral 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 tAventy-eight.

By ingenious mechanical contrivances persons
who have lost an extremity are enabled to per-
form the ordinary functions of the missing mem-
ber 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 dis-
membered athletes at Nogent-Sur-Marne, a
small town in the Department of the Seine, in France. Responding to a genei-al
a 133, 1879, xx., 210. ^ Quoted 476, 1895, ii., 220.

Fig. 212.— Spontaneous amputation at
the shoulder (Kooker).

DISMEMBERED ATHLETES.

599

invitation, no less than seven individuals who had lost either leg th^^-
peted in running raees for prizes. The enterprising enpples were div uled .n o
L» classes: tl^ ealssards, or those who had lost a tlugh, and jambard. o
t ose who had lost a leg / and, eontrary to what might have been expected,
h ^rand champion canfe f rom the former class. The distance n. each race
was 200 meters. M. Roullin, whose thigh, in consequence o an accidem ,
was amputated in 1887, succeeded in traversing the course ni the remarkable
time of thirty seconds (about 219 yards) ; whereas M. Florrant, the speediest
iambard, required thirty-six seconds to run the same distance ; and was,
moreover, defeated by two other cuissards besides the champion, ihe junior
race was won in thirt'y-five seconds, and this curious day's sport was ended by
a eom'se de comoJaUon, which was carried ofP 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 1 ear
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 re(;ent 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 hini
by a neighboring manufticturer. ^Yith 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 ]>roved 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 ]>halanx of the little finger and
had remained in this position for nearly twenty-two years.

a 251, 1866. ^ 224, 1889, ii., 1331.

600 SURGICAL ANOMALIES OF THE EXTREMITIES

White ^ has described a case in wliich a nail broken off' in the foot,
separated into 20 spHnters, which, after intense suliering, were successfully
removed. There was a case recently reported of a man admitted to tlie
Bellevue Hospital, New York, whose arm was supposed to have been frac-
tured by an explosion, but instead of which ii 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 \ 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 hosjHtal 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 sufliciently, a
diagnosis of fracture of the bones of the arm was made. There was no ex-
ternal injury of the skin of any magnitude, and the surgeons decided to cut
down on the trifling contusit)n, 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 \ 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 1 1 feet, the longest piece measuring two
feet and the shortest \ inch. The wire was found imbedded under the mus-
cles 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 l)()dy 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 foil 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 l)e 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

a 647, 1860. ^ 597, Jan. 12, 1895.

RACHITIS.

601

is a disease of the bones in adult life, occurring most frequently in puerperal
women, but also seen in wcmien not in the puerperal state, and ni 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 occa-
sionally to spontaneous fmcture.

Rachitis or rickets is not a disease of adult life, but of infancy and child-

iiood, and never occurs after the age of puberty.
It seldom begins before six months or after
three years. There are seveml theories as to
its causation, one being that it is due to an ab-
normal development of acids. There is little
doubt that defective nutrition and bad hygienic
surroundings are prominent factors in its pro-
duction. The principal pathologic change is
seen in the epiphyseal lines of long bones and

Fig. 213.— Appearance during life of the highest grade of rachitis :
pseudoos(eoi»alacia (I'ippingskjold).

Fig. 214. —Extreme deformity of skele-
ton due to rickets, showing eulargemcul of
the ends of the bones (Sp. 1545, Warren
Museum).

beneath the periosteum. Figure 213 shows the appearance during life of a
I)atient 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

602 SURGICAL ANOMALIES OF THE EXTREMITIES

most likely to break ; there is an assoeiatc deformity of the- head, known as
" craniotabes," together with pigeon-breast and various spinal curvature. The
accompanying illustration (Fig. 214) 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 moveil 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.

p'ig. 215.— Two adult cases of achondroplasia (Thomson).

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 affec-
tion, and the great majority of fetuses die in utero. Tliomson « 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

a 318, June, 1893.

DEFORMED JOINTS.

603

tmitiiient. The child died of pneumonia. Tlie otlier two cases (Fig. 215)
were in adults, one thirty-nine and the other thirty-six. 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 consider-
able intelligence. Neither had married. Both the upper and lower limbs

showed exaggerations of the normal curves ; the hands and feet were broad

1 1

and short ; the gait of both of these little men was waddling, the trunk
swaying when they attempted to make any rapid progress.

Osteitis deformans is a hyperplasia of bone described by Paget in
185G. 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| 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. Pie 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 osteosclerosis. 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. A\'ilson presented a similar
case before the Clinical Society of London, in 1888. The " Camel-bov,"
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, show-
ing curious deformity of the long bones and atrophy of the extremities. He
derived his name from the remarkable transparency of his deformed members

a 476, 1890, ii.

604 SURGICAL ANOMALIES OF THE EXTREMITIES.

to electric light, due to porosity of the bones and deficiency of the overlying
tissues.

Figure 217, taken from Hutchinson's Archives of Surgery," M^epresents
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.

Fig. 216.— Extreme deformity of the bones and joints.

Fig. 217.— Deformed knee-joints from severe
osteoartliritis (Hutchinson).

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 Wil-
lard^ mentions a boy of
fourteen, the victim of in-
fantile paralysis, who at the
age of eleven had never
walked, but dragged his
legs along (Fig. 218). 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-
a Vol. v., 82. b 124, May, 1891.

Fig. 218.— Distortion of the joints from infantile spinal paralysis

(Willard).

ANOMALOUS GROWTH OF LONG BONES.

605

of-Paris and extension, this hopek^ss crippk" walked witli c^nitches m two
months, and with an apparatus consisting of elastic straps over the qua(lrice])s
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 totallv unable to support the body in the erect position,
but could move on all fours, as shown in figure 219. There was equino-
varus 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
femoRil neck, simulating dislocation. Tliis patient was also operated on in
the sjuue manner as the preceding one.

Fig. 219. — Mode of locomotion in a case of deformity from infantile spinal paralysis (Willard).

Relative to anomalous increase or hypertrophy of the bones of the
extremities, Fischer shows that an increase in the length of bone mav fol-
low 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^ 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| cm.,
after a fracture, was reduced to one cm. by compensatory growth. Elonga-
tion 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 XIT.

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 re-
coveries from lung-injuries, despite the primitive and dirty methods of treat-
ment. X review of the literature previous to this century shows the names
of ArcEcus, Brunner, Collomb, Fabricius Hildanus, Yogel, 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, obstruc-
tion to the circulation, and death. It is said that Vesalius demonstrated this
condition on the thorax of a pig.

Goocii -'^'^ 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 exposetl to
view, showing the lungs, diaphragm, and pericardium all in motion. The
lungs soon became gangrenous, and in this horrible state the i)atient 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 gentle-
man who was wounded in a duel, and who had all the symptoms of hemo-
thorax ; his condition was immediately relieved by the evacuation of a con-
siderable 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

606

LOSS OF LUNQ- TISSUE.

607

thorax, wlio ^vas relieved and ultimately cured by a blocxly 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,
4tli, 5th, and 6tli 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 inches to the right of the spinous
process of the 6tli dorsal vertebra, and passed upward and very slightly in-
ward toward the median line. Its track could be followed only 1\ 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 fre-
quent, short, and gasping, the thoracic walls and the abdomen scarcely mov-
ing. 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 pro-
truded through a large wound of the lung under the left nipple. This wauind
received no medical attention for forty-eight hours, when the protruding por-
tion 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 lun<>-
adherent to it and this condition was found six years later at the necropsy of
this individual. Tulpius quoted Celsus 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
a Annual of the Universal Medical Sciences, 1892.

608 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

edges of the thoracic wound, yet the patient made a good recovery. Fabri-
cius Hildanus^^^ and Ruysch '^^y record instances of recovery in which large
pieces of hmg 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 pro-
truding, 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 experi-
ment 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 opera-
tion was done on healthy tissue and in deep and narrow-chested animals.
Excision of diseased portions of the lung has been practised by Kron-
lein (three cases), Ruggi of Bologna (two cases), Block, Milton, Weinlech-
ner ; 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 tubercu-
losis, 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 sus-
picious 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 pres-
sure 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 rup-
ture 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. Par6, Morgagni, Portal, Hewson Smith, Dupuytren,
Laennec, and others mention this injury. Gosselin reports two cases ter-
minating in recover)-. Ashhurst reports having seen three cases, all of which
terminated fatally before the fifth day ; he has collected the histories of 39

a 526, 1851. b 224, 1884, i., 1178. 533, Nov. 23, 1895.

RUPTURE OF THE LUNG WITHOUT FRACTURE 609

cases, of wliich 12 recovered. Otis lias 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 Ashlmrst very justly
remarks, this injury appears more fatal in civil than in military hfe.

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 ambu-
lance, on the afternoon of November lOtli, 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 emphy-
sema ; the neck and side of the face were enormously swollen with the extra-
vasated 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 hem-
orrhage 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°, and again, on the evening
of the sixth, to 102.3°. This rise was apparently without significance as the
patient at no time seemed disturbed by it. On the eighth day the tempera-
ture again rea(;hed 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 Avell 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

a 533, Feb. 24, 1894. l> 700, 1877-8, 246. c 368, Oct. 15, 1881. d 490, April 22 1837' 119
39 '

610 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

resembling pertussis, whose lung ruptured about two weeks after the begin-
ning 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 tlie wound. In this
case, the ball liad 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 travers-
ing the thoracic cavity, the patient completely recovering after treatment.
Girard, Weeds, Meacham, Bacon, Fryer and others ^ report cases of perfo-
rating; punshot wounds of the chest with recovery.

Sewell " describes a case of transfixion of the chest in a youth of eighteen.
After moAving 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 correspond-
ing 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 instru-
ment. 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 s mentions a man of twenty-five who
was discharging bar-iron from the hold of a ship ; in a stooping position, pre-
paratory 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 com-
bined efibrts 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 injurv ; the boy recovered.

There is deposited in the Museum of the Royal College of Surgeons in

a 659, 1855. b 744, 1848. 476, 1853. d 847, 27 et seq. e 124, 1849.

f 265^ i. g 491, 1863, ii., 241. ^ Trans. Med. Soc. Pa., 1877, pt. 2, 730.

3IAJ0R THORACIC WOUNDS.

611

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 guid-
ing 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 notwithstiinding his transfixion by so formidable
an instrument, in five mouths 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. Long-
more 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.^i In a brawl, a shipping clerk received a
thoracic wound extending from the 3d rib to within an inch of the navel,
13| 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 J 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.

a 435, 1873, 44. b 476, 1871, i., 78. c 656, 1842. d 702, Dec, 1890.

612 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

In wounds of the diaphragm, particularly those from stabs and gun-
shot injuries, death is generally due to accompanying lesions rather than to
injury of the muscle itself. The older writers, particularly Glandorp,^^*^
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 move-
ments 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 dia-
phragm 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 ex-
tremely small, protrusion of the stomach or some other viscera into the tho-
racic cavity will almost invariably result, constituting the condition known as
internal or diaphragmatic hernia. Par^^^^ 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
Par6, a part of the colon was found in the thorax, having passed through a
wound in the diaphragm. Gooch^^^ 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
a 807 1878. Leipzig, 1665. 550, vi., 374.

I

PERITONITIS IN THE THORACIC CAVITY.

613

of the ribs. The man was aged twenty-seven, and being an outside pas-
senger on a coach (and also intoxicated), when it broke down he was pro-
jected 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 olf part of the omentum, returned its stump to the abdo-
men, and finally closed both the wound in the diaphragm and the external
wound with sutures. Quoted by Ashhurst, Hunter recorded a case of gun-
shot wound, in which, after penetrating the stomach, bowels, and diaphragm,
the ball lodged iii the thoracic cavity, causing no difficulty in breathing until
shortly before death, and even then the dyspnea was mechanical — from gase-
ous 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 ob-
served 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 open-
ing 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. Tulpius^"*^ mentions a person who had a sponge shut up

a 174, 398.

614 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

in his thoracic cavity for six weeks ; it was then voided by the mouth, and
the man recovered. Fabricius Hildanus^^* relates a simikir 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 re-
mained for fourteen years. Leach ^' gives a case in which a bullet was im-
pacted 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 pres-
ence of Sir Morrell Mackenzie, Johnston of Baltimore removed a toy loco-
motive 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. Listen 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 wlio in-
haled a pebble placed on his tongue to relieve thirst. On removal tliis
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. BrighamS 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 post-
mortem 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, immcjdiately 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

a 550, 1827, xiii., 281. ^ 175, 1857. c 267, 1870, xi., 401.

d Archives of Clinical Surgery, N. Y., 1876, 1., 211, et seq.

e Rhode Island Med. Soc, Providence, 1860, i., 82. f 579, 1853, v., 129.

g 124, 1836, 46. 720, 1876, clxx., p. 271.

FOREIGN BODIES IN THE BRONCHI

615

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 ciirved forceps. Marcacci fils prac-
tised 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 irri-
tation 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 extem-
poraneously 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 fi)urteen months who swallowed a shawl-pin two inches long, which re-
mained 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 pnemnouia and cardiac dropsy which continued
two months longer, at which time, during a violent fit of coughing, the cigar-
ette 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 beliind the left clavicle and passing downward and across to the
right clavicle. Sometime afterward this patient expectorated two pieces of

a 476, 1876. t> 218, 1871. c 476, 1890, 628. d 133, 1873, 146.

616 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

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
hijuries 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 num-
ber 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 diag-
nosis. 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 fol-
lowing 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 run-
ning 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 mortahty 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 check 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 peri-
cardium, is advised by some surgeons.

Realizing the fatality of injuries of the heart, in consequence of which al-
most 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 feasi-
bility of any procedure in this direction, no matter how hypothetic.

Hall *^ states that his experience in the study of cardiac wounds, chiefly

a 392, 1842. b 684, April 4, 1895. c 843, 337. d 533, Nov. 2, 1895.

SURVIVAL AFTER CARDIAC INJURIES.

617

on game-animals, would lead him to the conclusion that transverse wounds of
the lower portions of the heart, giving rise to punctures rather than extensive
lacerations, do not connnonly cause cessation of life for a time varymg froni
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 instantane-
ous. It would seem that injury to the muscular walls of the heart is mucli
less efficient in the production of immediate death than destruction of the
cardiac nervous mechanism, serious irritation of the latter producing ahnost
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 i and | of a mile after having been shot through the
heart, each with a pellet of BB shot, the base in each instance being unin-
jured ; in several instances antelope and deer ran several rods after bemg
shot with a rifle ball in a similar manner ; on the other hand, deatli was prac-
tically 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.

Par6 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 250 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
rnn 400 paces after penetration of the left ventricle, and lived for five hours.
Momnd 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

a 303, L. ii., cap. vi., 266 and 381. b 470, T. xxxv.

c Melanges de Chirurgie, etc. d Medical Records, etc., 1798, No. 4.

618 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

follows : I'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,** Ricdlin/ two days ; Saviard/^^ eleven days ; Sen-
nert, j three days ; Triller,'' fourteen days ; and Tulpius,^ two and fifteen days ;
and Zittmau,'" eight days.

The Due 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 intro-
duced 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 carti-
lages of the 6th 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 ex-
amination the wounds in the organs were found to be liealed, but the cicatrices
were quite evident. Bowling i' 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\ inches from the left apex, traversing the left
wall obliquely, and making exit close to the septum ventriculorum. Rob-
erts 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
V)all having penetrated its anterior surface, near the origin of the pulmonary
artery (Fig. 220). 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

a 418, 1744. ^ Orteschi Giornale di Medicina, Venet, 1763. c 190, cent, i., liist. 77.

d Hufeland, N. Annalen, i., p. 301. « Journal de Sant6, T. i. f 462, T. xlviii, 243.

g Chirurgie, obs. 228. h 680, cent, ii., obs. 39. i 683, 1700, 985.

j Opera chirurg., L. v., P. iv., c. 3. ^ Diss. Viteb., 1775. 1 842, L. ii., c. 18.

m 835, cent, ill., cas. 50. n 124, 1829. o 124, July, 1857. P 476, 1852, ii., 491.

q 548, 1863, ii., 487. r 681, 1871, xii., 607. ^ 475, 1887, i., 673.

SURVIVAL AFTER CARDIAC INJURIES.

619

fourteen days in which the man lived. Vite « mentions an example of remark-
able 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 pass-
ing through the left ventricle of the heart into the opposite wall. Boone i> speaks
of a gunshot wound in which death was postponed until the thirteenth day.
Bullock ^ mentions a case of gunshot wound in wliich the ball was found
lodged in the cavity of the ventricle four days and eighteen hours after inflic-
tion 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 ex-
amination an opening in the heart was
found large enough to admit a blow-
pipe. Noble s speaks of duration of
life for five and a half days after rup-
ture of the heart ; and there are in-
stiinces on record in which life has
been prolonged for thirteen hours'^
and for fifty-three hours ^ after a simi-
lar injury. Glazebrook^ reports the
case of a colored man of thirty, of
powerful physique, who was admitted
to the Freedmen's Hospital, Wash-
ingtou, 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^ inches to the left of the median line, the incision being 2| inches in length
and its direction parallel with the 3d ril). 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 f inch

Fig. 220.— Wbuud of the lieart; survival, lourloeu days
(Curran).

in

a 681, 1876. ^ 124, 1879, 589. ^ 712, 1858, i., 295.

e 538, 1878. f 476, 1860.

I' 224, 1881, ii., 1051.

i 224, 1889, ii., 204.

d 128, 1855.
g 476, 1889, i., 774.
j 533, Ixvi., 508.

620 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

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 i inch in length, directly into the right
ventricle, the endocardial wound being f 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^ 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 i inch in diameter. The
wound of exit was | inch in diameter. After traversing the heart the ball
had penetrated the diaphragm, wounded the omentum in several jilaccs, 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
AVashington 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, ex-
cept 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 coni-
cal 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 pericar-
dium 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.

a 533, Oct. 27, 1894. b 597^ xiv., 411-434. c 847, 33. d 174^ 395.

NONFATAL CARDIAC INJURIES.

621

Among the oldor writers, several instances of nonfatal injuries to the
heart are reeorded. 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 steiy ot
a deer that was killed in hunting, and in whose heart was fixed a piece ot
arrow that appeared to have been there some time. Glandorp^ expeninent-
ally produced a nonfatal wound in the heart of a rabbit. Wounds ot the
heart, not lethal, have been reported by Benivenius,i«« Marcellus Doiiatus,
Schott,^ Stalpart van derWiel,'i 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 Middle-
sex 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 gen-
eral 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 fol-
lowing 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 pene-
trated. Strange to say, the blade had passed between the vertebral column
and the esophagus, and to the right of the aorta, but had Avounded 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. Miihlig s
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 bel-

a 380, Obs., 83. ^ 306, L. v., c. iv., 569. c " physic. Curios." L., iii., 576.

d750, cent, ii., Obs., 23. e 548, 1863, ii., 499.

f 362, No. 20, 1868. e 645, 1860, No. 43.

622 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

lows-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 sys-
tole, and entirely obscuring the physical signs. From this time the man
speedily failed, and after his death there were cicatricial signs found, particu-
larly on the wall of the left ventricle, together with patency of the interven-
tricular septum, with signs of cicatrization about this rent. At the side of
the left ventricle the rent was twice as large and lined with cicatricial 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 teaspoon-
ful 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 opera-
tor'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 tam-
pon, which protected the exposed pleural cavity, was drawn into this cavity
during a deep inspiration, and could not be found. Notwithstanding subse-
quent 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 inter-
costal 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 ven-
tricle, from which the patient recovered. Purple ^ gives an account of a recov-
ery from a wound penetrating both ventricles. The diagnosis was confirmed
by a necropsy nine years thereafter. Stoll ^ records a nonfatal injuiy to the
heart.

Mastin reports the case of a man of thirty-two who was shot by a 38-cali-

a 260, 1883, No. 25. b 529, 1893. c 770, 1851, 104, et seq.

d 597, xiv., 411 to 434 e 398, i., 354. f 533, 1895, i., 728.

NONFATAL CARDIAC INJURIES. 623

ber Winchester, from an ambush, at a distance of 1 10 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^ inches from the nipple. A
line drawn from the wound of entrance to that of exit would pass exactly
throuoh 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 dam-
age done in the track of the bullet is not known, although Mastin's supposi-
tion is that the heart was penetrated.

Mellichamp " speaks of a gunshot wound of the heart with recovery, and
Ford b 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 appar-
ent 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 him-
self 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 8 reports a case in which a leaden bullet remained twenty years in
the walls of the heart. Plamilton ^ mentions an instance of gunshot wound

a 264, 1876, iv., 17. b 533, 1875. c 319, 1853. d 548, 1861, ii., 229.

e 360, Oct. 16, 1869. f 548, 1861, ii., 229. g 124, xlii., 293. b 597, 1867, iv., 379.

624 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

of the heart, in which for tsventy 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, Learning,
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 sub-
stance of liis heart a bone 4^ inches long and possibly an inch thick. This
case is probably one of ossification of the cardiac muscle ; in the same connec-
tion Battolini says that the heart of Pope Urban YII. 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 Lusi-
tanus, Par6, 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 trichinae. 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 exami-
nation 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 toler-
ate. In his " Comment on the Aphorisms of Hippocrates," Cardanus says
that he witnessed the excision of a portion of the pericardium with the subse-
quent cure of the patient. According to Galen, Marulus, the son of Mimo-
graphus, recovered after a similar operation. Galen also adds, that upon one
occasion he removed a portion of carious sternum and found the pericar-
dium in a putrid state, leaving a portion of the heart naked. It is said that
in the presence of Leucatel and several theologians, Franyois Botta optnied
the body of a man who died after an extended illness and found the pericar-
dium putrefied and a great portion of the heart destroyed, but the remaining
portion still slightly palpitating. In this connection Young mentions a pa-
tient of sixty-five who in January, 1860, injured his right thumb and lost
the last joint by swelling and necrosis. Chloroform was administered to ex-
cise a portion of the necrosed bone and death ensued. Postmortem examina-
tion 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 inter-

a 550, Ivi., 203. b 543, 1861, ii., 119. c 476, 1879. <i 273, 1868. e 150, Feb., 1895.

RUPTURE OF THE HEART.

625

costal ai-tery, upon which he operated. An incision eight inches h)ng was
made over the 4th rib, six inches of the rib were resected, the bleeding inter-
costal 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 Aslihurst, 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 veiy 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 re-
ported 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

a 218, 1871, 241. b Medic. Bemerk. und Untersuclmngen, L. ii., 103, et seq.

c "Med. Observ. and Queries," vol. vi. d Quoted 174, 388. e 476^1895 No 3738 987
40 , , . , .

626 SURGICAL ANOMALIES OF THORAX AND ABDOMEN

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 sphinc-
ters 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^ 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 digi-
talis. 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. Ac-
cording to Osier, Beverly Robinson describes a heart weighing 53 ounces,
and Dulles has reported one weighing 48 ounces. Among other modern rec-
ords are the following: Fifty and one-half ounces,^ 57 ounces, and one
weighing four pounds and six ounces.^ The Ephemerides ® contains an in-
credible account of a heart that weighed 14 pounds. FavelH describes a
heart that only weighed 3| ounces.

Wounds of the aorta are almost invariably fatal, although cases are re-
corded by Pelletan, Heil, Legouest, and others, in which patients survived
such wounds for from two months to several years. Green s 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, in-
durated coagulum. No attempt at union had been made.

Zillner ^ observed a penetrating wound of the aorta after which the patient

a 490, 1831. b 476, 1854, ii., 332 c 548, 1884, i., 150.

<i548, 1860, ii., 644. « 104, Dec. 3, Ann., ill., Obs., 166.

f 656, 1843, v., 358. e 744, 1855. h Wien. Med. Zeitung, Nov. 29, 1881.

WOUNDS OF THE BLOOD-VESSELS.

627

lived sixteen days, finally dying of pericarditis. Zillner attributed this cir-
cumstance to the small size of the wound, atheroma and degenc^ration of the
aorta and slight retraction of the inner coat, together with a possible plugging
of the pericardial opening. In 1880 Cliiari 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 oft' 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. HeiP 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
suftered 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 surgi-
cal 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

a 131, 1875, ii., 389. b 834, 1837-8. c 543, 1874, ii., 363.

do79, 1856, xi., 59. e 646, 1883.

628 SURGICAL ANOMALIES OF THORAX AND ABDOMEN

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 Avhich not
only the gullet, but also the diaphragm, was ruptured in vomiting. In this
countiy , Bailey ^ and Fitz ^ have recorded cases of rupture of the esophagus.
Brewer relates a parallel instance of rupture from vomiting. All the fore-
going cases were linear ruptures, but there is a unique case given by Boer-
haave 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,
lie was in perfect health. To relieve this disagreeable feeling he was in the
habit of taking a copious drauglit 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 liis 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 exist-
ing signs of disease the esophagus had been completely rent across in a trans-
verse direction.

Schmidtmuller ^ mentions separation of the esophagus from the stomach ;
and Flints 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 sepa-
rated 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 heniatemesis 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 diges-
tion that only the pyloric and cardiac orifices were visible. Hanford suggests
that this was an instance of antemortem digestion of the stomach which phys-
iologists claim is impossible.

a 524, 1788, iii., 308.
c 779, 1848, i., 151.
f 101, L. i., No. 6.

b Bull, de la Fac. de M6d. de Paris, 1812, 73.
d597. May, 1873. ^ 124, Jan., 1877.

g 526, 1848, 715. ^ 476, 1886, i., 546.

RUPTURE OF THE STOMACH.

629

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 overdistcntion. There was a tear two inches long, beginning
near the cardiac end and running parallel to the lesser curvature. The mar-
gin of the tear showed no evidence of digestion. There were obstructing
esophageal neoplasms about lOJ 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.
(Jollins 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 examina-
tion 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 pre-
sented no marks of disease. The cavity of the peritoneum was full of half-
digested food. The records of St. Bartholomew's Hospital, London, con-
tain 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

a 644, xviii., No. 3, 21. l> 538, 1878, 208. c 606, 1893. d 134^ I894. e 302, xlix.

630 SURGICAL ANOMALIES OF THORAX AND ABDOMEN

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, Avho, 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 stom-
ach and not mere perforation. In both cases, at the time of rupture, the
stomach was empty, and the gastric juice had digested oif 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 tlie 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, Bam-
berger 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 expeling its contents without
nausea. Mont^gre mentions a distinguished member of the Faculty of Paris,
who, by his own volition and without nausea or any violent eflbrts, could
vomit the contents of his stomach. In his translation of " Spallanzani's Ex-
periments 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 h(>althy, 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 mus-
cles 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 cloth-
ing were driven into the muscles and cavity of the chest. When first seen

a 435, Aug., 1885. ^ 302, iv., 188.

WOUNDS OF THE STOMACH.

631

by Dr. Beaumont about a half hour after the accident, a portion of he 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
anotlL 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 token for breakfast. His injuries
were dressed; extensive sloughing commenced, and the wound became con-
siderably enlarged. Portions of the lung, cartilages, ribs, and of the ensitorm
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^ inches in circumfer-
ence, 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 com-
press, the protruding coats acting as a valve when the stomach was filled.
This valvular protrusion was easily depressed by the finger. St. Martin suf-
fered 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 hira.

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 fistulse 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 upM^ard, 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 bein

a 704, 1893.

632 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

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 4tli rib on the right side, and penetrating the stomach to
the extent of two inches at a point about two inches below the xiphoid carti-
lage. 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, wound-
ing 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 gastrot-
omy, 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. Glandorpj^^o f^Q^^ whom, possi-
bly. 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 po-
sition 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 541, 1812. b 317, 1836, i, 81. « 847, 91.

SWORD-SWALLOWING.

633

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 Pans,
who, nine months after swallowing a knife, voided it at the groin. In the
sixteenth century Laurentius Joubcrt relates a similar case, the knife havnig
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 opera-
tion 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|^ 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 ex-
tracted 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, inches long, 1^
inches wide, and 9| 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 1 1 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| inches long. By means of an army-bullet forceps the knife was extracted
easily through an incision | 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 per-
formed for the removal of knives and other foreign bodies, from the seven-
teenth century to the present time.

The physiologic explanation of sword-swallowing is quite interest-
ing. 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 respira-

a 641, 218. b Quoted 362, 1880. c 821, Dec. 20 and 27, 1883. d 476, 1885, i., 249.

634 SURGICAL ANOMALIES OF THORAX AND ABDOMEN

tion. It therefore seems remarkable that there are people whose physiologic
construction is such that, without apparent difficulty, they are enabled ta
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 (Fig. 221) ; 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 diam-
eter of the stomach. According to Guyot-
Daub^s,^^^ 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 medi-
cine. 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 Avith 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, lavage 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.

Fig. 221. — Position occupied by
the blade in the body of a sword-
swallower (after Guyot-Daub6s).

KNIFE S WALL 0 WERS.

635

From time to time iHclividuals are seen who possess the power of swal-
lowing pebbles, knives, bits of broken glass, etc., and, in fact, there
have been recent tricky exhibitionists wlio claimed to be able to swallow
poisons, in large quantities, with impunity. Henrion, called " Cassandra,
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, demonstrat-
ing the fact by percussion on the epigastric region. AVith 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 suifocated 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| 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 swal-
lowed a razor and two knives in the presence of King Charles II. of Eng-
land, the King himself placing the articles into the man's mouth. In 1810
Babbington and Curry ^"^^ are accredited with citing the history of an Ameri-
can 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. Par6®^^ recalls the instance of a shepherd who
suffered distressing symptoms after gulping a knife six inches long. After-
ward the knife was abstracted from his groin. F abricius Hildanus cites a
somewhat similar case.

Early in the century there was a man known as the " Yankee knife-swal-
lovver," whose name was John Cummings, an American sailor, who had per-
formed his feats in nearly all the ports of the world. One of his chief per-
formances 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 dis-
credited 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

a 162, 1839. b 392, 1864.

636 SURGICAL ANOMALIES OF THORAX AND ABDOMEN

Journal for 1825 * there is an account of a juggler who swallowed a kuife
which remained in his stomach and caused such intense symptoms that gas-
trotomy 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-swal-
lower," 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 swal-
low a real bayonet sword, weighted with a cross-bar and two 18-pound dumb-
bells. 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 pos-
sibly the most interesting cases, although the least authentic, are those relat-
ing 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 Epheme-
rides 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. '^^^ A. 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 Yiridet,
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 per-
sons who have eaten scorpions and spiders with impunity. Planchon ^

a 641, 187. b 541, 1822, 78. c 452, T. Iv., 203.

FOREIGN BODIES IN THE ALIMENTARY CANAL. 637

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.^ Marcelliis Dona-
tus'' 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, put-
ting 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. Grandcliamp 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 f 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,j 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 elFects, 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 Agnevv ™ found a pair of suspenders, a mass of straw,
and three roller-bandages, an inch in width and diameter. Velpeau " mentions

a 462, T. li., 460. b 107, i., 22. c 306, ii., c. xii., 222. d 458, T. xxv. and xxvi.
e 548, 1878, i., 676. f 312, 1864, li., 407. g 476, 1859, ii., 337. t 318, Ixvi., 384.
i Quart. Jour. Calcutta Med. and Phys. Soc, 1837, i., 291. j 312, liv., 478.

k538, xxix., 93. 1 "Maladies desVoiesUriuaires." "1526,1853. n 476, 1849, ii., 41.

638 SURGWAL ANOMALIES OF THORAX AND ABDOMEN.

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-live,'^ 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| 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 ^ swallowed ten ounces
of screws and bits of crockery, all of which were passed by the anus. Board-
man ^ gives an account of a child affected with hernia who swallowed a nail
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 s 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 ^ose 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 col-
lar. 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 tak-
ing hold of it, he drew out a yard of chain with links one inch long, with a

a 476, 1887, i., 1109. ^ Neue Jahrbucher der deutschen Medizin mid Chirurgie, 1823.

c 593, 1853. d 629, 1700-20, v. e 476, 1866, i., 619. f 230, 1867.

g 224, 1870. ^476, ]852. i 548, 1859, ii., 273. J 476, 1872, ii., 837.

FOREIGN BODIES IN THE ALIMENTARY CANAL.

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 Buret 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^ ounces. On receiving a sentence of three years' imprison-
ment, 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 be-
ing captured by Barbary pirates, swallowed all the money he had on his per-
son. 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 move-
ments 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 rec-
tum 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. Billrotli ^ mentions an
instance of gastrotomy for the removal of swallowed artificial teeth, Avith
recovery ; and another case in which a successful esophagotomy was per-
formed. 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

a 462, T. xlii. ^ 490, May 20, 1837. c 476, 1882, i., 381.

<i 476, 1885, i., 591. e 253, March, 1881.

640 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

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 re-
ported 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 de-
tached 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 in-
ducing vomiting by irritating her fauces and pharynx with a Japanese tooth-
brush— 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 attend-
ing 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 anes-
thetized, 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 ;

a 224, 1890, i., 1367. ^ 510, 1884. « 640, June, 1854.

FOREIGN BODIES IN THE INTESTINES.

641

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 subse-
quent years he lived an active life of labor.

Occasionally an enormous mass of hair has been removed from the stom-
ach. A girl of twenty^ 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 com-
pletely 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 adja-
cent end of the colon, showing a dessertspoon which was impacted in the latter.
The spoon was seven inches long, and its bowl measured 1^ 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 ineffect-
ual 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 2i 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. Fillionf mentions an in-
stance of recovery following the perforation of the jejunum by a piece of horn
which had been swallowed. Maddens 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 puro-ative
effect. Rodenbaugh ^ mentions a most interesting case of beans sprouting
while in the bowel. Harrison * relates a curious case in which the swallowed

a 476, 1895, i., 1581.
^ 476, 1870, i., 701.
g 629, 1732.
41

b 541, 1807, iv., 367.
« 476, 1834.
^ 613, 1876.

c 311, 1830, v., 319.
f 462, T. Ixiii., 538.
i 476, 1883, i., 863.

642 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

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 tlie 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 attri-
buted 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 2i and the other 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. Pres-
cott^ 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 extraordinaiy ;
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 mor-
tal 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 bot-
tle 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 re-

a 368, 1834.

c "Proceedings Patholog. Soc. of Phila.," 1858, i., 170.
e 589, 1815, iv., 221. ^ 299, 1875, x., 30.

b 810, 185fi, vu., 266.
d218, 1860, Ixiii., 231.
g 681, 1875, xix., 109.

SLOUGHING OF THE INTESTINES.

643.

CO very . NicoUs " 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 abdo-
men. 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 re-
ported 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 mori-
bund 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. Vaters 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, j 14 inches; Daw-
son,^ 29 inches; Sheldon,' 4 J feet; Stanley,"" three feet; Tremaine,° 17
inches ; and Grossoli,° 40 cm.

a 312, 1854, xxxii., 214. b ui, xxxix.,157. c 629, 1755, xlix., part i., 238,.

<i545, 1881. e Trans. Amer. lust. Homeop., 1870, Chicago, 871. f 124, 1846.
g 629, 1719-33. ^ 124, 1863. i 548, 1853. j 149, 1803. tSl?' 1840.

1 546, 1850. ni 426, 1826. n 252, 1879. o 746^ 1875^

644 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

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 liistory of a case in which the colon
was completely separated from the rectum by external violence. Hinder ^ re-
ports the rupture of the duodenum by a violent kick. Eccles,«= Ely/ and
Pollock « also mention cases of rupture of the duodenum. Zimmerman/ At-
well/ 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 wliole 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 weak-
ened 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 re-
lief 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 sur-
geons entirely unjustifiable, as there is seldom hope of cure or prospect of
amelioration. La Tribune Medicale for January 1 6, 1895, J 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, present-
ing extensive carcinomatous infiltration on its posterior surface. After divi-
sion of the epiploon section was made at the pylorus and at the cardiac ex-
tremities ; 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

a 463, xi. to 435, 1866.

f 827, 1840, 603.
h476, 1878, ii., 332.

c 548, 1863. d 218, 1859. e 700, 1877.
g Indiana Jour, of Med., Indianapolis, 1875.
i 845, 705. j 843, 246.

FOREIGN BODIES IN THE RECTUM.

645

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 con-
fined with iodoforni-gauze packing. Unfortunately the patient sulfered 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 por-
tion of the rectum, was first i)ractised by Littre. In early times the mor-
tality 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 carcinoma-
tous 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 Maison-
neuve, 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, Stamra, Baracz,
and Dawburn, have modified the material of the plates used, substituting cat-
gut 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
H^vin.'^ 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 Marchcttis, who ingeniously adopted the simple procedure of tak-
ing 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

" ^1^- ' «45, 720. c Quoted 641, 353.

646 SVRGICAL ANOMALIES OF THORAX AND ABDOMEN.

foreign body was followed by the issue of stercoraceous matter which had
accumulated the six days it had remained in situ.

Tuifet^'^^is quoted as mentioning a farmer of forty-six who, in masturba-
tion, introduced a barley-hcad 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 Veau de la reine de
Hongric, 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 inflanuiiation 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| by 3|
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 pre-
serving pot. Montanari removed from the rectum of a man a mortar
pestle 30 cm. long, and Poulet^^i mentions a pederast who accidentally
killed himself by introducing a similar instrument, 55 cm. long, which per-
forated 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. Torapsett^ 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 circum-
ference, 21 in length, and If in diameter. The removal was followed by a
veritable flood of fecal material, and the man recovered. Lane e reports

a 218 1855. ^ 297, T. iii., 177. « 446, 1844. ^ 476, 1868.

e 365, 1868. ^ 476, 1869, i., 448. g 224, May 9, 1874.

FOREIGN BODIES IN THE RECTUM.

647

perforation of the rectum by the introduction of two large pieces of soap ;
there was coincident strangukited hernia. , i • ^

Hunter ^ mentions a native Indian, a resident of Coorla, who had intro-
duced 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 ot
the sphincter, by traction with the fingers and tooth-forceps, the horn was ex-
tracted. 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,^«2 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 gun-
barrel 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 to-
gether with thread, a piece of thread, and a piece of tallow, the latter presum-
ably 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 ad-
mission 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 con-
scious 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. Tlie 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.

a 777, 1860. ^ 548, 1861, ii., 564. c 548, 1863, ii., 599. ^ 425, 1878.

648 SURGICAL ANOMALIES OF THORAX AND ABDOMEN

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. Lan-
derer speaks of a curious case in which the absorptive power of the rectum
was utiHzed 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 introduc-
ing 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 funda-
ment 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
IS'ew South Wales, who had received a spear-wound in the epigastrium dur-
ing 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 tliat
the spear measured seven inches, and the interference of treatment, the ab-
dominal wound closed on the sixth day, and recovery was uninterrupted.
Oilkrist s 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 postmor-

a 579, 1880. ^ 176, 1886-87, iii., 547. c 156 ; aud quoted 224, 1882, i., 498.

d London, 1663, 264. e 548, March 30, 1861. f 476, 1891. g 476, 1832, ii., 147.

TRANSFIXION OF THE ABDOMEN.

649

tern examination was held some time afterward, the soUlicr 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 an-
other 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^ inches entered the body ot
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 ster-
num, 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 ex-
traction were made. On account of the displacement of the heart it was de-
cided 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 pro-
truded from the wound and was replaced. The boy made a slow and uninter-
rupted 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 cica-
trix 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 direc-
tion. 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 slid-
ing down a liay-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

a 548, 1871, ii., 392. ^579, 1874, xiv., 151. c Ibid

<i218, 1861, 80. e Trans. Belmont M. Soc, Bridgeport, Ohio, 1849-50, 55,

650 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

of the pelvic cavity to the depth of ten inches by a stick | 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 ab-
dominal 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 ex-
posed, 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 thor-
ough 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 por-
tions 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|
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 re-
moving 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 ex-
amined inch by inch for anv 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.

a 224, 1884, ii. , 20. b 847, 93. c 847, 95.

GUNSHOT WOUNDS OF THE ABDOMEN. 651

Rogers" mentions the case of a carpenter of thirty-six who was strnck
by a n.issile thrown by a circular saw, making a wound two inclies above the
umbilicus and to the left. Through the opening a mass ot mtestmes and a
portion of the liver, attached by a pedicle, protruded. A portion of the iver
was detached, and the liver, as well as the intestines, were replaced, an<l the

imin recovered. , ,i a

BaiUie,^ Bhadoory,*^ Barker, Ednuindson/^ Johnson,^ and others, record
instances of abdominal wonnds accompanied by extensive protrusion ot the
intestines, and recovery. Shah mentions an abdominal wound with protru-
sion 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, Lo-
ring ^' 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
5i 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 Rem-
ington 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 dis-
charge 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. Ducacshefj mentions two cases at the Georgetown Seminar}^ Hospital
durino- 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 re-
volver. Immediately after the accident he complained of constant and press-

a 269, 1875, 884.

d312, xxxvi., 209.

g 847, 55. h 847, 48.

h 435, 1866, i., 9. c 435, 1872, vii., 135.

e 536, 1867, iii., 225. f 435, ix., 297.

i Ibid. j 130, 1863, vii., 134. k 331^ 1856.

652 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

ing 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
deatli.

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,
Glandorp38o 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-in-
flicted by a lunatic. This man had 18 wounds, 14 having penetrated the
abdomen, the liver, colon, and the jejunum being injured ; by frequent bleed-
ing, 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,*^*5 Schenck, Cabrolius,245 the Ephemerides, and Nolleson <i mention
recovery after wounds of the liver. Salmuth'O^ and the Ephemerides
report questionable instances in which portions of the liver were ejected in
violent vomiting. Macpherson*' describes a wound of the Hver occurring in
a Hindoo of sixty who had been struck by a spear. A portion of the liver
was protruding, and a piece weighing \\ ounces was removed, complete re-
covery 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 recov-
ered. Ganns 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 harjjoon was seen protruding from be-
low 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

a 250, 1872-73, 112. b 548, 1866, i., 306. c M6m. de I'Acad. Roy. des Sciences 1705
d 462, T. xxii., 258. e 661, 1846. f 684, June 9, 1888. g 476, 1894, i., 1371.

*

WOUNDS OF THE LIVER. 653

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 lurtlier
in to disengage the barbs, after which it was easily removed. Recovery lol-
lowed, and the patient was discharged in twenty-one days.

Romme " discusses the subject of punctured wounds of the liver, as a spe-
cial text using the case of the late President Carnot. He says that in 54 J
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, ihe
principal symptoms of wounds of the liver, such as traumatic shock, col-
lapse, local and radiating pains, nausea, vomiting, and respiratory disturb-
ances were all present in the case of President Carnot. From an experi-
ence gained in the case of the President, Romme strongly recommends
exploratory celiotomy in all penetrating wounds of the liver. . Zeidler ^' re-
ports 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
tiie 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 re-
ported by surgeons of the United States Army.s 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| 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,

a La Tribune Mediciile, July 5, 1894. ^ 300, Sept. 13, 1894. e 476, i860, ii., 431.
d 536, 1878, 200. e 591, 1855. f 593, ix., 146. g 847, 49.

654 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

New Mexico, who recovered after a gunshot wound of the liver. Hassig re-
ports the case of a private of twenty-six who was wounded in a fray near
Paducah, Kentucky, by a conoid ball, which passed through tlie liver. The
ball M^as 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, penetrat-
ing 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 re-
moved the greater portion of the
left lobe of a woman of thirty.
The lobe had been extensively de-
formed 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, re-
cords a case of dislodgment of an
enlarged liv^er from tight lacing.
Terrilon ^ mentions an instance in
which a portion of the liver was
removed by ligature after celi-
otomy. 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 un-
a Quoted 536, 1890, ii., 263. ^ 843, 236.

OPERATIONS ON THE GALLBLADDER.

655

successfully attempted by wire ligature aud the thermocautery The growth
was cut away, bleeding was arrested by the thermocautery and by iron-solu-
tion, the wound entirely healed, and the patient recovered. Valerian von
Meister has proved thai the liver has marvelous powers of regeneration, and
that in rabbits, cats, and dogs, even three-fourths of the organ may be repro-
duced 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 (l^g.
222) exhibits a typical case verified by postmortem examiiiation.^'^^

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 hyper-
trophic 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 to-day it is a most suc-
cessful operation. Tait reports 54 cases with 52 perfect recoveries. Cho-
lyecystectomy, or excision of the gall-bladder, was first practised 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

a 843, 237. "Traite des Mai, Internes," T. ii. c 174^ 400.

656 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

taken from a woman of fortv-five who was admitted into the hospital with a
strangulated femoral hernia. The sac was opened and its contents were re-
turned. 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 througli the ring.«'«

The fatality of rupture of the spleen is quite high. Out of 83 cases
of injury to this orgxui collected by Elder, and qu<3ted by MacCormac, only
11 recovered; but the mortality is less in punctured or incised wounds
of this org-an, the same authorities mentioning 29 recoveries out of '35 cases.
In his Surgery " Gooch says that at the battle of Dettingcn 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 morn-
ing he was carried to the surgeons who ligated the large vessels, and extir-
pated 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 oif ; 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. Por-
tal 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 hus-
band'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 suc-
cessfully ; of 82 operations for disease, only 32 recovered. Vulpius has col-
lected 117 cases of splenectomy, with a death-rate of 50 per cent. If, how-

a 629, 1738. b 230, xii., 86. 39, T. v., 345. d 605, 1844, i., 104.

RUPTURE OF THE THORACIC DUCT

657

ever, from these cases we deduct those suffering with leukocythemia and
lardaceous spleen, in which the operation should not be performed, the mor-
tality 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. Conk-
lin'^ reports a successful case of splenectomy for malarial spleen, and m re-
viewing 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 hyper-
trophy, with three deaths ; 12 cases of malarial spleen, with three deaths ;
four cases of leukemia and pseudoleukemia, with two deaths. In his experi-
ments on rabbits it was proved by Tizzoni, and in his experiments on dogs,
by Cred6, that an individual could live without a spleen ; but these observa-
tions were only confirmatory of what had long been known, for, in 1867,
P6an 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,-^^ 3 J pounds ; Richardson,' 3|^ pounds ; and Hare, 93 ounces.

The thoracic duct, although so much protected by its anatomical posi-
tion, 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 re-
sult 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 effu-
sion into the right pleural cavity. On postmortem examination it was found

a 538, July 28, 1894. b 843, 252. c ibid,

d Quoted Amer. Med. Review, Dec, 1895. e 752, i., H4. f 282 1732 260.

g 524, vii., 46. ^ 528, vii, i 548, 1852, ii., 399. j 548, 1861, i., 289. k 845 454
42

658 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

that the effusion was chyle, the thoracic duct being torn just opposite the 9th
dorsal vertebra, which had been transversely fractured. In one of Kircli-
ner'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 ultnnately
recovered her health. In 1891 Eyer reported a case of rupture of the thora-
cic 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 pres-
ence of a lluid, 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. i •

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 m 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 tor
lieation of the abdominal aorta for inguinal aneurysm. It was farst
pLtised by Sir Astley Cooper in 1817, and has since been performed
sevei-al times with a uniformly fatal result, although Monteiro s patient sur-
vived 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 he 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 he
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 practised by Gibson of Philadelphia in 1812, is happily,
notTlways fatal. Of 82 cases collected by Ashhurst, 23 terminated suc-

""'toreign bodies loose In the abdominal cavity are sometimes voided at
stool, or mav suppurate externally. Fabricius Hildaiius- gives us ahistory
of a person wounded with a sword-thrust into the abdomen, the point break-

^ . b 810, 1853.

a 533, lxv.,1894, 491.

FRACTURE OF THE LOWER SPINE.

659

ing olF. 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 ab-
scess 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
p()c;ket. 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 supj^oscd, received a wound in the back by can-
ister shot while serving on a Tartar privateer in 1779. There was no ship-
surgeon on board, and in about a mouth 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 examina-
tion, and a cicatrix of this region was noticed, and an extraneous body about
\ 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
vertcl^ra. 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 not-
withstanding the lay-idea that a broken back means certain death, patients
with well-authenticated cases of vertebral fracture have recovered. War-
ren 8 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 fracliire of the 4th dorsal ver-
tebra 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 ecchyraosis about the neck and shoulder.
Although complicated with tertiary syphilis, the woman made a fair recovery,

a 550, 1855, 15. b 463, iii., 343. c 536, 1884, ii., 419.

<i Western Lancet, Cincinnati, 1848, e 218, 1850. f 550, 1817. g 520, 1882

660 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

and eight weeks later she walked into a doctor's office. Many siniikir 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 J^Iahanov, 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, l^lie report is as follows :— " He had been a laborer
in the mines, and while working was injured March 18, 1889, by a fill 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 com])lete
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° to 100° in the morning, and
from 101° to 103° 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 Avas put on light, nourishing diet, iron and strychnin were given
internallv, and electricity was applied to the lower extremities every other
day • the cvstitis 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 tempera-
ture being 99° or less each morning, and seldom as high as 100" at niglit.
The cvstitis 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. ^ i \ . ^\

" The cord was found to be compressed and greatly congested, but there
was no evidence of laceration. The laminse and spinous processes of the
8th and 9th dorsal vertebra 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

a 533, Nov. 24, 1894.

INJURIES TO THE SPINAL CORD.

661

to slightly move botli legs, and had full control of urination ; from this time
on his paralysis rapidly improved ; the battery was applied daily, with mas-
sage 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 etfort ; he carried a cane, but this seemed more from habit than
from necessity. At present date he weighs 150 pounds, and drives a hucks-
ter wagon for a living, showing very little loss of motion in his lower
extremities."

Although few cases show such wonderful improvement as this one, statis-
tics 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
percent.; 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 sur-
viving, 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 percent),
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.

Fords 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

a 224, No. 1747, 1894. b 124, July, 1891. c 162, 1890, ii., 673. d 150, June, 1894.
e 547, 1879, ix., 265. f 124, Ivi., 103. g 744, 1866, i., 286. h 533, 1874, ix., 423.

662 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

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 in-
guinal 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 ma jus
in the female. In this form of
hernia the size of the sac is
sometimes enormous, the ac-
companying illustration show-
ing extreme cases of both
scrotal and labial hernia
(Plate 7). Umbilical hernia
may be classed under three
heads : congenital, infantile,
and adult. Congenital um-
bilical 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 con-
tain not only the intestines, but
various other organs, such as the spleen, liver, etc. (Fig. 223). In some
monsters all the abdominal contents are contained in the herma. 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, m 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 herma did not
enlarge until after his service as a soldier in the late war.

a 224, 1874, i., 805.

Fig. 223.

-Congenital umbilical hernia. A, liver ; C, intestine ;
D, cord ; E, pedicle.

PLATE 7.

I

I

HERNIA.

665

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 liernia 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.

Pirn'' 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 ensi-
form cartilage to the symphysis pubis, which contained the omentum, liver
(left lobe), small intestines, and colon. It rested u])on the abdominal mus-
cles 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| inches,
witli a vertical diameter of 11 J 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 (Fig. 224). The pa-
tient 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| inches ; circumference at the ex-
tremity, 11 J inches; distance of extremity from abdominal wall, 12| 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 dis-
tance of ten feet. The tumor was soft and velvety to the touch, and could
only partially be reduced. Borborygmus could be easily heard. On per-
cussion 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

Fig. 224.— Prodigious umbilical hernia (Dade).

a 218, Ixv., 161.
c 476, 1878, 693.

b 703, xvii., 224.

d Louisville Med. Monthly, Feb., 1895.

666 SURGICAL ANOMALIES OF THORAX AND ABDOMEN.

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, m
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. AVallace ^ 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.

a 545, 1862, vii., 53. ^ 436, 1881, 340.

CHAPTER XIII.

SURGICAL ANOMALIES OF THE GEOTTO-
TJRmARY 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 tes-
ticle. Under expectant treatment the man recovered. Castellanos ^ mentions
a case of recovery from punctured wound of the kidney by a knife that pene-
trated 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. Dusen-
burye 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.

a Revue de M6d. de Militaire, Oct., 1875. b 779 p^ig jggQ 140.

c 149, 1799, 466. d 809, 1874, 281. e 124^ Oct.",' 1865,' 399.

667

668 SURGICAL ANOMALIES OF THE GENITOURINARY SYSTEM.

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 necro])sy 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 pa-
tient 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 kid-
ney. 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 loca-
tion 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 eigh-
teen 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 containhig little
secreting substance, which Avas 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

a 392, vii., 1861, 41. ^ 779, 1847, i., 293. « 224, 1871, ii., 292.

dSt. Bart. Hosp. Reports, London, 1866, ii., 124. « 174, 400.

WOUNDS OF THE URETER.

669

the histories of four eases, one of which ended in recovery after the evacua-
tion 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.
Tiie only well authenticated case in which the ureter alone was divided is
the historic injury of the Arclibishop 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
tmnsverse process of the 3d lumbar vertebra, and divided the cauda
e(piina 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 impos-
sible 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 Baehe Emmet.'^ Reed reports a
most interesting series in which he has successfully transplanted ureters
into the rectum.

Ureterovaginal fistulse 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
hi m 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

a 363, 1848. b Kansas City Medical Index, No. 5, 1894. c 843, 446.

d 150, 1892. e 538, Feb. 10, 1894. f 845,' 825.

670 SURGICAL ANOMALIES OF THE GENITOURINARY SYSTEM,

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 in-
stances the condition was associated Avith pyonephrosis. Watson has col-
lected 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 dis-
tended, as when empty it sinks behind the pubic arch and is thus protected
from external injury. The rupture usually occurs on the posterior wall, in-
volving the peritoneal coat and allowing extravasation of urine into the peri-
toneal 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 per-
formed for ruptured bladder, in a manner suggested by the elder Gross, the
mortality is much less. Ashhurst collected the repoi*ts of 28 cases thus
treated, ten of which recovered— a mortality of 64.2 per cent. Ashhurst re-
marks 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 uncompli-
cated rupture of the bladder. In neither case was a history of injury ob-
a 526, 1850, 692. b 476, 1870, ii., 252. c 476, 1887, i., 418. d 224, July 21, 1894.

WOUNDS OF THE BLADDER.

671

tainable. The first patient was a maniac ; the second had been intoxicated
previous to his admission to tlie 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 sup-
posedly mortally wounded on the field, but was eventually picked up, and be-
fore receiving any treatment hauled 164 miles, over mountainous roads in
the midst of winter and in a wagon without springs. His urine and excre-
tions 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, 11 inches above
the symphysis, the wound of exit being in the median line at the back, i 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

' 843, 951. b 124, 1869, n. s. Ixii., 281. c 579, 1867-68, 161.

d Virginia Clin. Rec, 1873-74, iii., 367. e 641 296

672 SURGICAL ANOMALIES OF THE GENITOURINARY SYSTEM.

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 ex-
tracted 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 w^ound, 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 sacro-
sciatic 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 ex-
tracting an arrow which had resisted all previous attempts, by placing tlic
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 horse-
back. 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 his-
tory 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

a 368, No. 49, 1872. b 538, 1872, vii., 518. c 548, 1879, i., 646. d 847, 260.

WOUND OF THE BLADDER THROUGH THE BUTTOCKS. 673

few paces, drove an arrow deep into his right buttock. The stick was with-
drawn by his companions, but the iron point remained m h.s body. He
passed bloody urine immediately after the injury, but the wound soon healed,
LkI 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 ^-amp to camp, over hundreds of miles every summer. A
long time after the injury he began to feel distress in micturating which
steadilv 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 Iving 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 circumstaiK;es it was apparent that the arrow-head had passed
through the glutei muscles and the obturator foramen 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| inches
long, by I 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 wiiich 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

43

674 SURGICAL ANOMALIES OF THE GENITOURINARY SYSTEM.

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 manv Indians died in that vicinitv." The calculus
was deposited in the Army Medical Museum at Washington, and is repre-

Fig. 225.— Calculus having an arrow-head for a nucleus (Sp. 5931, A. M. M., Wash., D. C.) (Forwood).

sented in the accompanying photograph (Fig. 225), showing a cross-section
of the calculus with the arrow-head in situ.

As quoted by Chelius,^^^ both Henncn and Cline relate cases in which men
have been shot tlirough 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.

FISTULA OF THE BLADDER.

675

McGiiire'^ mentions the case of a man of twenty-throe who was wounded
at the Battle of McDowell, May 8, 1862. Tlie ball struck him on the hori-
zontal 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 treat-
ment for four months. During the first month urine passed freely through
tlic 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 sound-
ing the man, it was found that he had stone ; this was removed by lateral
operation, and was found to weigh 2^ ounces, having for its nucleus a piece
of bone about | 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, Tulpias, 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 re-
covery 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 neigh-
boring or connecting intestine ; Frank, from cohesion and suppuration of the
rectum ; Marcellus Donatus,^ from penetrating ulcer of the rectum ; and
Petit,8 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

a 847, 248. b 847, 259. c 524, li., 200. d 367, 1788, No. 48.

e 249, ii., 16. f 306, L. iv., c. xxix., 524. g 625, T. ii., 94. h 476, 1859, i., 534.

676 SURGICAL ANOMALIES OF THE GENITOURINARY SYSTEM.

of the gUins 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''' men-
tions 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 J
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 com-
pletely overcame her after micturition. An ulceration of the neck of the blad-
der 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 possi-
bility 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 pres-
ence 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 Cha])ter XV.), generally gain entrance through one of the natural
passages, as a rule l)eing 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 uncom-
mon 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
ctilculus taken from the bladder of a man of thirty-five. It was afterward
elicited that the patient had practised urethral masturbation with the tail of
this animal. Morand relates the history of a man of sixty-two who intro-
duced a sprig of wheat into his urethra for a supposed therapeutic purpose.

a 687, 660. ^ 550, ii., 385. « 130, 1864, 78.

FOREIGN BODIES IN THE BLADDER.

677

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 intro-
duced a pencil into his urethra. The body rested fifteen days in this cana ,
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. Follow-
ing 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. Caudniont «
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| inches in length and | inch in diameter.

Among females, whose urethrse 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 correspond-
ing 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 grav-
itv, albuminous, alkaline, and exhaled a disagreeable odor. In spite of
the signs of pregnancy already noted, paljntation 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 (Fig. 226). 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

a 641, 562. b 242, 1876, 651. c 242, 1850, 354.

d 641, 572. e 632, 1879, i., 262. f 476, Jan. 24, 1874, 127.

678 SURGICAL ANOMALIES OF THE GENITOURINARY SYSTEM.

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. Ilod6 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 four-
teen who was first seen suifering with j)ain 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 neces-
sary 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 symp-
toms had disappeared, and the next day the patient urin-
ated 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 posi-
tion for sixteen and a half years ; at this time a piece of wood 7| inches

a 124, xxix., 57. ^ 641, 637. ^ 302, iv., 432.

d 629, 1700, iii., 164. e 476, 1860, ii., 461. ^ 218, 1883.

Fig. 226.— Handle of
a tooth-brush, removed
from the bladder of a
young girl.

FRACTURE OF THE PENIS. 679

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. Bar-
well 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 rup-
tured 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 men-
tions 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. Post-
mortem examination revealed the presence of a ruptured urethra.

Watson « relates an instance of coitus performed en postilion by a man
while drunk, with rupture of the urethra and fracture of the corpus spongi-
osum 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 urethra following trau-
matism, 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 pa-
tient 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. Yeazie relates a case of fracture of
the corpora cavernosa occurring in coitus. During the act the female sud-
denly withdrew, and the male, following, violently struck the pubes, with the
resultant injury. Recovery ensued. M'Clellan^ speaks of removing the

a 218, 1856. h 650, 1874, viii., 280. c 629, No. 4. d 313, 1857, xxiii., 375.
e 218, 1885, cxiii., 463. f Amer. Pract. & News, 1886, ii., 80.

g 593, 1884-85, xii., 321. h Smith's Med. Jour., 1827, 256.

680 SURGICAL ANOMALIES OF THE GENITOURINARY SYSTEM.

cavernous septum from a man of fifty-two, in whom this part had become
infiltrated witli 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 fistulie 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 =^^4 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 ''^o and Celliez men-
tion 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, un-
fortunately 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 tliat 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 in-
creasing 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 re-

a 1874-77, 90-92. b 224, 1869, i., 209. c 462, T. xx., 169.

d536, 1869, vii., 31. e Indian Med. Jour., 1886, v., 647. f 476, 1828.

WOUNDS OF THE PENIS. 681

covery there was a distinct increase of sexual desire and frequent nocturnal
emissions. In the same report there is recorded the history of a man wlio liad
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 o'f 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| inches beyond the glans; it then entered the scrotum, and
after striking the pelvis near the symphysis, glanced off around the innomi-
nate 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, draw-
ing in the external genital organs. The testicles were found to be unin jured,
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 Coopei-'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 in-
jured in a runaway accident, a wheel passing over his body close to the ab-
domen. 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

a 124, 1864. ^ Indian Med. Jour., 1886, v., 647.

«1 363, 1850, No. 86.

f "Handbook of Surgery," ii., 774.

c 476, 1866, i., 67.

e 703, 1876, 232, n. s., xiii.

g 476, 1886, ii., 250

682 SURGICAL ANOMALIES OF THE GENITOURINARY SYSTEM.

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 IvanholF, 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 ^ men-
tions 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 gan-
grene. 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, leav-
ing 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 Avife had miscarried, and at
the time of report she was daily expecting to be again confined.

Willetfj relates the instance of a horseman of thirty-three who, after

a 779, xvi., 792. b " Trait6 des Mai. Chirurg." c 363, 1853. ^ 260, Baud., viii., 1874.
e 260, 1891. f 160, ii., 364. g Rev. M6d. de la Suisse Romaude, 1888.

h736, ii., 53. i 313, xxxii. j Med. and Surg. Month., 1866, i., 102.

PROLONGED PRIAPISM.

683

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 eventu-
ally recovered.

Priapism is sometimes seen as a curious symptom of lesion of the spmal
cord. In such cases it is totally unconnected with any voluptuous sensation,
and is only found accompanied by motor paralysis. It may occur spontane-
ously 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 de-
prived of the regulating influence of the brain. Priapism may also develop
spontaneously at a later period, and is then due to central irritation from extra-
vasation 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 " castrata" 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

a 129, 1823. b 818, 1835, ii., 295.

684 SURGICAL ANOMALIES OF THE GENITOURINARY SYSTEM.

on the fifth day, at which time the patient became affected with a sahicious
appetite, and was rational upon every subject except that pertaining to ven-
ery. He grew worse on tlie 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 condi-
tion 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 ex-
perienced an unusually fierce desire, with intense erection of the penis which,
With pain, lasted throughout the night. Though coitus was frequently re-
sorted to, these symptoms continued. He sought aid at the London Hospital,
but the priapism was persistent, and when he left, on May 10th, the jDcnis
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° with the pubes, and this condition, he affirmed, lasted three
months. On his return to England his penis was flaccid, and his symptoms
had disap})eared.

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
th(^ theories of priapism, mentions eight cases previously reported, and
concludes, that such cases are attributable to leukemia. Kremine believes
tliat 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 per-
sons. 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 })art, 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 ner\-es them-
selves, or by pressure upon them by enlarged lumbar glands, an associate
condition of leukemia.

a 476, 1845, ii., 8. b 199^ No. 11, 1879.

INJUBTES OF THE TESTICLES.

685

Burchard'^ reports a most interesting case of prolonged priapism m 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 unniter-
ruptedly, during the whole of which time the organ was in a state of violent
and continuous spasm. The paroxysm was controlled by | grain morphin
and 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 vol-
uptuous emotions. In these there would rarely be any emission, but occa-
sionally 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 treat-
ment, 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 ap-
parent 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 accom-
panies 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 Cos-
siah 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 in-
different in gratifying her sexual desire. The woman became so enraged that

a 597, 1887, xlv., 66. »> 476, 1873, i., 90. c 470^ i887, i., 978.

d476, 1863, ii., 162. e 224, 1890, ii., 1411

686 SURGICAL ANOMALIES OF THE GENITOURINARY SYSTEM.

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 bv 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 examina-
tion it was found that the injury was accompanied with considerable hemor-
rhage. 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 eitlier 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 strij^ped of its in-
tegument. 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 ani, 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 testi-
cles, but otherw^ise 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| inches wide.
Recovery ensued, leaving a penis which measured, when flaccid, three inches
long and 1 J inches in diameter.

a 682, vii., 594. b 548, 1857, 260.

c 545, 1877, 207. d West. Lancet, Cincin., 1875-76, iv., 517.

AVULSION OF THE TESTICLES.

687

There is a case reported « of a man who had his testicles caught in ma-
chinery 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 in-
tegument of the penis were torn off, yet the patient recovered with preserva-
tion 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 tis-
sue, from 2i 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 mictu-
rition took place through the wound. After a tedious process the wound
healed and the man was discharged, but he returned in ten days with gonor-
rhea, 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 absorp-
tion of the testicle. According to Larrey, on the return of the French Army

a 760, 1886-87, iv., 300. b 264^ 1355, 154. c 224, 1885, 375.

d Quoted 224, 1881, i., 171. e 476, 1832, ii., 670.

688 SURGICAL ANOMALIES OF THE GENITOURINARY SYSTEM.

from the Egyptian expedition the soldiers complained of atrophy and disap-
pearance of the testicle, without any venereal aifection. 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 de-
prived 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 sol-
dier 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 at-
tempt at reduction was made, but the pain was so severe that mani})ulation
could not be endured. A warm bath and laudanum were ordered, but unfor-
tunately, 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 observa-
tion 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 tes-
ticle 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 Avith 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 535, Ixi. b 224, 1885, i., 536. c 812, No. 4, 1888, 75.

INJURIES OF THE VAGINA.

689

A somewhat similar case occurred in the Hotel-Dieii, 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. Guit^iras ^ 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 mus-
cular 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 weigh-
ing 40 « and 60 pounds.*" Larrey speaks of a sarcocele in the coverings
of the testicle which weighed 100 pounds. Mursinna^" describes a hy-
drocele 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 inflam-
mation 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, th(> first to be mentioned will be
a remarkable case reported by Curran.'' Tiie subject was an Irish girl of
tAventv. 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,

a 538, Jan. 4, 1896. h Casper's Wocheuschrift, Oct. 22, 1842.

c 334, cent, v., obs. xl. ^ 215, Ann. 2. e 106, 1725, 492.

f M6m. de la Acad, des Sciences de Paris, 1711, 30. g 701, 1886. h 536, 1837, i., 116.
44

690 SURGICAL ANOMALIES OF THE GENITOURINARY SYSTEM.

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 ani,
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, mid-
way 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 Avho,
while attempting to obtain water from a hogshead, fell with one limb inside
the cistern, striking a projecting stave three inches wide and | inch thick.
The external labia were divided, the left crus of the clitoris separated, the
nymphse 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 Avhich the intes-
tines, with clean-cut ends, protruded. Over feet of the intestines had
been cut olf in three pieces. The cuts were all clean and carefully separated
from the mesentery. The woman survived her injuries a whole week, finally

a 587, xix., 311. ^ Med. Annals, Albany, 1881, ii., 136.

c 218, 1883, cviii., 344. d 218, 1840, xxii., 71. e 475, 1873, i., 673.

INJURIES DURING COITUS.

691

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 in-
stance 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 abdom-
inal cavity, and grasped the uterus, trying to drag it out. Outside of obstet-
ric 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 pro-
fuse hemorrhage, estimated to be between three and four pounds, and proceed-
ing 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 Feb-
ruary, 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 reap-
peared 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

a 453, 1889-90. ^ 476, 1846, ii., 478. c 376, No. 22.

692 SUBGICAL ANOMALIES OF THE GENITOURINARY SYSTEM.

of the septum of a duplex vagina ; injuries following coitus after perineor-
rhaphy. In the last century Plazzoni reports a case of vaginal rupture
occurring during coitus. Green of Boston ; Mann of Buifalo ; Sinclair and
Miinro 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 result-
ing 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. Examina-
tion showed that the columns of the posterior wall were torn from their at-
tachment, 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 hemor-
rhage. In another case by the same author, coitus in a sitting posture pro-
duced 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 at-
tempt 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
]Mtient 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 pa-
tients 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
bv coitus soon after the menstrual flow had ceased and while the uterus and
ovaries were highly congested. In anotlier 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 Phila-
delphia 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

a St. Louis Med. Review, April, 1893. b 252, 1876. c 435^ 1873.

d 832, Bailed xix. e International Klin., Rundschau, 1890. f 545, 1876.

LONG RETENTION OE PESSARIES.

693

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 pessaiy which had formed

its nucleus completely rotted. A

similar instrument found by Gos-

selin had remained in the vagina

thirty-six years, and was incrus-

tated 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 accom-
panying illustration (Fig. 227) shows the phosphatic deposits and incrustations
around a pessary after a long sojourn in the vagina. The specimen is in the
Mus6e Dupuytren. 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

a 841, 613. b 490, 1854. c 363, 1846. d 612, 1851.

Fig. 227. — Pessary incrusted with pliosphates after loug
sojourn in the vagina (after Poulet).

694 SURGICAL ANOMALIES OF THE GENITOURINARY SYSTEM.

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 discom-
fort 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 monor-
rhagia 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 urethro-
vaginal 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 f inch long had never been noticed. Poulet quotes two curious
cases : ^ in one a pregnant woman was examined by a doctor who diagnosti-
cated 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
foimd 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 con-
tinuous 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 sur-
prised by some one entering her chamber at the moment she was introducing

a 437, 1882, iii., 83. b 771, 1888. c 789, March 4, 1848.

d 614, 1890. e 224, June 28, 1873. f 641, 621. g 550, xxix., 15.

FOREIGN BODIES IN THE UTERUS.

695

a cedar pencil into her vagina. With tlie purpose of covenng up her act and
disserabling the woman sat down, and the shank of the wood was pushed
through tlie posterior wall of the vagina into the peritoneal eavity. ihe in-
testine was, without doubt, pierced in two of its curves, which was demon-
strated later by an autopsy. A plastic exudation had evidently agglutinated
the intestine at the points of penetration, and prevented an immediate tatal
issue. Erichsen practised extraction eight months after the accident, aiid a
pencil 51 inches long, having a strong fecal odor, was brought out. The
patient died the fourth day after the operation, from peritonitis, and an au-
topsy showed the perforation and agglutination of the two intestinal curva-
tures. 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 Dupuytren, 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 accident-
ally in vaginal applications, or for the purpose of producing abortion.
Zuhmeister'-o describes a case of a woman who shortly after the first mani-
festations 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 m 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 mate-
rial. Meschede of Schwctz, Germany, mentions death from a hair-pin in
the uterine cavity.

Crouzit was called to see a young girl who had attempted criminal abor-
tion 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

a 547, 1873, iii., 635. b 641, 628. c 162, 1823, T. iii.

696 SURGICAL ANOMALIES OF THE GENITOVRINARY SYSTEM.

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 A^TOMALIES.

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 con-
valescence he recovered. In the brutal capture of Fort Griswold, Connecticut,
in 1781, in which the brave occupants were massacred by the British, Lieu-
tenant 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 d la Ute de cire.'' The Lan-
cet gives his history briefly as follows : During the Franco-Prussian War, he
was liorribly 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 func-
tions 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 sim-
ply 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

a 534, 1779, v., 188.

697

698

MISCELLANEOUS SURGICAL ANOMALIES.

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 pamph-
let 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 sulfering numerous and almost in-
credible 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 fore-
arm at the middle third. Soon afterward at AVilliamsburg, Ya., 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, be-
hind 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 re-
volver on reception of this shot, and was soon bayonetted by his own com-
rades by mistake, this wound also penetrating the body. He showed a de-
pressed 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 dis-
ability 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.

a 538, 1875, i., 688.

MARVELOUS RECOVERIES.

699

(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 tlurd.

(4) A sword-cut across the spinal muscles covering the lower dorsal
vertebne.

(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 fore-
finger 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 oif 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 Avere 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 suttered
a gunshot wound of the skull, causing com})ound fracture of the cranium,
and who also received compound fractures of both bones of the leg. He did
not present himself for treatment vuitil 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 recovertni.

Recovery After Injuries by Machinery, with Multiple Fractures,
etc. — Persons accidentally caught in some portions of powerful machinery

a 597, 1866, 219.

MISCELLANEOUS SURGICAL ANOMALIES.

usually suffer several major injuries, any one of wliicli 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 maxi-
mum 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 IJ to two ounces of cerebral sub-
stance 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 dessertspoon, 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 frac-
tured 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 frac-
ture 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 trephmed, and the
comminuted fragments removed ; in about six weeks recovery was nearly com-
plete. Gibson reports the histor}^ 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 imme-
diate attention could be given to her injuries, which were found to be as fol-
lows : —

(1) An oblique fracture of the middle third of the right femur.

a Richmond Med. Jour., 1868. b 124, 1869. c 218, 1881, 61.

MULTIPLE FRACTURES.

701

(2) A transverse fracture of the middle third of the left femur.

(3) A slightly commiuuted 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 con-
tusions and abrasions all over the body.

During convalescence the little patient suffered an attack of measles, but

111

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 shoiixuiing.

Hulke ^ describes a silver-polisher of thirty-six who, while standing near
a machine, had his sleeve cauglit 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 Avheel had made 50 revolutions before
the machinery was stopped. After his removal it was found tliat 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 insen-
sible. 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 sus-
tained a fracture of the left humerus near the insertion of the deltoid, a frac-
ture 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 consider-
able 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 ban-
dages 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

a 767, 1878. b 124, 1854. c Atlanta Acad, of Med., 1874.

702

MISCELLANEOUS SURGICAL ANOMALIES.

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-siiwyer was run over by 20 or 30 logs, which produced innu-
merable 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, bv mus-
cular 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.

Yinnedge 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 s 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;^ 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

a 476, 1879. b 672, Sept. 30, 1868.

d 312, xlvi., 337. e 476, 1873, ii., 264.

g 218, 1881, 275. h 548, 1879, i., 702.

j Bull. Soc. de M6d. de Poitiers, 1854, 305.

c Toledo Med. and Surg. Jour., 1880.
f 476, 1861, ii., 229.
i 548, 1879, ii., 64.
k 218, cii., 35.

REMARKABLE FALLS.

703

of an individual who suffered fracture of both thighs, and compound com-
minuted 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 resuhed in 31 frac-
tures.

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. Keumeaux in the Bulletin de 1' In-
dustrie Minerale. Working with his brother in a gallery wdiich 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 lie 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^ at-
tempted to escape from the castle at Edinburgh. He fell almost perpendicu-
larly 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*^ men-
tions a man who fell from the dome of the Invalides in Paris, without sus-
taining 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 wdiere it w^as
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 w^as
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

a Quoted 124, 1833. ^ 124, 1837. c 312, 1850.

d 363, 1841. e 354, 1846, ii. f 302,' iv., 248.

704

MISCELLANEOUS SURGICAL ANOMALIES.

entertained. His friends were told of liis apparently hopeless condition.
There were no external signs of the injury with the exception of the emphy-
sema following rupture of the lung. Respiration was limited and thoracic
movement diminished by adhesive straps and a binder ; under careful treat-
ment 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
7 1 feet to a gmnite 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. Par rott ^ 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 scaifold pole in two, and fell through the wooden roof of an engine-house
below, breaking several planks and two strong joists, and landing U2)on 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 carj)al 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 supe-
rior angle of the occipital bone were removed, leaving the dura exposed for a
space one by four inches. The man was unconscious for four days, but en-
tirely recovered in eighteen days, with only a slightly subnormal hearing as
an after-effect of his fall.

For many vears 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 Odium
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 rejiorted that on June 20, 1896, a youth of nineteen made a head-
long 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 1 895. A part of the regular
nightly performance at this Hall, which is familiar on account of its immens-

a 476, 1880, i., 486. l> 224, 1886, ii., 451. ^ Laucet-Clinic, Feb. 22, 1896.

VITALITY IN CHILDREN.

705

ity, 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 com-
ing to the surface. In the same performance a female acrobat made a back-
ward 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 foil.'*

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, sim-
ply 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 oif a man's
cap, and broke its way through a four-inch plank. Again, another spanner
fell from a great height, actually tearing olf a man's clothes, from his waist-
coat to his ankle, but leaving him uninjured. On another occasion a stag-
ing 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. — [t is a remarkable foct that young
children, whose bones, cartilages, and tissues are remarkably elastic, are some-
times 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 fointness, 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

a 476, 1889, ii., 466. b Sept., 1888. c 476, 1829, 652.

45

706

MISCELLANEOUS SURGICAL ANOMALIES.

provoke a fatal issue, and were given in good faith as the means of effecting a
recovery in such a case. In a similar instance ^ a wagon weighing 1 200
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 some-
times surviving extreme exposure and major injuries. There was a remark-
able instance of this kind brought to light in the Mullings vs. Mullings di-
vorce-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. Tul-
loch to meet her at Paddington, Avhere 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. TuUoch, 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, aban-
doned 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 men-
tion 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 218, 1847. b 476, 1874, ii., 169. c 792, Feb., 1895. d224, 1884, i., 234.

REPEATED OPERATIONS.

707

a child of four ; Knowslcy Thornton, on a child of seven, and Spencer Wells,
Gupples, and Clienoweth, 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 i)erformed 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 s records a simi-
lar instance. Borsini and Terrier * cite instances of successful ovariotomy
in patients of seventy-seven. Carmichael j 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 ; McN utt " 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 p speaks of an operation for pilous dermoid
of the ovary in a woman of seventy-five. Shepherd ^ reports a case of recur-
rent 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 in-
tention, 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 opera-
tion the woman had had remarkably good health, and there was every indi-
cation 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.

a 610, 1880, 241. b 125, 1886, 1022. c 318, 1883-84, 1132.

d Proc. Dublin Obst. Soc, 1879-80, 16. e 476, 1871, ii., 850. f 130, 1861.

g 223, 1887. h688, 1881. i 653, 1888. j 590, 1883. k 223, 1889. 1 538^ 1888.
m548, 1864, i., 560. n West. Lancet, San Francisco, 1879-80, viii., 485.

o 653, 1888, vii., 466. P 363, xlvi., 1065. q 476, 1886, i., 1162. r 779^ x., 189.
8 490, Dec. 9, 1842. * 224, 1884, i., 555. u 351, 1889. v 708, 1718, 1985.

708 MISCELLANEOUS SURGICAL ANOMALIES.

Before leaving this subject, we mention a marvelous operation per-
formed by Billroth on a married woman of twenty-nine, after her sixth
pregnancy. This noted operator performed, synchronously, double ovari-
otomy and resections of portions of the bladder and ileum, for a large medul-
lary 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 Avith lint dipped in an emollient solution, and, being per-
fectly 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 suf-
ferer. A Dutch blacksmith and a German cooper each performed lithotomy
on themselves for the intense pain caused by a stone in the bladder. Tul-
pius,*^2 Walther,^^'^ and the Ephemerides each report an instance of self-per-
formed cystotomy.

The following case is probably the only instance in Avhich 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 asstride an iron bar. A permanent perineal
fistula was established, but the patient was averse to any ojierative 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 at-
tempted 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|^ ounces, and was lOf 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

a Wiener Med. Wochenscbrift, Nos. ii. and iii., 1883. b 391, 1889, i., 408.

EXTENSIVE LOSS OE BLOOD.

709

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 tlie
Edinburgh Iiitirniary with resultant great relief. After returning home to the
country he experienced considerable pain, and despite his vigorous efforts lie
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 (page 131), 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
inabilitv to secure surp ical assistance or from the incapacity to endure the pain
any longer. Tliese 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 chroni-
cles 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 wav in which venesection was resorted to, led to its disuse, until
to-dav it has so vanished from medical practice that even its benefits are
overlooked, and depletion is brought about in some other manner. Turn-
ing 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 re-
moval 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 pro-
duced a successful issue by extracting one gallon of blood from his patient
during twelve hours. Lucas speaks of 50 venesections being practised
during one pregnancy. Van der Wiel " performed venesection 49 times dur-
ing 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 1 020 repeated venesections.*^

The loss of blood through spontaneous hemorrhage is sometimes re-
markable. 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.
Ilorstius, Fabricius Hildanus, and Schenck, all record instances of death from

« 381, 1889, i., 408. ^ American Med. Repository. c 476^ 1827, 718.

'1 Med. Obs. & Inquiries. e Cent, i., obs. 65. f 462, T. Ixxi., 233. g 462, T. xv.
•>Samml. Med. Wahrnehni, Band 6, 408. i 334, cent, vi., obs. 13. j 470, 1683.

710

MISCELLANEOUS SURGICAL ANOMALIES

hemorrhage of the gums. Tulpius speaks of hemoptysis lasting chronic-
ally 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 in-
testinal 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 enlarge-
ment 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 Pana-
roli, 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 larpug, medicus,
was derived from i6q, 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. Diodes, invented a complicated
instrument for extracting foreign bodies, called graphiscos, which consisted of
a c^nula 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 re-
move firmly-impacted arrows. Albucasius ^^'^ and others of the Arabian
school did little or nothing toward aiding our knowledge of the means of

a "Eruptive Fevers." I' 847, 144.

c Advers. Math., L. I., cap. ii. d 259, L. vii., cap. v.

ARROW-WOUNDS.

711

extmcting 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 Par^'-' delineating the treatmentof 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, remark-
ing 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 inoc^ulated 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. Arnotf^
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 Brit-
ish 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 pa-
tients perished. There were two remarkable instances of recovery after pene-
tration 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

a 618, 445, et seq. ^ 124, xliv., 365 and 439, ii. c 318, 1864, x., 123.

d 777, 1855, ii., 314. e 847, 144.

1

712

MISCELLANEOUS SURGICAL ANOMALIES.

has been estimated that the initial veloeity 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 sur-
face 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 ex-
foliation of the humerus. The patient was treated with simple dressings, and
was returned to dutv in Julv, 1870.

Goddard mentions an arrow- wound by which the body was transfixed.
The patient was a sutler'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 produc-
tive of pleurisy but which was followed by recovery. Kugler ^ recites the
description of the case of an arrow- wound of the thorax, complicated by fright-
M. dyspnea and blood in the pleural cavity and in the bronchi, with recovery.

Smart extracted a hoop-iron arrow-head, If inches long and i 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 | inch around the track of the
arrow as a center, was soflened 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 in\vard
a 847, 156. b 847, 153. c 847, 151. d Ibid. e 847, 147. f 847, 145.

SERIOUS INSECT-STINOS.

713

and upward through the upper lobe of the riglit lung or trachea.^ Tlie hem-
orrhage at this time was so great that all h()i)e was abandoned. The patient,
however, rallied, but eontinued to experienee great pain on swallowing, and
occasionally spat blood. In July, 1866, more than tiiree years after the in-
jury, he called on Dr. Peabody to undergo an examination witli a view of
applying for a pension, stating that his healtii was affected from the presence
of an arrow-head. He was nuich 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 IJ inches below, the head lying against the trachea and eso-
phagus, 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, centi-
pedes, tarantulas, 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 prob-
ably 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 vio-
lent symptoms simulating spinal meningitis, but ultimately recovered. Kunst ^
mentions a man of thirty-six who received several bee-stings while tidving
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 swal-
lowed the insect. He was stung in the throat, followed by such intense in-
flammation 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 men-
tioned an English agriculturist who saved the life of one of his friends who
had inadvertently swallowed a wasp with a glass of beer. Alarming symp-
toms 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

a 124, 1839, 69. b 545, 1878, 130. c 302, i.

714

MISCELLANEOUS SURGICAL ANOMALIES.

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 dis-
tance 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 tliird 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 case 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. Notwith-
standing 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 ^ men-
tions 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 dis-
coloration 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, depriv-
ing 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

a 124, 1836-37, xix., 265. b ibid. c 462, 1765. d Gaz. de Sant6, 1776.

e 594, 1857, 3 s., ii., 339. <" 224, 1869, i., 374. g 535, 1819, xl., 479.

SNAKE-BITES.

715

rapidly disappeared under the use of mercury. The only interest about the
case was the question as to how the disease had been aajuired. The doctor
was evidently anxious to give all the information in his power, but was posi-
tive 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 wdl-
ingly stripped, and a careful examinatiim 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
stilted, 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 scratch-
ing 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 flea-
bite 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 asser-
tion 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 typ-
ical of animal poisons, being unrivaled in the fatality and rapidity of its ac-
tion. 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

716

MISCELLANEOUS SURGICAL ANOMALIES

is the Caudisona, or ground-rattlesnake ; the third is the Ancistrodon, or moc-
casin, 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| 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 conmion 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. Con-
trary 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 cir-
culation. 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 poi-
soning, 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 be-
comes prostrated immediately after the infliction of the wound, and his con-
dition 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 swell-
ing may spread to the neck, chest and back. Loss of speech after snake-bite
is discussed in Chapter XVIL, under the head of Aphasia.

A peculiar complication is a distressing inflammation of the mouth of in-
dividuals that have sucked the wounds containing venom. This custom is

CASES OF SNAKE-BITE.

in

still quite common, and is preferred by tlie 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 J ustice 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 foimd, 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 inflamma-
tion, and resulted in the destruction of the joint. Three years afterward the
joint swelled and became extremely painful, and it was necessary to ampu-
tate 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 pri-

a Repert. di Medicina, Torino, 1828. b 543^ igse, ii., 597.

c 847, 164. dibid. e ibid.

718

MISCELLANEOUS SURGICAL ANOMALIES.

vate, aged thirty-seven, remarkable for the singularity of his conduct, was
known in his Company as a snake-charmer, as he had many times, Mdthout
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 prov-
ing 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, com-
plaining 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 | inch
in diameter was discovered, imbedded in the soft tissues of the penis, con-
stricting 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 disar-
ticulated at the metacarpal articulation. Anesthesia was readily obtained,
but the appearance of the second stage was hardly perceptible. Le Carpen-
tier 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

HYDROPHOBIA.

719

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 kid-
neys 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 ob-
served in herbivorous animals, such as the ox, cow, or sheep, but is most com-
monly found in the carnivora, 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,56o ^olff,'^ Zacutus Lusitanus,^^! and Glandorp.^so Xhe Ephe-
merides 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 ani-
mal'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 Eobert 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 sup-
posed to swell and die. If the dog was not mad the cock would not sw^ell ;

a 481, 1872, vi., 119. ^ 462, T. ii., 90. c Diss, de Epilep., 15.

d Observ. deMed. Chirurg., ii., No. 5. e 224, 1872, i., 313. f 433, 1834, i., 202.

i

720

MISCELLANEOUS SURGICAL ANOMALIES.

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 rela-
tive 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 practised sucking tlie 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
melanciiolia, insomnia, loss of appetite, and occasionally shooting pains, radia-
ting 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 dis-
comfort 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 Avorked,
and his head shook. He finally almost tossed the water into his mouth, los-
ing the greater part of it, and staggered about the room gasping and groan-
ing. At this moment the respirations seemed wholly costal, and were per-
formed with great effort, the elbows being jerked upward with every inspira-
tion. 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 at-
tenuated in passing it through different species of animals, and also that
inoculation of this attenuated virus had a decided prophylactic effect on the

a 536, 1879, xxviii., 576.

SHARK-BITES.

721

disease ; hence, by cutting the spinal cord of inoculated animals into fragments
a few centimeters long, and drying them, an enudsion could be made con-
taining 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 viru-
l(Mi('e of saliva during fasting.

There is much discussion over the extent of injury a shark-bite can pro-
duce. 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 ciy out, felt a horrid crunch and was dragged be-
low 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 M^ere 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 re-
covery from extensive lacerated wounds from the bite of a shark. Both arms
were amputated as a consequence of the injuries. Eayrer^ mentions shark-
bites in the Plooghley.

Leprosy from a Fish-bite. — Ashmead « records the curious case of a

a 476, 1883, i., 1 160. b 550, ix. c 490, 1828-29, iii., 502.

•1 548, 1871, i. , 5. e 450, March 16, 1895.

46

722

MISCELLANEOUS SURGICAL ANOMALIES.

man that had Uved 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 ?

Cutliife records recovery after amputation at the elbow-joint, as a conse-
quence of an alligator-bite nine days before admission to the hospital. The
patient exhibited a compound connninuted 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 fore-
arm, 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, Avith its
diverse range of injuries, is of considerable interest, and, though not uncom-
mon, 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 eifect 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 ^vhich there has been complete
and rapid recovery from lightning-stroke. Crawford g mentions a woman
who, wliile 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

•a 435, 1870, v., 36.

c Customs Gaz. Med. Rep., Shangliai, 1874, iv., 12.
e 548, 1869, i., 5. f 594, 1844, iii.

I' 435, 1877, xii., 245.
d548, XV., 351.
g 579, 1870, 12.

I

LIQHTNING-STROKE. 723

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 tlie
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 palmar surface the hand lying on the abdomen was completely de-
nuded. 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 unplastcred
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
reachino- which it wound around the inner side of the leg. About four
inches below the knee a sound strip of cuticle, about 1| 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 sub-
sequently 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 strip-
ped off by lightning. In one case mentioned by Sir J ames Paget, the clothes

a 124, 1869. b 476, 1879, ii., 656.

!

724 MISCELLANEOUS SURGICAL ANOMALIES.

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 of-
fered 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 Eomney 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

a 224, 1890, i., 514.

LIGHTNING-STROKE.

725

of the affiiir, 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 tlie hospital he seemed very deaf and stupid.
He was discharged perfectly cured twenty weeks after the occurrence, ihe
scientific explanation of this amazing escape from tliis most eccentric vagary
of the electric fluid is given,-the fact that the wet condition of the man s
clothiiur increased its power of conduction, and in this way saved his lite, it
is said'that the electric current passed down the side of Orman's body, caus-
i„.r 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. ^^^a

There was a curious case of lightning-stroke reported at Cole Harbor,
Halitax. 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 conmiunicating 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.— Mac-
Donakl** 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
witli 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 heraianesthetic on the left side. She fully re-
covered 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.

a 655, 1886, 348. b Soc. MM. des H8p., Paris, May 25, 1894.

726

MISCELLANEOUS SURGICAL ANOMALIES.

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 pamlysis of the optic nerve. According to BuUer
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.
BuUer 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 atfection 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 specta-
cles, and had immediately afterward experienced a piercing sensation which

a 535, 1822, 369. b 548, 1869, i., 363. c 550, 1825.

d 594, 1844, 308. e 476, 1888, ii., 178.

LIOHTNING-STR ORE.

727

had passed through the eye to the back of the liead. The pain was brief,
and he was then able to see objects distinctly. From this occasion he stead-
ily 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 suffermg
from a progressive emaciation and feebleness akin to chlorosis. The diffi-
culty had probablv 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 Strieker 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-photo-
graphs of neighboring objects on the skin has probably arisen from the
resemblance of the burns due to the ramifications of the blood-vessels as con-
ductors, or to peculiar electric movements which can be demonstrated by
positive charges on lycopodium powder.

A Hghtning-stroke docs 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 installa-
tion 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
a 161, xxii. ^ 139, T. xii. c 126, 1830.

728

MISCELLANEOUS SURGICAL ANOMALIES.

— even as fur 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 Avas possible to re-
unite a resected nose or an amputated finger, and in Huntei-'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. AVolfer has been success-
ful 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 oph-
thalmia, and von Hippel has devised a special method of doing this. Ke-
cently 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 M^orthy 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 replace-
ment 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 im-
planted 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 daugh-
ter of two, who fell on the cellar stairs, completely excising the central incis-
ors. 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 in-
duced in sleep ; the gums were cleaned antiseptieally, and 3^ 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

a 838, Nov., 1894. b 227, 1889, viii., 65. c 632, Jan., 1896.

SKIN-GRAFTING.

729

eKperiraents Gl.ick and Magnus prove that there is a return of activity after
transplantation of muscle. After excision of malignant tumors of mus-
cles 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 mus-
cles 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
practised, and Gersung has transplanted the nerves of lower animals to the

nerve stumps of man.

Bone-grafting is quite frequently practised, portions from a recently am-
putated 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
nnsevered 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 fol-
lowed by the grafting of periosteal and osseous material taken from a dog.
Robson and Hayes of Rochester, N. Y., have successfully supplemented ex-
cision 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 gan-
grenous 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 witii 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

a 269, 1888. b 538, March 10, 1888. c Aunals of Surgery, St. Louis, 1890.

730

MISCELLANEOUS SURGICAL ANOMALIES.

fatlier 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 them-
selves 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 ex-
tensive 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, Al-
tramirano, used the gills of a cock.

Fowler of St. Louis ^ has grafted with the skin from the back and abdo-
men 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 man-
ner 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 granu-
lating 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 with-
out 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° F., grafts could be successfully
applied, but in such temperatures as 82° F., exposure of from six to seven
hours destroyed their vitality, so that if kept cool, the limb of a healthy

a 476, March 6, 1890. b Annals of Surgery, St. Louis, 1889. c 538, 1879, xiv.
d 773, 1890. e 548, I860, i., 282. f 199, 1888. S 224, 1889, ii., 1331.

SELF-MUTILA TION.

731

individual amputated for some accident, may be utilized for grafting pur-

poses.

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 elfected by Reverdm's method.
Thiersch contends that

healing of a granulated
surface results first from
a conversion of the soft,
vascular granulation-pa-
pillse, by contraction of
some of their elements
into young connective-
tissue cells, into "dry,
cicatricial papillie," actu-
ally approximating the
surrounding tissues, thus
the area to

diminishing

Fig. 228.— Extensive burn of the thigh, with skin-graft -early stage

(Harte).

be covered bv 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 gran-
ulations 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-g-rafts.

Fig 229.— Extensive burn of the thigh, with skiu-graft,— late stage. ^

Cases of seli-mutila-

tion may be divided into three classes : — those in which the injuries are
inflicted in a moment of temporary insanity from hallucinations or melan-
cholia ; 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
a 792, Nov., 1892. b 535, 1885, i., 211.

732

MISCELLANEOUS SURGICAL ANOMALIES

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 {^nimals
have been noticed by naturalists to mutilate themselves.

Self-mutilation in man is almost invariably the result of meditation
over the generative function, and tlie 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 whicli 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-castra-
tion. 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 eigh-
teen. 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 hospitiil. 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 dulncss, 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

a 730, 525. b 453, T. xvii., 404. c 524, ii.. No. 7. d 528, vii., No. 6.

e 462, T. ix. f Ibid. g 462, T. viii. h 491, 1881, 253. i 548, 1854, ii., 94.

SELF- CASTRATION.

733

first attempt at self-nuitilatioii ten days later. He was placed in an Asylum
at Astino where, though closely watched, he took advantage of the first op-
portunity and cut ott' two-thirds of his penis, when the delirium subsided.
Camp ^ describes a stout German of thirty-five who, while suffering from de-
lirium 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 con-
tracted syphilis, and convinced, no doubt, diat " nocit empta dolore volup-
tus," he had taken effective means of avoiding injury in the future by com-
pletely 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 hai)py consummation.
Che vers ^"^^ 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
too-ether 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 hos-
pital. Alexeef,*^ another Russian, speaks of a similar injury occurring dur-
ing an attack of delirium tremens.

a 593, 1852. b 435, xii. c 127, 1871. d 697, 1887, 93, No. 5. e 556, 1882, No. 22.

734

MISCELLANEOUS SURGICAL ANOMALIES.

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 prac-
ticed self-abuse for two years and ascribed his emissions to this cause. Al-
though 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 unmar-
ried 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 Avho 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 oif 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 in-
temperance, 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.

a 536, 1889, ii, 32. b 224, 1882, i., 105. c 224, 1882, i., 72.

d 476, 1882, i., 118. e 124, 1847, 265. f 178, Jan., 1886.

"NEEDLE- GIRLS."

735

There is on record « the history of an insane medical student in Dubhn
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 par-
ticularly that relating to enucleation. Another Dublin case quoted by the
same authority was that of a young girl who, upon being arrested and com-
mitted 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 im-
pressed 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.

Channingd gives an account of the case of Helen Miller, a German Jew-
ess of thirty, who was admitted to the Asylum for Insane Criminals at Au-
burn, 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 inflam-
mation, culminating in edema, which affected the glottis to such an extent
that tracheotomy was performed to save her life. Five weeks after convales-
cence, 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 re-
peated 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

a 536, 1888, ii., 260. b 476, 1851. c Quoted 465, Jnly, 1875.

d 123. xxxiv., 368. e Journal des Debats, 1823.

I

736

MISCELLANEOUS SURGICAL ANOMALIES

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, suc-
ceeding in committing suicide by introducing about 30 pins and needles in the
chest region, over tlie heart. Her method was to gently introduce tliem, and
then to press them deeper with a prayer-book. An autopsy sliowed 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 cava 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.s The Pliilosophical 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 okl 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 after-
ward from the knee. Borel 1 us gives an account of a thorn entering the
digit and passing out of the body by the anus.

a 44n, 1853. b 476^ 18(53^ ji.^ 524. c 123, July, 1872. ^ 476, 1887, i., 230.

e 47fi. 18.-,o. f 398, i.,586. g 398, i., 371. h DetroitMed. Jour., 1887, i., 895.

MANUFACTURE OF CRIPPLED BEGGARS.

737

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, vol-
untary mutilation is sometimes practised by those who prefer begging to toil-
ing. 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 thor-
oughly 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 car-
riage 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 per-
formed 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 be-

a 381, 1829, ii., 21. b 176, 1872, 218. c 313, 1856, 473. d 224, 1882, i.,397.
47

738

MISCELLANEOUS SURGICAL ANOMALIES

numbing 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 Avomen are. Figure
I. of the accompanying plate (Plate 8), taken from a paper by Kenthughes
on the " Feet of Chinese Ladies " ^ is from a photograph of a shoe that
measured only 3^ 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 photograj^h of a foot
measuring 5| 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 for-
ward inclination, forming a right angle with the bones in front of the medio-
tarsal 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 ex-
tremity 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
a Intercolonial Journal of Medicine and Surgery, Melbourne, 1894.

PLATE 8.

Chinese foot-binding (Keuthughes).

(

A PROFESSIONAL LEG-BREAKER. 741

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 ou 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 dis-
placement, is much compressed on the plantar 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 sur-
face 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 in-
dividual 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, de-
claring 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 authori-
ties 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, fall-
ing 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 alto-
gether 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 hos-

i

742

MISCELLANEOUS SURGICAL ANOMALIES.

pital 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 sulferer 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 tele-
graph office at the Union Depot here, when Henry C. Mahoney, the superin-
tendent, 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 fidl down, as it was
too expensive a performance for the company to stand. He beat the Mis-
souri 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 sui-
cides, in 1835, Arntzenius speaks of an ambitious Frenchman who was desir-
ous of leaving thcAvorld 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 rend-
ered 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 con-
stituents of explosives, he resolved to convert his body into a bomb, load it
with explosives, and thus blow himself to pieces. He procured some pow-
dered 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. In-
stead of the anticipated result the most violent eollicky 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

a 548, 1856, 103.

RELIGIOUS AND CEREMONIAL MUTILATIONS. 743

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 ac-
complished 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 insti-
tutes of Surgery" Sir Charles Bell remarks that his predecessor at tlie Mid-
dlesex 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 construc-
tion 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 savnig
him. It is supposed that one could commit suicide by completely gikling
or varnishing the body, thus eliminating the excret^)ry functions of the skin.
There is an old story of an infant who was gilded to appear at a Papal cere-
mony 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, Tecontjetf of St. Petersburg concludes that in this respect
man differs from animals. This authority states that in man no tangible risk
is entidled by this process, at least for any length of time required for tliera-
peutic 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,226 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 posi-
tive fact, and death was simply a change of residence. One of these philoso-
phers, 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

a 224, 1883, i., 88.

744

MISCELLANEOUS SURGICAL ANOMALIES.

de Boisraont,-^^ the suicides from indifference to life in this mystic country are
counted by the tliousands. 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 pre-
cepts 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 He-
brews 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 im-
mortality and eternal repose. They thought little of bodily cares and ills.
In Greece and Rome there was alw^ays 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 Tmhetur ! " 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

a " Hist. Nat. Philos.," T. iv., 11 and 670. ^ 638, April, 1878.

EXHIBITION OF SCARS.

746

Indians, as among people who form societies to practise simple mutilations in
slight forms. Mutilations in somewhat graver forms, but still in moderation,
are practised 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 practised by the New Zea-
landers, East Africans, Kondes, Kukas, and Calmucks. Among those prac-
tising 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, Taliitians, 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 com-
prehensive study of this subject, and his paper is a most valuable contribu-
tion 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 xiztecs 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 cus-
toms. 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 Avere
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 re-
ceived 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 practised ; 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

746

MISCELLANEOUS SURGICAL ANOMALIES

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 pro-
ducing 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 per-
formed imjustifiable plastic operations to satisfy the vanity of their patients.

Dobrizholfer says of the Abipones that boys of seven pierce their little
arms in imitation of their parents. Among some of the indigenous Austra-
lians 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 honor-
able 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 initia-
tion, 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 submis-
sion 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

a 224, 1880, ii., 609.

DEPILATORY CUSTOMS.

747

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 sub-
jected 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 addi-
tion to this crude dentistry, the youth is required to submit to cruel gashes
cut upon his back and slloulders, 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 Ingh
titne 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 Hiiayna Coapae made a law that
they and their descendants should have three front teeth i)ulled out in each
jaw. Cicza speaks of another tradition requiring the extraction of the teeth
of children by their fathers as a very acceptable service to their gods. The
Daniaras 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 mourn-
ing for his friend, Hephfestion, 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 eye-
brows 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 associa-
tion 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.,

748

MISCELLANEOUS SURGICAL ANOMALIES

was considered a sign of respect and honor. The respect and preservation of
the Chinese queue is well known in the present day. AVishing to divide their
brother's kingdom, Clothair and Childebert consulted whether to cutoff 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. Accord-
ing 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, accord-
mg 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 depil-
atory processes oh 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 con-
stituted 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 inhabi-
tants 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 oint-
ments 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 par-
ticular hair plucked singly from the body, the candidate being required not

TATTOOING.

749

to display evidences of pain during the operation. Formerly the Japanese
women at marriage blackened their teeth and shaved or pulled out their eye-
brows. .

The custom of boring the ear is very old, mention of it being made m
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 for-
ever." All the Burmese, says Sangermano, without exception, have the
custom of boring their ears. The days when the operations were performed

Fig. 230.— Perforation of the ears and lip practised by the Botocudos.

were kept as festivals. The ludicrous custom of piercing the ears for the
wearing of ornaments, typical of savagery and found in all indigenous Afri-
can 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 insert-
ing 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

750

MISCELLANEOUS SURGICAL ANOMALIES.

district. Among the Uapes, one tribe, the Tucanoes, have three vertical
bhie 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 oflP some danger. Bourke quotes
that among the Apaches- Yumas of Arizona the married women are dis-
tinguished 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 practised 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 im-
material to the torturers, as he would be branded for life and ostracized if he
recovered. Illustrative of this O'Conncll 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 218, 1871, 323.

SYPHILIS ACQUIRED IN TATTOOING.

751

a leader of a band of Greek robbers, organized to invade Cliinese Tartary,
and, together with an American and a Spaniard, was ordered by the ruler of
the invaded province to be branded in tliis manner as a criminal. It took
three months' continuons work to carry out this sentence, during which liis
commdes succumbed to the terrible agonies. During the entire day for this ex-
tended 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
(Fig. 231) represents the ap-
pearance of a "tattooed man"
who exhibited himself. He
claimed that his tattooing was
done by electricity. The de-
sign showing on his back is
a copy of a picture of the Vir-
gin Mary surrounded by 31
angels.

The custom of tattooing
the arms, chest, or back is
quite prevalent, and particu-
larly among sailors and sol-
diers. 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 em-
blems of his trade tattooed
upon his right forearm. At
the end of forty days small,

red, scaly elevations apjjeared at five different points in the tattooed area.
These broke down and formed ulcers. When examined these ideers pre-
sented 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
a Arch. f. Dermatol, u. Syph., Baud xxix., Heft 3.

Fig. 231.— " Tattooea man."

752

MISCELLANEOUS SURGICAL ANOMALIES.

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 militiaman of seventeen who, three days after an exten-
sive 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 in-
volved 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 pre-
vention of sexual congress is a very ancient custom. The Romans infibu-
lated 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 cujm
refibulavit turg'idmn faben^ penem." Heinsius considers Agamemnon cautious
when he left Demodocus near Clytemnestra, as he remarks that Demodocus
was infibulated. For such purposes as the foregoing infibulation oifered 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 chast-
ity, 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 practised 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 author-
ized by divine injunction ; for this reason the lips of the vagina were

a 224, 1895, i., 1200. b 224, No. 1800, 1440.

c Monumenti antichi inediti, Giov. Winkelman, Eomse, 1767. d 509, epig., 81, L. vii.

INFIBULATION.

753

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 sepa-
rated 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 nymphse 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 jeal-
ousy 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 mar-
ried several years, and was the mother of several children. Collier exam-
ined 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

a Schulz, Indes-Orientales, and others.

b Bull, de la Soc. de Geograph., Paris, Series iv., xvii., 339.

c 374, 1737, vii., 250. d 132, Dec. 15, 1894.

48

754

MISCELLANEOUS SURGICAL ANOMALIES.

her to be ill several weeks ; after she had sufficiently recovered he put on a
padlock, and for many years he had practised the habit of locking her up
after each intercourse. Strange to relate, no physician, excejjt Collier, had
ever inquired about the openings. In this connection the celebrated Har-
vey ^ 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 in-
fibulation.^ 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 nymphse and labia, wliile 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 pre-
vent conception. In the Australian Medical Gazette, May, 1883, there is an
account of some of the methods of the Central Australians of preventing con-
ception. 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 PhilHpine 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 nymphse in mummies. Herodotus remarks that the Egyptians
practised 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.

a 404, 346. t> 701, 1878, 266. c 224, 1889, ii., 1315.

CASTRATION.

755

Spencer and others say that in the early history of tlie Christian religion, St.
Paul and his Disciples did not believe in circumcision, while St. Peter and
his followers practised it. Spencer mentions that the Abyssinians take a
phallic trophy by circumcision from the enemy's dead body. In his " His-
tory 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 practised preputial
nuitilutions ; David brought 200 prepuces of the Philistines to Saul. Cir-
cumcision is practised in nearly every portion of the world, and by various
races, sometimes being a civil as well as a religious custom. Its use in sur-
gery is too well known to be discussed here. It might be mentioned, how-
ever, that Rake of Trinidad," has performed circumcision 16 times, usually
for phimosis due to leprous tuberculation of the prepuce. Circumcision, as
practised 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 fe-
males 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 opportu-
nity 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 mam-
mary glands wholly undeveloped, and the normal growth of pubic hairs ab-
sent The pubic arch was narrow, and the vaginal orifice practically obliter-
ated. 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 — practised ovariotomy for the utilitarian purpose
of creating a supply of prostitutes, without the danger of burdening the popu-
lation by unnecessary increase. MacGillibray found a native ovariotomized
female at Cape York who had been subjected to the operation because, hav-
ing been born dumb, she would be prevented from bearing dumb children, — a
wise, though primitive, method of preventing social dependents.

Castration lias long been practised, either for the production of
eunuchs, or castrata, through vengeance or jealousy, for excessive cupid-
ity, as a punishment for crime, in fanaticism, in ignonuice, 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 ; tlie 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

a 703, April, 1893. b 536^860, ii., 33.

756

MISCELLANEOUS SURGICAL ANOMALIES

and conquerors had their eunuchs. Alexander the Great had his celebrated
eunuch, Bagoas, and Nero, his Sporus, etc. Chevers ^'^^ says that the manu-
facture 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 testi-
cles 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 prac-
tices 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 exci-
sion 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 ecclesias-
tics. 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 fjillen into dis-
use. 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

a 655, April, 1886. ^ 476, 1877, ii., 123.

THE SKOPTZIES.

757

religion of the priests of Cybele, and rendered their offence equivalent to
homicide. At the annual festivals of the Phrygian Goddess Amma (Agdis-
tis) it was the custom of young men to make eunuchs of themselves with
sharp shells, and a similar rite was recorded among Plujenicians. 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 fa-
mous of the people of this description. The Russian government has con-
demned members of this heresy to hard labor in Siberia, but has been unable
to extinguish the sect. Pelikan, Privy Counsel of the government, has ex-
haustively considered this subject. Articles have appeared in Le Progr^s
Medical, December, 187G,
and there is an account in
the St. Louis Clinical Rec-
ord, 1877-78. The name
Skopt:zy means " the cas-
trated," and they call them-
selves the " White Doves."
They arose about 1757
from the Khlish or flagel-
lants. Paul I. caused Sseli-
wanow, the true founder,
to return from Siberia, and
after seeing him had him
confined in an insane asy-
lum. 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 con-
tinual fasts of the " White Doves." For the purpose of convincing novices
of the Scriptural foundation of their rites and belief they are referred to Mat-
thew 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 opera-
tion 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

Fig. 232.— Mutilated genital organs of a male Skoptzy.

758 MISCELLANEOUS SURGICAL ANOMALIES

and obstinacy. They had secret methods of communicating with one another,
and exhibited a passion for riches, a fact that possibly accounts for their ex-
tended 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 per-
formed at one stroke or at two different times, in the forjner case one cicatrix
being left, and in the latter two. The greater number — those who had sub-
mitted 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 instru-
ments 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 knoAvn.
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 purifica-
tion." 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 practised upon

Fig. 233.-Mutilated genital organs of a female Skoptzy. the CXtcmal genitals, the mammse,

and nipples. The first ablation
is obtained by applying fire or caustics to the nipples, the second by amputa-
tion of the breasts, one or both, the third by diverse gashes, chiefly across the
breast, and the fourth by resection of the nyraphse or of the nymphse 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 practised the same cere-
monies as the heretics there.

a 653, Dec. 23, 1876. b 176, Dec, 1873, xL, 483.

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 men-
tioned. It would be a difficult matter to decide which was the largest tumor
ever reported. In reviewing literature so many enormous growths arc 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 ele-
phantiasis 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 col-
lect 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, particu-
larly in India and Africa, long, dependant 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 V enus the
breasts are never pictured as engorged or enlarged. The celebrated traveler
Chardin says that the Circassian and Georgian women have the most beauti-
ful 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 mammse is
extraordinary. Borellus^^^ remarks that he knew of a woman of ordinary
size, each of whose mammse 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 suc-
cessfully 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.

a 331, 1862, iv., 214. b 629, 1(JG9.

759

f

760 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

Schaeffer ^ speaks of hypertrophied mammae in a girl of fourteen^ the right
.breast weighing 3900 grams (1361 oz.) and the right 3500 grams (122| 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 Labar-
racque 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 per-
fect lactation. This case was one of
pure hypertrophy and not an exam-
ple of fibro-adenoma, as illustrated by
Billroth. Warren figures a case of
diffused hypertrophy of the breast
which was operated on by Porter
(Fig. 234). The right breast in its
largest circumference measured 38
inches and from the chest-wall to the
nipple was 17 inches long, the cir-
cumference 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 circum-
ference at the base 23 inches. The

Fig. 234.-Diffuse hypertrophy of the breast (Warren). sMn WaS sdcmatOUS and thickeucd.

Throughout both breasts were to be
felt hardened movable masses, the size of oranges. Microscopic examina-
tion showed the growth to be a diffused intracanalicular fibroma. A pecu-
liar 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 advo-
cated, as applications of iodin had failed ; but she would not consent to opera-
a 261, 1893. b 450, March 9, 1895. c 672, Nov. 11, 1878.

GOITER.

761

tiou. 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 lactesccnit. The hypertrophy diminished to such a degree that, at the
age of thirty-two, when ag-ain 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 Hospibil in London, a man of
sixty, after a violent fall on the
chest, suffered enormous enlarge-
ment of the manmiae, and afterward
atrophy of the testicle and loss of
sexual desire.

The names goiter, struma, and
bronchocele are applied indiscrim-
inately 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 fol-
lowing classification of thyroid
tumors : 1. Hypertrophy of the
thyroid gland, which is a compara-
tively rare disease ; 2. Fetal aden-
oma, which is a formation of gland
tissue from the remains of fetal
structures in the gland ; 3. Gelatin-
ous 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
(Fig. 235) pictures an extreme case 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

a Surgical Pathology and Therapeutics, by J. C. Warren, Philadelphia, 1895.

b The Pathology and Surgical Treatment of Tumors, by N. Senn, Philadelphia, 1895.

Fig. 235.— Cystic goiter (Warren).

762 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

(Fig. 236). AVhen a tumor has attained this size, pressure-symptoms are often re-
lieved by the weight of the tumor making traction away from the trachea. Goiter
is endemic in some countries, particularly in Switzerland and Austria, and ap-
pears particularly at the age of childhood or of puberty. Some communities in
this country using water containing an excess of calcium salt show distinct evi-
dences of endemic goiter. Extirpation of the thyroid gland has in recent years
been successfully practised. Warren has extirpated one lobe of the thyroid after
preliminary ligation of the common carotid on the same side. Green practised
rapid removal of the tumor and ligated the bleeding vessels later. Rose tied each

vessel before cutting, pro-
ceeding slowly. Senn re-
marks that in 1878 he wit-
nessed one of Rose's opera-
tions which lasted for four
hours. Although the op-
eratic technic of removal
of the thyroid gland for
tumor has been greatly per-
fected by Billroth, Liicke,
JuUiard, Reverdin, Socin,
Kocher, and others, the cur-
rent opinion at the present
day seems to be that com-
plete extirpation of the thy-
roid gland, except for ma-
lignant disease, is unjustifi-
able. Partial extirpation
of the thyroid gland is still
practised ; and Wolfler has
revived the operation of
ligating the thyroid arteries

Fig. 236.— Enormous tumor of the thyroid gland (after Bruns). in the treatment of tumorS

of the thyroid gland.
Fibromata. — One of the commonest seats of fibroma is the skin. Mul-
tiple 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 moUuscum. 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, com-
plaining of a tumor which he described as a " wishing-mark." On examina-
tion he was found to be covered with a number of small tumors, ranging in

a 476, May 11, 1890.

FIBROMATA.

763

Fig. 2:59.— Multiple keloids (Collins).

764 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

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 (Fig. 238).
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 5| pounds. The patient made an early recoveiy.

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
(Fig. 239), 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 ap-
peared, 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 Hos-
pital a negro whose neck was encircled by enormous keloids, which, although
black, otherwise resembled tomatoes. A photograph of this remarkable case
(Fig. 240) was published in Philadelphia in 1870.t>

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 Cliina, from whom
he removed a fibro-lipoma weighing 50 pounds. The growth had progress-
ively 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 (Fig. 241). The hemorrhage was slight and the
patient was discharged in five days.

a 792, Oct., 1889. b 631, 1870. c 224, March 17, 1894.

LIPOMA TA.

765

Fig. 242.— Difluse lipoma of the neck and Fig. 24;i.— Enormous lipoma of the

abdomen (Warren). parietal region (Rotter).

766 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

Tlie true lipoma must be distinguished from diffuse accumulations of fat
in diti'erent parts of the body in the same way that fibroma is distinguished from

elephantiasis. Circumscribed lijioraa
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 gro-
tesque and peculiar appearance. (Fig.
242). It is generally found in men
addicted to the use of alcohol, and

/

Fig. 244.— Enchondroma of the thumb (Warren)

occurs between thirty-five and
forty-five years of age ; in no
case has general obesity been de-
scribed. In one of Madelung's
cases a large lobe extended
downward over the clavicle.
The growth has been found be-
tween the larymx and the phar-
ynx. Black ^ reports a remark-
able case of fatty tumor in a
child one year and five months
old which filled the whole ab-
dominal cavity, weighing nine
pounds and two ounces. Clii-
pault^ mentions a case of lipo-
ma of the parietal region, ob-
served by Rotter. This mon-
strous growth (Fig. 243) 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

Fig. 245.— Lad twenty years of age with multiple chondromata
(after Steudel).

left ear \yas plainly visible in the upper third of the growth.

Chondroma, or enchondroma, is a cartilaginous tumor occurring princi-

a 298, 1878, i., 491. b La M^d. Moderue, Dec. 11, 1895.

CHONDROMATA.

767

pally where eartilage is normally found, hut 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 Vircliow, then
takes the name of osteochon-
droma. Virchow has divided
chondromata into two forms —
those which he calls ecchon-
dromata, which grow from car-
tilage, and those that grow in-
dependently from cartilage, or
the enchondromata, which lat-
ter are in the great majority.
Enchondroma is often found
on the long bones, and very
frequently upon the bones of

Fig. 246.— Enormous fibroma growing from the parotid region.

the hands or on the metatarsal bones.

Figure 244 represents an enchondroma
of the thumb. Multiple enchondromata
(Fig. 245) are most peculiar, and may
attain enormous sizes. Whittaker
describes a farmer of forty who ex-
hibited peculiar tumors of the fingers,
which he calls multiple ostcoecchon-
dromata. His family history was nega-
tive. 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 ac-
cident there was noticed an enlargement
of the middle joint of the little finger,
and about the .same time an enlarge-
ment 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,
a International Med. Magazine, Philadelphia, Feb., 1894.

Fig. 247.-

-Hyaline encliondroma of the scapula
(VVarrenj.

768 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

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 carti-
laginous" 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 grow-
ing from the left parotid region (Fig. 246) ;
and there is a photograph of a similar case
in the Miitter 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 accompany-
ing illustration (Fig. 247), given by War-
ren, of a patient in whom the growth was
in the scapula.

In 1824 there is quoted^ the descrip-
tion 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 expecta-
tions it was successfully removed by Por-
talupi, a surgeon of Venice. It weighed
57 pounds, being 20|^ 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 differ-
ing from hypertrophies, as they only in-
volve a limited part of the circumference.
When developmental, originating in child-
hood, 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,
a 593, Feb., 1894. b 476, 1824, 26. c 476, 1861, ii., 446. d 476, 1860.

Fig. 248. — Exostoses of various dimensions
(Pierret).

^'OROS-NEZ."

769

Hartmann '* shows two cases of multiple exostoses (Fig. 249), both in males,
uiid universally distributed over the body.

Macland of the French navy ^ describes an affection of the bones of the

Fig. 249. — Multiple exostoses (Hartmann).

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 child-
hood are : more or less
persistent headache, par-
ticularly frontal, sanguine-
ous 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 in-
tact. The headache and discharge continue for a year, and the swelling con-
tinually increases through life, although the symptoms gradually disappear, the

a Archiv fiir Klinische Cbirurgie, Berlin, 1893. l> Quoted 224, 1895 i. 1217.

49 > ) •) •

Fig. 250.— Gros-nez (Macland).

770 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

skin not becoming involved, and no pain being present. It has been noticed
in young chimpanzees. The ilhistration (Fig. 250) represents a man of* forty
who suffered from tlie 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 sym-
metric osteomata of the nasal processes
of the maxilla. His patient was a native
of Great Britain.

Among neuromata, multiple neuro-
fibroma is of considerable interest,
chiefly for the extent of general involve-
ment. According to Senn,Heusinger re-
cords 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 tender-
ness. 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

Fig. 251.— Symmetric osteomata of the nasal pro-
cesses of the superior maxilhi (after Hutchinson).

Fig. 252.— Arm in which the musculo-spiral nerve was neuromatous (after Campbell de Morgan).

In

or number. Virchow collected 30 cases of multiple neurofibromata
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

NEUROMATA.

771

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 witii a plexifbrm neuroma of the musculo-spiral nerve and its
branches (Fig. 252). 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

Fig. 253. — Plexiform neurofibroma (Tietze).

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 (Fig. 253). The growth was simply excised
and recovery was promptly effected.

a Archiv fur klinische Chirurgie, Berlin, 1893.

772 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

Fig. 254. — Noli-me-tangere (Warren).

Carcinomatous growths, if left to themselves, make formidable devas-
tations of the parts which they affect. Warren pictures a case of noli-
me-tangere, a destructive type
of epithelial carcinoma (Fig.
254). The patient suffered
no enlargement of the lym-
phatic glands. The same ab-
sence of glandular involve-
ment was observ^ed in another
individual, in whom there was
extensive ulceration. The dis-
ease 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 corre-
sponding half of the upper
and lower lips.

Harlan reports a most
extraordinary epithelioma of
the orbit in a boy of about
five years (Plate 9). 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 situ-
ated between the scapula?.

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 low-
lands. The author called the disease
sarcomata pigmentosum diffusum mul-
tiplex. ^^.^ 255.— Deformity produced by a sarcoma of the
The bones are a common seat of Sar- nasal septum (after Moore).

comatous growths, the tumor in this in-
stance 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 765, May 18, 1894.

Plate io.

Enormous sarcoma of buttock (Keen and White).

SARCOMATA.

777

A case of nasal sarcoma is shown by Moore (Fig. 255). 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 liad all the
clinical history of an osteosarcoma of the tibia, and was amputated and pho-
tographed after removal (Fig. 256). In another case, in a white male of

Fig. 256. — Osteosarcoma of the tibia (Tillaiiy). I'ig. 2.57.— Sarcoma of the thigh (Titlany).

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 (Fig. 257).

The fatality and incurability of malignant growths has done much to
stimulate daring and marvelous operations in surgery. The utter hopeless-
ness 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 oilly
feasible and justifiable, but even peremptorily demanded.

a International Med. Magazine, Pliiladelphia, May, 1892.

778 ANOMALOUS TYPES AND INSTANCES OE DISEASE.

Varicose veins sometimes become so enlarged and distorted as to simu-
late 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 (Fig.
258). 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

Fig. 258. — Aneurysmal varix of hand (Abbe).

Fig. 259. —Cirsoid tumor of the ear before and after operation.

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.

a 491, 1858, i., 189. b 150, March, 1894. c Rev. m6d. de la Suisse Rom., Nov. 20, 1892-

ANEURYSM.

779

Jessop^ records a remarkable case of multiple aneurysm. This case
was particularly interesting as it was accompanied by a postmortem exami-
nation. 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 suf-
fered 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 admis-
sion the man was in great dis-
tress, 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. Laryn-
gotomy was done with the ho})e
of removing a foreign body, but
the man died on the tenth day.
A postmortem examination dis-
closed the existence of an aber-
rant right subclavian arterj^ 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 ster-
num 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

a 476, November 17, 1894. Quarterly Medical Journal, April, 1895.

c New England Q. J. Med. and Sc., Boston, 1842-43, i., 256. d 124, Oct., 1894.

Fig. 260.— Enormous uterine tumor (Mclntyre).

780 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

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, Mclntyre^ reported a case of
great interest. Tlio patient, a woman of thirty-eight, five feet 5J inches in
lioight, coarse, with masculine features, having hair on her upper lip and chin,
and weighing 199| pounds, was found in a poor-house in Trenton, Missouri,
on November 2(5, 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 (Fig. 260).
The measurements made at the
time were as follows : circum-
ference at the largest part,
just below the und^ilicus, 50
inches ; circumference just be-
low 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
^vithin a sac. The uterus was
drawn up to the extent of from
1 2 to 1 4 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

Fig. 261.-Uterine fibroma (Eastman). CUOrmOUS Wcigllt of the abdo-

men. 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. Au 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
a Western Medical Journal, Fort Scott, Kau., Jan., 1894.

UTERINE TUMORS.

781

largo number of pressure-forceps. Adliesions were found almost every wliere,
the most difficult to manage being those of the liver and diai)hragm. 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. xVfter operation the woman was immediately placed on
platform scales, and it was found that she had lost 931 pounds. Unfortunately
the patient developed symptoms of septicemia and died on the fifth day. In
looking over the literature on this
subject Mclntyre found no mention
of any solid tumor of this size hav-
ing 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 '-^ re-
marks that the largest uterine myoma
which he ever removed weighed 68
pounds, and adds that it grew after
the menopause. Mclntyre believes
that his tumor, weighing 93 J pounds,
is the largest yet reported. East-
man ^ reports the removal of a fibroid
tumor of the uterus weighing 60
pounds. The patient recovered from
the operation (Fig. 261).

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 cliildren. About
twelve years before a cyst in the
right iliac region was tapped. The Yig. 262.
woman presented the following ap-
pearance (Fig. 262) : The navel hung below her knees, and the skin near
the umbilicus resembled that of an elephant. The abdomen in its largest cir-
cumference 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.

-Fibrocyst of tlio uicnis, weighing 135 pounds
(Stockard).

a "Diseases of Women and Abdominal Surgery," i., 187.
b No. Amer. Pract., Sept., 1893, 387.

c 538, Aug. 16, 1884.

782 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

Ovarian cysts, of which by far the greater number are of the glandular
variety, form extremely large tumors ; ovarian dropsies of enormous dimen-
sions 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

Fig. 263.— Large ovarian cyst, weighing 149 pounds (N. Y. Med. Journal).

1 e50 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,

a 524, ii., No. 14.

c Kaccolta, prima et cet., No. 1.

e 597. Feb. 8, 1890.

b 629, 1748, 471.
d463, T. xviii., 360.
f Homoeopath. Jour, of Obstet., N. Y., 1884-85.

LARGE OVARIAN CYSTS.

783

659 pounds of fluid were withdrawn. Delivery was effected by instrumental
aid. The tumor of 70 pounds was removed and death followed. McGilli-
cuddy mentions a case of ovarian cyst containing 132 pounds of fluid. The
patient was a woman of twenty-eight whose abdomen at the umbilicus meas-
ured 69 inches in circumference and 47 inches from the sternum to thepubes.
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. Tiie 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
7f inches ; 88 quarts of fluid
were drawn off^ and the woman
recovered. In the College of
Physicians, Philadelphia, there
are photographs (Figs. 264 and
265) of this case, with an in-
scription 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 ova-
rian cyst to five feet 9^ inches.
The tumor was removed and
weighed 182| pounds; it con-
tained 22 gallons of fluid. Fig-
ure 265 shows the appearance of
the woman two months after the
operation, when the girth was reduced to normal. Stone performed ovariot-
omy on a girl of fifteen, removing a tumor weighing 81 J pounds. lianney'^
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 (Fig. 266) 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| pounds ; Gregory,'' 80 pounds ; Boerstler,' 65 pounds ; Bixby,j
70 pounds ; and Alston ^ a tumor of 70 pounds removed in the second opera-
tion of ovariotomy.

Fig. 264. — Large ovarian cyst in a Chinese woman
(Reifsnyder).

a 121, April, 1825.
e 230, 1878.
1 609, 1885.

b J25, April, 1895. c 606, 1883. d 450, 1884.

f 125, 1879, xii., 315. s 318, 1885. h 703, 1879.

j 218, 1882. k 667. 1871.

784 ANO}fALOUS TYPES AND INSTANCES OF DISEASE.

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 live 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 (Fig. 267). 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. Tlie patient recovered

in twenty-five days.

Culling worth ^ of St. Tliomas Hos-
pital, London, successfully removed
from a girl of sixteen an ovarian cyst
weighing over 80 pounds. The pa-
tient 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|^ 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| inches. By
vaginal examination the cervix Avas found to be pulled up and obliterated ;
the anterior vaginal wall was bulged downward by the tumor. On May 3d
a 164, Sept., 1893 ; quoted 124, 1894, xxix, 710. ^ 476, Juue 1, 1895.

Fig. 265. — Same woman two months after operation.

LARGE OVARIAN CYSTS.

785

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 tiic lower part, was revealed. It
was adherent to the abdominal wall, liver, spleen, and omentum. The adhe-
sions were separated and the cyst tapped with a large trocar, and then the

Fig. 266.— Enormous glandular ovarian cystoma (Rodenstein).

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

Fig. 267. — Large ovarian cyst in a girl of seventeen (Dayot).

patient having weighed 170 pounds on the night before the operation,
and 79| pounds a week after the operation. Alarming symptoms of col-
lapse were present during the night after the operation, but the patient re-
sponded to stimulation by hypodermic injections of ^ grain of strychnin
and of brandy, and after the first twenty-four hours the recovery was unin-
50

786 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

terrupted. 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 opera-
tion should be performed). Tliis 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 tlie etiology and pathology of dropsies was
obscure, we find the records of the most extraordinary cases. Before the
Royjd Society, in 1746, Glass of Oxford** read the report of a case of preter-
natural size of the abdomen, and stated that the dropsy was due to the ab-
sence of one kidney. The circumference of the abdomen was six feet four
inclies, and the distance from the xiphoid to the os pubis measured four feet
J 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. Daring 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 re-
moved. 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 hydro-
nephrosis 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.

Elliotsonii reports ^.}^at he calls the largest quantity of pus from the liver
on record. His patient was a man of thirty-eight, a victim of hydatid dis-
ease of the liver, from whom he withdrew one gallon of offensive material.

a 629, 1743-50, 1030. ^ 110, i., obs., viii.

d Ball, des Sciences M6d. Depart, de I'Eure.
f 282, 1738, 361. g 452, Band iv., 601.

c 282, 1731, 227.
e 534, 1779, 440.
b476, 1831-32, i., 756.

"OSSIFIED MEN.''

787

1

Lieutaud cites a case, reported by Blanchard,2'=' 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 rafts-
man, aged seventeen, who suffered with inflam-
matory symptoms of the right great toe, which
were followed in the next ten years by pro-
gressive 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 (Fig. 268). 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.

Percv'' speaks of a man named Simoore, born in 1752, who at the age of

Fig. 268. — Ossified man (front and side
views).

Fig. 269.— J. R. Bass, the "ossified man."

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
a International Jonr. of Surg., Feb., 1889. b 302 iv. 245.

788 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

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 diges-
tion 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 £)cole 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 mov-
able.

An ossified man has been recently found and exhibited to the Paris Acad-
emy 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 articula-
tions. Of the older writers Hellwigius,^i^ Horstius,'^23 ^nd 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 con-
verted 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 con-
verted 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

a " Lithologia," p. 69. b 548, 1861, ii., 470. « 548, 1861, ii., 392.

LARGE CALCULI.

789

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 Harmcr 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 Par6 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; He-
berden,"^ 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 pre-
served 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 Hdpital 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 Lon-
don there is a stone weighing 44 ounces, and measuring 16 inches in cir-
cumference. 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| inches long and four wide. Fr6re
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 ; Humphry s,s 33 ounces; Eve, 44 ounces; and Janeway,** 51 ounces.
Kirby ' has collected reports of a number of large vesical calculi.

a 629, li. ^ 398, i., 548. c 232, 1739.

d629, 1700, 150. e 476, ]886, i., 132. f 476, 1885, i., 559.

g 476, 1885, ii., 146. ^ 597, 1877, xxvi., 210. I 792, April, 1896.

790 AN03IAL0US TYPES AND INSTANCES OF DISEASE.

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 de-
scribes 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 pen-
holder over three inches long.

Multiple Vesical Calculi. — Usually the bladder contains a single cal-
culus, 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 Phila-
delphia is said to have successfully removed by lateral lithotomy more than
1000 calculi. Macgregor mentions a case in which 520 small calculi coex-
isted 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 s 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. J Schenck mentions a calculus perfo-
rating the bladder and lodging in the groin. Simmons ^ reports a case in
Avhich a calculus passed through a fistulous sore in the loins without any con-
comitant 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

a 476, 1890, i., 978. ^ 491, 1882, 287. c 536, 1889, i., 369.

d491, 1889, 486. e 124, 1852, xxiii., 411. f 218, 1852. g 629, 1700, 149.

h Jour, der Pract. Heilkunde, Hufeland, c. 18, Band i., p. 115. i 490, 1837, xx., 551-53.

j Samml. med. Wahrnehm, Band viii., p. 258. ^ 629, 1774, 108.

1 538, 1877, xii., 606. m 462, T. viii., 351. n 779, 1857-58, 295.

EXTRAVESICAL CALCULI.

791

Fig. 270.— Renal calculus (full size) (Cordier).

right kidnev were found a caloulus weiohing 36^ ounces, about 1000 small
calculi, and' a quantity of calcareous dust. In the left kidney there was a
calculus weighing 9| ounces, besides a quantity of calcareous dust, ihe cal-
culi in this case consisted chiefly of
phosphate of magnesium and animo-
niuin.-' Cordier of Kansas City,
Mo., successfully removed a renal
calculus weighing over three ounces
from a woman of forty-two. The ac-
companying illustration (Fig. 270)
shows the actual size of the calculus.

At the University College Hos-
pital, London, there are exhibited
485 gall-stones that were found
postmortem in a gall-bladder. Van-
zetti reports ^ the removal of a pre-
putial calculus weighing 224
grams. Phillipe " mentions the re-
moval of a calculus weighing 50
grams from the prepuce of an Arab
boy of seven. Croft ^ gives an ac-
count 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 uri-

narius of a man, after a lodgment of
twenty years. Block ^ mentions a simi-
lar case, in which the lodgment had lasted
twenty-eight years. Walton s speaks of
a urethral calculus gradually increas-
ing in size for fifty years. Ashburn'^
shows (Fig. 271) what he considers the
lary-est calculus ever removed from the
urethra. It was 2| inches long, and 1^
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

a See 550, vol. Ivii., 77. b 242, 1844. c 662, 1843, 226. d 767, xviii., 8.

e 629, 1700, 153. 104, 1748, viii., 441. g 476, J862, i., 384. ^ 553^ Nov. 23, 1895.

Fig. 271.— Urethral calculus (full size) (Ashburn).

792 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

weighed 60 grains. Huiit« speaks of eight calcuH 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 Har-
low ; ^ 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 wi iters, and it is said ^ that
two stones as large as almonds were found in the heart of the Earl of Bal-
carres.

Morand ^ speaks of a calculus ejected from the mouth by a woman.

An old record says s that stones in the brain sometimes are the cause of
convulsions. D'H^ricourt 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 mider his tongue.

Umbilical calculi are sometimes seen, and Dean ^ reports such a case.
There is a French record J 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 abso-
lute anuria may last an astonishingly extended period. Of the cases of
retention of urine, Fer^ol ^ 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 case 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 last-
ing fourteen days ; Cornarius, fourteen days ; Rhodius, fifteen days ; the Ephe-
merides, ten, eleven, and twelve days. Groom ^ notes a case of retention of

a 130, 1861, ii., 129. b Obs. Med. dec, ii. c 323, 1875, ii., 35. d 218, 1870, 70.
e 629, 1700, 158. f Paris, 1754. g 462, iv. h 462, vol. v. i 176, 1859.

j 363, 443. t 653, 1890, 152. l 318, 1874-75, xx., 317. ^ 318, 1885, xxxi., 734.

RETENTION AND SUPPRESSION OF URINE.

793

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 exces-
sive. 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, sup-
pression 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.

AVliitelaw ^ 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 exaggera-
tion 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 men-
tion.

Lemery ^ reports observation of a monk who during eight years vomited
periodically instead of urinating in a natural way. Five hours before vom-
iting 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 J
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 ^

a 100, XXX., 103. ^ 462, T. xlvii., 134. c 524, ii. d 351^ l. vi., 282.

e 565, 1810. 462, T. xi., 117. g 476, 1877, ii., 460. h 302, iv., 225.

i South. Clinic, Richmond, 1881, iv., 545. J 476, 1890, i., 79. k 739, 1879, 715.

1 809, 1874, i., 407. ^779, xi., 145. n 318, 1836, xM., 158. o 656, I849', x., 259.

794 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

speaks of total suppression of urine during seven days, with complete re-
covery ; 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 ShrolF 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,^!^ gj^
weeks ; Smetius,^''*^ five mouths ; Trioen,^^ three months ; Devilliers,^ two
years ; and Gignony,s seven years. Riverius mentions death following
constipation of one month, and says that the intestiiies 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 R^volat 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 peri-
odicity and without change in the excrement. Tommassini ^ records the his-
tory 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

a 548, 1879, i., 474. b Phenom. Medica. c 463, July, 1810, p. 74. d Ibid,

e Trans. Soc. for Improvement of Surg, and Med. Knowl., ii.. No. 14. f 462, T. iv., 256.
g 462, T. X., 410. h 524, 1797. i Journal de M6d. de Parme., 1808.

PERSISTENT CONSTIPATION.

795

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 proc-
totomy.

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 nour-
ished 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 Aviccuna, and it is possibly on this account that
the disease received the name elephantiasis arabum. The disease was after-
ward noticed by Forestus, Mercurialis, Kaempfer, Ludoff, and others. In 1 7 1 9
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 cle-
ft 656, 1851, 123. b 476, 1886, ii., 444. c 821, quoted 224, 1879, i., 594. d 822, 1891.

796 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

phantiasis 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 sub-
stance 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

rig. 272.— Lymphedema of the left leg five years after
its onset (Keen and White).

Fig. 273. — Lymphedema in its later stage
(Keen and White).

limb presents immense lobulated masses, heaped up at ditferont 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 (Fig. 272) 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

ELEPHANTIASIS ARABUM.

797

motlerate. 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 iiave occurred
during this period, each producing an
aggravation of the previous condition.
The leg below the knee has become enor-
mously deformed by the production of the
elcphantoid 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 lol)ulated mass.
A similar condition has begun to develop
in the other leg, which is now about in the
condition of the first, as shown in the fig-
Figure 273 represents this disease

ure.

Fig. 274 —Elephantiasis of enormous develop-
ment ( " Barbadoes leg" ) (after Smith).

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 in-
ception 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 w' oman
weighed 387 pounds.
There was little thicken-
ing of the skin. The cir-
cumference of the calf was
28 inches ; of the thigh, 38
in(?hes ; and of the abdo-
men, 80 inches ; while that
of the arm was only 15
inches.

The condition common-
ly known as " Barbadoes
leg" (Fig. 274) is a form
of elephantiasis deriving its name from its relative frequency in Barbadoes.

a Kansas City Med. Index, Dec, 1894.

Fig. 275.— Elephantoid change of both feet.

798 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

Figure 275 represents a well-known exhibitionist who, from all appear-
ances, is sulfering 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 Fanny 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 per-
manent swelling of the arm occurred after the application of a blister ; in an-
other 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. Tlie 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 Fab-
ricius Hildanus, and the fourth
from Hendy. Figure 276 repre-
sents 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

Fig. 276. -Elephantoid change of the hand.

chief enlargement being in the
middle finger, which was 6|
inches long, and 5| inches about the nail, and 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^ 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 suc-
cessfully amputated in August, 1894. The accompanying illustration (Fig.
277) shows a dorsal view of the affected hand.

Magalhaes of Rio Janeiro ^ reports a very interesting case of elephanti-
asis of the scalp, representing dermatolysis, in which the fold of hypertro-
phied skin fell over the face like the hide of an elephant (Fig. 278), somewhat
similar in appearance to the " elephant-man." Figure 279 represents a some-

a 593, July, 1895. b 134, 1893.

Fig. 278.— Elephantiasis of the scalp (Magalhaes).

800 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

Fig. 279.— Hypertrophic tumor of the scalp and
face.

what similar hypertrophic condition of the scalp and face reported in the Pho-
tographic 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 com-
plicated with eczema of the ear. Willier,
also quoted by Alard, describes a remark-
able 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 puifed.
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 elephan-
tiasis 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 (Fig. 280), 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

a 718, L. i., 12. b 706, cent, ii., obs. ix.

Fig. 280. — Elephantiasis of the labia
(Scanzoni).

ELEPHANTIASIS OF THE SCROTUM.

801

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 wliich 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, per-
forming 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<i 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 Q^ 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 1 8 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| pounds. The ingenious technic of this operation is well
worth perusal by those interested. Goodman ^ successfully removed an ele-
phantiasis of the scrotum from a native Fiji of forty-five. The tumor
weighed 42 pounds, without taking into consideration the weight of the fluid

a 476, 1831, ii., 86. b 363, 1834. « 523, 1852. d 434^ 1337, ii., 251.

e 597, May, 1867. ^ 548, 1880, i., 660. g 476. 1876, ii., 889.

51

802 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

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 Hos-
pital an operation on a patient of
thirty-five with elephantoid scrotum
of six years' duration. The propor-
tions of the scrotum were as follows :
Horizontally the circumference was
six feet 6 J 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 J 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 124f
pounds. Little blood was lost on ac-
count of an elastic cord tied about the
neck of the tumor, and secured by
straps to a leather waist-belt. Re-
covery was prompt. Cody ^ speaks of the 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 pre-
viously, 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 rep-
resented 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
a 476, 1882. ^ 124, Oct, 1891.

Fig. 281.— Elephantiasis of the scrotum in a native of
Fiji.

ACROMEGALY.

803

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 obliter-
ated their functions are undisturbed.

The statistics of this major operation show a surprisingly small mor-
tality. 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 practised as a medical missionaiy in the Samoan Islands, claims
to have operated 136 times with only two deaths. McLeod, Fayrer's suc-
cessor 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 extremi-
ties. It is characterized by an abnormally large development of the extremi-
ties 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 in-
volves 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 re-
gards 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 (Fig. 282). The en-
largement 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

a Inter. Med, Mag., June, 1894. b Centralbl. f. Nerv. u. Pscych., Dec, 1894.

804 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

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 enhxrgement of the

Fig. 282.

Mrs, A. B., aged twenty years, showing normal Same patient, aged forty-two years, affected
appearance of the patient. " ith acromegaly.

(Pershing.)

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

Fig. 28!!.— Progres-sive enlargements of the liands, anterior and ]iosterior views (Ilersman).

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
a 838, 1894, No. 14. ^ Inter. Med. Mag., Oct., 1894.

CliETJNISM.

805

hue. Sensation and teniporature remained normal in botli hands ; acromejraly
was exehided on account of the absence of similar changes elsewhere. Hers-
man remarks that the change was probably due to increase in growth of the
fibrous elements of the subcutaneous lesions about the tendons, caused by rheu-
matic poison. Figure 283 shows the palmar 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.'^89 this connection it is interesting to notice a case of what might
be called acute symptomatic transitory pseudoacromegaly, reported by Po-
tovski : '"^ In an insane woman, and without ascertainable cause, there ap-
peared 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
pneumonic osteoarthropathy simulating acromegaly have been reported by
Korn ^ and Murray.*'

Megalocephaly, or as it was called by Yirchow, 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 <i describes what he
supposes to be a case of this disease, and proposes the title megalocephaly as pre-
ferable to Virchow's term, because the soft parts are also included in the hyper-
trophic 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 loNver ex-
tremities, 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 subputaneous tissues, the first to the greatest degree. The circum-
ference of the neck was 16 inches ; the horizontal circumference of the head
was 24 inches ; from ear to ear, over the vertex, 15 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 Mcige noticed the same loss in height, only more pro^
nounced, 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, physio^
logic, and mental degeneracy and nondevelopment, and possibly goiter. The
a Quoted 843, 613. ^ 224, Dec. 2, 1893. c 224, Feb. 9, 1895. d 124, Dec, 1894.

806 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

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. Thev are found

ml

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 Derby-
shire. These creatures have been allowed to marry and generate, and thus ex-
tend 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, Beaupr6
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 nar-
row, his back curved, his breath asthmatic, his limbs short, misshapen, with-
out 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 follow-
ing 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 myxedema, is characterized by a con-
genital absence of the thyroid, diminutiveness of size, thickness of neck, short-
ness 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
(Fig. 284). It is popularly believed that coitus during intoxication is the
cause of this condition. Osier * 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

» 124, Nov., 1893.

MYXEDEMA.

807

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 spo-
radic 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 func-
tion 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 mxyedematous condition of the sub-
cutaneous tissues and mental fiiilure, 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 ; im-
perfect nutrition of the hair ; local tume-
faction of the skin and subcutaneous
tissues, particularly in the supraclavic-
ular region. The physiognomy is re-
markably 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 thy-
roid 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 myx-

a 165, May, 1894. ^ Le90ns sur les Mai. Nerv., Paris, 1895, 606.

Fig. 284.— Sporadic cretinism.

808 ANOiMALOUS TYPES AND INSTANCES OF DISEASE.

edema 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 Pyr-
enees, 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

Fig. 285. — Cases of myxedema and sporadic cretinism (Brissaud).

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^
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 agri-

Plate u.

PERSISTENT HICCOUGH.

811

culturally 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 educa-
tion, 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, — hys-
teria, epilepsy, shock, or cerebral tumors.

The obstinacy of continued hiccough has long been discussed. Osier
calls to mind that in Plato's " Symposium " the physician, Eryximachus, rec-
ommended 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 paral-

a 718, L. iii., obs. 49. b 462, Ixxxvi., 363.

812 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

of instances in reliable medical literature. Tlie 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 twen-
ty-two who experienced an attack of constant singultus for a week, and then
intermittent attacks for six years. Cowan also mentions instances of pro-
longed 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, M^hich 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 s 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 hic-
cough 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 continu-
ously 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.

WillardJ speaks of a man of thirty-four who began to hiccough after aii
attack of pneumonia, and continued for eighty-six hours. The treatment con-
sisted 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. Cap-
per^ describes the case of a young man who was seized with loud and dis-

a West. Lancet, Cincin., 1849. b 476, 1841-42, ii., 398. c 703, xlvii., 377.
dibid. e Ibid. f 310, 1881. g 218, xxxii., 195. h 594, 1857, ii., 264.
i 476, 1883, i., 1043. j 616, 1871-72, v., 507. k 535^ 1801, vi., 17.

ANOMALOUS SNEEZING.

813

tressing hiccough that never ceased for a minute during eighty hours. Two
ounces of laudanum were administered in the three days witiiout any decided
etfect, producing only slight languor.

lianney reports the case of an unmarried woman of forty-four who suf-
fered from paroxysms of hiccough that persisted for four years. A peculiar-
ity of this attack was that it invariably followed movements of the upper ex-
tremities. Tenderness and hyperesthesia over the spinous processes of the
4th, 5th, and 6th cervical vertebrae led to the application of the thermo-
cautery, which, in conjunction with the administration of ergot and
bromids, was attended with marked benefit, though not by complete cure.
Barlow ^ mentions a man with a rheumatic affection of tlie 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 tlie left hand.

Beilby reports a peculiar case in a girl of seventeen who suffered an
anomalous affection of the respiratory nmscle, 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 w^aking moments, and subsided during sleep.
Under rest and free purgation the patient recovered, but the paroxysms con-
tinued 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 re-
ports 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, occur-
ring after a debauch, by the administration of glonoin, y^-g- of a grain every
three hours. Pleidenhain ^ 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
I/'pine s 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. liaborde
referred to two cases of a similar character reported by Viand.

Anomalous Sneezing. — In the olden times sneezing was considered a
gocjd omen, and \vas 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, some-
what profanely wondering why sneezing had been deified rather than couo-h-
ing. The Greeks traced the origin of the sacred regard for sneezing to the

a 533, 1884, xliv., 695. ^ 475, 1840-41, i., 295. c 318, 1835. d 632, Oct., 1894.
e 450, Oct. 27, 1894. f 199, June 11, 1884. g Quoted 533, March 28, 1896, 354.

814 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

days of Prometheus, who blessed his man of clay when he sneezed. Ac-
cording 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 Mesopota-
mia 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 peo-
ple 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 con-
tinue 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 sneez-
ing. 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

a Memphis Jour. Med. Sc., 1889, i., 100. b 318, 1835.

c 536, 1888, i., 28. <i 476, 1880, i., 253.

HEMOPHILIA.

815

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 yawn-
ing. Woakes also speaks of " ear-giddiness " and offers a new associate symp-
tom— 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 ten-
dency to uncontrollable bleeding, either spontaneous or from slight wounds.
It is sometimes associated with a form of arthritis (Osier). 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 rufe the mother of a hemophile is not a
" bleeder " herself, but is the daughter of one. The daughters of a hemo-
phile, though healthy and free from any tendency themselves, are almost cer-
tain to transmit the disposition to the male offspring. The condition gener-
ally appears after some slight injury in the first two years of life ; but must
be distinguished from the hemorrhagic aifections of the new-born, which will
be discussed later. The social condition of the family does not alter the jire-
disposition ; the old Duke of Albany was a "bleeder" and bleeder fami-
lies are numerous, healthy looking, and have fine, soft skins.

The duration of this tendency, and its perpetuation in a family, is remark-
able. The Appleton-Swain family of Reading, Mass., has shown examples
for two centuries. Osier has been advised of instances already occurring in
the seventh generation. Kolster'' has investigated hemophilia in Avomen, 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 1 1 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, petechije, and
ecchymoses ; and the joint-affections. The external bleedings are seldom spon-
taneous, 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.

a 476, 1852, i., 360. b pinska Lakar. Handlingar, March, 1895.

816 ANOiMALOUS TYPES AND INSTANCES OF DISEASE.

Armstrong, Blagden,^ and Roberts,^ have seen fatal hemorrhage after the
extraction of teeth. MacCormac observed five bleeders at St. Thomas Hos-
pital, 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. Dunlap® reports a case of hemorrhagic diathesis,
following suppression of the catamenia, attended by vicarious hemorrhage
from the gums, which terminated fatally. Erichsen ^ 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.
Osier remarks that Professor Agnew knew of a case of a bleeder who had
alwavs bled from cuts and bruises above the neck, never from those below.
The joint-affections closely resemble acute rheumatism. Bleeders do not nec-
essarily die of their early bleedings, some living to old age. Oliver Appleton,
the first reported American bleeder, died at an advanced age, owing to hem-
orrhage 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
lo2 boy subjects 81 died before the termination of the seventh year. Hemo-
philia is rarely fatal in the first year.

Of the hemorrhagic diseases of the new-born three are worthy of note.
In syphilis hsemorrhagica 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
deeplv 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,

a Trans. Belfast Clin, and Path. Soc, 1854.

c 476, 1841-42, i., 752. ^ 548, 1869, ii., 277.

f 476, 1856, i., 511.

550, 1820.
e 594, 1850, iv., 314.
g 548, 1877, i., 258.

TETANUS NEONATORUM.

817

sometimes epidemic in lying-in institutions ; it develops about the fourth day-
after birth. The principal symptom is hematogenous icterus with cyanosis, —
the urine conhiins blood and blood-cok)ring 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 surfoces is a not uncommon event in
the new-born, particularly in hospital-practice. According to Osier Town-
send reports 45 cases in 6700 dehveries, 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 post-
mortem examination reveals no pathologic clianges, although the general and
not local nature of the afiection, its self-limited character, the presence of
fever, and the greater prevalence of the disease in hospitals, suggest an infec-
tious origin (Townsend). Kenf^ 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 1895.619

In an article on the successful preventive treatment of tetanus neo-
natorum, 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 gen-
eral was this trouble on the island of St. Kilda that the mothers never thought

to

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 dwel-
lings, make it extremely probable that the infection was through the umbili-
cal cord. All cases in which treatment was properly carried out by compe-
tent 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, conse-

a 476, 1868, ii., 487. b 381, March, IsOS.

52 ' '

818 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

quently, 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 taenia saginata 24 feet long. The older reports, according to which the
taenia solium (/. e., generally the tsenia saginata) grew to such lengths as 40,
60, 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 con-
tained in any human intestine.

The name solium has no relation to the Latin solas, 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 Avhich several
teni£e existed simultaneously in the stomach. David ^ speaks of the expulsion
of five tenias 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 tape-
worms, 12 heads being found. Laveran s reports a case in which 23 teniae
were expelled in the same day. Greenhow ^ mentions the occurrence of two
taeniae mediocanellata.

The size of a tapeworm in a small child is sometimes quite sur-
prising. Even the new-born have exhibited signs of teniae, and Hauss-
manni jj^s discussed this subject. Armor J 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 " men-
tions the expulsion of eight teniae from a child. Occasionally the tapeworm
is expelled from the mouth. Such cases are mentioned by Hitch ° and Mar-
tel.P White ^ speaks of a tapeworm which was discharged from the stomach

a 476, 1885, ii., 991. b 162, 1840, 310. ^ 368, 1843, xi., 41.

d 476, 1885, ii., 566. e 728, 1883. f 476, 1885, ii., 1221.

g Arch, de m6d. et pharm. mil., Paris, 1885, v., 173. ^ 476, 1863, ii., 699.

i 224, 1872, ii., 466. j 597, 1871, xiv., 518.
k " Proceedings of the Pathological Society of Dublin," 1885-87.

I 5.38, Nov. 24, 1878. ^744, 1847, iii., 413. ° 368, 1887, v., 447.

o 224, 1882, ii., 789. P 363, 1886, 101. ^ 149, 1798, ii., 292.

HUMAN PARASITES.

819

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 Mur-
sinna ^ has even observed a case of trismus, or lockjaw, due to taenia solmm.
F6r6ol speaks of a case of vertigo, accompanied with epileptic convulsions,
which was caused by tenise. 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
unminent 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 s speaks of 129 round- worms being discharged from a
child in the short space of five days. Pole ^ mentions the expulsion of 441
lurabricoid worms in thirty-four days, and Fauconneau-Dufresne ^ has re-
ported 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. Par6 speaks of a case of this kind
during a long illness ; and there is mention j of a man who voided a worm
half a yard long from his bladder after suppression of urine. The Ephe-
merides contains a curious case in which a stone was formed in the bladder,
having for its nucleus a worm. Fontanelle presented to the Eoyal 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 Avorm-like body,
not unlike a tapeworm as far as the segments and general appearance are con-
cerned, the length of each segment being about J inch, the breadth rather
less; sometimes 1^ segments are joined together. The worm is serrated on
the one side, each segment having li 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 ; spe-
cific gravity was 1010 ; there were no albumin nor tube-casts nor uric acid

a 545, 1890, 42. b Lond. Med. Rev. and Mag., 1799-1800 ii 290

c 237, 1876, 172. d 224, June, 1867. e 224, 1868,' il, 221.

f Trudi. obsch. dietsk vrach, St. Petersburg, 1869, ii., 67, g 435 1885 319

hMed. Chron., Bait., 1882-83, i., 184. i 7^9' I880' 186

j 629, 1700, 135. k 224', 1895,' ii., 512.

820 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

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° to 103.2° 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.

TurnbuU ^ has recorded two cases of perforation of the tympanic mem-
brane 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 men-
tions 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 trichiuje may be discovered anywhere
in the line of cardiac or lymphatic circulation. Quoted by Fournier, =^^2 La-
peyronnie 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.^ A Castro and Vidal speak of worms in the
aorta. Rake J 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 coun-
try 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 Dra-
cunculus medinensis or Guinea-worm is a widely-spread parasite in parts of
Africa and the West Indies. According to Osier 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.

a 436, 1891, ii., 381. b Lond. Med. Jour., 1786, vii., 372. « 789, 1856, x., 279.
d 545, 1881, 32. ^ Jour, de m6d. et chir. prat., Paris, 1883, 258.

f 547' 1870-71, i., 181. g 224, 1887, i., 1274. h 2I8, 1867, 409.

i 469 1772. j 703, 1890, 26. ^776, 1824, i., 663.

''EATEN OF WORMS."

821

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 AVoman'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 speak-
ing of the Emperor Galerius, Dean Milman, in his " History of Latin Chris-
tianity," ^ 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 " De-
cline 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 im-
mense 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 larvje of the estrus or the bot-fly in the skin are not
uncommon. In this country Allen ^ removed such larvje from the skin of
the neck, head, and arm of a boy of twelve. Betliunc, Delavigne, Howship,
Jacobs, Jannuzzi, and others, report similar cases. These flesh-flies are
called creophihe, and the condition they produce is called myiosis. Accord-
ing to Osier, in parts of Central America, the eggs of a bot-fly, called the
dermatobia, are not infrequently d(>posited in the skin, and produce a swell-
ing 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 con-
stipation and pain in the back and sides, passed large numbers of the larvte
of the flower-fly, anthomyia canicularis, and there are other instances of
myiosis interna from swallowing the larvae of the common house-flv.

There are forms of nasal disorder caused by larva, which some native
surgeons in India regard as a chronic and malignant ulceration of the nmcous

536, 1886, ii., 142. b Vol. i., 227. c Vol ii 120

d Maccabes, ch. ix., verses 1, 5, 9, and 10. e 218, Ixixvil, 306.

822 ANOMALOUS TYPES AND INSTANCES OF DISEASE.

membranes of the nose and adjacent sinuses in the debilitated and the scrofu-
lous. 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 sig-
nifies disease of the nose, and is the Indian term for the disease caused by
the deposition of larv£e in the nose. It is supposed to be more common in
South America than in India.

a Indian Annals of Medicine, Oct., 1885,

CHAPTER XVI.

ANOMALOUS SKIN-DISEASES.

Ichthyosis is a disease of the skin characterized by a morbid develop-
ment of the papilla 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 grand-
father was found by a whaler in a wild state in Davis's Straits, and for four gene-
rations the male members of the family had been so enaised. 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 four-
teen, were examined by Geoffroy-Saint-Hilaire. This thickening of the epi-
dermis and hair was the effect of some morbid predisposition which was
transmitted from father to son, the daughters not being affected. Five gene-
rations could be reckoned which had been affected in the manner described.

a 368, 1831, T. ii., 10. b 476, 1832, ii, 146.

823

824

ANOMALOUS SKIK-DISEASES.

The " porcupine-man " seen by Baker contracted small-pox, and his skin
was temporarily freed from the squamae, but these reappeared shortly after-
ward. There are several older records of prickly men or porcupine-men.
Ascanius ^ mentions a porcupine-man, as do Butfon and Schreber. Auten-
reith speaks of a porcupine-man w ho was covered with innumerable ver-
rucse. Martin^ described a remarkable variety of ichthyosis in which the

Fig. 286. — An alligator-boy.

skin was covered with strong hairs like the bristles of a boar. When numer-
ous 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 aifected in this case resembled in color and consistency
that of a young alligator. It was remarked that his olfactory sense was intact.

a 462, T. iv., 216. ^ 550, ix., part i., 53.

''HARLEQUIN FETUS."

825

The harlequin fetus, of which there are specimens in Guy's Hospital,
London Hospital, and the Royal College of Surgeons INIuseum, is the result
of ichthyosis congenita. According to Crocker either after the removal of
the vcrnix 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 i)lates.
In the harle(|uin fetus the whole surface of the body is thickly covered with
fatty epidermic plates, about -^-^ inch in thickness, which are broken up
by horizontal and vertical fissures, and arranged transversely to the sur-
face 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 stiif to permit of su(!king, 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 dis-
ease 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. Tiiese spots gradually developed
into papules, and the whole skin took on a dirty yellow color. Soon after-
ward 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 [)apules, and lastly pigmentation. The black specks soon began to pro-
ject, and comedo-like plugs and small, spine-like growths were produced.
Both the spines and plugs were very hard and firndy-rooted. They resisted
firm pressure with the forceps, and when ])laced on sheets of paper rattled
like scraps of metal. A direct history of contagion was traced from this case
to others.

Mibelli'' describes an unconmion 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 tlie neck, beyond a few centimeters below the
lobe of the ear, there were about ten small warty patches, irregularly scat-
tered, 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

a " luteruational Atlas of Rare Skin-Diseases."

826

ANOMALOUS SKIN-DISEASES.

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.

Diifuse 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 inter-
fere with the respiration and to flatten and almost obliterate the brea-sts ; 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. Hap-
pily 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, mor-
phea 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 indura-
tion 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.

THE ^^ELEPHANT-MAN." 827

Gerard reports recovery from a case of sclerema neonatorum in an infant
five weeks old, which seemed in perfect health but for this skin-afTection.
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 indu-
rated skin were sharply defined, irregular, and map-like. The affected skm
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 cod-
liver 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 aifected skin were left surrounded by normal integu-
ment. No pitting could be produced even after the tension of the skin had
decreased during recovery. The lowest rectal temperature was 98° 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 (Figs. 287 and 288). 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 un-
fortunate 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 ex-
hibited 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 devel-
oped on the skin of the back, buttock, and occiput. In the right pectoral
and posterior aspect of the riglit 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

a 476, May 4, 1895. b 224, 1890, i., 916.

828

ANOMALOUS SKIN- DISEASES.

heavy head showed a tendency to fall back and produce a sense of suifocation.
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,

Fig. 287.— Head of the " Elephant-man."

Fig. 288.— The"Elephant-nian" (Treves).

April 11, 1890 ; while in bed his ponderous head had fallen baclvAvard 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

AINHUM.

829

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 distribu-
tion, 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 prev-
alence 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 ainhura has been
shown in India, and considerable investigation made as to its etiology, path-
ologic histology, etc. Wise at Dacca, Smyth and Crombie at Calcutta, Hen-
derson 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 W^inckler 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
AVashington.

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 incon-
venience 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 brouglit 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 533, Jan. 26, 1895.

830

ANOMALOUS SKIN-DISEASES.

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 simi-
lar case in a negress on St. Thomas Island. Sen reports a case in a super-
numerary 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.

Fig. 289.

Ainhum (dorsal surface). Plantar surface (Ohmann-Dumesnil).

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 dis-
ease is between two and four years, but Dr. Evans's case had been in pro-
gress fifty years. It rarely runs its full course before a year.

Ainhum begins as a small furrow or crack, such as soldiers often experi-
ence, 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 ex-
pressive 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

AINHUM.

831

eruption accompanying the swelling. The furrow increases laterally and ni
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 dis-
tal end of the toe becomes ovoid, and soon an appearance as of a marble at-
tached to the toe by a fibrous pedicle presents itself. By this time the swell-
ing, if any, has subsided. The distal end of the toe bends under the foot,
and becomes twisted when walking, and causes inconvenience, and, unfortu-
nately, 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 observa-
tion showed no ulceration, and was absolutely painless, the negress applying
for diagnosis rather than treatment. The furrow deepens until spontaneous am-
putation 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, be-
ing 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 simul-
taneous in different toes. There are no associated constitutional symptoms,
no tendency to similar morbid changes in other parts, and no infiltration else-
where. 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 inflamma-
tory changes, which are followed subsequently by the changes peculiar to
ainhum. The cause has been ascribed to the practice of wearino- rino-s on

tote

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. Aouin the

832

ANOMALOUS SKIN- DISEASES.

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 annu-
laris ainhumoides. The patient was a boy about twelve years old, born in
Erzeroum, brought for treatment for scabies, and not for the aifection 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 ter-
minal phalanx. It did not advance as for 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 ser-
pent, 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 ^ men-
tions 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 consecu-
tive 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
a476, Oct. 22, 1881. ^124, July, 1891.

SKIN-SHEDDINO.

833

period. The cuticle began to shed some time between the third and twelfth
day, in large sheets, as pictured in the accompanying illustrations (Figs. 290
and 291). The nails were shed in about four weeks after the acute stage.
Crocker had an instance of this nature in a man with tylosis palmaB, in which
the skin was cast off every autunni, 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 Ephenierides of 1686 ; and NewelP' records a ease 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 sepa-
rate 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 symp-
toms, 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 witli pains in the head,
back, limbs, retching, vomiting, dry skin, furred tongue, urgent thirst, con-
stipation, and high-colored urine. Usually the whole surface of the bodv
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

' 490, iii, 576. b 629, Ix., 451. c 629, lix., 281.

53

834

ANOMALOUS SKIN-niSEASES.

Fig. 291. — Casts of a case of skin-shedding (Frank).

DERMATITIS EXFOLIATIVA NEONATORUM.

835

like a glove. The patient was never disposed to sweat, and when it was at-
tempted to force perspiration lie grew worse; nor was he ranch 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 eases 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 Shopardstown, 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 pliysical 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 oif 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 per-
mitted 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 lamina like
pityriasis rubra, and either dry or witli 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 surfiicc 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 exfi)liation 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 epi-
demic skin-disease which made its appearance in 1891 in England ; 425 cases
were collected in six institutions, besides sporadic cases in private houses.

a 124, Jan., 1888.

836

ANOMALOUS SKIN- DISEASES.

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 ilkistrate 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 ex-
hibited in this collection.

Of sphaceloderma, or gangrene of the skin, probably the most inter-
esting 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 pro-
duced by intense cold ; and local asphyxia, which usually follows local syn-
cope, 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, stifiP, 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 Osier 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 in-
tensely 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 779, xxxiv., 286.

NEUROSES OF THE SKIN.

837

A considerable number of cases of apparently spontaneous gangrene of
the skin have been recorded in medical literature as occurring generally m
hysteric young women. Crocker remarks that they are generally classified
as erythema gangmnosum, 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 eigh-
teen whose face, left breast, anus, legs, and feet became atfected 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, witli great loss
of blood, but there was no subse(|uent menstruation, and no vicarious hemor-
rhage. Afterward the riglit 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 conjunctiva 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 hyper-
esthesia and diminution of sensibility or anesthesia. There are some curi-
ous 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. Bartliolinus 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 " M6moires de 1' Academic
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

a 838, May 3, 1894. b Venetiis, 1612, Historia, 46.

838

ANOMALOUS SKIN-DISEASES.

the left mammary region to the haunch, and from the vertebrae to the
linea alba. Tliroughout this whole extent the skin was insensible and
could be pinched or even punctured without the patient being aware
that he was even touched, Tlie parts did not present any perceptible
alteration in texture or in color. Tlic i)atient 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

Fig. 292.— Neuroma cutis dolorosuin (Dubriiig).

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 liospital 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

YA WS.

implication of the power of voluntary motion. lie 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 (Fig.
292). The patient was a boiler-maker of seventy who had no family liistory
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 aft'ected 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 be-
coming 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 sur-
roundings, until the worst pain had ceased. Frequently he was unable to con-
trol 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 suff'ering 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 Osier 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 dis-
turbance. Its synonym, frambesla, is from the French, framboise, a rasp-
berry. Yaws is derived from a Carib word, the meaning of which is doubt-
ful. 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

a 124, Oct., 1881.

840

ANOMALOUS SKIN-DISEASES.

button-scurvy of Ireland, now extinct, but described by various writers of
1823 to 1857 as a contagions 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.

Franibesia or yaws was observed in Brazil as early as 1 643,* and in
America later by Lebat in 1722. In the last century Winterbottom and
Hume describe yaws in Afriai, 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, sec-
ondary, and tertiary. The incubation stage is taken from the date of infec-
tion 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 palpita-
tion, 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 any-
where 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

a De medicina BriEsilium, 1643. ^313, xv., 321.

c Obs. sur Ics maladies des uegres, Paris, 1742.

PIGMENTARY ANOMALIES.

841

and other uncovered spots, endemic in limited districts in liot climates, char-
acterized 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
nuiy be left unless great care is employed.

Pigmentary Processes. — Friction, pressure, or scratching, if long con-
tinued, may produce extensive and permanent pigmentation. This is seen
in its highest degree in itching diseases like prurigo and pityriasis. Green-
how '"^ 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
raucous 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 pig-
mented 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 re-
cords 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. Ka[)osi
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 recog-
nizable 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 \\ \t\\
papillary mole-like growths. In the " International Atlas of Rare Skin Dis-
eases " there are two cases pictured, one by Politzer in a Avoman 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

* ^ ^67, xiv. c 224, Nov. 29, 1884.

842

ANOMALOUS SKIN-DISEASES.

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 strise inter-
spersed 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 inocuous. 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. How-
ever, 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 Avhite 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 l)lack, 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
a 767, xiv., 152. b "Thfese de Bordeaux," 1890. « 400, v., 18.

ANOMALOUS DISCOLORATION OF THE SKIN.

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 ai)petite 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. Cliomel 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 inter-
mittent, burning, shooting character, chiefly in the epigastric and left lumbar
regions. The general health was good, and motion and sensation were nor-
mal. 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

a Bull, de la Fac. de M6d. de Paris, 1814, No. 6. b i^id,, 1817, Nos. 9 and 10.

844

ANOMALOUS SKIN-DISEASES.

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 fine-
ness 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 thin-
ner at the sides of the neck ; there were a great many individual hairs sur-
rounded by circles of coloring matter ; but there were also many which pre-
sented 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 charac-
ter, 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 fore-
head, the alse, 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
onlv morbid symptom was a dry cough, but without mucous rattle or any defi-
ciency 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 a])pcared 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

a 162, T. xxvi., 453.

LEUKODERMA.

845

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 tattoo-
ing, 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, achroraa, 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 leuko-
derma. 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 surfiice changes to white. The hair, though rarely
affected, may present a mottled appearance. There seems to be no constitu-
tional disturbances, no radical change in tjie skin, no pain in fact, no dig-

846

ANOMALOUS SKIN-DISEASES.

turbance worthy of note. The eye is not affected ; but in a negro the
sclerotic generally appears muddy.

It appears fii'st 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. Sev-
eral 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-

Fig. 293.— "The leopard family."

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 sweat-glands are unim-
paired.

The theor}^ of the absence of pigment causing a loss of the olfactory sense,
spoken of by Wallace, is not borne out by several observ^ations of AVood and
others. Wilson says : " Leukasma is a neurosis, the result of weakened
innervation of tlie skin, the cause being commonly referable to the organs of
assimilation or reproduction." It .is not a dermatitis, as a dermatitis usually

CANITIES UNGUIUM.

847

causes deposition of pigment. Tlie rays of the sun bronze the skin ; mustard,
cantluiridcs, and many like irritants cause a dermatitis, which is accompanied
by a deposition of pigment. Leukoderma is as common in housemaids as in
fiekl-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 niucosum. 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 leuko-
dermic 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 muco-
sum 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 ex-
periments 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 Mori-
son of Baltimore, in which transverse bars of white, alternating with the nor-
mal 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,

a 224, Jan. 17, 1891.

848

ANOMALOUS SKIN-DISEASES.

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 simi-
lar case, which, however, he calls leukonychia.

Plica polonica, or, as it was known in Cracow — weichselzopf, 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 Lezek-
le-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 in 20 ; and the nobility and burghers in the proportion of two in 30 or 40.
In AVarsaw 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 Lithu-
ania 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 agglu-
tinating 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
Eayer 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 mul-

a Traite dela Plique Polonaise, etc., Paris, 1808.

PLICA POLONICA.

849

tif'ormis). Sometimes these masses united together and formed one single
tiiick chib like the tail of a horse (plica caudiformis). Again, and particu-
larly 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 pos-
sessed 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 sec-
tion 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 the-
orizing 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 in-
numerable 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. Stell-
wagon <^ 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 nodu-
lar 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 con-
cretions. 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."

54 a 224, Jan. 26, 1884. b 475, Sept. 3, 1885. c 124, Dec, 1892.

850

ANOMALOUS SKIN-BISEASES.

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 firet were either pre-
mature or died a few days after their births. The seventli was under
treatment for interstitial keratitis and tuberculous ulceration of the lips
and throat. Tiie 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 prolifera-
tion 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 pre-
vious 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 tlie eyelashes absent. Tlie forehead was leonine in aspect.
From between the various nodosities a continual discharge exuded, the nodosi-
ties 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. Itcliing was intense. The patient became emaciated and died thir-
teen days after his admission into the liospital. A histologic examination
showed the sarcomatous nature of the various growths. The disease differed

a "Interiiat. Atlas Rare Skin Diseases."

Fig. 294.— Mycosis fungoides (Jamieson, Edin.
Med. Jour., March, 1893).

Plate 12.

Universal derniatitis (Morris).

I

A RARE CASE OF UNIVERSAL DERMATITIS.

851

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 (Plate 12). 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 dis-
ease 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 unaifected. 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
appeanince, 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 but-
tocks, 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 sleej). He \vas 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.

a 224, June 2, 1894.

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 Bartho-
linus 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 danc-
ing epilepsy. Bartholiuus and Hagendorn mention cases during which
various splendors appeared before the eyes during the paroxysm. Godart *
Fortius, and Salmuth speak of visions occurring before and after epileptic
paroxysms. The Ephemerides contains records of epilepsy in which blind-
ness 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 irrita-
tion 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. Muscroft men-
tions 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

a 462, xiii., 393. b 490, xlviii., 534. c 218, c, 513. ^ 476, 1856, i., 454.
e 538, 1872, 472. f West. Med. and Phar. Jour., Cincin., 1828-29, ii., 454.

g 318, 1868-69, xiv., 140. ^ 548, 1863, i., 538. i 476, 1861, i., 628.

852

THE DANCING MANIA.

853

an iittack of acute rheumatism. Thorington of Pliiladclpliia has seen a
paroxysm of epilepsy induced by the instillation of atropia in the eye of a
<'liild nearly cured of the malady. It was supposed that the child was terri-
fied 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 pec!uliar case of running ej)ilepsy recorded.'' The patient was
a workman who would be suddenly seized with a paroxysm, and uncon-
sciously run some distance at full speed. On one occasion he ran from Peter-
borough 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 hemor-
rhage, 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,
choroniania, 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 veiy little resemblance to
what, at the present day, is called by this name. The epidemic form ap-
peared about 1374, although Hecker^os claims that, at that time, it M^as 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
a 224, 1879, ii., 78. b 476, 1878, i., 89. c 816, 1835.' d 312, 1843, x. i46.

854 ANOMALOUS NERVOUS AND MENTAL DISEASES.

heavens open and disclose the Saviour enthroned with the Virgin Mary.
The participants seemed to suffer greatly from tympanites which was gener-
ally 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 pro-
tect 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 idiosyn-
crasies 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 magis-
trates 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 prob-
ably 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 sim-
ilar 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 Tigr^ 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 " Convulsion-
naires " arose in France ; and throughout England among the Methodist sect,
insane convulsions of this nature were witnessed ; and even to the present

PALMUS.

855

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 imagina-
tiva).

(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 pro-
duced 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 ac-
curate 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 "
wlio says that the French authors had their attention directed to the subject
by the descriptions of two American authors — those of Beard upon " The
Junipers of Maine," published in 1880, and that of Hammond upon " Miry-
acliit," 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 iEneid 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 com-
pletely, 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, furfcliermore, 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

a 124, May, 1894, 195.

856 ANOMALOUS NERVOUS AND MENTAL DISEASES.

of wood on an awning, anmsing- 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 neu-
rasthenia. His palmodic movement« 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-blne mark, or his head would be thrown
violently to one side, perhaps coming in contact with some adjacent hard ob-
ject 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 hap-
pened 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 per-
fectly 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 para-
myoclonus multiplex have been really acute palnms."

Gray mentions two cases of general palmus with pseudomclancliolia, 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 whiqh, 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

a 318, 1829, 299.

A THETOSIS.

857

botli men, one thirty-six and one thirty-eight years of age. The pseudo-
melanolioHa, 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
montiis' 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 periotl, 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 placed, 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
fixetl 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^piick
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 athe-
tosis. The two diseases, however, are somewhat alike. Paralysis a.ritans
(shaking palsy), with its coarse tremor, peculiar focies, immobility, shufflin<r
gait, the ' bread-crumbling ' attitude of the fingers, and deliberate speech, would
be readdy ehminated even by a novice. It is, too, a disease of advanced

a 809, May, 1895.

858 ANOMALOUS NERVOUS AND MENTAL DISEASES.

life, usually. Charcot, Gray, Kinger, Bernhardt, Shaw, Eulenberg, Grasset,
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 msamty :
''The patient was a negro woman, twenty-six years old when she was ad-
mitted into this, the Central State (Va.) Hospital, in April, 1886. She had
had epilepsy of the c/rand mal type for a number of years, was the mother oi
one child, and earned her living as a domestic. A careful physical examma-
tion revealed nothing of importance as an etiologic factor. Following in
the footsteps of many of those unfortunates afflicted with epilepsy, she degen-
erated 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 in-
voluntarily assumed various distorted positions and were constantly in motion.
The toes were usually in a state of tonic spasm,-contracted, and drawn down-
ward or extended, pointing upward, and slightly separated. Irregular alter-
nate extension and flexion of the toes were marked. The feet were moved
upon the ankles in a stiff and awkward manner. During these ' complex in-
voluntary 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 m slow,
methodic, quasi-rhythmic motion, never remaining long in the same atti-
tude. In grasping an object the palm of the hand was used, it being diffi-
cult to approximate the digits. The wrist-joints were also implicated, there
being alternate flexion and extension. In fact these odd contor ions affected
the entire limb from the shoulder to the digital extremities. ^\ hen standing
or walking the arms were held out horizontally, as if to maintain the equi-
librium of the body. The patient's general physical health was fairly good.
She frequently complained of headache, and when she was exceedingly irrita-
ble and violent all the athetoid movements would be intensified Speech
was ierky 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 obsti-
nate attack of status epilepticus."

FACIAL HEMIATROPHY.

859

Paramyoclonus multiplex is a condition of chronic muscular spasm
affecting the trunk, occasionally the muscles of the face, abdomen, or dia-
phragm. 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 some-
times be so violent as to throw the patient down or out of the chair.

Saltatoric spasm is an extremely rare condition, first observed by Bam-
berger 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 Hippoc-
rates, but it is only in recent times that we have had any definite knowledge

Fig. 295.— Facial hemiatrophy (Dana).

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 ap-
pearance of a " living skeleton."

Facial hemiatrophy is an incurable disease, as yet of unknown path-
ology. It consists of wasting of the bones, subcutaneous tissues, and mus-
cles of one-half of the face or head, the muscles suffering but slightly. The
accompanying illustration (Fig. 295) shows a case in which there was osse-
ous 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

8(50 ANOMALOUS NERVOUS AND MENTAL DLSEASES.

aiiection, usually begiuuing 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 nniscles 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 pres-
ent. 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 accommoda-
tion. Station and gait are normal. There is no incoordination of move-
ment 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. Accord-
ing 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

a 466, July, 1896.

MiNlkRE'S DISEASE.

861

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 togc^ther ; 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, char-
acterized 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 por-
tions 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 experi-
ence, 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 pale-
ness 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,
a -'Treatise on Mental and Nervous Diseases," Phila., 1893, 522.

862 ANOMALOUS NERVOUS AND MENTAL DISEASES.

Human rumination has been known for many years. Bartholin us, Paul-
linus, Blanchard, Bonet, the Ephemerides, Fabricius Hildanus, Horstius,
Morgagni, Peyer, Rhodius, Vogel, Salmuth, Percy, Laurent, and others de-
scribe it. Fabricius d'Aquapendente personally knew a victim of rumina-
tion, 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 sweet-
est honey. The patient related that from his infancy he had been the sub-
ject 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 opera-
tions on the cranium, or the result of the mental improvement, is a question
for discussion. Hammond added that, when acquired, merycism was almost
variablv the result of over-eating and loading the esophagus, or the result

inv:

of fast eating.

In remarks upon Hammond's paper Knapp said that two cases had come to
his knowledge, both in phvsicians, but one of them he knew of only by hear-
say 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 regurgi-
tated 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

.. -on ^ 302, xxxii., 526.

a 302, xxxu., 530.

SOMNAMB ULISM.

863

fulness in the stomach. Lloyd said tliat 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 aff^ected 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.

liunge * 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 state-
ments 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 experi-
ence any bad effects whatever from the spell, nor did he during his one hun-
dred and thirty-one days. During that spell he attended to all of his farm
business. He says now that he feels as tliough 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 prob-
ably 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 con-
sciousness occasionally observed in epileptics. Both Hippocrates and Aris-
totle discuss somnambulism, and it is said that the physician Galen was a vic-

=1 218, May 23, 1895.

864 ANOMALOUS NERVOUS AND MENTAL DISEASES.

tini 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, Hoff-
mann, Gassendi, Caelius Rliodiginus, Pinel, Hechler, Bohn, Richter,— hi fact
nearly all the ancient physiologists and anatomists have written on this sub-
ject. The marvelous manifestations of somnambulism are still among the more
surprising phenomena with which scieijce has to deal. That a person deeply
immersed in tliought should walk and talk while apparently unconscious,
excites no surprise, but that anyone should when fast asleep perform a series
of complicated actions wliich 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
anvthing 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 curtanis 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 plaving. In another room he struck with his empty hands a harpsi-
chord, and finally returned to his bed. He appeared to be irritated when any-
body 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, pur-
sued his studies, and returned to bed without awaking ; and there is another
record of an ecclesiastic who finished his sermon in his sleep.

a 476 1823, 40. ^ ^^1- * '

SOMNAMBULISM.

865

The Archbishop of Bordeaux attests the case of a young ecclesiastic who
was in tlie liabit of getting up during the night in a state of somnambulism,
taking pen, ink, and paper, and composing and writing sermons. When he
luid finished a page he would read aloud what he had written and correct it.
J n 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 inconniioded. In this state he also copied out pieces of
music, and when it happened that the words were written in too large char-
acters 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 imniediately began gro})ing 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 g, 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 tlie performance. At another
time she attempted to kill herself by violently throwing herself on the floor
after having fiiiled to fling herself out of the window. At still another time
slie 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 nWht
when she was again somnambulistic, she changed her mind once more, writing
to her family explaining her change of purpose. Mesnet relates some interest-
ing experiments made upon a French sergeant in a condition of somnambu-
lism, 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

55

866 ANOMALOUS NERVOm AND MENTAL DISEASES.

and an inkstand, and taking a chair he sat down and wrote to his command-
ing 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. Sonuiambulisni may assume such a serious phase as to re-
sult in the commission of murder. Tliere 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 twcntv-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 som-
nambulism was the impending fears and terrible visions to which he was sub-
jected. 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 star-
hig ; 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 over^vhelming grief he found that he had killed
his beloved babv. A similar record has been reported of a student who at-
tempted 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 Banie 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

J T -.o-Q Q-ri b 465, 1878, 451.

a Glasgow Med. Jour., 1878, p. 371. ' '

PROTRACTED SLEEP.

867

him one night. Leaving his home he followed the highway until he came to
a rough, narrow pig-trail leading to the Tow Kiver. 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, swim-
ming 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. Plammond 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 "sleepino-
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

868 ANOMALOUS NERVOUS AND MENTAL DISEASES.

and Hammond, and medical literature is full of interesting cases, many dif-
fering 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. ^
MuUer of Lowenburg^es records a case of lethargy in a young female, fol-
lowing 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 fright-
ened 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
a 476, 1832-33, i., 663. b 131, 1874. c 596, 1853. d 224, June 13, 1863.

PROTRACTED SLEEP.

869

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 excep-
tion 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 1 8 cases of protracted sleep, the longest continu-
ing uninterruptedly for six months. Chilton's case lasted seventeen weeks.
Six of the 18 cases passed a large part of eacli 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 recov-
ered 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 there-
after 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 autom-
aton. 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 ])rofound sleep, during which she was kept alive by
small quantities of liquid food, which she swallowed automatically. Tlie ex-
cretions were greatly diminished, and menstruation was suppressed. There
is a case reported « of a Spanish soldier of twenty-two, confined in the Mili-

' •'^48, 1864, ii., 518. b 768, iii. c 538, May 1, 1869

d 476, 1884, i., 5. e Quoted 476, 1885, ii., 354.

870

ANOMALOUS NERVOUS AND MENTAL DISEASES.

tary 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 nos-
talgia, after which he began to have intermittent and temporary attacks,
which cuhuinated as related. Camuset and Plants 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
montlis, 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 Decem-
ber 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 cen-
tury 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 mo-
tionless for days with their gaze directed steadily to the navel ; the Tasko-
drugitcs 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 autohypnotisra." (Gray.)

Hypnotism is spoken of as a morbid mental state artificially produced,
and characterized by perversion or suspension of consciousness, and abey-
ance of volition ; a condition of suggestibility leads the patient to yield

HYPNOTISM.

871

readily to commands of external sense-impressions, and there is intense con-
centration 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 con-
sist of certain stimuli of sight, hearing, and touch. Taste and smell have
generally given negative results. Fixation of the gaze has been tlie 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 stinudations 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, with-
out 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 practised by stimula-
tion 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, ac-
companied by music and other mental excitations.

Hypnosis is spoken of by Hue 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 liypnotic state. Tlie state may have been
induced by singing and uniform whirliug 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 fiiith-cures which
have extended over many centuries, and have their analogy in the supposed
therapeutic powers of the Saints.

872 ANOMALOm NERVOUS AND MENTAL DISEASES.

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, ap])arcntly 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 drowsi-
ness 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 tem-
perature 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 unaflPected, the patient has the ideas, but lacks the

a 476, May 19, 1894.

APHA8IA.

873

power to give them proper expression through words, written language, or
gesture. If the })atient is unable to write, the condition is known as agraphia.
Word-blindness, word-deafness, etc., are terras 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. Accord-
ing 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 ^ chair, at the same time addressing to him the words,
" voclion, animal, fiehue Fren(!h words hardly allowable in drawing-

room usage. She was totally aphasic but not paralyzed. AVomen often use
semi-religious expressions like " Oh dear," or " Oh Lord." Men of the
lower classes retjun 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 pri-
mary 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 chil-
dren scalded fell unconscious and motionless, and remained without food for
th ree days. It was then found that she suffered from complete aphasia Five
weeks after the incident she could articulate only in a very limited vocabu-
lary.

In the Philosophical Transactions Archdeacon Squire tells of the case of
Henry Axford, who lost the power of articulation for four years ; after a hor-
rible 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 her-
self; 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 suff'ering with hemiplegia of the left side. Aphasia developed several
days after admission and continued complete for three months. The boy

a Quart. Jour. Psych. Med, N. Y., 1868, ii, 74. b 47^ I870 ii 402

47b, 1889, 1., 373. 1 700, 1 869, iv, 245.

874 ANOMALOUS NERVOUS AND MENTAL DISEASES.

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 Wad-
ham first saw him. A postmortem examination showed nearly total destruc-
tion of the Island of Reil, popularly called the speech-center. Jackson ^ men-
tions 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 practising 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 Russnhis 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, olfactoiy nerve-changes, congenital absence,
or over-stimulation of the nerves, or it may be a symptom of hysteria.

0<de,« 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.

a 476 March 17, 1868. b 767, 1870, iii., 92. « 700, 1868, iii., 167.

d 243 1861 , 220. e 550, vol. liii., 1870, 264. ^ 476, 1873, n., 689.

g 162, April, 1870, 385. h 218, 1878.

ANOSMIA.

875

Mitchell reports a case of a woman of forty who, after an injury to her
nose from a fall, sulfered 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 pig-
mentation. 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 overstinuilation 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 bot-
tom of which the arms were found. He suffered greatly from the abom-
inable 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 imagi-
nary disagreeable, personal odors.

Perversion of the tactile sense, or wrong reference to the sensation of
pain, has occasionally been noticed. The Ephenierides records a case in
which there was the sense of two objects from a single touch on the hypo-
chondrium. Weir Mitchell remarks that soldiers often misplace the loca-
tion 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
a 124, 1890. b 550, 1870, 263. c 309, 1884, vi., 69. d 533, March 16, 1895.

I

876 ANOMALOUS NERVOUS AND MENTAL DISEASES.

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 tlie name generally given to that variety of melancholia in
which there is an intense longing for home or country. This subject has ap-
parently been overlooked in recent years, but in the olden times it was exten-
sively discussed. Swinger, Harderus, Tackius, Guerbois, Hueber, Therrin,
Castellanau, Pauquet, and others have written extensively upon this theme.
It is said that the inliabitants 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 tlie social constitution of the Swiss mountaineers, wlio are
brought up to a solitary home life, and who universally exhibit great attach-
ment 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 acci-
dent, 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. Tay-
lor^ 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 talk-
ing 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 im-
portance, their exaggeration being at times so great as to amount to actual

a 302, xxxvi. b r,24, 1787, 343. Araer. Med. Bi- Weekly, 1879, 121.

FEAR-PSYCHOSES.

877

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 Ziv(mgsvoM/ungen,
or Zwatigshandlungen, and by the French, peurs makidies, 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. G6lineau 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 Kenopho-
bia. 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
Held, is seized with an intense feeling of fright, and has to run to a Avail 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 foolish-
ness of the fears, but is unable to overcome them. The will is in abeyance
and is quite subservient to the violent emotional disturbances. Gray men-
tions 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. Chazariu mentions a case in a woman of fifty, without any
other apparent symptom of diathesis. Gelineau ^"^^ quotes a case of agora-
phobia, 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 uninter-
rupted 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 Em-
peror peacefully traversed on horseback. The moralist Nicole, was equally
a thalassophobe, and always had to close his eyes at the sio-ht of a laro-e sheet

878 ANOMALOUS NEBVOUS AND MENTAL DISEASES.

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 at 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 un-
locked, and then the attack would immediately subside. Suckling also men-
tions 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 claustro-
phobia. Gorodoiclize ^ 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 light-
ning. 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. Some-
times she could tell the approach of a storm by her nervous symptoms. Calig-
ula, 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

a 363, 1878. ^ 124, 1890. c Jour; de I'Hypnotisme, Sept., 1893. "J 144, 1879.

FEAR-PSYCHOSES.

879

the horror is aggravated to such an extent as to cause distressing symptoms
or unconsciousness, it takes the name of heniatophobia. 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. G^linoau 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 pleas-
ure in conning over the causes of death in the health-reports. Goyard men-
tions 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 tAvo 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 dis-
ease, 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

a " Les frontiferes de la folie," p. 82.

880 ANOMALOUS NERVOUS AND MENTAL DISEASES.

pseudohydrophobia. 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 in-
creased by inspection of sensational literature, treatises on the subject of
spermatorrhea, etc. Ferr6 mentions a woman of thirty-six, of mtense
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 over-
come 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 'pliobias,
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 sor-
ceress, saw devils, and had all sorts of hallucinations, which necessitated the
confinement of the whole family in an asylum for over a month. They con-
tinued 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 re-
lates the history of a lady who, at the beginning of her first pregnancy, ac-
quired an overpowering aversion to a half-breed Indian woman who was em-
ployed 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 eifort, was, however, too

a 144, Nov., 1846.

CIRCULAR OR PERIODIC INSANITY.

881

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 peri-
odic 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 drcu-
laire.' 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 in-
sane 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 Hart-
ford (Conn.) Retreat classed as mania and melancholia have proved to be
folie circulaire. Upon examination of the annual reports of the superinten-
dents 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 ' circu-
lar (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 'alter-
nating (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 ' peri-
odic 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

a 466, April, 1895.

56

882 ANOMALOUS NERVOUS AND MENTAL DISEASES.

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 mforma-
tion could be obtained regarding his antecedents. When admitted he was in a
state of melancholic hypochondriasis ; he was the very picture of abject mis-
ery. Many imaginary ills troubled his peace of mind. He spoke of commit-
ting 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 con-
dition 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-satis-
faction ; 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 furni-
ture 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.' " t ^.

Katatonia, according to Gray, is a cerebral disease of cyclic symptoms,
rano-in- in succession from primary melancholia to mania, confusion, and de-
mentia" one or more of these stages being occasionally absent, while convul-
sive 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 Pygmahon." ^ It
recorded a history of a man named Justin, who died in the Bic^tre Insane

a 476, 1879, ii., 436.

DOUBLE CONSCIOUSNESS.

883

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 indi-
vidual 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 at-
tacks, 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 exis-
tence, 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 mem-
ories and again assumed a melancholy character, which seemed to be aggra-
vated. 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 varia-
tions 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

a 768, X.

884 ANOMALOUS NERVOUS AND MENTAL DISEASES.

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 Ehode 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 con-
sciousness, 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 abso-
lutely 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 liv-
ing) has been under the care of a physician named Azam m 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. Sud-
denly and without the slightest premonition save a violent pain in the tem-
ples she woukl 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
liad happened in her second, or joyous, stage. One day, just after passing
into the second stage, she attended the funeral of an acquaintance. Returning

D 0 UBLE CONSCIO WNESS.

885

in a cab she felt the period coining 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 witli people wlio, 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 hap-
pened. Once when in her abnormal condition she discovered that lier hus-
band 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
tlie regular center of her psychic life. It is rather satisfactory to chronicle
that as between the two egos which alternately possess her, tJie more cheerful
has finally reached the ascendant."

Jackson reports the history of the case of a young dry-goods clerk Avho
was seized with convulsions of a violent nature during which he became uncon-
scious. 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 re-
finement 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 plienomenon was furnished quite
recently at a meeting of the Clinical Society of London, where a well known
physician exliibited 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 liave 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 her'
self or her parents. By patient training in the abnormal condition she has

» 124, 1869.

886 ANOMALOUS NERVOUS AND MENTAL DISEASES.

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, with-
out 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 ap-
pears to have entered on a new phase, for after a mental blank of a fort-
night'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 infre-
quently 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 uni-
son ; in other words, that there has been some interference with the connec-
tions 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 impression-
able. 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 caf6, he suddenly fell into a sleep, and was taken to
the Charit6 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 vir-
tually 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 let-
ters, and had even had sentence passed upon him by a police court for misde-
meanor. 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 Avay 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,
a Quoted 224, 1890, i., 1143. ^

AUTOMATISM.

887

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 reck-
less 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 con-
dition. His faculties seem perfect, his education manifests itself in his intel-
ligent 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 " Cor-
sican Brothers," has been discussed by Sedgwick, Elliotson, Trousseau, Lay-
cock, 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

a 368, 1837, 559. ^ 144, 1863, No. 2. c 221 , July, 1844, 169. d 362, July 17, 1874.

m ANOMALOUS NEBVOUS AND MENTAL DISEASES.

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.
AVhen 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 con-
tinued, 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 un-
til 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 Avho
suffered from simple misdirection of movement without any mental derange-
ment. If from his own desire, or by direction of others, he wanted to at-
tempt 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

a Penins. and Ind. Med. Jour., Detroit, 1859-60, ii., 14. b 465, Oct., 1876, 474.

PRESENTIMENT OF DEATH.

889

muscles were quiet except when called to action bv 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 produc-
tion 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, Ricliter, 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 pros-
tration, and at noon on the 28th she died. In substantiation of the possi-
bility 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
nmth 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
a 308, 1857, n. s., vol. iv., 18.

b 526, 1872.

890 ANOMALOUS NERVOUS AND MENTAL DISEASES.

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 roll-
ing 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."

a 224, 1895, ii., 460.

CHAPTER XVIII.

HISTOEIC 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 work-
ings 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, fortun-
ately, in our enlightened sanitary era, have entirely disappeared. In the his-
tory of such epidemics the name of Hecker stands out so prominently that
any remarks on tliis 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 consid-
ered 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 1552, gave us a primitive treatise on the sweating sickness. It

. 891

892

HISTORIC EPIDEMICS.

is due to the translation of Keeker's " Epidemics of the ^liddle Ages " by Bab-
bington, made possible through the good offices of the Sydenham Society, that
a major part of the knowledge on this subject of the English-reading popu-
lace 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 Mor-
talega * * (the great mortality) derived its name from the Orient ; its inflam-
matory boils, tumors of the glands, and black spots, indicative of putrid decom-
position, were such as have been seen in no other febrile disease. All the symp-
toms were not found in every case, and in many cases one symptom alone pre-
ceded 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 with-
out rest. The fauces and tongue were black and as if sutFused 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 pes-
tiferous 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 inflam-
matory boils did not at first appear, but the disease in the form of carbun-
cular affection of the lungs (anthrax artigen) caused the fatal issue before the
other symptoms developed. Later on in the history of the plague the inflam-
matory 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 tlie sixth century, which, after having ravaged the terri-
tory of the Gauls, extended westward. In 542 a Greek historian, Proco-
pius, 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 Alex-
andria 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

THE BLACK DEATH. 893

Constantinople, from 5000 to 10,000 people dying each day. In his " His-
tory of France," from 417 to 591, Gregorius speaks of a malady under the
name inguinale which depopulated the Province of Aries. In another
passage this illustrious liistorian 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 fea-
ture. 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 enor-
mous floods in which thousands of people perished. There arc traditions
of a plague in Tche in 1334, following a drought, which is said to have car-
ried off about 5,000,000 people. During the fifteen years before the appear-
ance of the plague in Europe there were peculiar atmospheric j^henomena 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 Cliina 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 w^as attacked throughout the year, and after
ravishing the whole of France and Germany, the plague appeared in Eng-
land, a period of three months elapsing before it reached I^ondon. 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 Dupouy 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 ])e(>ple liad 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,

894

HISTORIC EPIDEMICS.

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 unaccOiuitable manner remained free. The shores of the Mediter-
ranean 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. Accord-
ing to Hecker, Venice lost 100,000 ; London, 100,000 ; Paris, 50,000 ;
Siena, 70,000; Avignon, 60,000; Strasburg, 16,000; Norwich, 51,100.
Dupouy 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 suf-
fered 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 AYestgothland 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 sur-
mised. The mental shock sustained by all nations during the prevalence of
the black plague is beyond parallel and description. An awful sense of con-
trition and repentance seized Christians of every community. They resolved
to forsake their vices, and to make restitution for past offenses ; hence ex-
treme 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 thir-
teenth 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 pil-
grimages. 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 suppres-
sion. 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 GREAT PLAGUE OF LONDON.

895

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 scaifold 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 1 603 to 1 604 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 de-
lirium 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 extra-
vasation 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

896

HISTORIC EPIDEMICS.

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 hygi-
enic conditions under which the people in the cities lived, and it was proba-
bly 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 Yun-
nan. 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 peo-
ple of the densely populated city. According to Lord Bacon the disease be-
gan 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 dis-
order of the nervous system, and was characterized by a profuse and injuri-
ous perspiration. In the English epidemic the brain, meninges, and the
nerves were affected in a peculiar manner. The functions of the pneumo-

a " The Healing Art," London, 1887. ^ 597, Oct. 13, 1894.

SWEATING SICKNESS.

897

gastric nerves were violently disordered in this disease, as was shown by the
oppressed respiration and extreme anxiety, with nausea and vomiting, — symp-
toms 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 Ger-
many, at this time, is described by authorities in a tone of deep sympathy.
Swabia, Lorraine, Alsace, and provinces on the border of the loAvcr 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 deter-
mined to await his destiny at Tytynhangar. It was not the inhabitants of
tiie land alone who were affected, but even fish and the fowls of the air sick-
ened. Accordiug 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 occa-
sional 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, wius again to increase religious fimaticism 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
57

898

HISTORIC EPIDEMICS.

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 Belgmm
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. K. C. S., published a chronologic table of some of the prin-
cipal 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 OF PLAGUES.

{

Date.

B.C.

1495, .

1471,
1490,
1310,

1141,
1190,

1017,

790, .
738, .

710, .

694, .
671, .
545, .

594, .

480, .
476, .
463, .

452, .
430, .

427, . . •
404, . . .
393 and

383,

366, . . •
362, . . •

Locality.

Egypt,

Desert of Paran, . . .
In the wilderness, ....
^guia (island of), . . . .
Ashdod, a place between \
Guza and Joppa, . . J

Troy (siege of), . .

MOKTALITY.

Remarks.

14,000

{

{
{

Canaan,

Rome,
Rome,

Rome,

{

{

Velitrae, . . . .

Jerusalem, . . .

Army of Xerxes,

Spain,

Rome,

Rome, . . . . .

{

Athens,

Spain (from Egypt), . . •

Carthage,

Gaul and Rome (armies \

of), i

Rome

Murviedro (Sicily), . • •

70,000
in three days,

185,000 {

::: I

Depopulated, .
One -third of~l
inhabitants, J
150,000 ■

Half the in- "I
habitants, )

Depopulated,

10,000 daily.

During the reign of Pharaoh,
King of Egypt, A.M. 2509.—
Exodus xii.

Numbers xi.
Ovid's Metam., lib. vii.
Among the Philistines, 1 Sam. v.
and vi.

In the Grecian camp, Homer's

Iliad, lib. i.
In the time of David, 2 Sam.

xxiv.

Plutarch's Life of Romulus.
Assyrian armies at the siege of
Jerusalem .

Described by Livy.

Small town near Rome.

Livy, iii., 6.
Livy, iii., 32.

Continued without interruption
for five years. —Thucydides.
ii., 48.

Justin, xix., 2; Diod. Sic, xiii.

• • "

Livy, vii., 1 ; Short, On Air.

a Jour. Statis. Soc. Lond., Dec, 1880.

CHRONOLOGIC TABLE OF THE PRINCIPAL PLAGUES. 899
TABLE OF PLAGUES.— Confonwed.

Date.

■}

B.C.

346,
332,
296,
291,
237,

218,

216,

213,

206, .
182-177,
144,
140, ,
134 and f
130, \
126, . . . .

89, .
88, ....
60, ....

A.D.

68, ....

114, ....
187, ....
158, . ,
175 and

178
252, . .
262, . .
310, . .
325, . .
365-394,
400, . .
450-67 and 1

Locality.

473, /

562,
517, . .
544, . .

565-610,

590, . .
654, . .
664, . .
665-683,
696, . .
703 and

Rome,

Cadiz,

Carthaginian armies, . . .

Carthage,

Carthaginian and Eomau \

armies, j

Capua,

Rome and all Italy, . . .

Rome,

Rome,

Italy,

Numidia,

Seacoast of Carthage, . .

Roman armies,

Rome (people in), ....
Spain,

Mortality.

Rome, ....

Wales, ....
Rome and Italy,
Arabia, ....

Rome, ....

Alexandria, . .

Rome,

England,

Britain,

Italy and Syria, ....
Asia, Africa, and Europe,

Rome, . .

Scotland,

Palestine,

France,

717, 724,
and 729,

732,

740,

762,
853,
896,
937,
940,

^ 1
713,/

.}
■{
•{

Especially France, Ger- >
many, and Italy, . . J

Rome,

Constantinople,

South Britain,

England,

Constantinople,

Scotland,

Constantinople,

Norwich in England, and "I
Syria, /

Various parts of Europe \
and the East, . . . . j

Wales. In Chichester, . .

Scotland,

Gaul, Germany, and Italy,

England, . '.

North of Europe, ....

Remarks.

800,000
200,000
10,000
30,000

45,000

{

5,000 daily,
40,000

71

719

Livy.

On their route to besiege Tagun-
tum.

Before Syracuse, Livy, xxv.
Livy, xli., 21.

Orosius, lib. v.

? Leprosy.

Tacitus Annals, xv.
Orosius, lib. vii.

Zonaras, lib. xii.

Nicephorus, xiii.

30,000

? Dysentery.

A plague raging, with intermis-
sions, in most parts of the
world. — Niceph., xvii.

With intermissions.

34,000

Raged for 260 years.

Affecting chiefly the cattle.

900

HISTORIC EPIDEMICS.

TABLE OF FLkG\JE8.— Continued.

Date.

A.D.
964, . .

1005, .
1012-25,

Locality.

I

Mortality.

1027, . . .

1029-31 \
aud 1033, i

1064, . . .

1068, . . .
1075, . . .
1096-1111, .
1120, . . .
1126-28, \
1133-46, J
1172, . . .
1183, . . .
1193-96, \
1200-1201, J

1217, . . .

1235, . . .
1237, . . .
1278, . . .

1283, . . .

1335, . . .

1345, . . \

1346, . . .

1347, . . .

1348, .
1350-51,
1352, .

1355, .

1363, .

1365, .
1368-70,

1371, .

1372, .

1374, .

1379, .

1383, .
1384,

1387, .

1391, .

England and other parts 1
of Europe, j

England and Gaul, . . .

Saracen army, |

York and Durham, . . .

Constantinople,

Europe (various parts), . .
Various parts of the globe,

Engh\nd,

England,

England and Rome, . . ,

England, •

Damietta, j

London, ■

Egypt,

Utrecht,

Half the hu
man race

Remarks.

Many thou- (
sands, . . \

Emperor Otho's army.
Raged for three years.

"With intermissions.

Convulsive disease ; dance of St.
Vitus.

Marching to invade Rome ; raged
for two years.

Lasted 272 years.

? Dysentery.

Spain, -
England,

Spain, and spread over
the whole world, . .

Florence,

London,

Venice,

Lubeck,

Spain,

Syria, Greece, Italy, Cyprus,

Ireland,

China,

London,

Florence,

Norwich,

Yarmouth,

Spain,

Cologne,

England and Ireland, . .

Barcelona,

Germany, Egypt, Greece, "I

and all the East, . . . /
Holland, France, and)

Rhenish provinces, . . J

England,

Seville,

Mallorca,

Portugal,

England, York, and Nor

folk especially, . . .

Only 3 persons ")
out of 70, 000 y
survived, . J
20,000

4,000

Great mortality,
Leaving ^

scarcely a

quarter of the (
human race. J
60,000 '
50,000
100,000
90,000
200,000

900,000
50,000

100,000
37,104
7,502

Dancing disease among the chil-
dren.
Dancing mania.

King Philip of France invaded
Spain with 20,000 infantry and
8,600 cavalry.

}

20,000

Lubeck, 90,000

Interred in one graveyard.

Dancing disease of St. Vitus or
St. John.

CHRONOLOGIC TABLE OF THE PRINCIPAL PLAGUES. 901
TABLE OF PLAGUES.— CVM^mMcd.

Date.

Locality.

1593, . .
1600-1602,

1603, .".

1606, . .

1609, . .

1610, . .

1613, . .

1616. . .

Spain,

London,

Seville,

Strasburg,

Barcelona,

Huescar in the kingdom \

of Aragon, J

Italy, Gaul, Germany, |

and Spain, /

Italy,

Parma,

France,

Seville,

Andalusia,

Barcelona,

Mallorca,

Saragossa,

Britain,

England,

Germany,

Cork and Dresden, ....

England,

Con.stantinople,

Metz,

England, Holland, and \

Germany, j

Spain,

Murcia, .......

London and most of the")

principal cities of Eu- >■

rope, J

Barcelona,

Lyons,

" Morbus Hungaricus," .

Spain ,

Dresden,

Spain and Italy,

Rome,

Lubeck,

HamVnirg,

Cairo an(i the East, . . .
Spain, especially Cadiz,
Narva and Revel, in Li- \

vonia, J

Seville,

Dre.sden,

Malta, I

Muscovy,

Livonia,

London,

Paris,

Throngliout Europe, . , .

Seville,

Granada

Constantinople,

France and Constantino- \

pie, )

Germany, Denmark,")

Egypt, and Levant, . j

Mortality.

30

London

000

{

Remarks.

Dancing disease.

"Sweating sickness" in Eng-
land.

30,000,

Saragos.sa,10,000

4,000
8,000
3,000
500,000

Revel, 6,000

70,000 in ]
Lis1)on and >■
Spain, J
500,000
30,000
36,000
2,000 weekly,

200,000

Spread to Brabant
Sweating sickness.

Spotted fever.

Flanders, etc.

902

HISTORIC EPIDEMICS.

TABLE OF PLAGUES.— Co/i<m«ed.

Date.

Locality.

A.D.
1622,

1625,
1626,
1634,
1635,

1644,
1649,
1653,

1656,

London,

Mortality.

Remarks.

1662, .

1663, .

1664, .

1665, .
1673, .
1675, .
1677, .
1679, .
1691, .
1698, .
1705, .

1710, .

1720, .

1722, .

1727, .

1732, .

1735, .

1736, .
1740, .
1743, .

1751, .

1751-60,

1761, .

1762, .

1763, .

1769, .

1770, .

Throughout England, . .

Lyons,

Dresden,

Leydeu and Nineguen, , .

Madrid,

Spain,

Moscow,

Riga,

Amsterdam,

Ley den,

Naples,

Benevento,

Genoa,

Rome,

Neapolitan territories, .
Venice, ........

England,

Amsterdam,

London,

Spain,

Malta,

Murcia and Carthagena,

Germany,

Germany,

Spain,

Ceuta,

Copenhagen,

Stockholm,

Marseilles,

Vienna, Hungary, and in

the East,

Spain,

London,

1st year, 8,000^

3d r2,Zf Lasted four yeai^.

4th " 35,417 J
London, 30,000
60,000

Leyden, 20,000
London, 10,000

200,000
200,000
9,000
13,200
13,000

240,000

9,000
10,000
10,000
400,000
60,000

{

24,000
68,596

11,300

Three-quarters of the
tants.

inhabi-

{

Egypt, .

Cairo,
Ireland,
Aleppo, .

Cordova,

25,000
30,000

{

Ireland and France, . . |

Carthagena,

Aleppo, Jerusalem, and 1

Damascus, i

Naples,

1,500 in one\
■week, . . i

Many thou- ">
sands, . . /
100,000

40, 000 in Cairo ^
andConstan- >■
tinople, . . J

30,000 in Cy-1
prus, ... J

Bengal,

Poland and Russia,
Bohemia, . . , . .

1

Constantinople,

{

ms "I
I," J

20,000
" 3 millions
and
upward
20,000
168,000
1,000 buried^
daily for >•
some weeks, j

In six months, the "sweating
sickness."

Epidemic mania.

7,000 buried daily for some days.

SMALL-POX.

903*

TABLE OF FhAGVES.— Continued.

Datk.

Locality,

A T TTV

Rkmakks.

A.D.

1771, . . .

Bassora,

133,299 in 18)
months, . /
80,000

• • •

. . .

1783-85, . <

Egypt, Dalraatia, Con- \
stautiuople, etc., . . /

• • •

1792, . . .

Effvnt

800,000

1799, . . .

Barbary

3,000 daily,
247,000

In the French army in Egypt.

1809, . . .

Portugal

Among British troops.

1816, . . .

Out of '14,000]

Gibraltar ■<

only 28 es- f
caped, . . J

1812, . . .

Constantinople, ....

160,000

1813, . . .

Malta,

4,483

1815, . . .

Corfu,

. . .

1817, . . {

1 hrougnout the habitable \
globe, /

1841, . . 1

Syria, especially about!
Erzerouni /

Dancing mania.

1843, . . .

Asiatic Turkey,

1844, . . .

Egypt, .

1873-76, . .

20,000 in 1876,

1877, . . .

Resht, near the Caspian, .

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 practised
at Rome, mention small-pox, although it is now believed that the Emperor
Marcus Aurelius died of this disease. According to Dupouy, the first docu-
ment mentioning variola was in 570 A. D., by Marius, a scholar of Avenches,
in Switzerland. ("Anno 570, morbus validus mm profluvio venhis, 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 tlie 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
Zacariyd Ar-Razi, in the latter part of the ninth century wrote a most cele-
brated work on small-pox and measles, which is the earliest accurate descrip-
tion 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

904

HISTORIC EPIDEMICS.

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 tmcks of their conquests, and was in this way
propagated over Europe. The foregoing statement disagrees with Dupouy
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 eigh-
teenth 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 in-
creased 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 Roh6 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 intro-
duced into the Sandwich Islands in 1853, and it then carried off eight per cent,
of the natives. Australia, Tasmania, New Zealand, and the Fiji Archi-
pelago 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 cliannels 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.

. a " Text-Book of Hygiene, ' ' Phila. , 1 890.

INOCULATION.

905

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 harm-
less, 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 immedi-
ately 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 liady 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 Provi-
dence. Preaching in 1722, the Rev. Edward Massey, for example, affirmed
that Job's distemper was confluent small-pox, and that he had been in-
<x;ulated 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 Legisla-
ture. Toward the end of the century an inoculating hospital was again
opened in that city.

Early in the eighteenth century inoculation was extensively practised 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.

906

HISTORIC EPIDEMICS.

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. Ed-
ward Jenner, a pupil of the celebrated John Hunter, born May 17, 1749.

In his comments on the life of Edward Jenner, Adams, in " The Heal-
ing 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 lil^ely 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 infec-
tion, 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 men-
tioned 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, con-
tinued 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 small-
pox by the mode of treatment now so familiar under the name of vaccina-
tion. r^^ u f
" At the meetings of the Alveston and Radborough Medical Clubs, ot

both of which Jenner was a member, he so frequently enlarged upon his
fiivorite 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 ex-
pelled 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

VACCINATION.

907

by the disease, and the thought occurred to him that he was on the point of
finding u sure and certain remedy, his benevolent heart overflowed with un-
selfish 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 Avorld one of its greatest calami-
ties, 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 niyself 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 eifect, and the boy was afterward inoculated for the small-pox, — hap-
pily 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 Variolse Vac-
cinae,' 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 vac-
cination. It was then spread all over the continent; and in 1800 Dr. Ben-
jamin 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
aimually to 310 per million annually. During the small-pox epidemic in

a 510, June 23 and 30, 1883.

908

HISTORIC EPIDEMICS.

London in 1863, Seaton and Buchanan examined over 50,000 school chil-
dren, and among every thousand without evidences of vaccination they
fomid 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 vaccina-
tion, the remembrance of a few important statistic facts is all that is neces-
sary to fully appreciate the blessing which Jenner conferred upon humanity.
In the last century, besides the enormous mortality of small-pox (it was com-
puted 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 Roh6, 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 Roh6.'' 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 Cliinese
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.

a " Militar-Medicin, " p. 461. Loc. cit., p. 315.

ASIATIC CHOLERA.

909

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, caus-
ing sad havoc among the aborigines, it advanced westward until its further
progress was stayed by the shores of the Pacific Ocean. In 1834 it reap-
peared 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, reach-
ing 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).

910

HISTORIC EPIDEMICS.

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 1 886 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 hemi-
sphere 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 aj)-
peared in New York Bay and several in New York city, but rigorous quar-
antine 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 A tlantic and Africa.

(3) The zone of accidental epidemics, between the parallels of 45° north
and 35° south latitude.

In the seventeenth century Guadaloupe, Dominica, Martinique, and Bar-
badoes 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, Philadel-
phia, 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 Osier, 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 mortal-
ity, as given by Carey, was 4041, of whom 3435 died in the months of Septem-
ber and October. During the following ten years epidemics of a lesser degree

LEPROSY.

911

occurred along the coast of the United States, and in 1853 the disease raged
throughout the Soutlioru States, there being a mortality in New Orleans alone
of nearly 8000. In the epidemic of 1878 in the Southern States the mor-
tality 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 unaccli-
mated Spanish soldiers than on their own efforts.

Leprosy is distinctly a malady of Oriental origin, and existed in prehis-
toric 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 Dupouy, 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 grsecorum,
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 grjBcorum, 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 im-
perfect cases — liistories of elephantiasis grsecorum, 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 grsecorum ; and Pliny recapitulates the
principal features and tells us that the disease is indigenous in Egypt. The
opinion of the contagiousness of elephantiasis gr£ecorum which we find
announced in Herodotus and Galen is more strongly insisted upon by Cselius
Aurelianus who recommends isolation of those affected. Paulus ^genita
discusses the disease. The Arabian writers have described elephantiasis
grsecorum under the name of juzam, which their translators have rendered
by the word lepra. Later, Hensler, Fernel, Par6, Vesalius, Horstius, Fores-
tus, and others have discussed it.

912

HISTORIC EPIDEMICS.

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 lep-
rosy. 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 Nineteenth 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 syphi-
lis had its origin in 1594, 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 pre-
historic 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 Avriters claim to have found
evidences of syphilitic disease in the skulls and other bones of tlie pre-
historic 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 goMicm, while the French in return called it morbus
neapolitanns or mcd d'ltalie. The name of syphilis was said to have been

MODERN MORTALITY FROM INFECTIOUS DISEASES. 913

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 pagan-
ism, 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.

" SypkUidemque ah eo labem dix^e Goloni." *

Buret traces the origin of the word syphilis from ffuv, with, and <pdta,
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 suifered from it; and White of Philadel-
phia pronounces the opinion that " not less than 50,000 people in that city
are affected with syphilis." According to RoU, 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 agencv 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 influ-
ence 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. Osier mentions that in the
Blood Indian Keserve of the Canadian Northwest Territories, during six
years, among a population of about 2000 there were 127 deaths from pul-
monary 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 Eocky Mountains, a region in which consumption is
extremely rare among the white population, and in which cases of tubercu-
losis 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 tx) small-pox show the absence in Italy and
a "HieronymiFracastorii," Veron«e,1530. » statistics and Sociology, New York, 1885.

914

HISTORIC EPIDEMICS.

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.

Country.

Italy, ....
France (cities),
England, . . .
Ireland, . . .
Germany (cities),
Prussia, . . .
Austria, . . .
Switzerland,
Belgium, . . .
Holland, . . .
Sweden. . . .

Small-
pox.

3.86

2.3

0.11

0.01

0.04

0.03

4.43

0.06

1.52

0.02

0.01

Measles.

6.17

5.18

4.68

2.01

2.8

3.2

5.36

1.53

6.2

3.93

2.3

Scarlet
Fever.

2.99

3.1

2.31

1.22

2.15

2.46

5.57

1.22

1.62

0.38

3.69

Diphthe-
ria.

6.08
6.66
1.74
0.76
10.21
14.17
13.2
3.53
5.77
1.45
3.89

Typhoid
Fever.

7.49

5.32

1.9

2.33

2.11

2.26

5.42

1.47

3.83

2.5

2.22

Tubercu-
losis.

13.61

33.

16.09

21.15

31.29

28.06

37.2

21.07

19.87

19.21

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, ^-^^ ^•

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.

BTBLTOGRAPHIC INDEX.

BEING A PARTIAL BIBLIOGRAPHY NUMERICALLY ARRANGED FOR PURPOSE

OF REFERENCE.*

A.

100. Abeille (L') m^dicale. Paris.

101. Abhandlungen der konigl. Schwe-

dischen Akademie, etc. Vol. for
1763. Leipzig, 1768.

102. Abhandlungen der k. k. medizinisoh-

chirurgischen Josephs - Akademie
zu Wieu. 1801.

103. Abhandlungen der physikalisch-niedi-

zinischen Societat zu Erlaugen.
1810-.

104. Acad. nat. curios, ephemerides.

Francofurti et Lipsse, 1712 ; Nori-
bergse, 1715-17. (The Ephemeri-
des.)

105. Acta. Acad. Csesarese-natura; curio-

sornm. Norimbergse, 1727-.

106. Acta Eruditorum. Leipzig.

107. Acta Helvetica physico-mathematico-

botanico-medica. Basila>, 1751-77.

108. Acta medicorum Berolinensium, etc.

Berolini, 1717- .

109. Acta regife Societatis medicae Havien-

sis. Havnife.

110. Acta medica Hafniensia, Prodromus,

etc. Hafniae et Lipsse, 1775-.

111. Aerztliches Intel! igenz-Blatt. Mlin-

chen.

112. Albertus (Michaelis). Dissertatio de

Longevitati, etc. 1728.

113. Albertus (Michaelis). Systema juris-

prudentiae medicjc. 6 vols., 4°.
Halae, 1736-47.

114. Albinus (Bernhardus). Dissertatio

de sterilitatis.

115. Albuca»sis. De chirurgia. Arabice

et Latine. Oxford, 1778.

116

117.
118.

119

120.

121.

122.
123.

124.

125.

126.

127.

128.

129.

130.
131.

132.

133.

134.
135.

Aldrovandus (Ulysses). Opera. 13

vols. Bonon., 1646-48.
AUgemeine Literatur-Zeitung. Jena.
AUgemeine Wiener raedizinlsche Zei-

tung.

Amatus Lusitanus (J. R.). Cura-
tionum raedicinalium medici phy-
sici, etc. 8°. Venetiis, 1557.

Amman (Paulus). Medicina critica.
ErflFurti, 1670.

American Gynaecological and Obstet-
rical Journal. New York.

American Homoeopathist. Chicago.

American Journal of Insanity. Utica,
N. Y.

American Journal of Medical Science.

Philadelphia.
American Journal of Obstetrics. New

York.

American Journal of Science and
Arts. Nev? Haven, Conn.

American Journal of Syphilography
and Dermatology. New York.

American Medical Monthly. New
York.

American Medical Recorder. Phila-
delphia.

American Medical Times. New York.
American Medical Weekly. Louis-
ville, Ky.

American Medico-Surgical Bulletin.

New York.
American Practitioner. Louisville,

Ky.

American Therapist. New York.
Annalen der Entbindungs- Lehran-

stalt auf der Universitat z,u Got-

tingen. Von Osiander.

* The numbers in this index have been used in all the reference foot-notes and in the text to indicate the
corresponding authorities.

915

916

BIBLIOGRAPHIC INDEX.

136. AnBalen der Staatsarzneikunde. Tu-

bingen, 1836-.

137. Annalen der Staatsarzneykunde. Zlxl-

lichau, 1790-.

138. Annalen fur die gesammte Heilkunde.

Karlsruhe, 1824-

139. Anuales de chimie et de physique.

Paris.

140. Anuales de gyn^cologie. Paris.

141. Annales d'hygifene, etc. Paris.

142. Annales des maladies des organes

g6nitx)-urinaires. Paris.

143. Anuales de medecine beige et 6tran-

gfere. Bruxelles.

144. Annales medico - psychologiques.

Paris.

145. Annales d'oculistique. Bruxelles.

146. Annales de la Soci6t6 de medecine de

Saint^Etienne et de la Loire.

147. Annales de la Society de medecine-

pratique de Montpellier.

148. Annals of the Anatomical and Surgi-

cal Society. Brooklyn.

149. Annals of Medicine. Edinburgh.

150. Annals of Surgery. New York.

151. Annali di medicina. Milano, 1802.

152. Annali di ostetricia, etc. Milano.

153. Annali universali di medicina. Mi-

lano, (Omodei. )

154. Arand (Franciscus). Observationes

medico - chirurgicse. 8°. Goet-
tingse, 1770.

155. Archiv der Heilkunde. Leipzig.

156. Archiv der Pharmacie. Halle.

157. Archiv fiir Anthropologie. Braun-

schweig.

158. Archiv fiir praktische Medizin und

Klinik. Berlin, 1807-.

159. Archiv fiir medizinische Erfahrung.

1801-. (Horn.)

160. Archiv fiir die Geburtshiilfe, etc. J.

C. Stark, Jena. (1798-1800 as N.
Archiv, etc.)

161. Archiv fiir pathologische Anatomic

und Physiologic, etc. Berlin.
(Virchow's Archives.)

162. Archives g6n6rales de m6decine.

Paris.

163. Archives de medecine navale. Paris.

164. Archives provinciales chirurgie.

Paris.

165. Archives of Pediatrics.

166. Archives of Surgery. London. (Hut-

chinson.)

167. Archives of Surgery. New York.

168. Archives de tocologie. Paris.

169. Aristoteles. Opera omnia. 5 vols.

Parisiis, 1862-74.

170. Aristoteles. Historia de Animalibus.

Tolos, 1619.

171. Art (L') medical. Bruxelles.

172. Arzneykundige Annalen von Tode.

Kopenhagen, 1787-.

173. Asclepiad. London.

174. Ashhurst (John, Jr. ). Principles and

Practice of Surgery. Philadelphia,
1889.

175. Association Medical Journal. Lon-

don.

176. Atlanta Medical and Surgical Journal.

Atlanta, Ga.

177. Aurran (J. F.). E Unguis feminae

loquela. Argeutinte, 1766.

178. Australasian Medical Gazette. Syd-

ney.

179. Australian Medical Gazette. Mel-

bourne.

180. Australian Medical Journal. Mel-

bourne.

181. Autenrieth (J. F. H.). Handbuch

der Physiologic. 3 vols. 8°. Tu-
bingen, 1801.

B.

182. Bacchetoni (H. L.). Anatomia medi-

cinse, etc. Oeniponti, 1740.

183. Bailey (J. B.). Modern Methusalehs^

8°. London, 1888.

184. Baily (T.). Eecords of Longevity.

8°. London, 1857.

185. Ballonius (Guilielmus). Opera me-

dica omnia. 4 vols. Genevse, 1762..

186. Baltimore Medical Journal.

187. Baltimore Medical and Surgical

Journal and Review.

188. Bartholinus (Thomas). Acta medica

et philosophica. Hafniensia,
1671-79.

189. Bartholinus (Thomas). Epistolarum

medicinalium. Hafniae, 1663.

190. Bartholinus (Thomas). Historiarum

anatomicarnm rariorura. Cent, i-
vi. Hafniai, 1654-61.

191. Bateman (— ). The Doome. 1581.

(In the British Museum.)

192. Becker (J. C). De submersorum

Morte, etc. Giessre, 1704.

193. Becker (Dan.). Cultrivori Prussiaci

Curatio singulis. Lug d. Bat. , 1646h.

BIBLIOGRAPHIC INDEX.

917

3.94
J.95
196.
197.
198.

199.
200.

201
202

203

204,
205.

206.

207.
208.

209.

210.
211.
212.

213.

214.

215.
216.
217.
218.

Bell (Charles) . Institutes of Surgery,

etc. 8°. Philadelphia, 1840.
Bellini (Laureutius). Opera omnia.

4°. Venetiis, 1732.
Benetlictus (Crispus). Commentariura

niedicinale.
Beniveuius (A.). Mem, observat.

exerapla rara colon., 1581.
Benivenius (A,). De abditis nonnu-
lis ac mirandis Morborum et Sana-
tionuni Causis, 1521.
Berliner klinische Woclienschrift.
Berlinische Samnilungen zur Befor-
dernng der Arzneywissenschaft,
etc. Berlin, 1768-79.
Bernstein (J. G.). Wien, 1805.
Berthold (A. A.). Ueber das Gesetz
der Schwangerschaftsdauer. 4°.
Gottingen, 1844.
. Beytrage zum Archiv der medizini-
schen Polizei, etc. Leipzig, 1789-
99.

. Bianchi (Giovanni). De monstris,

etc. Venetiis, 1749.
. Bianchi (Giovanni). Storia del mou-

stros di due Corp., etc. Turin,

1748.

Bibliothek fiir die Chirurgie. Got-
tingen. Von Langenbeck.

Bibliothek lor Laeger. Kj^ftbeuhavn.

Bibliothek der praktischen Heil-
kunde. Berlin, 1799-1843.

Bichat (M.-F.-X.). Anatomic g6n6-
rale appliquee a la physiologic et
il la m6decine.

Bierling (C. T.). Adversariornm
cnriosornm, etc. Jenae, 1679.

Bierling (C. G.). Thesaurus Theo-
retico-practicas, etc. Jenae, 1694.

Blanc (L.). Les anomalies chez
I'homraeetdes mammifere.s. Paris,
1893.

Blanchard (S.) (editor). CoUectanse
medico-physica, etc. Amsterdam,
1680.

Blasius (Gerardus). Observationes

medicje rariores, Accedit mon.stri

triplicis historia. 1677.
de Blegny (Nicolas). Zodiacus

medico-gallicus, etc. Geneva.
Bonet (Th6ophilius). Sepulchretum,

etc. Genevge, 1679.
Bontius (Jacob). De medicina In-

dorum. Lugd. Bat., 1642.
Boston Medical and Surgical Journal.

219. Bouchut (E.). Les signes de la mort,

etc. Paris, 1883.

220. Braithwaite's Retrospect of Medicine.

221. British and Foreign Medical Review.

London.

222. British and Foreign Medico-Chirurgi-

cal Review. Loudon.

223. British Gynaecological Journal. Lon-

don.

224. British Medical Journal. London.

225. British Record of Obstetric Medicine

and Surgery. Manchester, 1848-.

226. Brierre de Boismont (A.). Du suicide

et de la folie suicide. Paris, 1865.

227. Brooklyn Medical Journal,

228. Bruyerinus (Joannes). De re cibaria

libri xxii, etc. Lugduni, 1560.

229. Buttner (C. G.). Sechs seltene Ana-

tomisch - chirurgische Wahrneh-
mungen. Konigsberg, 1774.

230. Buffalo Medical and Surgical Journal,

231. Buffalo Medical Journal.
Buffon (G.-L.-L. ). Giluvres completes,

6 vols. Bruxelles, 1828-.
Bulletin de I'Acad^mie de m^decine.
Paris.

Bulletin de I'Academie roj'ale de
medecine de Belgique. Bruxelles.
235. Bulletin g6n. de therapeutique med,
et chir. Paris.
Bulletin medical du nord, Lille.
Bulletins et m^moires de la Societe

m6dicale des hQpitaux de Paris,
Bulletin et M6m. Soci6t6 de Obst, et

Gynecol, de Paris.
Bulletin de la Soci6t6 m^dicale de la

Suisse Romande. Lausanne.
Bulletin des Sciences m6dicales.

Paris, 1824-.
Bulletin des Sciences Naturelles et de

G6ologie. Paris. (Brouginart.)
Bulletin de la Soci6t6 auatomique de
Paris.

Bulletin de la Soci6t6 d'anthropologie
de Paris,

Buttner (Chr, Gottl.). Sechs seltene
Anatomisch - chirurgische Wahr-
nehmungen. 4°. Konigsberg,
1774, (Same as 2.29.)

c.

245, Cabrolius(Bartholoma;us). Observa-

tiones.

246. California Medical Gazette. San Fran-

cisco,

232.

233.

234.

236.
237.

238.

239.

240.

241.

242.

243.

244.

918

BIBLIOGRAPHIC INDEX.

247. Camerarius (J. R.). Sylloges raemo-

rabilium mediciuae, etc. Tubiugti?,
1683.

248. Campbell (C.-J.). De raccoiicbemeut

des feiuines iiui lueureut :\ une
ei)oque avanoee de la grosses.se.
Paris, 1849. (Thesis.)

249. Camper (Petrus). Demoustrationum

anatomico - patbologicarum. Am-
stelodami, 1760-.

250. Cauada Laucet. Toronto.

251. Canada Medical Journal. Montreal.

252. Canada Medical and Surgical Jour-

nal. Montreal.

253. Canadian Journal of Medical Science.

Toronto.

254. Capurou (Joseph). La m^deciue

legale relative k I'art des accouche-
ments. Paris, 1821.

255. Cardanus (Jerome). Opera omnia.

10 vols. Lugduni, 1663.

256. Carolina Journal of Medicine, Science,

and Agriculture. Charleston, 1825.

257. a Castro (Rodericns). De universa

niuliebrium morborum raedicina.
Hamburg!, 1617.

258. Cattieri (Isaac). Observationes medi-

cinales rarjB.

259. Celsus (A. C). De medicina, libri

octo.

260. Centralblatt fur Chirurgie. Leipzig.

261. Centralblatt fiir Gynakologie. Leip-

262.

263.
264.

265.

266.

267.
268.
269.

270.

271.

272
273
274
275

Centralblatt fiir praktische Augen-

heilkunde. Leipzig.
Charit6-Annaleu. Berlin.
Charleston Medical Journal and Re-
view. Charleston, S. C.
von Chelius (M. J.). Surgery, trans-
lated by J. F. South. Philadel-
phia, 1847.
Chevers (N.). A Manual of Medical

Jurisprudence for India.
Chicago Mediciil Examiner.
Chicago Medical Journal.
Chicago Medical Journal and Exam-
iner.

Chirurgicheskaja liaitopsis. Moskva,
1891-.

Cincinnati Journal of Medicine. Cin-
cinnati and Indianapolis.
Cincinnati Lancet and Clinic.
Cincinnati Medical Repertory.
Clinic (The). Cincinnati, 1871-78.
Clinical Sketches. London.

276. Clinique (La) des hopitaux et de la

ville. Paris.

277. Cohausen (J. H.). Lumen novum

Phosphoris. Amstelodami, 1717.

278. Coimbra medica. Coimbra.

279. Coindet (E.-N.-P.). Des dechirures

traumatiques spontau^es du pou-
mon. Paris, 1860.

280. Collection academique, etc. Dijon et

Paris, 1755-79.

281. Comitis Mythyologie libri decern, etc.

Genevse, 1656.

282. Commercium literarium, etc. Norim-

bergai, 1731.

283. Comptes rendus hebdomadaires des

seances de 1' Academic des Sciences.
Paris.

284. Crantz (H. J. N.). Comm. de rupt.

in partu dolor a fet. uterus, etc.
Translation by Clay.

285. Cruikshank (William). The Anatomy

of the Absorbing Vessels. 4°. Lon-
don, 1786.

D.

286. Daniel's Texas Medical JournaL

Austin.

287. Dantes (Alfred). Dictionnaire bio-

graphique et bibliographique.
Paris, 1875.

288. Darwin (Chas. R.). On the Origin

of Species, etc.

289. Darwin (Chas. R.). The Descent of

Man, etc.

290. Debes (Lucas). NatUrliche und poli-

tische Historie der Inseln Faroe.
Kopenhagen, 1757.

291. Debierre (Ch.). L'hermaphrodisme.

Paris, 1891.

292. Dechambre (director) Diet, encyclo-

ped. des Sciences medicales. 102
vols. Paris.

293. Delestre (J. B.)- De la physiogno-
monie. Paris, 1846.

294. Deneux (L.-C). Essai sur la rupture
de la matrice, etc. Paris, 1804.
(Thesis.)

295. Denkschriften der vaterlandischen
Gesellschaft der Aerzte und Natur-
forscher Schwabens. Tubingen,
1805-.

296. Dental Cosmos. Philadelphia.

297. Desault (P. -J.)- Journal de chirur-
gie. Paris, 1791-

BIBLIOGRAPHIC INDEX.

919

298. Detroit Lancet.

299. Detroit Review of Medicine and

Pharmacy.

300. Deutsche medizinische Wochen-

sclirilt. Berlin.

301. Dewees (W. P.). Medical Miscel-

lanies. Philadelphia, 1805.

302. Dictionuaire des sciences medicales.

60 vols. Paris, 181 2-.

303. de Diemerbroeck (Isbrand). Ana-

tome corporis huraani. 1672.

304. de Diemerbroeck (Isbrand). Opera

omnia. 4°. Ultraj., 1685.

305. Dilthey (P. M.). Diss, sistens obser-

vationem rariorum de valvulis in
ureteribns repertis. 1723.

306. Donatns (Marcellus). De medica

historia niirabili libri sex. 4°.
Mantuse, 1586.

307. Dover (Thomas). The Ancient Phy-

sician's Legacy, etc. 8°. Lon-
don, 1762.

308. Dublin Hospital Gazette.

309. Dublin Journal of Medical and Chem-

ical Science.

310. Dublin Journal of Medical Science.

311. Dublin Hospital Reports. 1818-.

312. Dublin Medical Press.

313. Dublin Quarterly Journal of Medical i

Sciences. i

314. Dupouy (E.). Le moyen age m6di- i

cale. Paris, 1895.

E.

315. Eclectic Medical Journal. Cincinnati.

316. Eclectic Repertory, etc. Philadelphia.

317. Edinburgh .lournal of Medical Science.

318. Edinburgh Medical and Surgical

.Journal (after July, 1855-, Edin-
burgh Medical .Journal).

319. Edinburgh Monthly Journal of Medi-

cal Science.

320. Ehrlich (J. A.). Chirurgische Beo-

bachtungen .

321. Eira. Giiteburg.

322. EUiotson ( John). Human Physiology.

London, 1841.

323. Emulacion (La). Merida. j

324. Encyclopedia Britannica.

325. Engelmann (G. J.). La pratique des

accouchements chez les peuples
primitifs ; edition fran9ais par
Rodet. Paris, 1886.

326. Escuela medica. Cardcas.

327. Eudes de M6zeray (Fran9ois). His-

toire de France. Vol. iii.

328. European Magazine and London Re-

view.

329. Ethnological Journal, London.

330. Experience (L'), journal de medecine

at de chirurgie. Paris.

331. Extracts from the Records of the

Boston Society for Medical Im-
provement.

F.

332. Fabricius (P. C). Diss, sistens seg-

rum epilepsia, etc. 4°. Giessae,
1738.

333. Fabricius (P. C). Idea anatoraicsB

practicse. Wetzlarise, 1741.

334. Fabricius Hildanus (Guilielmus).

Opera omnia. Francof. a. M., 1646.

335. Fantoni (Joh.). Opuscula medica et

physiologica. Geneva?, 1738.

336. Facultad (La). Madrid.

337. Fauzago (F. L.). Storia del monstro

di due corpi, etc. Padova, 1803.

338. Farmer (J. ). Select Cases in Surgery.

4°. London, 1758.

339. Fatio(Joh.). Helvetisch-vernunftige

Wehe-Mutter, etc. Basle, 1752.

340. Feruelius (Jo.). Universa medicina.

1645.

341. Ficker (Wilhelm Anton). Comment,

etc. Gottingen, 1791.

342. Fickius (J. J.). Diss, de abortu epi-

demicus. Jenae, 1697.

343. Figuer (L.). L'homme jmmitif.

Paris, 1870.

344. Flajani (Giuseppe). Medizinisch-

chirurgische Beobachtungen.
Translated from the Italian.

345. Flourens (P.). De la long6vit6 hu-

raaine. Paris, 1856.

346. Foissac(P.). Hygiene philosophique

de I'ame. Paris, 1860.

347. Fontanus (Nicolaus). Reaponsionum

et c u r a t i o n u m medicinalinm.
Amstelodami, 1639.

348. Forestus (Petrus). Observationem et

curationem medicinalinm ac chi-
rurgicixrum. 1653.

349. France (La) medicale. Paris.

350. Francus de Frankenau (Georgius).

Satyne medica;. Lipsise, 1722.

351. Frank (J. p.). De curandis hominnm

morbis, etc. Viennse, 1810.

920

BIBLIOGRAPHIC INDEX.

352. Frank (J. P.). Interpretatioiies cliui-

cse. Tubingse, 1812.

353. Fulgosi (B. ). De dictis et factis

luemonibilibus. Mediolani, 1509.

G.

354. Gaceta medica. Madrid.

355. Gaceta medica. Mexico.

356. Gassendus (Pierre). Viri illnstris N.

C. Fabricii de Peirescii . . . vitse.
Parisiis, 1641.

357. Gazeta lekarska. Wai-szawa.

358. Gazeta medica da Baliia.

359. Gazzetta degli ospitali. Milano.

360. Gazzetta medica italiaua lombardi.

Milauo.

361. Gazzetta medica di Torino. 1884-.

362. Gazette hebdomadaire de medicine et

de chirurgie. Paris.

363. Gazette des hopitaux, etc. Paris.

364. Gazette medicale de Lifege.

365. Gazette medicale de Lyon.

366. Gazette medicale de Montpellier.

367. Gazette de sante. Paris, 1773-80.

368. Gazette medicale de Paris.

369. Gazette medicale de Strasbourg.

370. Gelineau (E.). Des peurs maladives

on phobies. Paris, 1894.

371. Gemeinsame deutscbe Zeitschrift fur

Geburtsknnde. Weimar,

372. General-Berichte des kbnigl. rheini-

schen Medicinal - Collegii. Kob-
lenz.

373. Genio (El) m6dico-quirdrgico. Ma-

drid.

374. Gentleman's Magazine. London,

1731-.

375. Gesundheit. Frankfurt a. M.

376. Giornale delle scienze medico-cliirur-

giche. Pavia.

377. Giornale della Societii medico-chirur-

gica di Parma. 1806-

378. Giornale di anatomia e fisiologia pato-

logica. Pavia, 1864.

379. Giornale di medicina. Venezia, 1762-.

380. Glandorp (Matthias). Speculum chi-

rnrgorum. Bremse, 1619.

381. Glasgow Medical Journal.

382. Gooch (Benj.). A Practical Treatise

on Wounds. 8°. Norwich, 1767.

383. Good (J. M.). A Physiological System

of Nosology. 8°. Boston, 1823.

384. de Graaf (Regnerus). De mulierum

organis, etc. 1672.

385. Graseccus (Georgius). Anatomia,

386. Grasseus (Job.). Theatrum chemi-

cum. 8°. Argeutori, 1661.

387. Gro.ss (Samuel D.). A System of

Surgery. 2 vols. Philadelphia,
1882.

388. Guillemeau (Jacques). De la gros-

sesse et accouchement des femmes.
Paris, 1620.

389. Guillemeau (Jacques). CEuvres de

chirurgie. Rouen, 1649.

390. Guinard (L.). Precis de Teratologic.

Paris, 1893.

391. Gurlt (E. F.). Lehrbuch der patho-

logischen Anatomic der Hau.s-
Saugethiere, etc. Berlin, 1832.

392. Guy's Hospital Reports. Loudon.

393. Guy and Ferrier. Principles of Foren-

sic Medicine. London, 1 875.

394. Guyot-Daubes. Les hommes— ph6no-

mfenes. Paris, 1885.

H.

395. Haen (Antonins). Ratio medendi in

noscomio practico. Parisiis, 1761.

396. Haller (Albertus). Bibliotheca ana-

tomica.

397. Haller (Albertus). Bibliotheca medi-

cinai practical.

398. Haller (Albertus). Bibliotheca chi-

rurgica. 8°. 1774.

399. Haller (Albertus). Disputationes ana-

tomica2 selectee. GottingsB, 1746.

400. Haller (Albertus). Elementa physio-

logise corporis humani. 8 vols.
Lausanne and Berne.

401. Haller (Albertus). Epistolarum ab

erudtis viris ad Hallerum scrip-
tum. Berua;, 1773. 6 vols.

402. Hamburgisches Magazin. Hamburg,

1747-.

403. Hartmann (Petr. L). De sudore

unius lateris. Halaj ad Salam,
1751.

404. Harvey (William). Exercitiones de

generatione animalium. London,
1651,

405. Harvey (William). The Works of.

(Translated.) Sydenham Society,
London, 1847.

406. Hasenest (J. G.). Der medicinische

Richter, oder acta physico-medico
forensia, etc, Onolzbacb, 1755-9.

BIBLIOGRAPHIC INDEX.

921

407. Hebra (Ferdinand). On Diseases of

the Skin. Translated lioni the
German. London, 1866-.

408. Heoker (J. F. C). The Epidemics

of the Middle Ages. Translated
by Babbiugton. London, 1859.

409. ah Heers (Henricus). Observatiorum

medicarum. Lugd. Bat., 1645.

410. Heister (Laurenz). Compendium ana-

tomicuni, etc. Altorti et Norimb.,
1727.

411. Heister (Laurenz). Diss. Altorfi,

1720.

412. Heister (Laurenz). Medicinische,

chirurgische und anatomische
Wahrnehmungen. Rostock, 1753.

413. van Helmout (J. B.). Opuscnla

medica inaudita. Veuetiis, 1651.

414. Hellwigius (J.). Observationes phy-

sico-medicse, etc. Augustas Vin-
delicorum, 1680.

415. Herodotus. Historiarum. Libri ix.

Francofurti, 1608.

416. Hippocrates. Opera omnia, or the

edition translated by Adams. In
two vols. 8°. London, 1849.

417. Hirst and Piersol. Human Monstro-

sities. Philadelphia.
438. Histoire de PAcad6mie des sciences.
Paris.

419. Hotlge (H. L.). Principles and Prac-

tice of Obstetrics. Philadelphia,
1864.

420. Hoffmann (Frid.). A System of

Practical Medicine. Translated by
Lewis. London, 1783.

421. Hollerius (Jacobus). Omnia opera

])racfeicix, ad Calcem, etc. Genevae,
1623.

422. Holmes (Timothy). A System

of Surgery, etc. Philadelphia,
1881.

423. Horstius (Gregorius). Opera medica.

1660.

424. Hospital Gazette and Archives of

Clinical Surgery. New York.

425. Hospital s-Tidende. Kj^>behavn,

1858-.

426. Hufeland (C. W.). Die Kunst, das

menschliche Leben zu verlangern.

427. Hufeland (C. W.). Art of Prolonging

Life. Edited by Erasmus Wilson.
Philadelphia, 1870.

428. Huxham (John). Opera physico-

medica. Lipsise, 1773.

I.

429. Illustration (L'). Paris.

430. Illustrated Medical News. London.

431. Index Catalogue of the Library of the

Surgeon-General's Office. Wash-
ington, 1879-.

432. Index Medicus.

433. Indian Annals of Medical Science.

Calcutta.

434. India Journal of Medical and Physi-

cal Science. Calcutta.

435. Indian Medical Gazette. Calcutta.

436. Indian Medical Record. Calcutta.

437. Independent Practitioner. Baltimore,

and continued elsewhere.

438. International Clinics. Philadelphia,

1891-.

439. International Encyclopedia of Sur-

gery. Edited by John Ashhurst,
Jr. 1881-84.

440. Iowa Medical Journal. Keokuk.

441. Insfeldt (J. C). De lusibus naturae.

4°. Lugd. Bat., 1772.

442. Isenflamm et Rosenmliller. Beytrage

fiir die Zerg.

J.

443. Jacobson (W. H. A.). Diseases of

the Male Organs of Generation.
8°. London, 1893.

444. Jahrbuch der Staatsarzneikunde.

Frankfurt a. M. (Kopp.)

445. Jeaffresou (William). A Practical

Treatise on Diseas&s of the Eye.
8°. London, 1844.

446. Johns Hopkins Bulletin. Baltimore.

447. Jonston (Job.). Thaumatographia

naturalis. 1665.

448. Josephus (Flavins). Historia, etc.

Paris, 1528.

449. Joubert (Laurentius). Trait6 du ris,

etc. Paris, 1579.

450. Journal of the American Medical

Association.

451. Journal of Anatomy and Physiology.

London.

452. Journal der praktischen Arzneykunde

und Wundarzneykunde. Heraus-
gegeben von C. W. Hufeland.

453. Journal of the National Association

of Railway Surgeons. Fort Wayne,
Indiana.

922

BIBLIOGRAPHIC INDEX.

454. Journal complementaire du diction-

naire des sciences m6dicales. Paris,
1818-.

455. Journal of Cutaneous and Venereal

Diseases. New York.

456. Journal fur die Chirurgie, etc. Von

Loder. Jena, 1797.

457. Journal fiirGeburtshUlfe, etc. Frank-

furt a. M., 1813-.

458. Journal g6n6ral de m^decine, de chi-

rurgie, et de pharniacie. Paris.

459. Journal of the Gynsecological Society

of Boston.

460. Journal de med., chir., pharm., etc.

Paris, 1754-93.

461. Journal de med., chir., pharm., etc.

Paris, 1801-17.

462. Journal de m6decine. Paris. (See

460.)

463. Journal de medecine. Paris (con-

tinued). (See 461.)

464. Journal de medecine militaire. Paris,

1782-.

465. Journal of Mental Science. London.

466. Journal of Nervous and Mental Dis-

eases. New York.

467. Journal Politique de Manheim.

468. Journal der praktischen Heilkunde.

Berlin, 1801-41.

469. Journal des Savans. Paris.

470. Journal de S9avans, etc. Paris.

471. Journal de la section de m6decine de

la Soci6t6 academique, etc., Loire-
Inferieure. Nantes.

472. Journal da Sociedade das sciencias

medicas de Lisboa.

K.

473. Kerckringius (Theodoras). Spicile-

o-ium anatomicum. Amstelodami,
1670.

L.

474. de La Motte (G.-M.). Trait6 com-

plet des accoucheraents, etc. 4°.
Paris, 1722.

475. Lancisi ( J.-M.). De subitaneis mor-

tibus. Roma?, 1707.

476. Lancet, London.

477. Lanzoni (Josephus). Opera omnia.

Lausanne. 1738.

478. Larrey (D.-J.). Memoires de chirur-

(rie militaire et campagnes. 4
vols. 8°. Paris, 1812-17.

479. Laurent (E.). Les bisexu6s, gyn6co-

mastes, et hermaphrodites. Paris,
1894.

480. Laurentius (Andreas). Historia ana-

tomica humani corporis, etc.
Francofurti, 1636.

481. Leavenworth Medical Herald.

482. Lebert (Herman). Ueber Keratose.

8°. Breslau, 1864.

483. Leigh (Charles). Exercitationes

quinque. Oxonii, 1697. 8°.

484. Leutilius (Rosinus). Misc. medico-

practica, etc. Ulmse, 1698.

485. Lheritier (S. -D.). Trait6 complet

des maladies de la femme. 8°.
Paris, 1838.

486. Licetus (Fortunius). De monstris.

4°. Amstelodami, 1665.

487. Loaring (H. J.). Epitaphs, etc,

London.

488. Lobstein (J.-G.-C.-F.-M.). Traite

d'anatomie pathologique. Paris,
1829.

489. Loeseke (J. L. L.). Observationes

auatomico-chirurgico-medicse, etc.
Berolini, 1754.

490. London Medical Gazette.

491. Loudon Medical Record.

492. London Medical and Surgical Journal.

493. Lonsdale (E. F.). A Practical Trea-

tise on Fractures. 8°. London,
1838.

494. Louisville Medical News. Louisville,

Ky.

495. Lucina. Leipzig, 1802-11. Editor

A. E. von Siebold.

496. Lycosthenes (Wolflfhart) (C). Pro-

digiorum ac ostentorum chronicon.
Basileae, 1557.

497. Lyon medical.

498. Lyser (Michael). Observationes me-

dic£e. Hafnise, 1665.

M.

499. Mackenzie (Sir M.). A Manual of

Diseases of the Throat and Nose,
etc. London, 1884.

500. Madras Quarterly Journal of Medical

Science.

501. Magazin vor Aerzte. Von Baldinger.

(Also N. Mag., etc.)

502. Macazin der anslandischen Literatur

der gesammten Heilkunde, etc.
Hamburg. (Julius und Gerson.)

BIBLIOGRAPHIC INDEX.

923

503. Magazin fur die neuesten Entdeck-

iiiigeu iu tier gesiimniteii Natur-
kiuule. Berlin, 1807-.

504. Magaziu fiir die gesammte Heilkunde,

etc. Berlin. (Herausgegebeu von
Rust.)

505. Mandelslo (J. A.). Schreiben von

Olearium. Schlesswig, 1G58.

506. Martin de Pedro (Ecequiel). Estu-

dios de teratologia, etc. 8°. Ma-
drid, 1879.

507. Marold (J. O.). De abortu per vomi-

tum rejecto. Altdorff, 1669.

508. de Marque (Jacques). Traite des

Bandages, etc. Paris, 1662.

509. Martialis (Marcus Valerius). Epi-

grammata lib. xiiii.

510. Maryland Medical Journal. Balti-

more.

511. Maryland Medical and Surgical Jour-

nal, etc. Baltimore.

512. Massachusetts MedicalJournal. Bos-

ton.

513. Mauriceau (Fran9ois). Traite des

maladies des fenimes grosses, etc.
4°. Paris, 1683.

514. Maziuus (J. B.). Opera omnia.

Brixi«, 1743.

515. Mead (Richard). De imperio solis ac

luna; in corpora humana et morbis
unde oriundis. 16°. Londoni,
1704.

516. Meckel's Archive fiir Anatomic und

Physiologic. Leipzig, 1789-.

517. de Meara (Edraundo). Historise me-

dicoe rariores. Amstelodarai, 1667.

518. Medical Age. Detroit.

519. Medical Archives. St. Louis.

520. Medical Bulletin. Philadelphia.

521. Medical Chronicle. Manchester.

522. Medical Chronicle. Montreal.

523. Medical Circular. London.

524. Medical Commentaries. Edinburgh.

525. Medical Counselor. Columbus, Ohio.

526. Medical Examiner. Philadelphia.

527. Medical Essays and Observations.

Revised and published by a society
in Edinl)urgh. 1733-.

528. Medical Facts and Observations.

London, 1791-.

529. Medical Fortnightly. St. Louis.

530. Medical Herald. Louisville, Ky.

531. Medical Independent, etc. Detroit.

532. Medical Mirror. London.

533. Medical News. Philadelphia.

534. Medical and Philosophical Commen-

taries. London, 1774-.

535. Medical and Phy.sical Journal. Lon-

don.

536. Medical Press and Circular. London.

537. Medical Quarterly Review. Loudon.

538. Medical Record. New York.

539. Medical Records and Researches of a

Private Medical Association. Lon-
don, 1798.

540. Medical Reporter. Calcutta.

541. Medical Repository. New York.

542. Medical Standard. Chicago.

543. Medical Summary. Philadelphia.

544. Medical and Surgical History of the

War of the Rebellion.

545. Medical and Surgical Reporter. Phi-

ladelphia.

546. Medical Times. London.

547. Medical Times. Philadelphia.

548. Medical Times and Gazette. Lon-

don.

549. Medico-Chirurgical Review. London.

550. Medico-Chirurgical Transactions.

London.

551. Medicorum Silesiacorum Satyrse.

Wratislavi£e et Lipsise, 1736.

552. Medicinische und chirurgische Ber-

linische wochentliche Nachrichten.
Von Schaarschmidt. Berlin, 1 738-.

553. Medizinische Jahrblicher. Wien.

554. Medicinische Zeituug. Berlin.

555. Medicinisches Journal von Baldinger.

Gottingen.

556. Meditsinskiy Vestnik. St. Peters-

burg.

557. Meditsinskoye Obozrainie. Moskva.

558. Medicinisch- chirurgische Bibliothek

von Tode. Copenhagen, 1775.

559. Medicinisch - Cliirurgische Zeituug.

Salsburg, 1790-.

560. van Meek'ren (.Job). Observationes

1 uedico-ch i r u rgicaj. Amste 1 odam i ,
1682.

561. Meibomius (H.). Dissertationes, etc.

Helnifestadi, 1668.

562. Melanges biologi(iues, etc., de I'Aca-

d6mie iniperiale des sciences de
St. Petersbours:.

563. M6moires de I'Acad^mie royale de

chirurgie. Paris.

564. Memoirs of the Medical Society of

London.

565. Memoires de la Soci6te m6dicale

d'^mulation de Paris. 1796-.

924

BIBLIOGRAPHIC INDEX.

566. Mercuric delle scienze mediche. Li-

voruo.

567. Meyer ( — ). Diss, de abortu epi-

deiuico. 1780.

568. Meyer (J. C. H.). Gruudriss der

Physiologie des meuschlicheii Kor-
pers, etc. Berliu, 1805.

569. Michigan Medical News. Detroit.

570. Miscellaueti curiosa medico -physica

Acad. Csesara; Leopoldino- Caro-
linaj naturae curiosoruni. Lipsia;,
1670-.

571. Mississippi Valley Medical Monthly.

Memphis, Teun.

572. Moliuetti (Antouius). Dissertatioues

anatomicse et pathologicae, etc.
Patavii, 1669.

573. Monatsschrift fur Gehurtskunde und

Fraueukrankheiteu. Berlin.

574. Mouitore med. marchigiano Loreto.

1889-.

575. Morand (S.-F.). Opuscules de chi-

rurgie. Paris, 1768. 4°.

576. Morgagni (.T. B.). De sedibus et

causis morborum, etc. Patavii,
1765.

577. Mursinna (C. L.). Neue niedizinisch-

chirurgische Beobachtungen. Ber-
lin, 1796.

578. Musitanus (Carolus). Chirurgia theo-

retico-practica. 1698.

N.

579. Nashville Journal of Medicine and

Surgery.

580. Naturalist. London.

581. Nebraska Medical Journal. Lincoln,

Nebraska.

582. Nelson's Northern Lancet. Platts-

burg, N. Y.

583. Nemnich (P. A.). Opus. Tubingen,

1800.

584. Neubauer (J. E.). Describens obser-

vationem de triplici nympharum
ordine. Jenae, 1774.

585. Neue Bibliothek fiir die Chirurgie

xiud Ophthalmologic. Hannover,
1815-28. (Langenbeck.)

586. Neues Hannoverisches Magazin.

587. Neues medicinisches und physisches

Journal. Von Baldinger zu Mar-
burg, 1797-1802.

588. Neue Zeitschrift fiir Geburtskunde.

Berlin.

589. New England Journal of Medicine

and Surgery. Boston.

590. New England Medical Gazette.

Boston.

591. New Jersey Medical Reporter. Bur-

lington.

592. New Orleans Medical News and Hos-

pital Gazette.

593. New Orleans Medical and Surgical

Journal.

594. New York Journal of Medicine.

595. New York Journal of Medicine and

Surgerjf.

596. New York Medical Gazette.

597. New York Medical Journal.

598. New York Medical and Philosophical

Journal and Review.

599. New York Medical and Physical

Journal.

600. New York Medical and Surgical Brief.

601. Nordisches Archiv fiir Natur- und

Arzneiwissenschaft, etc. Kopen-
bagen, 1779.

602. Nordiskt mediciniskt Arkiv, Stock-

holm.

603. Norsk Magazin for Laegevidenskaben.

Christiania.

604. North Carolina Medical Journal.

Wilmington, N. C.

605. Northern Journal of Medicine. Edin-

burgh.

606. Northwestern Lancet. St. Paul, Minn.

607. Nova acta physico-medica, etc. Er-

langae.

608. Nuck (Antonius). Sialographia.

Lugd. Bat., 1723.

O.

609. Obstetrical Gazette. Cincinnati.

610. Obstetrical Journal of Great Britain

and Ireland. London.

611. Oesterreichische medicinische Wo-

chenschrift. Wien.

612. Ohio Medical and Surgical Journal.

Columbus.

613. Ohio Medical Recorder. Columbus.

614. Orvosi helitap. Budapest.

615. Osiander (F. B.). Epigrammata, etc.

12°. Gottingae, 1807.

P.

616. Pacific Medical and Surgical Journal.

San Francisco.

BIBLIOGRAPHIC INDEX.

925

617. Panaroli (Doininico). Tatrolofjismo-

rnm sen. med. observ. pentecosta',
etc. Koiute, 1652.

618. Pare (Ambroise). CEuvres. Fifth

Edition. Paris, 1598.

619. Pathological Museum of the British

Medical Association at the Meeting
in London, 1895. (Catalogue.)

620. Paullini (C. F.). Observationes

medico-physicaj rarje, selectae et
curiosa', etc. 12°. Lipsia>, 1706.

621. Pechlin (J. N.). De aeris et alimenti

defectu, etc. Kiloni, 1676.

622. Pechliu (J. N.). Observationum

phj'sico - medic;iriim, etc. Haiu-
burgi, 1691.

623. Pennsylvania Hospital Reports.

Philadelphia.

624. Petermann and Albrecht. Scrutiuium

icteri ex calculi vesisculse, etc.
Lipsiffi, 1696.

625. Petit (J.-L.). Traite des maladies

chirurgicales, etc. 8°. Paris,
1790.

626. P6trequin (J.-P.-E.). Trait6 d'ana-

tomie m^dico-chirurgical, etc. 8°.
Paris, 1844.

627. Peyer (J. C. ). Myrecologia. Basi-

lese, 1685.

628. Pfaft's Mittheilungen aus dera Ge-

biete der Medizin, Chirnrgie, und
Pharmacologic. Kiel, 1832-.

629. Philosophical Transactions of the

Royal Society of London.

630. Phlegon Trallianus. de Mirab. in

Opuscula. 4°. 1620.

631. Photographic Review of Medicine

and Surgery. Philadelphia.

632. Physician and Surgeon. Ann Arbor,

Mich.

633. Piccinelli (G. A.). Opuscoli scelti

sulle Scienze, etc. 1778.

634. Pittsburgh Medical Review.

635. Plater (Felix), Observationum, etc.

Ba.<iile8e, 1680.

636. Plinius (Cajus Secundns). Historije

naturalis.

637. Plot (Robert). The Natural History

of Staffordshire. Oxford, 1686.

638. Popular Science Monthly. New York.

639. Portal f Antoine). Cours d'auatomie

m6dicale. 5 vols. 4°. Paris, 1804.

640. Porvenir (El). Mexico.

641. Poulet (A.). Trait6 des corps Stran-

gers en chirurgie. Paris, 1879,

642. Powell (Richard). Observations on

Bile, etc. 8°. London, 1800.

643. Practitioner. London.

644. Prager medizinische Wochenschrift,

645. Presse (La) m6dicale beige. Bruxelles,

646. Presse (La) niedicale. Paris.

647. Proceedings ol' the Connecticut Medi-

cal Society,

648. Proceedings of the Kings County

Medical Society. Brooklyn, N. Y.

649. Proceedings of the Louisiana State

Medical Association.

650. Proceedings of the Royal Medical

and Chirurgical Society of London.

651. Proceedings of the Royal Society of

London. 1854-.

652. Prochaska(Georgius). Adnotationum

academicarum. Pragse, 1780.

653. Progrfes (Le) medical. Paris.

654. Provincial Medical Journal. Halifax.

655. Provincial Medical Journal. Leices-

ter, 1885.

656. Provincial Medical and Surgical Jour-

nal. London.

657. Przeglad lekarski, etc. Krak6w.

Q.

658. Quercetanus (Josephus). Diaeteticon
polyhistoricum. 4°. Francofurti,.
1607.

659.
660.

661.

662.

663.

664.
665,
666.

667,

668.

R.

Raccoglitore medico di Fano.
Ramazzini (Bernardino). Epist., an,
1692.

Ranking's Half- Yearly Abstract.

London, 1845-64.
Recueil de memoires de m6decine, de

chirurgie et de pharmacie mili-

taires. Paris,
Recueil periodique d'observations de

mMecine de chirurgie et de phar-
macie, Paris, 1754-
Recueil periodique de la Soci6t6 de

mSdecine de Paris, 1797-
Recueil periodique de la Soci6t6 de

sant6 de Paris.
Reference Handbook of the Medical

Sciences. Wm, Wood & Co., New

York.

Revista mgdico-quirCirgica. Buenos
Aires.

Revista mSdica de Chile. Santiago
de Chile.

926

BIBLIOGRAPHIC INDEX.

669. Revue des cours scientifiques, etc.

Paris.

670. Revue general de clinique et de th^ra-

peutique. Paris, 1887-.

671. Revue de I'liypuotism, etc. Paris,

1886- .

672. Revue de m^decine. Paris.

673. Revue m6dicale de Limoges.

674. Revue meusuelle des maladies de

I'enfauce. Paris.

675. Revue militaire de m^decine et de

chirurgie. Paris, 1881-.

676. Revue philcsophique, etc. Paris,

1887- .

677. Revue photographique des hopitaux

de Paris.

678. Revue de therapeutique medico-chi-

rnrgicale. Paris.

679. Rhodigiuus (L. C). Lectionum anti-

quariuni libri xxx. Basilese,
1524.

680. Rhodius (Joannes). Mantissa anato-

mica. 8°. 1654.

681. Richmond and Louisville Medical

Journal. Louisville, Ky.

682. Richter (A. G.). Chirurgisclie Biblio-

thek. Gottingen, 1771-.

683. Riedlin (Vitus). Linea; medicse sin-

gulos. 1695-.

684. Ritorma (La) medica. Napoli.

685. Riolan (Jean) tils. Anthropographia.

Parisiis, 1618.

686. Riolan (Jean) fils. Encheiridium

anatomicum, etc. 16°. Paris, 1648.

687. Riverius (Lazarus). Observationes

medicsE et curationes insignes.
Londini, 1646.

688. Rivista italiana di terapia ed igiene.

Piacenza.

689. Roger of Wendover. Flowers of His-

tory. Bohn's edition, 1849, vol. i.

690. von Rokitansky (Carl). Lehrbuch

der pathologischen Anatomic. 3
vols. 8°. Wien, 1855-.

691. Rosenbladt (A. C). Dissertationes.

1781.

692. Rossius (P. M.). Observationes med.

chirurg. et practicse, etc. 12°.
Franco furti, 1608.

693. Royal London Ophthalmic Hospital

Reports. London.

694. Rudtoflfer (F. X.). Abhandlungen,

etc. 2 vols. 8°. Wien, 1805-.

695. Rudolph (J. P. J.)- De partu sicco.

Erlangae, 1790.

696. Rush (Benj.). Medical Inquiries and

Observations. Philadelphia, 1805.

697. Russkaya Meditsina. St. Petersburg,

1883-.

698. Ruysch (Fredericus). Adversariorum

anatomico -medico- chirurgicorum.
Decas tertia, 1723.

699. Ruysch (Fredericus). Opera omnia.

4 vols. 8°. Amstelodami, 1737.

s.

700. Saint George's Hospital Reports.

London.

701. St. Louis Clinical Record. St. Louis,

Mo.

702. St. Louis Courier of Medicine, etc.

703. St. Louis Medical and Surgical Jour-

nal. St. Louis, Mo.

704. St. Petersburger medicinische

Wochenschrift.

705. St. Thomas' Hospital Reports. Lon-

don.

706. Salmuth (P.). Observationem medi-

carum centurise tres posthuma;. 4°.
Brunsvigse, 1648.

707. Salute (La). Genova.

708. Sammlung von Natur- und Medizin-

Gesch., etc. Breslau. (Buchner.)

709. Sandifort (Eduard). Museum ana-

tomicum, etc. Lugd. Bat., 1793.

710. Sandifort (Gerard). Tabula; anato-

micse. 4 fasc. 1804.

711. Sangalli (Giacomo). La scienza e la

practica della anatomia patologica.
Milan o, 1873-.

712. Savannah Journal of Medicine. Sa-

vannah, Ga.

713. Saviard (Barth.). Observationes chi-

rurgicales. Paris, 1784.

714. Savonarola (G. M.). Practica, in

sex tractus. Venetiis impressum,
1497.

715. Scarpa (Antonius). De structura

fenestrse rotundse, etc., 1772.

716. Schacher (P. G.). De polypis. Lip-

siae, 1721.

717. Schacher (P. G.). De superfcetatione.

Lipsia;, 1721.

718. Schenck (J.). Observationum medi-

carum, etc. 2 vols. 8°. Franco-
furti, 1600.

719. Schlichting (J. D.). Traumatologia.

Amsterdam, 1748.

720. Schmidt's JahrbUcher. Leipzig.

BIBLIOGRAPHIC INDEX.

927

721. Schmucker (J. L.). Vermisclite chi-

rurgische Schrifteii. Berlin,
1772-.

722. Schrader (H. H. C). Observ. rario-

ruin, etc. Guelpherbyti, 1760.

723. Scribner's Magazine. New York.

724. Schurig (Martin). Partheuologia bis-

torico-medica, etc. 4°. Dresden
et Lipsiae, 1729.

725. Schurig (Martin). Gynaecologia, etc.

Dresden et Lipsia>, 1730.

726. Schurig (Martin). Euibryologia, etc.

Dresden, 1732.

727. Science. Cambridge and New York.

728. Semaine (La) modicale. Paris.

729. Serai-monthly Medical News. Louis-

ville, Ky.

730. Smetius (Heinrich). Miscellanea

medica, etc. Francof. a. M.,
1611.

731. de Senac (J. B.). Traite de la struc-

ture da coeur. Paris, 1749.

732. Sennert (Daniel). Paraphimosis.

Wittebergse, 1642.

733. Sermon (William). English Mid-

wifery. 8°. London, 1671.

734. Severinus (M. A.). De efficaci medi-

cina. Francolurti, 1671.

735. von Siebold (J. B.) chirur-

gischen Clinicums. Wurzburg,
1814.

736. von Siebold (J. B.). Sammlung, etc.

3 vols. 12°. Rudolstadt, 1805-12.

737. Sinibaldus (.L B.). Geneanthropeiae,

etc. Konise, 1642.

738. Skene (A. .I.e.). Diseases of Women.

New York, 1892.

739. Smellie (G.). Thesaurus medicus,

etc. Edinburgi, 1778-.

740. Societatis raedicae Havniensis collec-

tanea. Havnise.

741. Solingen (Cornelius) Byson-

dere aanmerkiugen. Amsterdam,
1698.

742. Solingen (Cornelius) Sonder-

bare Anmerckungen. Wittenber-
ger, 1712. (Same as 741.)

743. de Sorbait (Paulus). Praxios medi-

cse, etc. ViennsB. 1680.

744. Southern Medical and Surgical Jour-

nal. Augusfci, Ga.

745. Sozinskey (T. S.). Medical Symbol-

ism. Philadelphia, 1891.

746. Spallanzani (Lo). Modena.

747. Sperimentale (Lo). Firenze.

748. Spindler (Paulus). Observationum

medicinalium ceuturia, etc. Fran-
cof. ad M., 1691.

749. Spitalul. Bucuresci, 1881-.

750. Stalpart van der Wiel (Cornelius).

Observ. rariorum. Lugd. Bat.,
1687.

751. StoU (Maximilian). Kationis me-

dendi. Paris, 1787.

752. Storck (Antouius). Annus medicus.

753. Sue (Pierre). Essais historique, etc.

Paris, 1779.

754. Suetouius. De xii Caesaribus.

755. van Swieten (G. L. B.). Commen-

tariain Hermanni Boerhaave apho-
rismos, etc. 1742-76.

T.

756. Tardieu (A.). Etude mMico-legale

sur les attentats aux Moeurs.
Paris, 1862.

757. Taylor (A. F.). A Manual of Medi-

cal Jurisprudence.

758. Testa (A. G.). Bemerkungen liber

die per. Veranderungen, etc Leip-
zig, 1790.

759. Teratologia. London and Edinburgh.

Edited by Ballantj-ne.

760. Texas Courier-Record of Medicine.

Dallas, Tex.

761. Todd(R. B.). Cyclopedia of Anatomy

and Physiology. London, 1835-.

762. Tolberg (J. G.). Diss, de ovar.

hymen. Halaj, 1791.

763. Transactions of the Albany Institute.

Albany, N. Y.

764. Transactions of the American Gyne-

cological Society. Boston.

765. Transactions of the American Oph-

thalmological Society. New York.

766. Transactions of the Associated Apoth-

ecaries, etc. London.

767. Transactions of the Clinical Society

of London.

768. Transactions of the College of Physi-

cians of Philadelphia.

769. Transactions of the Edinburgh Ob-

stetrical Society.

770. Transactions of the Medical Associa-

tion of the State of Alabama.

771. Transactions of the South Carolina

Medical Association.

772. Transactions of the Medical Society

of the State of Georgia.

928

BIBLIOGRAPHIC INDEX.

773. Transactions of the Medical Society

of the State of New York.

774. Transactions of the Medical Society

of Tennessee.

775. Transactions of the Medical and

Chirurgical Faculty of Maryland.

776. Transactions of the Medico-Chirurgi-

eal Society of Edinburgh.

777. Transactions of the Medical and Phy-

sical Society of Bombay.

778. Transactions of the Obstetrical Society

of London.

779. Transactions of the Pathological So-

ciety of Loudon.

780. Transactions of the Philadelphia Ob-

stetrical Society.

781. Transactions of the Provincial Medi-

cal and Surgical Association . Lon-
don.

782. Transactions of the Ninth Interna-

tional Medical Congress. Wash-
ington, 1887.

783. Transylvania Medical Journal. Lex-

ington, Ky.

784. Trioen (Cornelius). Observ. medico-

chirurgicarura. Lugd. Bat., 1743.

785. Trnka de Krzowitz (W.). Hlstoria

Tynipanitidis. 1788.

786. Trousseau (Arniand). Clinique medi-

cale, etc. 3 vols. Paris, 1865.

787. Tweedie(Alex.). Cyclopedia of Prac-

tical Medicine. Philadelphia, 1845.

u.

788. Union (L') m6dicale du Canada.

Montreal.

789. Union (L') m6dicale. Paris.

790. United States Medical Investigator.

Chicago.

791. Universal Medical Journal. Phila-

delphia.

792. University Medical Magazine. Phila-

delphia.

V.

793. Valentini (M. B.). Novelise medico-

legales, etc. Francof. ad M., 1711.

794. Valentini (M. B.). Polychresta exo-

tica. Francof. ad M., 1700.

795. Vallee (Leon). Bibliographie des bib-

liographies. Paris, 1883.

796. Vallisneri (Antonio). Opere fi.sico-

raediche. Venezia, 1733.

797. Van Oven (Barnard). On Decline of

Life, Longevity, etc. London, 1853.

798. Velschius (G. H.). Curationum exo-

tericaruni. Ulmse, 1676.

799. Verduc (J. B.). Pathologic de Chi-

rurgie. 12°. Paris, 1723.

800. Verhandlungen der Genootsch. t. Be-

vord. d. Heelk. te Amsterdam.

801. Verhandlungen der physikalisch-me-

diciuischen Gesellschaft in Wiirz-
burg.

802. Vermischte chirurgische Schriften.

Berlin und Stettin, 1776-.

803. Vesalius (Andreas). Anatomia, etc.

fol. Amstelodami, 1617.

804. Vesalius (Andreas). Suorum de

humani corporis fabrica lib. epi-
tome, 1543.

805. Veslingius (Joannes). Syntagmaana-

tomicum. Patav., 1647.

806. Veterinary Journal and Annals of

Comparative Pathology. London.

807. Vierteljahrsschrift fiir gerichtliche

Medicin, etc. Berlin.

808. Vierteljahrsschrift fiir die praktische

Heilkunde. Prag.

809. Virginia Medical Monthly. Rich-

mond, Va.

810. Virginia Medical and Surgical Jour-

nal. Eichmoud, Va.

811. Vrachebniya Vaidomosti. St. Peters-

burg.

812. Vrach. St. Petersburg.

W.

813. Walford (Cornelius). The Insurance

Cyclopsedia. London, 1871-80.

814. Walther (A. F.). De obstetricum

erroribus, etc. 4°. Leipzig, 1729.

815. Walther (C. L.). Thesaurus medico-

chirurg. observationum curiosa^
rum, etc. Leipzig, 1715.

816. Western Journal of Medical and

Physical Sciences. Cincinnati.

817. Western Journal of Medicine and

Surgery. Louisville, Ky.

818. Western Medical Gazette. Cincinnati.

819. Western Medical and Physical Jour-

nal. Cincinnati.

820. Wiener Klinik.

821. Wiener medizinische Blatter. "Wien.

822. Wiener medizinische Presse.

823. Wienerische Beytriige zur praktischen

Arzneykunde, etc. Wien, 1781.

BIBLIOGRAPHIC INDEX.

929

824. Willonghby (P.). Observations in

Midwii'eiy. Ee-edited in War-
wick, 1863.

825. Wilnier (Bradford). Cases and Ee-

niarks in Surgery. 8°. London,
1779.

826. Wilson (Sir W. J. Erasmus). On

Diseases of the Skin. 8°. Lon-
don, 1867.

827. Wochenschrift fur die gesammte Heil-

kunde. Berlin.

828. Wolff (Casp. F.). Tbeoria generati-

onis. Hala;, 1759.

829. Wood (H. C). Therapeutics, etc.

Philadelphia, 1890.

830. Zacchia.s (Pauhis). Quaestiones me-

dico-legales. Lngd., 1701.

831. Zacutus Lusitanus (Abraham). Pra-

xis medica admiranda, etc. Lug-
duni, 1637. 8°.

832. Zeitschrift fiir Geburtshlilfe und Gy-

nakologie. Stuttgart.

833. Zeitschrift der k. k. Gesellschaft der

Aerzte zu Wien.

834. Zeitschrift fiir die Staafsarzueikunde.

Erlangen, 1821. (Henke.)

835. Zittman (J. F.). Medicina Forensis.

Francof. a. M., 1706.

836. Zoologist. London.

ADDENDA.

837.

838.
839.
840.

841.

842.

843.

Transactions of the American Surgi-
cal Association. Phihidelphia,1888.

Wiener klinische Wochenschrift.

Archiv fur Gyniikologie.

Devergie (Alph. ). Medecine Legale.
Paris, 1840.

Borellus (Peter). Historiani et ob-
servat. medico-physicarum, 1676.

Tulpius (Nicolas). Observat. medicse.
Fifth edition, 1716.

The American Year-Book of Medicine
and Surgery. Gould. Philadel-
phia, 1896.

844. American Text^Book of Obstetrics.

Norris. Philadelphia, 1896.

845. An American Text-Book of Surgery.

Keen and White. Philadelphia,
1895.

846. Warren (J. C). Surgical Pathology

and Therapeutics. Philadelphia,
1895.

847. Circular No. 3. War Department,

Surgeon-General's Office, Washing-
ton, August 17, 1871.

59

INDEX.

A.

Abbe on aneurysmal varix, 778
Abbot on hernia, 665

Abdomen, evisceration through, 650; foreign

bodies in, 658 ; gunshot wounds of, 651 ;

transfixion of, 648 ; walls of, spontaneous

rupture of. 666
Abel and Colman on brain injury, 547
Abernethy, William, 353
Abortion after anal operation, 105; attempts

at, 695 ; bloodless, 110 ; causes of, 109 ;

caused by worms in the uterus, 112 ;

epidemics of, 109 ; by the mouth, 52 ; in

twin pregnancy, 110
Abstinence from food and drink, 413
Acanthosis nigricans, 841
Acheson on luxation of the cervical spine, 580
Achondroplasia, 602
Acne cornee, 825
Acrobats, 463

Acromegaly, 803 ; association with gigant-
ism, 327

Acrophobia, 877

Acton on dos Santos, 196

Adams on a case of cut-throat, 577 ; on
hemihypertrophy, 351 ; on Jenner, 906 ;
on labial manipulation, 307 ; on varicose
veins, 778

Addison an anomalous twin births, 142

Adenomata, 759 ; of the breast, 759

Adiposis dolorosa, 360

Adler on ocular injury, 528

Adrian, Emperor, on legitimacy, 68

Aetius on sloughing of the genitals, 138

African sleep-sickness, 872

Age, old, 365 ; ovariotomy in, 707 ; preg-
nancy in, 39

Agnathes, 251

Agnevv on hemophilia, 816 ; on polyphazia,
637

Agoraphobia, 877

Ahlfeld on combined fetation, 57 ; on fetal

therapeusis, 92 ; on polymazia, 299
Aichmophobia, 877
Ainhum, 828

Air, effects of working in compressed, 432
A'fssaoui, 476
" Ajax," 468
" A-Ke," 193
Akers, Carrie, 342
Alard on elephantiasis arabum, 800
Albers on opium, 505 ; on pathognomonic
dreams, 867

Albertus on abortion, 110 ; in vicarious

menstruation, 25
Albes, Georgius, 218

Albinism, 220 ; in the lower animals, 222 ;

in negroes, 220 ; partial, 221
Albosius on retention of the fetus, 63
Albrecht on anomalous spleens, 290
Albucasis on extrauterine pregnancy, 50 ;

on multiple births, 152, 154
Alchemy, 368

Alderson on diaphragmatic hernia, 286
Aldrovandus on hirsuties, 231 ; on parasitic

terata, 189
d'Alechampius on multiple births, 152
Aleppo boil, 840
Alexander on double colon, 287
Alexeef on self-mutilation, 733
Algora on expulsion of the ectopic fetus, 53
Alibert on anomalous coloration of the hair,

239, 240 ; on vicarious menstruation, 24
Alix and Richter on rheumatism, 688
Allen on double ureter, 294 ; on precocious

pregnancy, 38 ; on triple amputation,

597 ; on wound of the liver and lung,

653

Alley on molten lead in the ear, 540

Alleyne on elephantiasis of the scrotum, 801

Alligator-bite, 722

"Alligator-boy," 824

Allport on vicarious menstruation, 24

Alopecia, association with edeutulousness,

227 ; congenital, 226 ; in lower animals,

232 ; strange (iauses of, 241
Alston on ovarian cyst, 783
Amatus Lusitanus on foreign body in the

brain, 560 ; on hair on the tongue, 256 ;

on vicarious menstruation, 20
Amazia, 297

Ambrosini on telegony, 89
Ambrosioni on combined fetation, 57
"American crow-bar case," 551
Ames on fasting, 415

Ammann on artificial penis, 319 ; on pro-
tracted pregnancy, 69

Amos on a case of cut-throat, 574

Amputations, intrauterine, 94 ; by light-
ning-stroke, 727 ; multiple. 596 ; in preg-
nancy, 105 ; spontaneous, 597

Amussat on absence of the vagina, 303

Amyelia, 281

Anakhre, 769

Anal tags, 280

Anche on avulsion of the finger, 589
Anderson on easy birth, 118

932

INDEX.

Andouard on blue bile, 385

Andrews on birth by the anus, 121 ; on

needles in the body, 736 ; on presentiment

of death. 889
Andrews, William Thomas, 249
Aneucephalous monsters, living, 24&
Anesthesia of the skin, 837
Aneurysm, 779 ; cure of abdominal, 658
Aneurysmal varix, 778
Angeli and Eisner on aneucephaly, 246
Anger causing abortion, 110
Angle on brain-injury, 550
d'Angoulenie, on artiticial impregnation, 43
Animation, suspended, 513
Aniridia, 259

Ankylosis of the articulations, 787
Annandale on orbital injury, 529 ; on super-
numerary digits, 273, 274
Anomalies of stature, size, and develop-
ment, 324

Anomalous nervous and mental diseases,
852

Anomalous skin diseases, 823
Anomalous types and instances of disease,
759

Anorchism, 319
Anorexia nervosa, 414
Anosmia, 874

Ansiaux on gynecomazia, 396
Antemortem digestion of the stoniacli, 628
Antenatal pathology, 89
Antepartum crying, 127
Anthropophagy, 400
An thro po phobia, 879
Antimony, tolerance of, 499
Anuria, 792

Anus, artiticial, operation for, 645 ; imper-
forate, 288, 794; parturition through,
121 ; passage of urine by, 675

Aorta, abdominal, ligature of, 658 ; double,
297 ; perlbration of, 572 ; wounds of, 626

Aphasia, 872 ; snake-bite causing, 874

Apoplexy, birth during, 113

Appendix, vermiform, foreign body in, 642

Appetite, depraved, for human flesh, 409 ;
excessive or canine. 403 ; perverted, 405 ;
perverted in pregnancy, 81

Arand on excrement issuing from the vulva,
675

Archer on superfetation, 49 ; on wound of
the stomach, 632

Aret;E0s on fetus in fetu, 201

Argles on combined fetation, 57

Aristotle on divisions of life, 370 ; on men-
strual superstitions, 17 ; on quintuplets,
147 ; on superfetation, 46

Arm. absence of, 265 ; avulsion of, 591 ; ele-
phantiasis of, 798 ; foreign body in, 599 ;
piercing the, 746

Armor on tapeworms, 818

Armstrong on discharge of fetal bones, 53 ;
on mercuric chlorid, 504

Arnaud on intestinal resection, 643

Arndt on branchial fissures, 284

Arnold on anomalous urination, 383 ; on
infantile menstruation, 30

Arnot on foreign body in the thorax, 614

Arnott on arrow-poison, 711

Amtzenius on anomalous suicide, 742

Aronsohnon foreign body in the larynx, 581
Arrow-poison, 711

Arrow- wounds, 710 ; of the bladder through

the buttocks, 672
Ai-senic, idiosyncrasies to, 500 ; sources of

poisoning by, 500
Arsenic-eating, 413
Arteries, wounds of some, 627
Articulation without a tongue, 254, 566
Articulations, ankylosis of, 787 : deformed,

603

Artificial impregnation, 42
Artificial limbs, 598
Arton on rupture of the stomach, 629
Ascaniuson the "porcupine-man," 824
Ascarides, 819
Ascites, 786
Ash on horns, 225
Ashburu on urethral calculus, 791
Ashby and Wright on absence of the penis,
314

Ashhurst on avulsion of the leg, 592 ; on
choly cystectomy, 655 ; on esophagotomy,
574 : on fracture of axis and atlas, 578 ;
on ligature of the carotid artery, 575 ; on
ligature of the iliac artery, 658 ; on mul-
tiple amputations, 597 ; on rupture of the
bladder, 670 ; on rupture of the heart,
625 ; on rupture of the lung, 608 ; on
scalp-injury, 542 ; on splenectomy, 656 ;
on vesical calculi, 790

Ashniead on leprosy from a fish-bite, 721

Asiatic cholera, 908

Asphyxia, birth during, 113 ; recovery after,
519

Assmuth on rupture of the bladder, 670
Astasia-abasia, 860

Astbury on vicarious menstruation, 26

Astrophobia, 878

Asymmetry, congenital, 350

Atiienaius on obesity, 356

Athetosis, 857

Athletes, dismembered, 599

Athletic feats, 455

Atkins on foreign body in the esophagus,
572

Atkinson on congenital alopecia, 227 ; on
intrauterine fractures, 97 ; on polydipsia,
404 ; on prolificity, 157

Atlas, dislocation of, 578

Atlee on fetus in fetu, 201 ; on protracted
pregnancy, 70

Attachment of the fetal head, 142

Auricles, supernumerary, 261

Auricular movement, 263

Autenrieth on injury during pregnancy, 98

Automatism, 887

Auvard incubator, 68

Aveling on postmorteni births, 124

Aventium on protracted pregnancy, 70

Aversions, 481, 880

Avulsion of the arm, 589 ; of the finger,
590 ; of the leg, 592 ; of the male external
genitals, 686, self-peribrmed, 732

Aylesbury on Ibreign body in the esopha-
gus, 570

A/iMua on absence of the vagina, 304
"Aztec children," 335
Aztecs, 248

INDEX.

933

B.

Bubbinstou aud Curry ou kuife-swallow-
iiii!;,

Baber on premature birth, {)8

Biil)iiigtou ou curdiae iujurv, 617

" Baby Chambers," 35-2

Bar h man ou hy paridrosis, 387

Bacinopliobia, 879

Back, foreign bodies in, 059

Bacon ou abortion, 110

Bacon, Lord, ou human combustion, 427 ;
ou lougevity, 375, 378 ; ou sympathetic
male nausea, 79 ; on triple dentition, 243

Bacque ou repeated Cesarean section, 130

Bader ou belladonna, 501

Bainbridge ou enhirged clitoris, 309

Bainbrigge ou supernumerary spleen, 291

Bailey on impalement, (549

Bailey, J. B., ou longevity, 371

Baillot on precocious menstruation, 30

Baker ou small infants, 348 ; on tongue-
injury, 5()() ; ou vicarious meustruatiou,20

Balade ou absence of the uterus, 311

Balch ou cardiac injury, 623

Baldness, congenital, 227

Baldwin, Barney, 579

Baldwin on Cesarean section, 129 ; on large
infant, 349

Baldy ou dermoid cyst, 203

Balfour on telegouy, 87

Ball ou aphasia, 873 ; ou basal fracture, 559

Ballautyne on antenatal pathology, 90 ; on
the Kiddeudeu Maids, 175 ; ou coiliugs of
the funis, 95 ; ou fetomaucy, 213 ; on ma-
ternal impressions, 81 ; on monsters, 161 ;
on worms in the fetus, 112

Ballautvue and vSkirviug on diphallic ter-
ata, 199

Ballingal ou flogging, 481

"BaU()on-raan,""287

Ballowitz on al>sence of thekidnej^^ 292

Bally ou migration of Ibreign bodies in the
esophagus, 571

Baly ou epilepsy, 852

Bancroft ou accidents during pregnancy,

Banerjee ou multiple births. 1.56
Banks on Turkish l)aths, 424
Bauon ou speech without a tongue, 566
Barbadoes leg. 797
Barbee ou vicarious meustruatiou, 26
Barbieux ou transposition of the viscera
291

Barclay ou hair-pin iu the ear, 542

Bardsley ou monsters, 193

Bardt on premature rupture of the fetal

membranes, 108
Barliam ou vicarious menstruation, 19
Barkan on orbital injury, 529
Barkar on foreign body iu the eye, 532
Barker on a case of cut-throat, 575 : on pre-
mature fetus, 66 ; on self-performed Ce-
sarean section, 132
Barker, Fordyce, on fetal therapeutics, 92
Barkesdale on rupture of the bladder, 671
Barlow on ankylosed joints, 603 ; on hic-
cough, 813; on postmortem movements
522

Barlow's disease, 817

Barnes ou evisceration, 650 ; on vicarious
menstruation, 20, 24, 25

Barrett on hiccough, 812 ; on vicarious men-
struation, 26

Barrow ou enlarged clitoris, 307

Bartels on human tails, 279 ; on rupture of
the bladder, 670

Bartens ou skin-grafting, 730

Barth ou rupture of tlie heart, 625 ; on su-
pernumerary nipple, 302

Bartholf, 607 '

Bartholinns ou abortion by the mouth, 52;
on anomalies of the nails, 241 ; on ante-
partum crying, 128 ; ou chromidrosis,
385 ; on dropsy, 786 ; on foreign body in
the eye, 532 ; on horns, 224 ; ou obesity,
353 ; ou jiarasitic terata, 191 ; on polyma-
zia, 299 ; ou postnu)rtem delivery, 125 ;
ou prolonged pregnancy, 69 ; on vicarious
menstruation, 24, 25, 27
Bartlett on bullets voided by the anus, 651
Barton ou vesical calculi in children, 790
Barwell on broken neck, 578 ; ou exostoses,

7(i8 ; on multij)le fractures, 702
Basal fractures, 559
Bass, J. R., 787
Bassett on late dentition, 243
Bastianelli ou ligature of the liver, 654
Batemau on bicephallic monster, 187 ; on
craniopagus, 173 ; on double monster,
184 ; on ischiopagus, 181 ; on pygopagus,
174

Bates on abortion iu twin pregnancy, 111

Bates, Captain, 332

Bath-tub, birth iu a, 120

Battersby on lactation in infants, 392

Battey on multiple fractures, 702 ; ou the

Skoptzies, 758
Battle on basal fractures, 559
Baudeloque on superfetation; 47
Baudoin ou the Blazek Sisters, 180
Bauuir on twin-sympathy, 887
Baux ou absence of the vagina, 303 ; on

anomalous urination, 383
Baxter on foreign body in the pelvis, 678
Baxter-Tyrie ou dislocation of the shoulder-
joint, 595
Bayle ou retention of ectopic fetus, 62
Baynes, Dr. R., 380
Baytraff on multiple liirth, 154
Bazzauella ou foreign body in the vagina,

694 ■
Beach on combined fetation, 56 ; on large

infants, 349 ; on Tuultiple fractures. 702
Beale on maternal impressions, 84 ; on

pregnancy with unruptured hymen, 42
Beau in the bronchus, 614 ; sprouting in the

bowel, 641
Beard, long, 234
Bearded women, 228
Beardsley ou epilepsy, 852
Beatty ou acciideut t<^ the fetus, 103
Beau on tartar emetic. 499
Beauchamp ou abortion. 111
Beaudry and Brothers on cleft tongue, 255
Beaumont on brain-injury, 548
Beaupre on cretinism,' 806
Beauvais, 228

934

INDEX.

Beb6, 339

Beebliuger ou monsters, 194

Beck on Cesarean section, 130 ; on preco-
cious pregnancy, 3o ; on self-mutilation,
734

Beckett on impalement, G90
Beckman ou postmortem Cesarean section,
136

Bedford on postmortem birth, 126 ; on

tjuadruplets, 150
B6dor ou gynecomazia, 395
Beebe ou intestinal resection, 643
Bee-stings, 713

Begg on quadruple amputation, 597

Begin ou idiosyncrasy, 481

Behrend on opium, 505

Bebreuds ou tartar emetic, 500

Bebrens on labor during sleep, 116

Beigel on anomalous coloration of the hair,

"240 ; on cryptorcliids, 321
Beilby ou anomalous sneezing, 814 ; on

hiccough, 813
Beiruc on anomalous cure of epilepsy, 853
Beisone ou the late of ectopic children, 62
Bejan on horns, 224

de Belamizarau, ou combined fetation, 57
Belin on injury during pregnancy, 101
Belinovski on human tails, 278
Bell on abortion, 110 ; on gastrotomy, 633 ;
on anomalous suicide, 743 ; ou human
magnetism, 430
Belladonna, idiosyncrasy to, 501
Bellamy ou horns, 226
Bellini on vicarious menstruation, 23
Belloste on cranial fractures, 558
Belluzzi ou postmortem birth, 124
Belt ou twin-labor. 111
Benedictus on protracted pregnancy, 69
Benham on discharge of fetal bones, 53
Benicke on fetal therapeutics, 92
Beniveuius on male menstruation, 28 ; on
rupture of the uterus, 137 ; on self-muti-
lation, 732 ; on sloughing of the genitals,
138 ; on vicarious menstruation, 27
Bennett on ovariotomy in age, 707
Benvenuti on macrocepbaly, 248
Benzin-poisoning, 501
Berard on absence of the vagina, 304
Berchon on diaphragmatic hernia, 286
Berdot on abseuce of the tongue, 254
Bergtold on brain-injury, 554
Berillon on lyssopholua, 879
Bernard on urethral calculus, 791
Bernard. Claude, on absence of the olfactory

lobes, 246
Bernays on gastrotomy, 633
Berncastle ou late restoration of sight, 535
Bernhardt on cervical ribs, 282
Bernstein on fecundity in the old, 39 ; on

protracted menstruation, 32
Berry on the Hindoo Sisters, 168
Bertherand on enlarged clitoris, 308
Berthier on delivery during melancholia,

Berthold on precocious pregnancy, 34
Bertrandi on repeated Cesarean section, 130
Berwick on organ-handle swallowed, 640
Besse on bicephalic monsters, 187
Bessems on twin-birth, 143

Bestiality, 162, 163
Bey rat on protracted menstruation, 32
Bbadoory on evisceration, 651
Bianchini on spontaneous human combus-
tion, 427

Biaudet and Buginou on double monster,
173

Bibliographic index, 915

Bicephalic monsters, 187

Bichat ou canities, 236 ; on hirsuties, 232

Biddenden Maids, 174

Bidel on worms in the uterus, 111

Bidwell on precocious boy, 345

Bielschowsky on canities unguium, 847

Bierlingou vicarious menstruation, 20

Biffi on cardiac injury, 623

Bigelow on the '"crow-bar case," 533; on

foreign body in the bladder, 678 ; on

boms, 225
Bijoux on depraved appetites, 411
Bile, blue, 385
Bill on arrow- wounds, 711
Billard ou blue coloration of the skin, 844 ;

on infantile menstruation, 29
Billroth on avulsion of the arm, 591 ; mar-
velous operation by, 708 ; on opium, 505 ;

on teeth swallowed, 639
Binet on double consciousness, 884 ; on

fetichism, 401 ; on rudimentary penis,

315

Biondi on surgery of the lung, 608
"Biped armadillo," 823
Birch on retention of ectopic fetus, 62
Bird on brain-injury, 557
Birds, injury to the eye by, 533
Birth through the abdominal wall, 122 ;
during apoplexy, 113 ; during asphyxia,
113 ; in aAvkward places, 116 ; by cattle-
horns, 133 ; in epileptic convulsions, 113 ;
during intoxication, 114 ; with mem-
branes intact, 122; painless, 113; in
paraplegia, 116 ; through perineal per-
foration, 121 ; postmortem, 123 ; prema-
ture, 65 ; ])y the rectum, 120 ; retarded,
68; during somnambulism, 116 ; at stool,
116, 117, 118, 119; unconscious, 113;
unusual places of, 115, 119
Biskra button, 840
Bisset on triple dentition, 243
Bissieu on fetus in fetu, 201
Bites, alligator-, 722 ; animal-, 719, 721 ;
fish-, 721 ; fowl-, 719 ; insect-, 713 ;
shark-, 721 ; snake-, 715 ; spider-, 713
Bixby on conception after ovariotomy, 46 ;

on ovarian cyst, 783
Bizzen on coiling of the funis, 95
Black Death, 892 ; in London, 895 ; moral
effect of, 894 ; mortality of, 893 ; nobility
stricken by, 894
Black on hydrochloric acid, 498 ; on lipoma,

766 ; on self-mutilation, 734
Bladder, anomalies of, 295 ; calculi in, 788 ;
exstrophy of, 295 ; fetus in, 53, 63 ; fis-
tula of, 675 ; foreign bodies in, 676 ; gun-
shot wounds of, 671 ; injuries of, 670 ;
menstruation from, 26 ; penetration
through anus, buttocks, or vagina, 671 ;
rupture of, 670 ; triple, 295 ; worms in,
676, 819

INDEX.

935

Blaikie, Bruutoii, ou telegony, 86, 87, 89

Blair on vicarious nieustrnation, 24

Blake ou iutrauterine amputation, 94 ; ou

nieustrnation during pregnancy, 29
Blanc on precocious boys, 346
Blaucanli, 32

Blancliard on conception with hymen in-
tegrum, 40 ; ou fecundity in the old, 39 ;
on gynecomazia, 395 ; ou lactation in the
aged, 394

Blaudiu on anomalous growth of nails, 589
Blasius on triple monsters, 167
Blatner on postmortem Cesarean section,
137

Biaudet on protracted sleep, 869
Blaxland on perforation of the aorta, 572
Blazek Sisters, 179
" Bleeders," 815

Bleeding, extensive, 709 ; self-performed,
745

de Blegny, on protracted pregnancy, 69 ;

ou retention of ectopic fetus, 62
Blenkinsop on rupture of the vagina, 138
Blind, extraordinary sense-development in

the. 433
"Blind-Tom," 433
Block ou urethral calculi, 791
Blok on cyclopia, 258
Blondin, 450
Blood, great loss of, 709
Blood-vessels, anomalies of, 297
"Bloody sweat," 388
Blot ou absence of the oviducts, 310
Blower ou passage of a nail swallowed, 638
Blumenthal on iutrauterine amputation, 95
Bluudel on mercury, 504
Blundell on fetus in fetu, 200
Boardnian ou nail iu the bowel, 638
Boeiuit on precocious lactation, 392
Boddiugton on absence of the tongue, 254
Bodinier on delivery of ectopic fetus, 54
Bodkin ou exophthalmos, 527
Bodwitch on diaphragmatic hernia, 286
Boehm on operation on double monsters,

173

Boerhaave on rupture of the esophagus,
628 ; on spontaneous amputation, 597 ;
on vicarious menstruation, 25

Boerstler on ovarian cyst, 783

Bohemian Twins, 180

Boling on cranial fractures, 559

Bolsot on fasting, 415

Bone, anomalous growth of, 605 ; tumors of,
768

Bone-grafting, 729
Bonet on postmortem birth, 126
Bonhoure on protracted menstruation, 33
Bonnain on anomalous vaginal opening

306 '
Bonnar on short pregnancy, 65
Bonnet on multiple fractures, 702
Bontius on brain-injury, 554
Bookey on gunshot wound of the penis,

681 ; on horse-bite of the penis, 680
Boone on cardiac injury, 619
Booth on infant- vitality, 706 ; on priapism

685 '
Boqui^ on unilateral sweating, 388
Bordat on parasitic terata, 191

Bordenave on triple monster, 167

Borellus on antepartum crying, 128 ; on
chromidrosis, 385 ; ou hypertropliy ol the
heart, 759 ; on multiple birth, 153 ; on
triple monster, 167

Borgeois ou ascarides, 820

Borghini, 249

Boric acid, idiosyncrasy to, 497
Borsini ou ovariotomy in age, 707
Borthwick on wound of the kidney, 667
Borwilaski, 339

Bosquet ou absence of the vagina, 303 ; on

deticient uterus, 311
Bot-fly, 821

Bothwell on twin-labor. 111
Botocudos, 749
Botta on obesity, 355
Bouchacourt on fetus in fetu, 202
Bouchaud on anomalous diaphragm, 285
Boulger on vicarious menstruation, 20
BouUard on anomaly of the jaw, 251
Bouillon on rupture of the uterus, 137 ; on

superfetatiou, 49
Bouilly ou rupture of the lung, 609
Boulting on multiple fractures, 702
Bourke on menstrual superstitions, 17 ; on

scatologic rites, 406
Bourton on postmortem Cesarean section,

135

Bousquet on quadruplets, 149

Bouzal ou expulsion of ectopic fetus, 53

Bowel-injuries, 642

Bower ou orbital injury, 529

Bowling ou cardiac injury, 618

Boxing the ears, 537

Boyer on deficient uterus, 311 ; on gangrene
of the penis, 682 ; on hyijertrophy of the
heart, 759

Boyle on shark-bite, 721

Bradley on dislocation of the humerus, 594 ;
on premature rupture of the fetal mem-
branes, 108

Braid on supernumerary digits, 275

Braidwood on dajaksch, 711

Brain, anomalies of, 245 ; double, 249 ;
foreign bodies iu, 559 ; gunshot injuries
of, 549 ; injuries of, 545, with loss of
cerebral substance, 551 ; largest, 249 ;
life without, 246 ; penetration and trans-
fixiou of, 545 ; study of wounds of, 550 ;
tumors of, 557

Brain-substance, loss of, 551, 700

Braino ou anonuily of the tougue, 256

Braman on neck-injury, 576

Braniaun ou dermoid cyst, 204

Branch ()n extraoral dentition, 245

Branchial fissures. 284

Brand on opium, 505

Brander on fibrolipoma, 764

Brandis on partial canities, 238

Brasavolus ou brain-injury, 553

Bran, Haus, 329

Braun ou intrauterine fracture, 97; on
pregnancy with unruptured hymen, 42

Breast, adenoma of, 759 ; anomalies of, 297 ;
diffuse hypertrophy of, 759 ; nienstrua-
tion from, 19 ; removal of, during preg-
nancy, 105 ; supernumerary, 298

Breeding, influence of telegony in, 87

936

INDEX.

Breisky on foreign bod}' in the vagina, 694
Bvenmse on rupture of the diaphragm, 612
Brendelius on injury during pregnancy, 98
Brentano on anonialnus esophagus, 285
Breschet on foreign body in the nose, 564
Brioe, the giant, 330

Bricheteau on accidental growth of hair,
235 ; on anomaly of the nails, 241

Briddon on ovarian cvst, 782

Brides, injuries to, (iO'i

Bridginan. Laura I>ewey, 4:54

Brierre de Boisinont on precocious men-
struation, 31 ; on protracted menstrua-
tion, 33 ; on suicide, 744 ; on vicarious
menstruation, 18

Brieude on human odors, 398

Briggs on a wine-glass in the rectum, 648

Brighani on avulsion of the genitals, 686 ;
on a nail in the bronchus, 614

Bright, Edward, 357

Bright on hydrocephaly, 250

Brignatelli on foreign body in the uterus, 695

Brill on pregnane}" with unruptured hymen,
42

Brincken on vicarious menstruation, 25

Brissaud on myxedema, 807

Brissaud and Meige on gigantism, 328

Bristowe on aphasia, 874

Broca on fetus in fetu, 201 ; on hennhyper-

trophy. 350 ; on Jacques Inaudi, 439 ; on

James Leedgwood, 265
Brochin on opium, 505 ; on tumors in the

pregnant uterus. 106
Brodhurst on absence of the vagina and

uterus, 304
Brodie on chromidrosis, 385 ; on expulsion

of tlie ectopic fetus, 53 ; on fetus in

Ibtu, 200
Brokaw on chest-injuries, 611
Broken back, 659

Bronchi, foreign bodies in, 614 ; injuries of,
606

Bronchocele, 761

Brooke on acne cornee, 825

Brouzet on premature fetus, 66

Brown on birtli through the perineum, 121 ;
on impalement, 610 : on perineal testicle,
322 : on pregnancy after ovariotomy, 46 ;
on protrusion of ' the fetal membranes,
107 : on teeth in the larynx, 582 ; on un-
usual birth. 120

Brown-Sequard on epilepsy, 852 ; on sudden
canities, 236

Bro%vne on elephantiasis of the scrotum,
802 ; on ectopic fetus, 57

Bruce, Mitchell, anomalous discoloration of
the skin and mucous nieml)ranes, 843

Bruce on priapism. 685

Brucker on suicides, 744

Bruyh on avulsion of the testicles, 686

BruFey on anomalous coloration of the hair,
210

Bninet on anencephalous child, 246
Brunton on death from fear, 525
Bruyesinus on perverted appetites of preg-
nancy, 80
Bryan on protracted pregnancy, 70
Bryant on lightning-stroke, 727 ; on wound
of the kidney, 668

Bryce on anuria, 793

Bryk on dermoids, 204

Birbendorf on discharge of the fetal skele-
ton, 53

Bubonic plague, 892, 896

Bucchetoni on diphallic monster, 195

Buchanan on brain-injury, 555 ; on intra-
uterine amputation, 96 ; on orbital injury,
529 ; on the Scottish Brothers, 184 ; on
vicarious menstruation, 26

Buchner on injury during pregnancy, 98 ;
on protracted pregnancy, 69 ; on reten-
tion of the fetus, 64

Buck on hydatid in the heart, 624

Buckler on foieign body in the appendix,
642

Bud in on premature fetus, 67

Buflfon on albinism, 221 ; on dwarfs, 340 ;

on giants, 327 ; on longevity, 374 ; on

strength ol" jaws, 469
Buhl on anomalous extremities, 267
Buhl's disease, 817
Bnhring on bicephaly, 246
Bulatoft'on polyorchism, 320
Bulimia, 403 ; in pregnancy, 81
Bull on supernumerary feet, 270
Buller on lightning-stroke, 726
Bullet in the brain, 561 ; voided by bladder

or bowel, 651
Bullock m\ cardiac injury, 619
Bumm on large infant, 349
Burchard on priapism, 685
Burdach on telegony, 89
Buret on syphilis, 912
Burge on iniperlorate anus, 289
Burgess on large infant, 348 ; on ijregnancy

with unruptured hymen, 42
Burial, premature, 519
Burke on twins, 143
Burman on hydrocyanic acid, 499
Burr on liugual hemiatrophy, 860
Burrall on dry birth, 123
Burroughs on bulimia, 403
Burrows on odors of the insane, 400
Bursting from over-eating, 628, 629
Burton on venesection, 709
Bury on fetus in fetu, 201
Busch on phenol, 498
Bush on twins, 143
Bussiere on triple bladder, 295
Butcher on discharge of fetal bones, 53
Butler on anuria, 793

Buxtorf on infantile menstruation, 30 ; on

parasitic terata, 189
Buzzard on accident during pregnancy, 103
Buzzell on retention of fetus, 64
Byrne on tumor in the pregnant uterus,

106

c.

Cabrolius on coitus, 512

Cachot on fecundity in the old, 39

Caddy on torsion of the penis, 316

Cadet de Gassicourt on hypersensitiveness

of smell, 398
Caen on anomalous suicide, 736
1 Caesar on hyperthermy, 422

INDEX.

937

Cagots, 808

Caille, Kent», on albinism, 221

"Calculating boy," 4:35)

Calculi, 788 ; cardiac, 792 ; extravesical,
790 ; after penetration of tiie bladder,
672, 674 ; pineal, 792 ; renal, 790 ; saliv-
ary, 792 ; spontaneons discharge of, 790 ;
umbilical, 792 ; urethral, 791 ; uterine,
792 ; vesical, 788

Caldani on anomalies of the ossicles, 263

Calder on vicarious menstruation, 25

Caldwell on postmortem growth of hair,
523 ; on retention of fetus, (54

Calhoun on exophthalmos, 529 ; on maggots
in the ear, 5139

Callender on cardiac injury, 624

Camby on lightning stroke, 725

Camden on tbrei<>n body in the brain, 561

"Camel-boy," 603

Camerer on infantile menstruation, 29 ; on
retention of fetus, 64

Cameron on gynecomazia, 396 ; on labial
manipulation, 307 ; on obesitj', 354

Camp on self-mutilation, 732

Campaignac on hirsuties, 233

Campbell on delivery of ectopic fetus, 53 ;
on extrauterine pregn;incy, 50, 51 ; on
fistula-operation during pregnancy, 105 ;
on postmortem Cesarean section, 135 ; on
a precocious boy, 346 ; on precocious
menstruation, 29 ; on premature rupture
of the fetal membranes, 108 ; on pro-
tracted pregnancy, 70 ; on snake-bite,
717 ; on vi;il)le ectopic fetus, 57

Campbell, William, 333, 359

Campbell de Morgan on plexiform neuroma,
771

Camper on bladder injury, 671 ; on intes-
tinal fistula, 675

Camuset and Planes on protracted sleep,
870

Canities, sudden, 235 ; temporary and par-
tial, 238
Canities unguium, 847
Cannibalism, 406
Cannon-ball, delivery by, 134
Cantharides, poisoning by, 501
Canton on anomaly of the jaw, 252
Capers on accidental conception, 44
Capuron on fecundity in the old, 39 ; on
perineal birth, 122 ; on premature fetus,
67

CarboIi(! acid, poisoning by, 498 ; tolerance

of, 498
Carcinoma, 772

Cardanus on injury to the pericardium, 624
Cardiac injuries. 616, nonfatal, 620; sur-
vival after, 617
Cardiac surgery, 616
Cardinal, James, 249

Carey on pregnancy with unruptured hy-
men, 42 ; on protracted pregnancy, 71 ;
on yellow fever, 910
Carhart on injury during pregnancy, 99
Carlisle on anomalous urination, 384
Carmichael on ovariotomy in old age, 707
Cam on precocious pregnancy, 35
Carnochan on cardiac injury, 619 ; on hy-
pertrophy of the heart, 566

Carnot, President, injury of, 653

Carotid artery, ligature of, 575

Car|)enter on the Aissaoui, 476 ; on brain
injury, 548 ; on sudden birth, 116 ; on
tartar emetic, 499 ; on tattooing, 750 ; on
teeth in the bronchus, 616

Carper on absence of the lungs, 285

Carre on triple dentition, 243

Carson on twin birth, 142

Carter on avulsion of the leg, 592 ; on late
dentition, 243 ; on short pregnancy, 65

Carver on extraoral dentition, 245

Casals, Gaugirau, on precocious menstrua-
tion, 31

Case on birth during sleep, 114
Caso on vicarious menstruation, 24
"Cassandra," 635

Cassano and Pedretti on enlarged clitoris,
309

Cassidy on birth through the perineum, 121
Castor oil, untoward action of, 504
Castellanos on wound of the kidney, 667
"Castrata," 785

Castration, ceremonial, 755 ; for excessive
cupidity, 756 ; as a religious rite, 756 ;
self-performed, 732; sexual desire after,
687

t\ Castro on cannibalism, 410 ; worms in the

heart, 820
Catalepsy, 867
Caterpillars swallowed, 637
Catesby on obesity, 358
Cathell on pregnancy complicated with both

uterine fibroids and measles, 107
Cattle-horns, delivery by, 133 ; injuries to

pregnant women by, 99
Caudmonton foreign body in the bladder,

677

Cavalier family, 221

Cazenave on sloughing of the genitals, 138 ;

on vicarious menstruation, 20
Cazin on anal operation causing abortion,

105

Cazzan on canities, 236
Cecil on precocious menstruation, 30
Celiotomies, six on one woman, 707
Celliez on injury to the penis. 680
Centenarians, censuses of, 366 ; operation
on, 707

Centipede in the ear, 539 ; in the nose, 565

Cerebellum, defective, 246

Cerebrum, anomalies of, 245 ; foreign bodies

in, 559; injuries of, 545; life without,

245 ; tumor of, 557
Cervical ribs, 282
Cervical vertebrae, injuries of, 578
Cesarean section, 128 ; in Africa, 131 ; on a

dwarf, 129 ; history of, 128 ; postmortem,

135 ; repeated, 130 ; self-performed, 131 ;

with twins, 129
Chabert on combined fetation, 57
Chaffee on morphin, 506
Chaldean teratoscopy, 214
Chalk on hypertrophy, 567
Chalk-eating, 412

Chambers on belladonna, 501 ; on bloodv
sweat, 390 ; on vicarious menstruation,
18

Chambon on quintuplets, 150

938

INDEX.

Chamouni, 424

Champenois on multiple amputations, 596
Champion on impregnation with hymen in-
tact, 41

Chance on gangrene of the penis, 682
Chandler on laceration of the liver, 141
Chang, 331

Chaiiuing on self-mutihition, 735

Chantreuil on aural anomaly, 261

Chapman on abortion, 110 ; on dilatation
of the colon, 288 ; on extensive hemor-
rhage, 710

Charcot on fetal variola, 91

Chariere on horns, 224

Charlton, on repeated Cesarean section, 131

Charpentier on polymazia, 300 ; on pre-
mature birth, 67

Charriu on obesity, 356

Chasser on combined fetation, 55

Chastity -girdles, 753

Chatard, Jr., on expulsion of fetal mem-
branes, 108
Chateaubriand, 304
Chaumeton on wasp-sting, 713
Chaupier on intrauterine fractures, 97
Chaussier on absence of ovary, 309
Chenisse on syphilis from tattooing, 751
Chelius on brain-injury, 548 ; on injury
during pregnancy, 102 ; on transfixion of
the chest, 610
Cheselden on avulsion of the arm, 591 ;

on retention of fetus, 63
Chesney on premature rupture of the fetal

membranes, 108
Chest, foreign bodies in, 613 ; injuries of,

606 ; transfixion of, 610
Chester on retention of ectopic fetus, 63
Chevalier on (luiuin, 509
"Chevalier Cliquot," 636
Cheverson asphyxiation, 519, on eunuch-
making. 756; on fish in the pharynx,
567 ; on injuries to the testicle, 685 ; on
precocious pregnancy, 37 ; on self-mutila-
tion, 733
Chiari on wound of the aorta, 627
Chicken-pox in fetus, 91
Chiene on ovariotomy in a child, 707
Child-bearing after the menopause, 29
Child-marriages in India, 18, 37
Child-mothers, 34; in India, 37; with twins,
38

Children, operations on, 706 ; resistance of,

to injury, 705
Chinese foot-binding, 737
Chipault on laminectomy, 661 ; on lipoma,

766

Chiromegaly, 805

Chisholm on foreign body in the eye, 532,

535 • on multiple Cesarean sections, 131
Chitten on dermoid cyst, 204
Chloasma uterinum, 841
Cholecystectomy, 655
Cholecvstot<miy, 655
Cholera, 908

Chomel on anomalous coloration of the skin,
843

Chondromata, 766
Chopart on polyphagia, 637
Chorea, 853

Chretien on penis pal me, 316

Christison on cardiac injury, 623

Chromidrosis, 385

Chronology, ancient, 368

Chubb on large infant, 349

Church on cardiac injury, 620

Churchill on absence of the vagina, 303

Chylothorax, 657

Cigarette in the bronchus, 615

Cinquevelli, Paul, 451

Circular insanity, 881

Circumcision, 754 ; in the female, 308

Clark on combined letation, 55 ; on foreign
body in the eye, 533; on paternal im-
pression, 86 ; on precocious menstruation,
30 ; on rupture of the stomach, 630

Claustrophobia, 878

Clay on pseudocyesis, 79 ; on vicarious
menstruation, 26

Clerc on maternal impression, 85

Clericus on absence of the cerebrum, 245

Clements on wound of the stomach, 632

Cleveland on anomalous membranes, 49 ;
on coiling of the cord, 95 ; on postmortem
Cesarean section, 137

Clevenger on Oscar Moore. 440

Clitoris, absence of, 307 ; ceremonial cir-
cumcision of, 308 ; double, 309 ; enlarged,
308 ; ossified, 309 ; rupture of, 691

Cloquet on fetichism, 402 ; on foreign body
in the vagina, 693

Closmadenc on polyphagia, 638

Clot-Bey on elephantiasis of the scrotum,801

Club-foot, 276

Coats on rupture of the bladder, 670

Cobbe on opium -eating, 507

Cobleigh on premature rupture of fetal

membranes, 108
Cock on wound of the kidney, 668
Cody on elephantiasis of the scrotum, 802
Coe on multiple Cesarean section, 131 ; on

obesity, 358
Coen on removal of the breast in pregnancy,

105

Coeyne on double ureter, 294
Coffey, J. W., 364
Cohen on tongue-swallowing, 565
Coilings of the umbilical cord, 95
Coitus, anomalous, 513 ; death during, 513 ;
with a dog, injury from, 692 ; excessive,
512 ; hemorrhage after, 692 ; idiosyncrasy
in, 511 ; injuries in, 679, 680, 691 ; odor
of breath after, 399 ; temperature during,
512

Cold causing abortion, 109 ; effects of, 430
Cole on pregnancy with unruptured hymen,

42 ; on superiuimerary penis, 198
Coleman on sudden birth, 119
Colles on foreign body in the esophagus,

572 ; on rupture of the urethra, 679
Collette on foreign l)ody in the orbit, 531
Collier on infibulation, 753
Coilings on rupture of the heart, 625
Collins on anomalous lung, 285 ; on fasting,

419 ; on keloids, 764 ; on protracted

pregnancy, 72 ; on rupture of the stomach,

629

Collins and Leidy on birth of a monster by
Cesarean section, 131

INDEX.

939

CoUoredo, 191

Colly on precocious meustraation, 30
Coloboma, 260

Colomb on twins borne beyond the meno-
pause, 40

Colou, dilatation of, 287 ; double, 287
Colostomy, 645
Coltou on unusual birth, 119
Columbus on hermaphroditism, 207
Colzi on anomalous ureter, 294
Combettes on absence of the cerebellum, 247
Combined intrauterine and extrauterine ges-
tation, 54

Combustion, spontaneous, of the human

body, 426
Compagne on canities, 238
Compensatory development of the senses,

432

Compressed air, effects of working in, 432
Conanton terata, 166

Conarmoud on precocious menstruation, 30

Conception with defloieut organs, 45; opera-
tion to prevent, 754 ; after ovariotomy,
45 ; precocious, 34 ; soon after a preceding
pregnancy, 46 ; during sleep, 45

Conklin on splenectomy, 657

Cousbruch on fasting, 415

Consciousnevss, double, 883

Constantiuedes on absence of the nymphte,
306

Constipation, persistent, 794

Contortionists, 473

Cook on intrauterine amputation, 94

Cooke on combined fetation, 56

Cooke and Lay cock on brain- injury, 556

Cooper on belladonna, 501 ; on hermaphro-
ditism, 210

Cooper, Sir Astley, on diaphragmatic hernia,
612 ; on elephantiasis of the scrotum,
801 ; on precocious menstruation, 31 ; on
precocious pregnancy, 34

Copeland on maternal impression, 84

Copulation (see Coitus)

Cord, anomalies of, 109 ; coilings of, 95 ;
knots in, 109

Cordajus on extrauterine gestation, 50

Cordier on renal calculi, 791 ; on retention
of ectopic fetus, 63

Corey on injuries during pregnancy, 99

Corneal grafting, 728

Corpora callosum, 246

Corrosive sublimate, untoward action and
tolerance of, 504

"Corsican Brothers," 887

Corson on hiccough, 812

Cosentiuo on dry birth, 123

Cosmetic mutilations, 746

Costa on excessive dentition, 244

da Costa Simoes on retention of ectopic
fetus, 63

Cotter, Patrick, 331

Coughing causing abortion, 110; causing

rupture of the abdominal walls, 666
Couper on wound of the bladder, 672
Couriers, 456 ; in India, 458
Cousins on hemophilia, 816
Couveuse, 66

Cowan on hiccough, 812 ; on scalp-develop-
ment, 218

Cowger on birth in membranes, 123
Cowles on neck-injury, 576
Cowley on scalp-injury, 543 ; on self-per-
formed Cesarean section, 131
Cox on prolonged pregnancy, 64
Craddock on retention of ectopic fetus, 63
Craudall on injuries in coitus, 692
Crauiopagi, 173

Cranium, deficiency of, 250 ; fracture of,
basal, 559 ; extensive, 558 ; internal, 559 ;
injuries to, 551

Cranz on large infants, 348

Crawford on lightning stroke, 722 ; on un-
conscious birth, 114

Craw lord and Yule on hirsuties, 231

Creaser, Thomas, 416

Crede on splenectomy, 657

Cretinism, 805 ; sporadic, 806

Crichton on " leaping ague," 856

Cridland on effects of cold, 431

Crippled beggars, nianutacture of, 737

Cripps on absence of the ovary, 309 ; on
colostomy, 645 ; on constipation, 795 ; on
painless parturition, 115

Crisp on abortion, 110

Critchett on foreign body in the eye, 532

Crocker on albinism, 220 ; on anomalous
coloring, 382, 383 ; on anomalous color-
changes of the hair, 240 ; on chromidrosis,
386 ; on hyperidrosis, 387 ; on canities,
237, 238 ; on dermatolytic growths, 234 ;
on harlequin fetus, 825 , on pigmented
skin, 841 , on skin-shedding, 833 ; on
tinea nodosa, 849 ; on xeroderma pigmen-
tosum, 842 ; on yaws, 840

Crocodile-bite, 722

Croft on preputial calculus, 791

de la Croix on flatus from the penis, 675

CroUius on knife-swallowing, 632

Cromerus on 36 children at a birth, 147

Crompton on endurance of pain, 479

Crouyn on foreign body in the brain, 561

Crooks on anomalous stomach, 287

Crootn on ischuria, 792

Croon on pseudocyesis, 79

Cross on anomalous tears, 384 ; on vesical
calculus, 789

Croston on delivery of a monster by Cesa-
rean section, 129

Croton oil, on tolerance of, 504

Crouch on conception after ovariotomy, 46

Crouzit on foreign body in the uterus, 695

" Crow-bar case," 551

Crowdace on injury during pregnancy,
100

Crowell on unconscious pregnancy, 72
Crumb on epistaxis through the eyes, 535
Cruveilhier on defective cerebellum, 246;

on horns, 226
Crying of the fetus, 127
Cryptoi-chism, 321

Crystalline lens, anomalies of, 260 ; disloca-
tion of, 533 ; injuries to, 533

Csurgay on postmortem birth, 124

Cuevas on uterine calculi, 792

Cullfere on kleptomania, 879

Cullingwortb on dermoid cyst, 203 ; on in-
jury during pregnancy, 99 ; on ovarian
cyst, 784 ; on vaginal septa, 305

940

INDEX.

Cuuniughani on retention of ectopic fetus,
63

Cuuyghanie on retention of urine, 792

Cupidity, castration for, 756

Curling on hypertrophy of the digits, 276

Currau on an armless woman, 2G5 ; on car-
diac surgery, 618 ; on cranial surgery,
559; on "eaten of worms," 821 ; on
eunuch-making, 756 ; on injury to the
vagina, 689

Curtis oji precocious i)regnancy, 36

Cuthbert on coiling of the funis, 95

Cutlitfe on alligator-bite, 722

Cutter^n conception after ovariotomy, 46

Cut-throat, cases of nonfatal, 574

Cyclopia, living, 258

Cystotomy during pregnancy, 105 ; self-
performed, 708

Cysts, dermoid, 202 ; echinococcus, removal
of during pregnancy, 105 ; ovarian, 782

Czarten, Setrasch, 373

D.

Dade on hernia, 665

Dagan on ascarides, 820

Dagron on perforation of the esophagus, 573

D'Aguanno on larva; in the ear, 539

Dajaksch, 711

D'Alben on sudden canities, 237
Dalby on rupture of the tympanum, 537
Dalton on injury to the pericardium, 624
Daly on tumor of the pregnant uterus, 107
D' Amador on perverted appetites, 410
Damascene on maternal impressions. 82
Dana on African sleep-sickness, 872; on

facial liemiatroj^hy, 859 ; on giants, 327 ;

on pathognomonic dreams, 867
" Dance of the eggs," 452
Dancing mania, 853

D'Andrade on vicarious menstruation, 19
Danthez on absence of the funis, 109
Dantra on fish in the pharynx, 569
Danyau on intrauterine fracture, 97
Danz on congenital alopecia, 226
Dareste on teratogenesis, 166
Dargan on lactation in the aged, 393
D'Aub6 on albinism, 220
Daubenton on craniopagus, 174
Dave on extraoral dentition, 245
Davidson on flogging, 481
Da vies on loss of memory, 886 ; on prema-
ture rupture of membranes, 107 ; on short
pregnancy, 65
Davies-Colley on transfixion of the neck, 575
Davis on an armless monster, 265 ; on poly-
pus in the pregnant uterus, 107 ; on trans-
position of the viscera, 291
Day-blindness, 536

Dayot on foreign body in the ))ladder, 677 ;

on ovarian cyst. 784
Davral on unconscious pregnancy, 73
D'Azara on longevity, 374
Deafness, sudden. 538

Deason on tumor of the pregnant uterus, 107

Death presentiments, 889

De Beck on congenital defect of the eye, 260

Debes on fecundity in the old, 39
Debierre on double uterus, 313 ; on hernia

of the uterus, 313 ; on hernia of the ovary,

310

Debiois on web of the vocal bands, 256
De Bosch on twin parturition, 142
Debout on anomalous extremity, 267 ; on

vaginal anomaly, 307
DeBruu de Bois Noir on discharge of fetal

bones, 53
Decapitation, self-performed, 576
Deciduous skin. 832
"Deerlbot," 457

Deever on precocious menstruation, 30
DeFuisseaux on reunion of the tongue, 565
Deguise on coitus, 512

Delafield and Prudden on multilocular echi-
nococcus, 820
Delaistre on hornet-sting, 714
Delamater on a large tumor, 759
De la Vergne on protracted pregnancy, 72
Del ens on hi perforate hymen, 303
De Leon on quadruplets, 148
Delhi boil, 840

Delivery by a cannon-ball, 134 ; by cattle-
horn, 133 ; of extrauterine fetus, 57 ;
postmortem, 123 ; by the rectum, 120 ;
. during sleep, lethargies, and trances, 115 ;

sudden, 116
Delmas on superfetation, 49
Delpecb on extraoral dentition, 245
De Luna on intrauterine fracture, 97
Del Vecchio on cardiac suture, 617
Demarquay on bloody semen, 3^5
Demonomania, 880

Denaux de Breyne on menstruation during

pregnancy, 29
Denby on I'oreigu body in the intestine, 641
Deneux on deliverj' by a bull's horn, 133
Dentition, anomalies of 242 ; excessive,

244 ; extraoral, 244 ; fetal, 242 ; late, 32 ;

sixth, 243 ; triple, 243
Depasse on fecundity in the old, 39
Depaul on delivery during syncope, 115;

on discharge of fetal bones, 53
Depilatory customs, 747
De Quincey, Thomas, 496, 506
"Derates," 461

Dercum on adijiosis dolorosa, 360
Dermatitis exfoliativa neonatorum, 835 ;

epidemic exfoliative, 835 ; universal, 851
Dermatolysis, 217
Dermatolytic growths, 232
Dermoid cysts, 202
Dermoids, multiple, 205
Desaguliers on strong men, 464
Desbarreaux-Bernard on lasting, 415
Desbois on rupture of the uterus, 137
Desbrest on l)ee-sting, 714 ; on protracted

pregnancy, 72
Descendants, numerous, 159
De Schweinitz on canities, 238
Desgranges on fish-spine in the abdomen,

659 ; on superfetation, 47
Desmond, Countess of, 243, 375
Desormeux on protracted menstruation, 32
Desquamation, antepartum, 217
Detliardingius on postmortem birth, 125
De Thou on stigmata, 388

INDEX.

941

Devergie oxi oonibiued fetation, 55

De Vilde on ischuria, 793

Devilliors ou postmortem birth, 124

Dewees on locuiulitv in the old, 39 ; on pro-
longed pregnancy, G4 ; ou protracted meu-
strnation, 32 ; ou sudden canities, 237 ;
on supertetation, 48

Dewey ou nuiltiple fractures, 701

Dexter on hiccough, 812

Diamond in the ear, r)41

Diaphragm, anomalies of, 285 ; hernia of,
28G, G12 ; rupture of, G12 ; wounds of,
612

Dibot oil combined fetation, 57

Dickinson on colored saliva, 383 ; on human
tails, 279 : on imperforate anus, 675 ; on
large iufant, 349 ; on parasitic terata,
191

Dicksou on fasting, 419

de Diemerbroeck on cardiac injuries, 617 ;
ou conception with hymen intact, 40; ou
gastrotomy, 633

Digitalis, idiosyncrasy to, 502

Digits, anomalies of, 271 ; reunion of sev-
ered, 588 ; supernumerary, 273

Dimples, nuinufacture of, 746

Dii)hallic terata, 194

Diphthongia, 257

Dirt-eating, 412

Dislocations, anomalous, 594 ; congenital,
595 ; of the neck, 578 ; treatment of,
594

Dismukes on wound of tiie subclavian

artery, 627
Dittel on anomalous diaphragm, 286
Divers, 514

Dives from heights, 704
Diving in shallow water, 559
Dix ou precocious lactation, 393
Dixon ou aniridia, 259 ; on anomalous tears,
384

Dodd on precocious pregnancy, 35

Dodouseus on vicarious menstruation, 23

Doii-bite, 719 ; of the penis, 680

'•Dog-boy," 162

Dolaius pn double tongue, 255

Dolbeau on intrauterine fractures, 97

Domonceau on horus, 226

Donatus, IMarcellus, on antepartum crying,

128 ; ou colored saliva, 383
Donkey-bite, 590 ; of the penis, 680
Donlon on epistaxis, 534
Donne on priapism, 683
Doran on horns, 225 ; on supernumerary

oviducts, 310 ; ou supernumerary ovaries,

310

Double consciousness, 883

Doubting mania, 879

Dougherty ou wound of the bladder, 675

Doughty on evisceration, 650

Douglas ou twin birth, 143

Douglass on a precocious boy, 346 ; on sub-
mersion, 513

Dover on venesection, 709

Doyle on a bullet in the brain, 561 ; on dis-
location of the neck, 578

Drake on epilepsy and aphasia, 853 ; on
sword-swallowing, 636

Dreams, pathognomonic, 867

Drewry on athetosis, 857 ; on circular in-
sanity, 881

Driver on postmortem birth, 124

Dropsies, 786

Drouin Twins, 186

Drowning, recovery from, 513

Drugs, tolerance and untoward action of,
and idiosyncrasy to, 496

Drummond on infantile menstruation, 30

Dry births, 123

Dryden on rupture of the esophagus, 628
Dual personality, 883

Dubois ou human horns, 223 ; ou super-
numerary eyelid, 259

Dubrisay on brain-injury, 545

Dubuc on ischuria, 793

Ducachet on bullet voided by the anus,
651

Du Chaillu, Paul, ou pigmies, 334
Duchesne ou vicarious menstruation, 19
Du cornet, Caisar, 265

Ductus communis choledochus, obliteration
of, 290

Dudley ou perforation of the esophagus,
572

Duer on postmortem birth, 124 ; on post-
mortem Cesarean section, 135

Dutty ou hypothermy, 424

Dnibnr on hirsuties, 233 ; on j)ostmortem
Cesarean section, 135

Duhouset ou circumcision of the clitoris,
308

Duhring on keloids, 764 ; on neuroma cutis
dolorosuju, 839

Duke on uncouscious pregnancy, 73

Dumas ou fetal dentition, 243 ; on intestinal
coalition, 288

Dunias, Blanche, 194

Dumeril ou supernumerary limbs, 269

Duucan on absence of the vagina, 303 ; on
conception with unruptured hymen, 42 ;
on epilepsy, 852

Duudore ou laminectomy, 660

Duuglisou on expulsion of ectopic fetus, 53 ;
on gynecomazia, 397

Dunlap on hemophilia, 816

Du Peyrou de Cheyssiole on protracted men-
struation, 33

Duplication of the lower extremities, 193

Dupont on hyperidrosis, 387 ; ou veutrilo-
quism, 453

Dupouy ou black death, 892 ; on leprosy,
911 ; on small-pox, 903

Dupuytren on birth through the perineum,
122 ; on fetus in ifetu, 200 ; on Ibreign
body in the vagina, 695 ; ou obesity, 358 ;
on vicarious menstruation, 26

Durston ou hypertrophy of the breast, 759

Du Saulle ou appetite for blood, 411

Dnsenbury on wound of the kidney, 667

Duverney ou conception without .sexual
desire, 45

Duyse on dermoids, 204

Dwarfs, 333 ; ancient popularity of, 336 ;
artificial production of, 335 ; celebrated,
338; Cesarean section on, 129; intel-
lectual, 337; longevity among, 339;
species of, 338 ; women predisposed to
bear, 337

942

INDEX.

E.

Ear, anomalies of, 261 ; foreigu bodies in,
539, 540 ; injuries to, 537 ; insects in,
539 ; menstruation Irom, 24 ; nitric acid
in, 540 ; piercing, 749 ; power to move,
263

" Ear-sueezing," 815

Eastman on fibroma of the uterus, 781

Easton on teeth swallowed, 639

" Eaten of -worms,'' b'21

Ebersbach on ectopic fetus, 53

Ebstein on obesity, 353

Echinococcus cyst, 820 ; in the eye, 534 ;
removal of, during pregnancy, 105

Ecker on bearded women, 229

Eckley on supernumerary lung, 285

Ectopic children, ultimate fate of, 62;
gestation of, 50 ; multiple, 57

Eddowes on large infant, 349

Edeutulousness, 243 ; association with alo-
pecia, 227

Eder on opium-eating, 507

Edge on chorea in pregnancy, 103

Edwards on impregnation with the hymen
intiict. 41

Eggs, idiosyncrasy to, 490

Ehrl on spontaneous gangrene of the skin',
837

Eight children at a birth, 153

Eikam on short pregnane}^ 67

Eisenmeuger on prolificity, 157

"Elastic-skin man," 217

Elder and MacCormac on rupture of the

spleen, 656
Eldredge on a lerrule in the bronchus, 614
Eldridge on separation of the symphysis

pubis, 140
Electric anomalies, 429
"Electric Lady," 430
Electric light, injuries of the eyes by, 537
Elephantiasis arabum, 795 ; of the face,

800 ; of the lower extremities, 798 ; of the

scalp, 798 ; of the scrotum, 800 ; of the

upper extremities, 798
"Elephant-man," 81, 827
Eleven children at a l)irth, 153
Elliotson on hydatid disease of the liver,

786 ; on obesity, 352 ; on unilateral

sweating, 388
Elliott on dermatitis exfoliativa neonatorum,

835

Ellis on i sell iopagus, 183; on ligature of the

carotids, 575 : on oxalic acid, 499
Ellison on anomalous sneezing, 814
"Elixir of Life," 368
Elvert on protracted pregnancy, 70
Ely on chalk-eating, 412
Emeryaki, 855

Emmet on protracted menstruation, 33
Emond on pregnancy Avith unruptured

hymen, 42
Emotions causing death, 524
Empedocles on prolificity, 146
Enchondromata, 766

Engelmann on fistula-operation in preg-
nancy, 105
Engleman on obstetric customs, 113
Englisch on double penis, 198

Enguin on protracted pregnancy, 69
Enos on absence of the epiglottis, 256
Ensor on shark-bite, 721
Enterostomy, 645

Enucleation of the eye, self-performed, 735
Epidemics, 891; of abortion, 109; chrono-
logic table of the principal, 898
Epidermis, congenital defect of, 217
Epigastrium, blows upon the, 526
Epiglottis, anomalies of, 256 ; double, with

double voice, 357
Epignathus, 193

Epilepsy, 852 ; birth in, 113 ; peculiar forms

of, 852
Epispadias, 318

Epistaxis, extensive, 710 ; through the eyes,

534

Epithelioma, 772

Eplej' on painless labor, 116

Epsom salts, idiosyncrasy to, 496, 503

Equestrians, 460

Equilibrists, 449

Erba, Luigi, experiments of, 158

Erection of the penis, long continued, 683

Ergot, idios.yncrasy to, 502

Ergotism, 502

Erich on expulsion of ectopic fetus, 53

Erichseu on exostoses, 768 ; on hemophilia,
816 ; on Ibreign body in the abdomen,
659 ; on multiple fractures, 702

Esophagismus, 863

Esophagotomy lor foreign bodies, 574

Esophagus, anomalies of, 284 ; foreign bodies
in, 570 ; perforation of, 573 ; rupture of,
628 ; wounds of, 575

Esquimaux, menstruation among, 29

Estrus, larvae of the, 821

Eunuch-making, 755

Eustaches and Tzetzes on jumping, 462

Evans on birth in membranes, 123 ; on for-
eign body in the esophagus, 571

Evans, William, 329

Eve, birth of, 200

Eve on injury to the spinal cord, 661 ; on a
nail in the bronchus, 614 ; on rupture of
the bladder, 671 ; on thoracic wounds,
610

Eventration, 650 ; congenital, 292
Evisceration, 650
Evrard, Gustav, 269
Ewald on obesity, 356
Exophthalmos, 527
Exostoses, 768

Exostosis on the' sacrum, 138
Exstrophy of the bladder, 295
Extrauterine pregnancy, 50 ; combined

with uterine, 54 ; discharge of the fetus

in, 52 ; long retention of the fetus in, 62 ;

successful delivery in, 57 ; termination

of, 51

Extremities, absence of, 263 ; menstrua-
tion from, 25 ; supernumerary, 269

Eyelid, supernumerary, 259

Eyer on rupture of the thoracic duct, 659

Eyes, congenital absence of, 257 ; congeni-
tal defects of the muscles of, 260; enu-
cleation of, 527; self-performed, 735;
epistaxis through, 534 ; foreign bodies
in, 532 ; injuries to, 527 ; by birds, 533 ;

INDEX.

943

lishtning-injnries to, 727; menstraation
from, 23 ; rupture of, 528 ; two, iu one
orbit, 258
Eyles on aiuhum, 831

F.

Fabre on tapeworms, 718

Fabricius Hildanus on abortion, 110 ; on
burn of the spermatic vessels, 689 ; on a
glass ball in the ear, 539 ; on horns, 222 ;
on injury to the penis, 680 ; ou injury to
a pregnant woman, 98 ; on male menstru-
ation, 28 ; on a postmortem Cesarean sec-
tion, 135 ; on spontaneous hemorrhage,
709 ; on stigmata, 389 ; on vesical cal-
culi, 790

Fabricius on horns, 222

Face, injuries of the, 585 ; gunshot, 697

Facial hemiatrophy, 859

Fahnestock on birth in somnambulism, 116

Fakirs of India, 517

Falla on anomalous limbs, 273

Fallopian tubes, anomalies of the, 310

Falls from heights, 703

Falot on tartar emetic, 499

Fancon on injury duinng pregnancy, 101;
on operations during pregnancy, 105

Fano on supernumerary eyelid, 259

Fautou on hypnotism in labor, 114

Fanton-Touvet on edentula, 243

Fantoui on quintuple bladder, 295

Farber and McCassy on high fall, 704

Farcjuharsou ou birth through the abdomi-
nal wall, 122 ; on rupture of the uterus,
137

Farr on longevity, 366
Fascial sarcomata, 772
Fasters, modern, 420

Fasting, 413 ; modern cases of, 419 ; older

cases of, 414
Fasting girls, 413, 418, 419
Fat children, 352
Fatti on fetus in fetu, 201
Fauconneau-Dufresne on ascarides, 819
Favell on anomalous heart, 626
Faye on lactation iu infants, 392
Fayrer on elephantiasis of the scrotum, 803 ;

on shark-bite, 721 ; on wolf-bite, 722
Fear of child-birth, death from, 525
Fear-psychoses, 877

Fecundity in the old, 38 ; in the young, 34

Feet, anomalies of the, 270

Felkin on Cesarean section in Africa, 131 ;

on fetal malaria, 91
Fenger on elephantiasis of the scrotum, 802
Ferdinandus on neurosis of the skin, 837
Fereol on ischuria, 792 ; on tapeworm. 819
Fergus on rupture of the gall-bladder, 655
Ferguson on absence of the vagina, 303
Fern on large infants, 348
Fernandez on gynecomazia, 397
Ferrari on rupture of the lung, 610
Ferraton and Rivington on rupture of the

bladder, 671
Ferre on spermatophobia, 880
Ferry, Nicholas, 339

Fertilization of plants, 43
Fetichism, 401
Fetomancy, 213

Fetus, anomalous discharge of, 53 ; eaten
by a worm, 110, 111 ; enclosed in mem-
branes, 122 ; iu fetu, 199 ; medication of,
92 ; movements of, long-continued, 64 ;
movements of, simulation of, 65, 74-79 :
worms in, 111, 112

F6vre on human odors, 400

F6vrier on branchial fissures, 284

Fibro-lipoma, 764

Fibromata, 762 ; molluscum, 762 ; of the
uterus, 781

Ficker ou exophthalmos, 527

Field on polydipsia, 404 ; on vicarious men-
struation, 24

Fields, Kube, 443

Fielitz on fecundity in the old, 39

Fienus on telegouy, 89

Fifteen at a birth, 154

Filaria sanguinis hominis, 820

Filippi ou intrauterine fracture, 97

Filliou on foreign body in the intestines,
641

Finger, absence of, 271 ; avulsion of, 589 ;
ceremonial amputation of, 746 ; re-
union of severed, 588 ; supernumerary,
273

Finlayson on hemihypertrophy, 350
Finley on vicarious menstruation, 20
Finley Twins, 183
Fire-worship, 425

Fischer on anomalous growth of bones, 605 ;
on avulsion of the arm, 591 ; on cardiac
injuries, 616, 620

Fish, alive, in the pharynx, 567

Fish- bite, leprosy from, 721

Fisher on anorchism, 319 ; on the Hunga-
rian sisters, 178 ; on Santos, 197

Fitz ou rupture of the esophagus, 628

Flachsland on absence of the limbs, 263

Flagellation, 480

Flea, syphilis from a bite of a, 714
Fleck on anomalous constipation, 795
Fleishman on unconscious pregnancy, 73
Flemming ou menstrual superstitions, 17
Fleury de Clermont on foreign bodies in the
ear, 541

Flint on rupture of the esophagus, 628 ; on

telegony, 88
Floating liver, 655
Flogging, 481
Flour, idiosyncrasy to, 492
" Folie de doute," 879
Folker on albinism, 221
Foil and Warynski ou teratogenesis, 166
Foil on torsion of the penis, 316
Fontaine on infibulation, 754 ; on intestinal

injury, 642 ; on ischuria, 793
Fontanelle on worms in the bladder, 819
Food-superstitious, 493
Foods, idiosyncrasy to, 489
Foot, foreign body in the, 600
Foot on hiccough, 812
Foot-binding, 737
Foot-race, 455
Foramen ovale, patent, 296
Forbes on African sleep-sickness, 872

944

INDEX.

Ford ou braiu-injtiry, 549 ; ou cardiac in-
jury, 623 ; on gynecomazia, 397 ; ou in-
jury to the spinal cord, 6G1 ; on lactation
in the aged, 394 ; on ovarian cysts, 782 ;
on vicarious menstruation, 26
Fordereon premature births, 68
Foreign bodies in the abdominal cavity,
658 ; in the alimentary canal, 636 ; in
the back, 659 ; in the bladder, 676 ; in
the brain, 545, 559 ; in the bronchi, 614 ;
in the chest, 613 ; in the ear, 539 ; in the
esophagus, 570 ; in the extremities, 599 ;
in the eye, 532 ; in the heart, 624 ; in
the intestines, (541 ; in the htrynx, 580 ;
in the nose, 562 ; in the orbit, 531 ; in
the i>elvis, 678 ; in the pharynx, 570 ; in
the rectum, 645 ; in the tongue, 566 ; in
the trachea, 580 ; in the urethra, 676 ; in
the uterus, 695 ; in the vagina, 692 ; in
the vermiform appendix, 642
Forel on male ujenstruation, 28
Formad on the " balloon-man," 287
Forman on birth with unruptured hymen,
123

Fornix, double, 249
Forster on vicarious menstruation, 25
Fortunatus Fidelis on absence of the penis,
314

Forwood on arrow- wound of the bladder, 673
Foucard on ischuria, 793
Fouquet on spontaneous human combustion,
427

"Four-eyed man of Cricklade," 258

Four-legged monsters, 193

Fournier on anomalies of the tympanum,
263 ; on bloody sweat, 390 ; ou displace-
ment of the heart, 297 ; on hermaphrodi-
tism. 209 ; on imperforate anus, 289 ; on
large tongue, 256 ; on macrocephaly. 249 ;
on menstrnation in the male, 28 ; on obes-
ity, 359 ; on ossified clitoris, 309 ; on per-
verted appetite of pregnancy, 80 ; on su-
persensitiveness of smell, 397 ; on urethral
anomalies, 318

Fowl-bites, 719

Fowler on canities, 237 ; on skin-grafting,
730

Fox on expulsion of ectopic fetus, 53 ; on
hydrophobia, 719 ; on unconscious preg-
nancy, 73 ; on chromidrosis, 386

Fractures, of the cervical vertebra?, 578 ; in-
trauterine, 97 ; multiple, 699 ; of the
skull, 551, 558 ; basal, 559 ; spontaneous,
594

Fraipont on hysteropaxy, 106
Franibesia, 839

Francis on pregnancy with unruptured hy-
men, 42

Frank on rupture of the urethra, 679 ; on

skin-shedding, 832
Franklin on twins by Cesarean section, 129
Franzolini on six celiotomies on one woman,

707

Fraser on defective (!erobellura, 246 ; on

multiple fractures, 700
Frazer on wound of the liver, 653
French on double voice, 257 ; on longevity,

366

Frenum, absence of the, 317

Friilich on vaccination, 908
Frommann on menstrual superstitions, 17
Fuchs on corneal grafting, 728
Fuller on belladonna, 501
Fuller, Sarah, on Helen Kellar, 436
FuUerton ou bloody sweat, 390
Fulton on depraved appetite, 411 ; on rup-
ture of the stomacli, 629
Furunculosis orientalis, 840

G.

Gabb on epistaxis, 534

GiEtano-Nocito on fetus in fetu, 200

Gairdner on protracted sleep, 869

Gaither on letus in fetu, 200

Galabin on combined fetation, 57 ; on ovari-
otomy during pregnancy, 104 ; on galac-
torrhea, 394

Gale, William, 459

Galeazzi on chromidrosis, 385

Gall-bladder in a hernial sac, 655 ; opera-
tions ou the, 655 ; rupture of the, 655

Galle on pregnancy in a bicorn uterus, 49

Gallieni on circumcision of the clitoris, 308

Galtier ou the " Living Angel," 844

Galvagui on a triple monster, 167

Gambardella, Teresa, 231

Games, Grecian, 455

Gamgee on perforation of the tympanum,
538 ; on rupture of the heart, 625

Gann on wound of the liver, 652

Gapper on hiccough, 812

Garcia on a long swab swallowed, 640

Gardane on milk metastasis, 392

Gardiner on polymazia, 299 ; on teeth swal-
lowed, 639

Garesky on postmortem Cesarean section,
135

Garrtnkel on tapeworms, 818
Garlick on absence of the limbs, 263
Gamier on fetichism, 402
Garroway on tapeworm, 819
Garthshore on quintuplets, 150
Gassendus on maternal impressions, 82
Gastaher on horns, 222
Gastrectomy, 644
Gastric fistula, 631
Gastrostomy, 644
Gastrotomy, 632
Gaubius on opium, 505
Gaultier on intrauterine fractures, 97
Gautier on fetal measles, 91 ; on pigmented
skin, 841

Gay ou foreign body in the back, 659 ; on

torsion of the penis, 316
Gayet on cystotomy during pregnancy, 105
Gazdar on foreign body in the nose, 565
Gelineau on morbid I'ears, 877, 878, 879
Gellius, Aulus, on protracted pregnancy, 68
Gellyon menstruation during pregnancy, 29
Genetic anomalies, 17

Genitals, avulsion of the, 686 ; self-per-
formed, 732; injuries of the, during

pregnancy, 98
Geoffroy-Saint-Hilaire on albinism, 220 ; on
animal terata, 166 ; on craniopagi, 173 ;

INDEX.

945

on cryptorchisni, 321 ; on diphallic mons-
ter, 196, 197; on extrauterine pregnancy,
50 ; on ischiopa<^ns, 182 ; on precocious
menstruation, ;U ; on triple monster, 167
Geogliegan on rupture ol' the uterus, 137
Gerard on fasting, 415 ; on sclerema neona-
torum, 827
Gerberon on infantile beard, 228
Germain on coiling of the funis, 95
Gerster on imperforate anus, 289
Gervis on polypus of the pregnant uterus,
107

Gestation, congenital, 200 ; extrauterine,
50 ; precocious, 34

Getchell on foreign body in the vagina, 695

Giants, 324 ; ancient, 324 ; discovery of the
bones of, 325 ; celebrated, 328 ; general
opinions relative to, 326 ; of history, 333 ;
in Patagonia, 325

Gibb on injuries during pregnancy, 98 ; on
lactation in infants, 392

Gibbons on longevity, 376

Gibbs on automatism, 888 ; on avulsion of
the genitals, 687

Gibney on rupture of the quadriceps ten-
don, 593

Gibson, Richard, 338

Gibson and Malet on presternal fissure, 283
Gigantism, association v?ith acromegaly,
327

Gihon on syphilis, 913
Gilbert on impregnation with hymen in-
tact, 41

Gilkrist on transfixion of the abdomen, 648
Gil land on discharge of the fetal bones, 53
Gillilamon intrauterine amputation, 95
Gilman on multiple fractures, 702
Gilraore on ovariotomy during pregnancy,
104

Giovannini on canities unguium, 847
Giraldfes on double hand, 271 : on edentula,
244

Girard on pseudocyesis, 77
Girault on artificial impregnation, 43
Girdwood on foreign body in the arm, 599
Girl grandmothers, 38
Glandorp on gastrotomy, 632
Glass on dropsy, 786
Glass-l)lowers, excessive thirst of, 405
Glazebrook on cardiac injury, 619
Gleaves on precocious pregnancy, 35
Gloninger on male menstruation, 28
Gmelin on the effects of cold, 430
"Go-as-you-please " pedestrians, 459
Gockelius on dropsy, 786
Goddard on arrow-wounds, 712
Godfrey on lightning-stroke, 726
Goiter, 761

Grolden on belladonna, 501
Goldschmidt, 409

Gooch on injury to the spleen, 656 ; on
knife-swallowing, 633 ; on sloughing of
the genitals, 138 ; on thoracic injury, 606
Good on late menstruation, 32
Goodell on ischiopagus, 183
Gooding on absence of the vagina, 304
Goodman on elephantiasis of the scrotum
801 '
Goodwin on belladonna, 500
60

Gordon on anomalous ribs, 282 ; on delivery
of ectopic fetus, 54

Gore on diphallic monster, 196

Gorodoichze on claustrophobia, 878

Goschler on small penis, 314

Gosselinon absence of the vagina, 304 ; on
foreign body in the vagina, 693 ; on tails,
278 ; on rupture of the lung, 608

"Gouging," 528

Gould on electric-light injuries of the eyes,

537 ; on horns, 229
Goundron, 769

Gouiges on vesical calculi, 790
Graftings, 728

Graham on maternal impressions, 83
Grandider on hemophilia, 816
Granger on a leech in the pharynx, 569
Grant on cardiac injury, 618 ; on fasting,419
Graves on anosmia, 875 ; on dermoid cyst,
203

Gravis on perineal birth, 122

Gray on acute ijalnius, 855 ; on dermoids,
206 ; on i'ear-psychoses, 877, 879 ; on
hypnotism, 870 ; on Meniere's disease,
861 ; on an artificial penis, 318 ; on som-
nambulism, 865 ; on stigmata, 389 ; on
strychnin, 510

Grecian games. 455

Green on absence of the kidney, 293 ; on
postmortem Cesarean section, 136 ; on
precocious pregnancy, 37 ; on prolonged
lactation, 394 ; on submersion, 513 ; on
wounds of the aorta, 626

Greenhow on amazia, 297 ; on epilepsy,
852 ; on vagabond's disease, 841

Gregory on delayed menstruation, 34 ; on
ovarian cyst, 783

Grellois on foreign body in the esophagus,
571

Grief causing death, 524

Griffith on absence of the vagina, 303

Griffiths on elephantiasis arabum, 797 ; on

premature rupture of the fetal membranes,

108

Griffon on double ureter, 294
Griswold on hiccough, 813
Gros-uez, 769

Gross on adenoma of the breast, 759 ; on
gastrotomy, 632, 644 ; on intrauterine
fractures, 97 ; on scalp-injury, 545

Grove on foreign body in tlie nose, 564

Growth, rapid, 347

Gruber on monorchids, 319

Gruger on gynecomazia, 396

Gruner on depraved appetite for human
flesh, 409

Guattani on foreign body in the esophagus
571 ^ '

Gueniot on multiple Cesarean section, 131
Guepin on vic^irious menstruation, 24
Gu(^rard on impregnation with imperforate
vagina, 41 ; on suspended animation, 513
Guerin on supenmmerary leg, 269
^"^™ton absence of the fetal membranes,

Guersant on rupture of the esophagus, 628
Guilford on edentula, 243
Guillemeau on conception with imperforate
vagma, 40

946

INDEX.

Guillemont on injury during pregnancy, 98
Guiuard on displacement of the kidney, 294
Guiteras on yellow fever, 910 ; on ectopia of

the testicle, 689
Guiteras and Riesnian on absence of one

kidney, 293
Gull on anorexia nervasa, 414 ; on myxe-
dema, 807 ; on the odor of syphilis, 400
Gulhnannus on abortion, 110
Gunning on foreign body in the eye, 532
Gunshot injuries, recovery after many, 699
Gunson on protracted sleep, 868
Gurlt on injury during pregnancy, 102
Gusserow on fetal therapeutics, 92
Guthrie on atrophy of the testicles, 687
Gutteridge on rupture of the clitoris, 691
Guy-Patin on anomalous spleens, 290
Guyon on postmortem priapism, 523
Guyot Daubes on divers, 515 ; on equili-
Imsts, 449 ; on strength, 463 ; on strength
of jaws, 469 ; on supernumerary digits,
274 ; on sword-swallowing, 634
Gynecomazia, 394

H.

Habershon on aphasia, 873

Haen on painless birth, 113

Hagedorn on male menstruation, 28 ; on

partial canities, 238 ; on postmortem

birth, 125

Haig on pregnancy with hymen integrum,
42

Haines on maggots in the vagina, 11

Hair, absence of, 226 ; accidental growths
of, 235 ; anomalies of, 226 ; anomalous
color changes of, 235, 239 ; in the blad-
der, 678 ; chemic coloration of, 240 ; ex-
aggerated development of, 230 ; cere-
monial extraction of, 747; long, 234;
mottled, 238 ; sudden changing of the
color of, 235 ; on the tongue, 256

"Hair-eaters," 641, 849

Hair-growth and sexualism, 228, 232

Hair-pin in the ear, 542

Hairv people, 230

Hajek on supernumerary tongue, 255
Hale, Robert, 330

Hall on analogy to the " Corsican Brothers,"
887 ; on cardiac injuries, 616 ; on extra-
oral dentition, 245 ; on hair in the blad-
der, 678 ; on precocious pregnancy, 37 ;
on a study of gunshot wounds of the
brain 550 ; on supernumerary mamma,

301 ' ,
Haller on death from joy, 524 ; on fastmg,
415 • on fecundity in the old, 39 ; on
liermaphroditism, 206 ; on longevity, 367 ;
on polyorchids, 320 ; on precocious im-
pre<rnation, 36 ; on protracted menstrua-
tion, 32 ; on teeth at birth, 242 ; on triple
Tiion'ster, 167 ; on vicarious menstruation,
18

Halliburton on male menstruation, 28
Halsted on braiu-injury, 557
Halton on lightning-stroke, 723
Hamelin on hair in the bladder, 678
Haraill on male nausea of pregnancy, 80

Hamilton on abortion in twin pregnancy,
111 ; on cardiac injury, 619, 623 ; on fast-
ing, 416 ; on hypertrophy of the breast,
760 ; on impalement, 649 ; on nostalgia,
876 ; on pseudocyesis, 78

Hammond on fasting girls, 413, 418 ; on
fear-psychoses, 878, 879 ; on human odors,
398 ; on merycism, 862 ; on odors of
nervous lesions, 400

Hancock on vicarious menstruation, 23

Hand, anomalies of, 270 ; elephantiasis of,
798 ; ioreign bodies in, 599 ; reunion of a
severed, 588 ; strength in, 470

Handford on digestion of the stomach, 628

Handles swallowed, 640

Hanging, recovery after, 519

Hanks on antepartum desquamation, 217

Hanuseus on retention of ectopic fetus, 62,
64

Hansen and Clark on late restoration of

sight, 546
Hard on monsters, 163
Hardie on dwarfs, 341

Harding on conception after ovariotomy, 46

Hardy on longevity, 366

Hare on a legless child, 266 ; on supernu-
merary mamma, 301

Hare-lip, 254

Hargens on opium, 505

Harlan on epithelioma of the orbit, 772

Harle on anomaly of the gall-bladder, 290 ;
on precocious menstruation, 30

Harlequin fetus, 825

Harley on fakirs, 518 ; on hibernation, 517
Harley and Tanner on superfetation, 48
Harlow on the "crow-bar case," 551 ; on

uterine calculi, 792
Harris on bearded women, 229 ; on a Cesar-
ean section upon a dwarf, 129 ; on horns,
226 ; on injury to the pericardium, 625 ;
on injury during pregnancy, 100 ; on
postmortem Cesarean section, 135 ; on
premature expulsion of the letal mem-
branes, 108 ; on statistics of cattle-horn
injuries in pregnancy, 133
Harrison on birth by the rectum, 121 ; on

foreign body in the intestines, 642
Hart on anomalous stomach, 287 ; on the

case of Santos, 197
Harte on skin-grafting, 731
Hartmann on exostoses, 769
Hartung on supernumerary mamma, 301
Harvey on conception with the hymen in-
tact, 40 ; on fetus enclosed in its mem-
branes, 122 ; on postmortem birth, 126 ;
on pseudocyesis, 77 ; on sudden birth,
116 ; on superfetation, 46 ; on Thomas
Parr, 373
Hasenet on short pregnancy, 65
Hashimoto on tooth-brush swallowed, 640
Haslam on artificial penis, 319 ; on injury
to the penis, 680; on self-mutilation,
735

Hastings on absence of the limbs, 263

Hatte on supernumerary feet, 270

Haug on a tic in the ear, 539

Haul tain on pseudocyesis, 79

Hauser on milk-metastasis, 392

Hawkins on abortion in twin pregnancy,

INDEX.

947

111 ; ou anomalous hepatic dncts, 290 ;

on herniotomy upon a centenarian, 707
Hawley on abortion, 110
Hay ou pregnancy with the hymen intact,

42

Head, anomalies of the, 245 ; injuries of,

with loss of cerebral substance, 551
Healey ou a leech in the uose, 5(j3
Hearing, idiosyncrasy through the sense
of, 484

Heart, anomalies of, 296 ; calculi in, 792 ;

displacement of, 626 ; foreign body in,

624 ; hypertrophy of, 626 ; injuries of,

617; inversion of, 297; uoufatal, 620;

rupture of, 625 ; surgery of, 616 ; worms

in, 820
Heat, endurance of, 424
Heath ou wounds of the iliac artery, 627
Heaton on the Biddenden Maids, 174 ; on

brain-injury, 553
Hebra on antimony, 499 ; on bloody sweat,

391

Hecker on the dancing mania, 853 ; on
plagues, 891

Heidenhain ou hiccough, 813

Heil on wound of the aorta, 627

Heisberg ou tapeworms, 818

Heister ou birth during sleep, 114 ; ou post-
mortem Cesarean section, 135

Helen and Judith, 177

Heliodorus on maternal impressions, 82

Hell wig on vicarious menstruation, 23

van Hehnont on maternal impression, 82

Helmuth ou ovarian cyst, 782

Henuiteniesis, extensive, 710

Hematophobia, 878

Hemeralopia, 536

Hemiatrophy of the face, 859 ; of the tongue,
860

Hem illy pertrophy, 350

Hemoglobinuria, epidemic, 816

Hemophilia, 815

Hemoptysis, extensive, 410

Hemorrhages, extensive, 709

Hemorrhagic diseases of the new-born, 816

Hemorrhoidal bleeding, 710

Hendenberg and Packard on tumor of the
pregnant uterus, 106

Henderson on protracted pregnancy, 72

Hendrichsen on contraction of the levator
ani in coitus, 512

Hendy on elephantiasis of the scrotum, 802

Henley on injury to the spinal cord, 661

Hennig on neck-injury, 578

Henning on fetal therapeutics, 92

Henry on filaria sanguinis honiinis 821 •
on foreign body in the esophagus', 570 ;
on vicarious menstruation, 25

Henschel on protracted pregnancy, 70

Hensler on ancient chronology, 369

Hentzschel on aniridia, 259

Herbolt on "needle-girls," 735

Hercules, modern, 463

Heredity in absence of the uterus, 311 • in
congenital defects of the eye, 260 •' in
gynecomazia, 395 ; Hippocrates' expla-
nation of, 82 ; in longevity, 379 ; in obes-
ity, 356 ; in polymazia, 302 ; in sexdigi-
tism, 275 ; in urethral malformations, sls

D'H^ricourt on pineal calculi, 792
Herman of Berne on postmortem births,
126

Hermann on multiple births, 157
Hermaphroditism, 204 ; double, 165 ; law

of evolution in, 211 ; legal aspect of, 212 ;

neuter, 212; spurious, 207, 211
Hernia, 662 ; congenital umbilical, 662 ;

diaphragmatic, 286, 612 ; multiple, 662 ;

of the ovaries, 310 ; remarkable examples

of, 665 ; of the uterus, 313 ; ventriculi,

612

Herniotomy in a centenarian, 707 ; during

pregnancy, 105
Herodotus on giants, 325 ; on mutilation

of the genitals, 754
Herrick on precocious pregnancy, 37 ; ou

transposition of the viscera, 291
Hersman on enlargement ol" the hands, 804
Hertz on a tooth in the larynx, 581
Heschl on a monster, 193 ; on tlie sexual in-
fluence of odors, 402
Hesse- Wartegg on obesity, 355
Heuremann on urethral anomalies, 318
Heusinger on neuromata, 770 ; on quinin,
509

H6vin on a pig-tail in tlie rectum, 645
Heyerdahl on discharge of fetal bones, 53
Heysham ou absence of the cerebrum, 246
Hibernation, 517

Hiccough causing abortion, 110 ; ijersistent,
811

Hickinbotham on impregnation with im-
perforate hymen, 41
Hickman on foreign body in the nose, 564
Hicks, Ben, 331

Hicks on rupture of the lung, 609

Hide-bound disease, 826

Higgens on multiple pupils, 260

Higgins on protracted menstruation, 32

Hildman on obesity, 355

Hill on bloody sweat, 391 ; on congenital

abortion, 227 ; on wound of the aorta,

627

Hillairet on obesity, 355

Hillier ou diaphragmatic hernia, 286

Hind on phenol, 498

Hindoo Sisters, 168

von Hippel on corneal grafting, 728

Hippocrates on abortion, 110 ; on a bearded

woman, 228 ; on coiling of the funis, 95 ;

on the divisions of life, 370 ; on maternal

impressions, 81 ; on monsters, 161 ; on

prolificity, 146 ; on superfetation, 46 ; on

worms in the fetus, 112
Hippona, origin of, 163
Hirschfeld on intrauterine fractures, 97
Hirshberg on canities, 238
Hirst on hemorrhage in first coitus, 692 ; on

polymazia, 298, 300 ; on pseudocyesis, 77
Hirst and Borland on symphysiotorny, 141 ;

on the fate of ectopic children, 62
Hirsnties, 230

Hislop on a case of cut-throat, 576

Historic epidemics, 891

Hoag on a bullet voided by the anus, 652

Hoare on paternal impression, 86

Hobbes on fasting, 415

Hobbs on tongue- injury, 565

948

INDEX.

Hochstetter on cutaneous defect, 217
HockenhuU on stones in the rectum, 648
Hodgen on combined fetation, 5o
Hotinuin on accidental extraction of the

genitalia, 141 ; on postmortem birth, 127 ;

oil postmortem Cesarean section, 136
Hoffman, Catherine or Charles, 207
Holmokl on injuries during coitus, 692
Hogg on vicarious menstruation, 25
Hogner on boric acid, 497
Hohlberg on polyorc hids, 320
Holdefrund on delayed menstruation, 34
Hole on maggots in the uterus. 111
Hollander ou double uterus, 311
Hollerius on birth through the abdomen,

122

Holly on cardiac surgery, 619
Holman on molten lead in the ear, 540
Holmes on absence of the eyes, 257 ; on a

bottle in the vagina, 693
Holmes, Oliver Wendell, on human tails,

279

Holston on hiccough, 812

Homans on a wound in the vagina, 690

Home-sickness, 876

Home on hermaphroditism, 212 ; on a small

infant, 348 ; on a two-headed boy, 187
Hom melius on double aorta, 297
" 1' Homme i\ la tete de cire," 697
"I'Homme-chien," 231
" I'Homme-lapin," 248
"I'Homme-oiseaux," 247
" I'Homme-poisson,' ' 614
" 1' Hom me protee," 475
Honigberger on fakirs, 518
Hooks on ovariotomy in children, 707
Hooper on vicarious menstruation, 26
Horlbeck on avulsion of the leg, 592
Horn in the rectum, 647
"Horned men of Africa," 223
Horns, human, 22 ; of cattle, injuries by,

during pregnancy, 99 ; delivery by, 133 ;

multiple, 226
Horrocks ou anal tags, 280
Horton on pregnancy with hymen integrum,

42

Horse-bite of the penis, 680
Horse-shoe kidney, 293
Horsley on operations on anomalous testi-
cles 322

Horsti'us on extrauterine gestation, 50 ; on
retention of fetus, 64 ; on somnambulism,
864

Hotchkiss, Dr. William, 381
Hottentot females, labial appendages of, 307
Hough on anomalous position of the testi-
cle, 321 . ^ ^
Houghton on conception with hymen in-

Houston on a spoon in the bowel, 641
Howard on a thimble in the nose, 565
Howarth, Philip, 344

Howe on foreign body in the appendix, 642 ;

on impalement, 690
Hoyer on delayed menstruation, 34 ; on

postmortem birth, 126
Hoyland on transfixion ot the chest, 610
Hubbard on fetal varicella, 91 ; on rupture

of the spleen, 141

Hubbauer on foreign body in the vagina,
693

Hubert on postmortem Cesarean section,
136

Hudson, Geoffrey, 338

Hulelaud on longevity, 368, 370, 372, 374

Huff ou ischiopagus, 183

Hugier on hermaphroditism, 210

Hulke on atresia of the vagina, 304 ; on her-
nia, 665 ; on a limbless child, 264 ; on
multiple fractures, 701 ; on a tube in the
bronclnis, 615

Hulse on a spider-bite, 713

" Human flowers," 398

Human hibernation, 517

"Human pyramids," 451

" Human succubus,'' 80

Humboldt on gynecomazia, 397

Humphreys on accidents in labor, 141 ; on
transiixion of the abdomen, 649

Hungarian sisters, 177

Hunger causing abortion, 110 ; excessive
morbid, 403

Hunt on maternal impression, 83 ; on poly-
phagia, 638 ; on urethral calculi, 792

Hunter, John, and the Irish giant, 331

Hunter on birth by the rectum, 121 ; on
double vagina, 304 ; on gynecomazia,
397 ; on horn in the rectum, 647 ; on tor-
sion of the penis, 316 ; on wound of the
diaphragm, 613

Huppert on Ibreign body in the brain, 561

Hurxthal on long retention of pessaries, 694

Huse on superfetation, 48

Hutcheson on anomalous position of the tes-
ticles, 322

Hutchinson on absence of the limbs, 264 ;
on congenital alopecia, 227 ; on edentu-
la, 243 ; on exophthalmos, 527 ; on gan-
grene of the penis, 682 ; on gynecomazia,
396 ; on hyperidrosis, 387 ; on idiosyn-
crasy to parsley, 491 ; on nasal osteomata,
770 '; on obesity, 359 ; on supernumerary
digits, 273 ; on syphilis from a flea-bite,
714 ; on tuberculosis from tattooing, 751

Huxham on colored saliva, 383 ; on fetus in
fetu, 200 ; on intestinal coalition, 288

Huxley on automatism, 887

Hydatid cyst in the heart, 624 ; in the
liver, 786 ; multilocular, 820

Hyde on nsevus pilosus, 233

Hydroadipsia, 405

Hydrocele, 689

Hydrocephaly, 249, 786

Hydrochloric acid, tolerance of, 498

Hydrocyanic acid, tolerance of, 499

Hydronephrosis, 786

Hydrophobia, 719

Hymen, absence of, 302 ; biperforation of,
302 ; duplication of, 302 ; integrum, preg-
nancy with, 40

Hyneaux on postmortem birth, 124

Hyperesthesia of the skin, 837

Hyperidrosis, 386

Hyperosmia, 875

Hyperthermy, 420

Hypertrichosis, 233

Hypertrophy of the digits, 276 ; of the hps,
254 ; unilateral, 351

INDEX.

949

Hypnotism, 870 ; in child-birth, 114 ; in

hyper id rosis, 387
Hypochondria, 876
Hypospadias, 318
Hypotliermy, 424

Hysteropaxy, eflect of, on subsequent preg-
nancies, 106

I.

Ibbetson on excessive dentition, 244
Ichthyosis, 823

Idiosyncrasy, 481 ; to certain foods, 489 ; in
coitus, 511 ; to objects, 487 ; to odors,
482 ; to sounds, 484 ; to touch, 488 ; tol-
erance, and untoward action in relation
to drusis, 496

"Ignis Sacer," 502

Iliac artery, iiu;ature of, 658 ; wound of the

external, 627
111 on birth through the abdominal wall,

122

Imaginary pregnancy, 73

Imbert do Laiines on double nose, 563

Impalement through the abdomen, 648 ;

through the chest, 610 ; by the vagina,

690

Impregnation, accidental, 43 ; in the aged,
38 ; artificial, 42 ; by a bullet (Caper's
case) 44; without complete entrance, 40;
with hymen integrum, 40,- precocious, 34 ;
during sleep, 45; unconscious, 45

Impressions, nuiternal, 81 ; paternal, 85

Inaudi, Jaccjues, 439

Incubator, 68

Indian runners, 457

Infantile menstruation, 29; spinal paraly-
sis, 604

Infants, beard on, 228 ; large, 348 ; small,

347 ; vitality of, 117, 706
Infectious diseases, modern mortality from,

913

Infibulation, 752; to prevent masturbation,
754

Ingham on anomalous semen, 385
Ingleby on tumor in the pregnant uterus,
106

Innominate artery, ligature of, 575
Inoculation, 905

Insanity, anomalous, 880 ; endurance of

cold in, 430 ; odors of, 400
Insect-stings, 713

Insects in the ear, 539 ; in the nose, 564

Intestinal anastomosis, 645

Intestines, anomalies of, 287 ; coalition of,
288 ; foreign bodies in, 641 ; extensive
hemorrhage from, 710; injuries of, 642 ;
obstruction of 794 ; operations on, 644 ;
resection of, 643 ; rupture of, 644 ; slough-
ing of, after intussusception, 643

Intoxication, birth during, 114

Intrauterine amputations, 94 ; fractures,
97

Intussusception of the intestines, sloughing
after, 643

lodin preparations, untoward action, and

tolerance of, 503
lodoform-poisoning, 503

Iris, absence of the, 259 ; bicolored, 260 ;

ossification of the, 259
Irish giant, :}30

Irish women, ancient obstetric customs of,
113

"Iron-jaw," 468

Irvine on twin birth, 142

Irwin on attachment of the fetal head, 142

Ischiopagi, 181

Ischuria, 792

Isham on unconscious pregnancy, 73
Israelites, knowledge of telegony among
the, 89

Ivanhotr on death from shock, 525 ; on re-
traction of the penis, 682

J.

Jackson on aphasia, 874 ; on arsenic, 500 ;
on discharge of fetal bones, 53 ; on double
consciousness, 885 ; on long retention of a
pessary, 694 ; on wound of the bladder,
671

Jacob on a foreign body in the eye, 532 ;

on human tails, 278
Jacobi on a double monster, 180 ; on hyper-

thermy, 423
Jacobs on spontaneous human combustion,

428

Jacobson on gangrene of the penis, 682 ; on
giant-growth, 351 ; on lithotomy during
pregnancy, 104 ; on vicarious menstrua-
tion, 20
Jacques, Alexander, 420
Jaffe on protracted pregnancy, 70
James on retention of ectopic fetus, 63
Jameson on twin labor. 111
Jamieson on dermoids, 205 ; on eunuch-
making, 756 ; on mycosis fuugoides, 850 ;
on self-mutilation, 737
Janovsky on acanthosis nigricans, 841
Jansen on twin parturition, 142
Jarvis on maggots in the nose, 564
Jautfret on restoration of sight, 535
Jaw, anomalies of the, 251 ; strength of the,
468

Jdanoff on polyorchids, 320
Jeafifreson on ossi(i<'ation of the penis, 259
Jeiferies on protracted pregnancy, 72
Jefferson, Thomas, on albinism in negroes,
221

Jeftichew, Adrian, 231
Jenisch on diphallic monster, 195
Jenkins, Henry, 373
Jenner, Edward, 906
Jennings on cranial fractures, 558
Jessop on multiple aneurysm, 779 ; on rup-
ture of the eye, 528 ; on viable ectopic
fetus, 57

Jewett on brain injury, 549, 553 ; on horns,

Jinrickisha-men, 457

Joch on a bearded woman, 228

Joints, defornuMl, 603

"Jo- Jo," 232

Johnson on cry])torchids, 321 ; on horns,
229 ; on hydrochloric acid, 499 ; on pre-

950

INDEX.

cocious boys, 345 ; on retention of ectopic
fetus, (5;? ; on rupture of the lieart, 625
Johnson, Tom, 4G5

Johnston on bulimia, 403 ; on a large in-
fant, 349 ; on a triple lieart, 290
Joly on diaphraginatic- hernia, 28(5
Joly and Peyrat on double monster, 177
Jones on foreign bodies in the pelvis, 679 ;
on rupture of the bladder, 670 ; on pro-
tracted sleep, 869
Jones twins, 183

Jonstou on antepartum crying, 127 ; on
artificial penis, 319 ; on blind savants,
433 ; on maternal impressions, 82 ; on
protracted pregnancy, 70 ; on short preg-
nancy, 65 ; on vicarious menstruation, 24

Josephi ou retention of ectopic fetus, 63

Joseph us on giants, 325

Jouilletou ou male menstruation, 28 ; on
vicarious menstruation, 24

Joy, death from, 524

Joyce on injury to the penis, 680

Judkins on morning nausea in the male, 80

Jugglers, 451

Jumpers, 462, 855

Jumps from heights, 704

Jurine on pliosphorescent urine, 429

Jurist on mobility of the tongue, 255

Jussieu on absence of the tongue, 254 ; on
supernumerary mamma, 301

K.

Kaestner on obesity, 354
Kaltschmid on dropsy, 786
Kameya Iwa on horns, 224
Kaposi on pigmented mole, 841
"Kara," 451

Kartulns on a high fall, 704 ; on hyper-

thermy, 422
Katatonia, 882

Kauflmaun on objective tinnitus aurium,

538 ; on rudimentary penis, 315
Kay on a girl grandmother, 38
Kealy on perforation of the tympanum, 538
Keel'an on lithotomy during pregnancy, 104
Keen on amputation during pregnancy,
105; on double fornix, 249; on injury
to cervical vertebnc, 578 ; on vpounds of
the thoracic duct, 658
Keen and Da Costa on cardiac surgery, 616
Keetley on a spelling-book in the groin, 659
Keith on ovarian cyst, 683
Kellar, Helen, 435
Keller on intrauterine fracture, 97
Kelly on ovarian cyst, 783 ; on postmortem

birth 124 ; on vesical calculi, 790
Keloids, 764

Kelvin, Lord, on longevity, 371
Kennard on protracted menstruation, 33
Kennedy on fecundity in the old, 39 ; on
profuse lactation, 394 ; on quintuplets,
150 • on self-mntili^t'O", ''31 ; on shark-
bite,' 721 ; on tapeworms, 818
Kenophobia, 877

Kenthuf^hes on the feet of Chinese ladies,
738

Keratoderniia, 825
Keratolysis, 832

Keratosis, contagious follicular, 825

Kerckring on scrotal anomaly, 321 ; on
vicarious menstruation, 25

Kerr on maternal impression, 83

Kesteven on brain-injury, 38

Ketchum on a young grandmother, 38

Keysler on obesity, 358

Kick causing abortion, 110

Kidd on operations upon children, 707

Kidney, absence of, 292 ; anomalies of, 292 ;
calculi in, 790 ; displacement of, 294 ;
operations on, 668 ; during pregnancy,
104, 105 ; rupture of, 653, 667 ; super-
numerary, 293 ; wound of, 667

Killiau on perforation of the uterus, 141

Kilpatrick on precocious preguancty, 37

Kimura on ectopic gestation, 54

King on amazia, 297 ; on fasting, 420 ; on
male menstruation, 28 ; on precocious
pregnancy, 37

Kinney ou precocious pregnancy, 37 ; on
absence of the eyes, 258

Kirby on vesical calculi, 789

Kirchner on wounds of the thoracic duct,
657

Kirilow, 156

Kirmisson on anomaly of the liver, 290

Kisel on tapeworm, 819

Kiss on the ear causing deafness, 537

Klein ou milk-metastasis, 392

Kleptomania, 879

Kleptophobia, 879

Klob on supernumerary mamma, 301
Knaggs on vicarious menstruation, 26
Knapp on merycisin, 862 ; on quiuin, 510
Knehel on twins born to an old woman, 40
Knies on lightning-blindness, 537
Knife-blade in the chest, 614
Knife-swallowing, 632, 635
Knoll on avulsion of the genitals, 686
Knots in the umbilical cord, 109
Knott on ceremonial ovariotomy, 755
Koeberle ou intestinal resection, 643
Koehler on gangrene of the penis, 682
Kohler ou anomalies of the digits, 271
Kohler on phenol. 498
Kohnhorn on digitalis, 502
Kolster on hemophilia, 815
Kiinig on operation on a monster, 172 ; on

retardation of putretaction, 523
Kopp on premature birth, 66 ; on derma-

tolysis, 218
Korin, Jean, 373
Koser on cerebral tumor, 558
Krabbel on wound of the thoracic duct, 657
Krafft-Ebing on anthropophagy, 410 ; on

fetichism, 402 ; on perverted appetite in

pregnancy, 80
"Krao," 231

Kraus on hypertrophied liver, 655

Kreutzman on ovariotomy during preg-
nancy, 104

Krishaber on vicarious menstruation, 25

Kngler on arrow-wound, 712

Kuhu on congenital defects of ocular move-
ments, 260'

Kunst on bee-stings, 713

INDEX.

951

Kuss on maternal impressions, 85
Knssmaul on precocious pregnancy, 35
KUster ou iiijuries of the sciatic nerve, 592
Kustermann on liyperidrosis, 387
Kyle on foreign body in the abdominal

parietes, (i59
Kyphosis, 281

L.

Labia, absence of, 300 ; of the Hottentot
females, 307

Labor, accidents incident to, 141 ; hypnot-
ism in, 114 ; postmortem, 124 ; rapid,
llfi ; retardation of, 58

Lahorde and Lepine on hiccongh, 813

Lachansse on superfetation, 47

Lactation in the aged, 393 ; anomalies of,
391 ; in infants, 392 ; male, 397 ; preco-
cious, 392 ; prolongo(i, 394

" La dame a quatre janil)es, " 192

" Lady with a mane," 233

Lafoutaine on plica polonica, 848

Laget on supernumerary liver, 290

Lall on horns, 224

Lallemand on rupture of the stomach, 629

"Laloo," 192

Lamb on submersion, 513

Lambert, Daniel, 357

Lambert family, 823

Laminectomy, 060

de La Motte on precocious pregnancy, 37 ;

on premature birth, 68
Lamprey on " homed men," 223
Lancisi on anomalous sneezing, 814
Landes on absence of the eyes, 258
Landois on sudden canities, 236
Lane on polyorchism, 320
Lang on Epsom salts, 503
Lange on double penis, 198
Langenbeck on atrophy of the maxilla, 251
Laugenl)nch on gastrectomy, 644 ; on resec-
tion of the liver, 654
Langlet on hemihypertrophy, 350
Langmore on superfetation, 48
Langston on sudden birth, 119
Lanigan ou postmortem birth, 126
Lapeyre on cigarette in the bronchus, 615
La Peyronia on anomalous urethra, 317
Lapiada, 400

Lapointe on demonomania, 880
Larkin and Jones on supernumerary limbs,
209

Larrey on atrophy of the testicles, 087 ; on
elephantiasis of tlie scrotum, 801 ; injury
to the external genitalia, 080 ; on sarco-
cele, 089

Laryngectomy, 584

Larynx, artificial pouch in, 584 ; excision
of, 584 ; foreign bodies in, 580 ; impac-
tion of artificial teeth in, 582

Lateau, Louise, 389

Latham on skin-shedding, 833

Latimer on knots in the funis, 109

Laughter, death from violent, 524

Laughton on ascarides, 820

Laugier on venesection, 709

Laurent on gynecomazia, 395

Laurentiuson vicarious menstruation, 20

Lauth on absence of the ovaries, 309

Laveran on tapeworm, 818

Law on vicarious menstruation, 24

Lawrence on aneucephaly, 246 ; on anoma-
lous diaphragm, 285 ; on rupture of the
nterus, l.'5S

Lawson on coitus, 512 ; on foreign body in
the brain, 560 ; on impregnation with un-
ruptured hymen, 41

Lazzaretto on dislocated atlas, 578

Leach, Harvey, 2(i6

Leach on bullet in the chest, 614

Lead-pencil in tiie arm, 600

Lead-poisoning, 503

Lead-wire in tlie arm, 600

" Leah, the giantess," 332

Leale on skin-grafting, 730

Leanness, 363

Le Beau on operation for monster, 172 ; on

precocious pregnancj% 31
Lebedeff on ovariotomy during pregnancy,

104

Lebert on horns, 223

Leblond on bearded women, 229

Le Brun on multiple birth, 154

Lebrun on perineal birth, 122

Le Carpentier on snake-bite, 717

Le Cat on anomalous pigmentation, 842 ;

on blind savants, 433 ; on hydrophobia,

719

Le Conte on lightning-stroke, 723

Lediberder on double aorta, 294

Le Due on absence of the brain, 246

Lee on anomalous sneezing, 814

Leech in the nose, 563 ; in the pharynx,

509 ; swallowed, 637 ; in the vagina, 694
Leedgwood, James, 205
Lefebvre on precocious pregnancy, 35
Lefort, Marie-Madeline, 207
Leg, absence of the, 200 ; avulsion of the,

592 ; reunion of an almost severed, 593 ;

supernumerary, 209
Leg-brealcer, professional, 741
Leger, 410

Legg on anosmia, 874

Legitimacy, 05, 08, 09

Leichtenstein ou obesity, 356

Leichtenstem on polymazia, 298

Leidy on terata, 166

Leigh on hydrocele, 689

Leisenring on pregnancy with unruptured

hymen, 42
Lejoucourt on longevity, 369
Leukemia, priapism in, 684
Leukoderma, 845
Lemaire, Jacob, on giants, 325
Lemery on anuria, 793
Lenormant on fetomancy, 213
Lenox on bullet voided by the bowel, 652
Lenis^ dislocation of the, 533 ; injury to the,

Lente on dry births, 123

Leonard on long beard, 234

Leonhard on unusual birth, 120

Leontiasis ossea, 805

" Leopard -boy, " 845

Le Page on neuropathic plica, 849

Leprosy, 911 ; from a fish-bite, 721

Lereboullett and Knoch on teratogenesis,166

952

INDEX.

Lesbian love, 308

Lesser on albinism, 220

Lethargy, protracted, 867

Lettsoni on polyphagia, 638

Levator aui, spasmodic contraction of, in

coitus, 512
Levison on fetal dentition, 243
Lewin on idiosyncrasy to drugs, 497 ; on

quinin, 509 ; on oi)ium-t'ating, 507
Lewin and Heller on horns, 226
Lewis on unilateral sweating, 388
Lberitier on vicarious menstruation, 17
Licetus on ischiopagus, 181 ; on double

monster, 167
Lidell on basal fracture, 559
Liebreich on vicarious menstruation, 24
Lieutaud on absence of the liver and spleen,

290

Life, divisions of, 370

Lightning-stroke, 722 ; amputation by,

726 ; blindness from, 537 ; etfect on the
nervous system, 725 ; ocular injuries
from, 726 ; photographic properties of,

727 ; recovery after, 723 ; therapeusis of,
726

Lile on tapeworm, 819
Lilliputians, 342
Limbless athletes, 599

Limbs, absence of, 263 ; artificial, 598 ;
foreign bodies in, 599 ; supernumerary,
269

Liusniayer on acromegaly, 804
Lion-tamer, injury to a, 591
Lipomata, 764 ; diffuse, 766
Liprandi on the Skoptzies, 758
Lips, anomalies of, 254
Liquor amnii, absence of, 123
Lisfrauc on Ibreign bodies in the uterus,
696

Lison on sixth dentition, 243

Lister on longevity, 379

Lithopediou, 50, 63, 64

Lithotomy during pregnancy, 104 ; self-
performed, 708

Litten on hermaphroditism, 211

Little on self-decapitation, 575

Littre on Hipiiocrates, 90

Liver, anomalies of, 290 ; floating, 655 ; hy-
datid disease of, 786 ; hypertrophy of,
655 ; laceration of, 141 ; ligature of, 654 ;
regeneration of, 655 ; resection of, 654 ;
supernumerary, 290 ; surgery of, 653, 654 ;
suture of, 652 ; wounds of, 652

" Living angel," 844

" Living skeletons," 363

Lizard in the nose, 564 ; swallowed, 637

Lloyd on aural anomaly, 261 ; on laminec-
tomy, 661

Loakes, Wybrand, 339

Lobstein on intussusception, 643

Locke on horns, 226

Lockier, Joseph, 416

Locomotive (toy) in the subglottic cavity,
614

Lodge on mercuric chlorid, 504
Logan on hemihypertrophy, 350
Loin on maternal impressions, 85
Lombnrd on pregnancy with unruptured
hymen, 42

Lombroso on hirsuties, 231 ; on micro-
cephaly, 247
Lomer on letal measles, 91
London plague, 895

Longevit}^, 365 ; in active military service,
379 ; activity in, 371 ; in actors, 377 ;
among the ancients, 369 ; in a deaf mute,
377 ; diet in, 379 ; in dwarls, 339 ; effect
of class-influence, occupation, etc., on,
367 ; generative ability compatible with,
376 ; among the Greeks, 370 ; heredity in,
379 ; in hermits and ecclesiastics, 370 ;
among Indians, 376 ; influence of mental
culture in, 371 ; influence of personal
habits, 372 ; influence of stimulants, 377 ;
in Ireland, 378 ; among the Jews, 369 ;
in physicians, 380 ; possession of faculties
in, 377 ; recent instances of, 382 ; re-
markable instances of, 373 ; among the
Romans, 370 ; in rulers, 372 ; statistics
of, 365, 366, 367
Longhi on sloughing of the vagina, 691
Longmore on transfixion of the chest, 611
Longworth on inversion of the diaphragm,
286

Lopez on precocious boys, 345
Lordosis, 281

Loreta on abdominal aneurysm, 659
Loring on gunshot wound of the abdomen,
651

Lorry on canities, 238

Lospichlerus on retention of ectopic fetus,
63

Louis and Louise, 181

Louis on birth by the rectum, 121

Louise, L., 192

Loushkin, 331

Lousier on polymazia, 302

Lovort on enucleation of the eye in preg-
nancy, 105

Lowe on injury to the lens, 533

Lozes on horns, 224 ; on unconscious preg-
nancy, 73

Luce on injury during pregnancy, 100

Ludwig on canities, 238

Lumbricoides, 819 ; in the uterus. 111

Lumby on twin birth, 143

Lundie on protracted pregnancy, 71

Lungs, anomalies of, 285 ; injuries of, 606 ;
rupture of, without Iracture of a rib, 608 ;
spontaneous rupture of, 609 ; surgery of,
608 ; transfixion of, 610

"Lurline," 513

Lnsk on delivery of ectopic fetus. 54 ; on

tumor in the pregnant uterus, 106
Lust-murder, 410
Lycosthenes on monsters, 162-164
Lyford on hypertrophy of the tongue, 567
Lymphedema, 795
Lyssophobia, 879

M.

Maas on painless births, 113
Macann on polyorchids, 320
Macaulay on tetanus neonatorum, 817
McCallum on double monster, 186
M'Clellan on fracture of the penis, 679

INDEX.

953

MacClellan on ossification of the penis, 316
McClelliui on penetration of tlie ureter, 670
McClintock on fear of child-birth, 525 ; on
fetal tlierapeutics, 92 ; on lithotomy dur-
ing pregnancy, 1U6
MacCorniac on basal fracture, 559 ; on

hemophilia, 816
McCosh on recovery after multiple injuries,
699

McCreery on tartar emetic, 500
MacDonald on lightning-stroke, 725
Mc Do wall on scalp-development, 218
McElmail on anomalous position of the tes-
ticle, 322
McElroy on polydipsia, 405
McGee on combined gestation, 55
MacGillibray on ceremonial ovariotomy,
755

McGillicuddy on ovarian cyst, 783 ; on

supernumerary mamma, 301
MacGovvan on " wild-boys," 448
McGrath, Cornelius, 330
McGraw on vicarious menstruation, 26
Macgregor on vesical calculi, 790
Macgrigor on shark-bite, 721
McGiiire on wound of the bladder, 675
Machinery, recovery after injuries from,

699

Mclntyre on fetus in fetu, 201 ; on uterine

tumors, 780
Mackay on nuiternal impression, 85
McKee on wound of the liver, 653
Mackenzie on arsenic, 500 ; on hemophilia,
816 ; on hyperthermy, 421 ; ou idiosyn-
crasy^ to eggs, 490 ; ou polydipsia, 404 ;
on protracted pregnancy, 71 ; on web of
the vocal bands, 257
McKeown on late restoration of sight, 535
Mackey on long retention of pessaries, 694
Mackinlay on pregnancy with unruptured

hymen, 42
Macknus on bii:th in membranes, 123
Macland on gros-nez, 769
MacLauren on fish in the pharynx, 568
McLean on amputation during pregnancy,

105 ; on antepartum crying, 128
MacLean on avulsion of the arm, 591
MacLoughlin on fasting, 420
McMillan on wound of the liver, 653
Macnab on diaphragmatic hernia, 286
MacNal) on hyperthermy, 422
Macnal on arsenic, 500
McNaughton on fasting, 418 ; on obesity,
353

McNntt on ovariotomy in age, 707

Macpherson on wounds of the liver, 652

Macrocephaly, 248 '

Macroglossia, 567

Macrostoma, congenital, 253

Madden on avulsion of the testicles, 686 •

on fissure of the sternum, 283 ; on foreign

body in the intestines, 641 ; on pseudo-

cyesis, 77
Maddox on belladonna, 501
Madigan on self-performed Cesarean section

132

Magalhaes on elephantiasis of the scalp, 798
Maggots in the ear, 539 ; in the nose, 564 •
in the uterus, 111 '

Magitot on microcephaly, 248

Magnetism, human, 429

Magruder on discharge of fetal bones, 53

Mahomed on hyperthermy, 423

Maisonneuve ou pregnancy with imperfor-
ate hymen, 42 ; on short pregnancy, 65

Major on foreign body in the nose, 565 ; on
tongue-swallowing, 565

Major terata, 161

Malacarne on anenceijhaly, 246

Malaria in the fietus, 91 ; splenectomy in,
657

Maldemeure, family of, 154

de Maldigny, Clever, 708

Mamma, abdominal, 301 ; adenoma of, 759 ;
anomalies of, 297 ; axillary, 301 ; diffuse
hypertrophy of, 759 ; erratica, 302 ; on
the thigh, 301

" Man boys," 343

"Man-motbers," 202

Mandelshof on precocious menstruation, 31
von Mandelslo (m precocious pregnancy, 35
Mane on a woman's back, 233
Mangiagalli on supernumerary ovary, 310
Manifold on bifurcated epiglottis, 256
Mauley on rupture of the thoracic duct, 658
Mann on lithotomy during pregnancy, 105,

106 ; on operations during pregnancy, 103
Manzini on high falls, 703
Marc on a hermaphrodite, 212
Marcacci ou a beau in the bronchus, 614
Marchal de Calvi on foreign bodies in the

ear, 541
Marey on albinism, 221
Marie on chiromegaly, 805
Marie- Adfele, 173
Marie-Doroth6e, 212

Marie-Louise and Hortense-Honorine, 182
" Market Harbo rough fasting girl," 419
Marks on cardiac injury, 622
Marksmen, 452

Maroldus on abortion by the mouth, 52
Marriages, early, in India, 18, 37 ; multiple,

159 ; statistics of, 146
Marsa on fecundity in the old, 38
Marsden on anomalous urination, 384
Marsh on delivery by cow-horn, 134
Marshall on anomalous position of the testi-
cle, 322 ; on rupture ofthe femoral artery.
594

Marteau on protracted pregnancy, 69

Martial on inlibulation, 752

Martin ou ichthyosis, 824 ; on injuries dur-
ing coitus, 692 ; on longevity, 374 ; on
protracted pregnancy, 71 ; on skin-graft-
ing, 730 ; on supernumerary mamma, 301

Martineau on ovarian cysts 782

Martinez, 424

Martyn on bulimia, 403

Marvaud on wounds of the kidney, 667

MarviUe on somnambulism, 864

Marx on delayed menstruation, 34

Mascha ou cannibalism, 411

Masochism, 480

Mason on bulimia, 403 ; on foreign body in
the intestine, 641 ; on supernumerary
digits, 275 ; on tartar emetic, 500
Massie on wound ofthe liver, 653
Masters on intestinal coalition, 288

954

INDEX.

Mastin on cardiac injury, 622 ; on foreign
body in the brain, 561 ; on maternal im-
pression, 85
Masturbation, infantile, 345 ; intibulation

to prevent, 754-
Matas on tumor of the parotid, 768
Matches in the rectum, 648
Maternal impressions, 81
Mathieson on delivery of ectopic fetus, 54
Matthseus ou postmortem delivery, 125
Matthysseus on coiling of the fuuis, 95
Maurice on anomaly ol the jaw, 252
Mauriceau on abortion, 110 ; on extrauterine
preguaiK-y, 50 ; on fetal variola, 90 ; on
postmortem Cesarean section, 135 ; on
superfetatiou, 47
Maury and Dulles on syphilis from tattoo-
ing, 751
Mauvezin on croton oil, 504
Maxilla, anomalies of, 251
Maximilian, Emperor, 325, 464
Maxsou ou combined fetation, 57
Maxwell on injury to the nose, 562
May on ovariotomy during pregnancy, 104
Mayer ou postmortem birth, 126
Maygrier ou absence of the digits, 271 ; on

precocious pregnancy, 36
Mayham on fecundity in the old, 39
Mayo ou transplantation of the ureter, 669
Mayo-Smith on marriage, 145 ; on modem
mortality from infectious diseases, 913 ;
on multiple births, 147; on prolificity,
145

Maziuus on antepartum crymg, 128

Mead on male menstruation, 28

Meadows on large inlants, 348

Mears on conception after ovariotomy, 46

Mease ou bee-stings, 714

Measles in the fetus, 91

Meckel on superuumerary digits, 275 ; on

triple monsters, 167
Medicines, action of, on the fetus in utero,

Meek on pregnancy with unruptured by-
men 42

van Meek'ren on brain injury, 555 ; on

dermatolysis, 217
Meeres on mercuric chlorid, 504
Megacolon congenito, 288
Megalocephaly, 805

Mehliss on gynecomazia, 397 ; on male
menstruation, 27 ; on late dentition, lac-
tation, and menstruation, 32

Meibomins on vicarious menstruation, 24

Meigs on protracted pregnancy, 70 ; on re-
tention of fetus. 64 ; on twins borne by a
child-mother, 38 . .o

Meisner on vicarious menstruation, 18

Mckeln on birth by the rectum, 121

Melanism, 222

Melasma, 845

Mellichamp on cardiac injury, 623
Membranes, absence of fetal, 109 ; anom-
alies of fetal, 107 ; enclosing fetus un-
ruptured, 122 ; expulsion of fetal, 108 ;
premature protrusion of fetal. 107
Memory, feats of, 439 ; peculiar loss ot,
883-886

Menard on lactation in infants, 392

Mendenhall on brain-injury, 554
Menesclou, 410
Meniere's disease, 861
Meningitis from foreign body in the brain,
540

Meningocele, 251
Menopause, delayed, 32
Meuseu, Ernest, 460

Menstruation, 17 ; anomalies of, 18 ; black,
27 ; from the bladder, 26 ; from the
breasts, 19 ; alter death, 27 ; from the
ears, 24 ; from the extremities, 25 ; IVom
the eyes, 23 ; by hematemesis, 27 ; late
establishment of, 33 ; from the male ure-
thra, 27 ; migratory, 27 ; from the mouth,

24 ; from old ulcers, wounds, or cicatrices,

25 ; after ovariotomy, 26 ; precocious, 29 ;
during pregnancy and lactation, 28 ;
protracted, 32 ; from the rectum, 26 ;
after removal of the uterus and ovaries,
26; from the skin, 18; simulating stig-
mata, 25 ; superstitions relative to, 17 ;
suppression of, 27 ; Irom the urinary
tract, 26 ; vicarious and compensatory,
18

Mental and nervous diseases, anomalous,
852

Mentzelius ou triple dentition, 243
Menzie on protracted pregnancy, 71
Mercurialis on imperforated anus, 289 ; on

protracted pregnancy, 70
Mercury, tolerance of, and idiosyncrasy to,

504

Merensky on Hottentot females, 307
Merinar on repeated Cesarean section, 130
Merlatti, 420
Merlet on alopecia, 241
Merriman on multiple births, 154 ; on un-
conscious pregnancy, 73
M6ry on anencephaly, 346
Merycism, 862

Meschede on automatism, 888 ; on foreign
bodies in the uterus, 695

Mesnet on automatism, 887 ; on somnam-
bulism, 865

Meyer on abortion, 110 ; on avulsion of the
finger, 590 ; on precocious pregnancy. 35 ;
on rupture of the heart, 625 ; statistics
of protracted menstruation, 32

"Mexican wild-boy," 248

Mezeray on stigmata, 388

Mibelli on keratodermia, 825

Michaelis on multiple Cesarean section, 131

Michel on telegony, 88

Michelson on mottled hair, 239

Mickle ou unilateral sweating, 387

Micklucho-Maclay on ceremonial ovariot-
omv, 755

Microcephaly, 247 ; artificial, 248

Micromazia, 298

Microstoma, 253

Middleton, John, 330

Middleton on retention of ectopic fetus, 63
on snake-bite, 717

Milk, colored, 391 ; metastasis of, 391

anomalies of the secretion of, 391
Miller on human tails, 279
" Millie-Chri.stine," 179
" Millie Josephine," 355

INDEX.

955

Millinijtou on aversions, 880
Mills on iujury to the spimil cord, 661
Milne on lieiuiliypertropby, 351
Miluer on injury durinfi pregnancy, 101
Mineer on gunshot wound of the abdomen,
651

Miner on fetus in fetu, 202
Minna and Martha Fiuley, 183
Minor terata, 213

Minot on horns, 225 ; on hydrocephaly,

250 ; on impalement, 6-19
Mirabeau on triplets, 148
Miranduke, Franoiscus Picus, on multiple

birth, 153, 154
Miryachit, 855

Miscellaneous surgical anomalies, 697
Mitchell on anosmia, 875 ; on Newport
twins, 168

Mitchell, Weir, on double consciousness,
583 ; on male nausea of pregnancy, 79 ;
odor of nervous diseases, 400 ; on perver-
sion of the tactile sense, 875 ; on pro-
tracted sleep, 8(59 ; on pseudocyesis, 73

Mitra on ascarides, 820

Mittehauser on large infant, 348

Moffitt on quintuplets, 150

"Moi Boy," 279

IMoldenhauer on luxation of the penis, 681
Mole, hairy, 232

Molinetti on multiple ureters, 294
Molinier on foreign body in the nose, 565
Molitor on precocious pregnancy, 35
Moll on automatism, 888 ; on hypnotism,
871

Molodenkow on boric acid, 497
Money swallowed, 639
Monin on human odors, 399
Monophobia, 879
Monorchids, 319

Monsters, 161 ; ancient explanation of, 161 ;
artificial production of, 166, 448, 737 ; de-
livered by Cesarean section, 129 ; double
167 ; triple, 167
Montagu, Lady, on inoculation, 905
Montare and Reyes on parasitic terata, 192
Montegre on lactation in the aged, 393
Montgomery on birth during sleep, 114 ;
intrauterine amputation, 94 ; on ischio-
pagus, 182 ; on premature rupture of fetal
membranes, 108 ; on presentiment of
death, 889 ; on twins borne by a child-
mother, 38 ; on twins borne beyond the
menopause, 40
"Moon-blindness," 537
Moore on abortion. 111 ; on hiccough, 812 ;
on nasal sarcoma, 777 ; on premature
fetus, 66 ; on priapism, 683
Moore, Oscar, 440

Moorehead on accident to the eye, 533

Moosman on constipation, 794

Morand on cardiac injury, 617 ; on dropsy
786 ; on foreign bodies in the bladder
676 ; on ovarian cvst, 782

Mordake, Edward, 188

Mordie on recto- vaginal septa, 305

Moreau de la Sarthe on hair-growth, 228

Moreau on monsters, 187 ; on parasitic ter-
ata, 191

Morgagni on (atal sneezing, 814

Morgan on gynecomazia, 396 ; on injury to
the penis, 680 ; on macrostoma, 253

Morisani on birth by the rectum, 121 ; on
symphysiotomy, 141

Morison on white spots on the nails, 847

Moritz on postmortem birth, 127

Moritz, Miss M., 343

Morland on ascarides, 820 ; on injury dur-
ing pregnancy, 99
Morphea, 826

Morris on rupture of the bladder, 670 ; on
tongue sucking, 565 ; on universal derma-
titis, 851

Morrison on nitric acid in the ear, 540
"la Mortalega," 892
Mortar-pestle in the rectum, 646
Mortimer on bulimia, 403 ; on double

tongue, 255
Morton on brain-injury, 557 ; on leg-injury,

593

Moscati on spontaneous human combustion,
427

Moseley on self-performed Cesarean section,
132

Moses on vicarious menstruation, 25
Motte on knots in the funis, 109
Mounsey on retention of ectopic fetus, 63
Mourouval on uncionscious pregnancy, 73
Mourray on crocodile-bite, 722
Mouth, anomalies of the, 253 ; atresia of

the, 254 ; menstruation from the, 25
Movements, fetal, 64 ; in pseudocyesis, 73
Moxhay on supernumerary auricles, 263
Mlihlig on cardiac injury, 621
Muirhead on thoracic defects, 284
Mulherou on idiosyncras^'^ to drugs, 497
Muller on arrow-wounds, 712 ; on multiple

amputations, 597 ; on protracted sleep,

868

Muller, Eosine- Marguerite, 229

Multiple births, 147 ; in the aged, 40 ;

repetition of, 154 ; over six, 152
Mund6 on Cesarean section with twins, 129 ;

on vulvar operation during pregnancy,

105

Munro on aural anomalies, 261
Munster, Christopher, 329
Murfee on retention of ectopic fetus, 63
Murillo on precocious pregnancy, 37
Murphy on absence of the penis, 314
Murray on double hand, 271
Mursick on small infant, 348
Mursinna on hydrocele, 689 ; on tapeworm,
819 ' * . '

Mnsifus on anomalous nails, 242
Muscle-transplantation, 728
Mnsculo-spiral nerve, plexiform neuroma
of, 771

Music, idiosyncrasy to, 485; therapeutic

value of, 485
Musser on anomalous stomach, 287
Mussey on aural anomaly, 261 ; on avulsion

of the arm, 591
Mutilations, cosmetic, 746 ; religious and

ceremonial, 743 ; self-performed, 731
Miizenthaler on unconscious pregnancy, 73
Mya on megacolon congenito, 288
Mycosis fungoides, 850
Myoma of the uterus, 781

956

INDEX.

Myrtle on hyperidrosis, 387
M"ysopho])ia, 878
Myxedema, 807

N.

Naegele on injury during pregnancy, 102;

on precocious menstruation, 30
N«vus pilosus, 232

Nail in tbe bronchus, 611 ; swallowed, 638
Nails, anomalies of the, 241 ; reproduction

of the, 589 ; white spots on the, 847
Nankivell on multiple fractures, 702
Napper on amputation during pregnancy,

105

Nares, occlusion of the, 253

Nasal sarcoma, 777

Nauraann on postmortem birth, 126

Nausea of pregnancy in the male, 79

Nebel on anomalous ureters, 294

Nebiuger on intrauterine amputations, 96

Neck, broken and dislocated, 578 ; injuries

of the, 574 ; transtixion of the, 575
Necrophobia, 879

Nedham on intestinal resection, 643

Needle in the l)ladder, 676 ; fall on a, caus-
ing death, 627

"Needle-girls," 735

Neimau on brain injury, 549

Nelaton on absence of the penis, 314 ; on
luxation of the penis, 681

Nemnich on longevity, 375

Neoplasms, 759

Nephrolithotomy, 668

Nephrorrhaphy, 668

Nephrotomy in pregnancy, 104

Nerve-grafting, 729

Nervous diseases, anomalous, 852

Netter on fetal pneumonia, 91

Neubauer on triple nymphoe, 306

Neuhof on anomalous nails, 241

Neugebauer on injury during pregnancy,
102 ; on supernumerary nipples, 302

Neuro-fibroma, 770

Neuroma cutis dolorosum, 839

Neuromata, 770 ; plexiform, 770

New-born, hemorrhagic diseases of the, 816

Newell on skin shedding, 833

Newington on premature twins, 66

Newliu on superfetation, 48

Newman on knots in the umbilical cord,
10^

Newnham on abortion m twin pregnancy,
11

"Newport Twins," 168
Nevronis on alopecia, 241
Nicholson on maggots in the ear, 564
Nicod on amputation during pregnancy,
105

NicoUs on intestinal injury, 643
Nicotin-poisoning, 511
Night-blindness, 536
Night-vision, 536
Nigrities. 84^

Niles on bubonic plague, 896

Nine children at a birth, 153 -

Nipple, avulsion of, 728; deficient, 302;

supernumerary, 302
Nitric acid in the ear, 540 ; tolerance of, 499

Nitzsch on triple dentition, 243

Nivison on bee-sting, 714

Noble on cardiac injury, 619

Nolde on the funis, 109

" Noli-me-tangere," 772

Norris on gunshot wound of the penis, 681

Nose, anomalies of, 252 ; congenital division

of, 252 ; deformity of, 563 ; double, 563 ;

foreign bodies in, 563 ; injuries to, 561 ;

larvai in, 822 ; restitution of a severed,

562 ; tooth in, 224
Nose-making, 561
Nostalgia, 876
Notta on anosmia, 874
Noyes on horns, 225 ; on foreign body in the

vermiform appendix, 642
Numa Rat on yaws, 840
Nunnely on avulsion of a finger, 589 ; on

congenital ocular malformations, 261 ; on

ischuria, 793
Nyctalopia, 536

NymphjE, absence of, 306 ; enlarged, 306 ;

supernumerary, 307 ; triple, 306
Nymphotomy, 307

o.

Oakman on pregnancy with hymen integ-
rum, 42

Obermeier on sternal fissure, 283
Oberteuffer on absence of the vagina, 303
Obesity, 352 ; in childhood, 352 ; general
remarks on, 355 ; hereditary, 356 ; re-
markable instances of, 356 ; simulation
of, 360 ; thyroid feeding in, 356 ; treat-
ment of, 356
Obstetric anomalies, 113
O'Conuell on tattooing, 750
O'Connor on cardiac injury, 621, 623
Odors associated with nervous disorders,
400 ; cadaveric, during life, 400 ; caus-
ing abortion, 110 ; causing loss of
smell, 875 ; of certain races, 399 ; of
diseases. 401 ; of hospitals, 401 ; human,
397; influence of the emotions on, 399 ;
idiosyncrasy to, 482 ; individual, 398 ; of
the insane, 400 ; sexual influence of, 401
Oedmanon abortion, 110
Ogle on absence of the uvula, 256 ; on
anosmia, 874, 875 ; on aphasia from snake-
bite, 874 ; on longevity, 366 ; on a stick
in the rectum, 647
O'Hara on injury to the spinal cord, 661
Ohmann-Dumesnil on ainhum, 830 (Fig.) ;

on nose-making, 561
Oke on ischuria, 793
Olfactory lobes, absence of, 246, 403
Olier on twin pregnancy after ovariotomy,
45

Oliver on accidental extraction of the lens,
533

Ollsner on diphallic monster, 195
Olmstead on lightning-stroke, 726
O'Neill on hermaphroditism, 211 ; on nico-
tin-poisoning ; on a pot on the head, 587
Operations on conjoined twins, 172 ; during
pregnancy, 103 ; repeated, 707 ; self-per-

INDEX.

957

formed, 131, 708, 732 ; on the young and
old, 706

Opium, tolerance of, and untoward action
of, 505 •

Opium-eating, 506

Opport on fetomancy, 214

Orbit, epithelioma of, 772 ; foreign bodies
in, 531 ; gunshot injuries of, 529; inju-
ries of, 528

Ord on anomaly of the Mlillerian ducts,
2})5 ; on myxedema, 807

Orissa Sisters, 171

Orlotf, 603

Ormau, James, 724

Orman(;ey on anomalous growth of nails,

588

Ormerod on hyperthermy, 422

Orton on telegony, 89

Orwin on self-mutilation, 734

Osiander on antepartum crying, 128 ; on
birth during sleep, 114 ; on protracted
pregnancy, 69 ; on venesection, 709

Osier on anorexia nervosa, 414 ; on dilata-
tion of the colon, 287 ; on filaria sangui-
nis liominis, 820 ; on hemophilia, 815 ;
on hypertrophy of the heart, 626 ; on spo-
radic cretinism, 806 ; on tuberculosis,
913 ; on yellow fever, 910

Ossicles, anomalous. 263

"Ossified man," 787

Osteitis detbrmans, 603

Osteoartliropathy, pneumonic, 805

Osteomalacia, 600

Osteosarc-oma, 772

Ostmann on postmortem birth, 127

Oswald on wolt-cbildren, 445

Otis on arrow-wounds, 710 ; on rupture of
the lung, 609

Otte on ovarian hernia, 310

Otto on enlarged clitoris, 308

Ottolengni on teeth-replantation, 728

Oudet on edentuia, 244

Ovariotomy in aged women, 707 ; cere-
monial, 735 ; in children, 79, 706 ; dur-
ing pregnancy, 104 : menstruation after,
26

Ovary, absence of the, 309 ; cysts of the,

782 ; hernia of the, 310 ; separation of

the, 689 ; supernumerary, 310
Overton on idiosyncrasy to wheat flour,

492 ; on spontaneous human combustion,

427

Owen on longevity, 366 ; on maternal im-
pression, 84
Owens on ovariotomy in old age, 707
Oxalic acid, tolerance of, 499

P.

Packard on centipede in the nostril, 564 •
on combined fetation, .57 ; on forei<^n
body in the appendix, 642

Paddock on quintuplets, 150

Paget on colored saliva, 383 ; on lightning-
stroke, 723 ; on osteitis deformans, 603 •
on teeth in the larynx, 582 ; on vicarious
menstruation, 24

Pain, births without, 113; endurance of,
475 ; morbid desire for, 480 ; sexual
enjoyment from, 480 ; relation of siiock
to, 480 ; supersensitiveness to, 480
Palate, anomalies of the, 256 ; artificial, 256
Palfrey on birth during sleep, 114
Palmer on pregnancy with unruptured

hymen, 42
Palmus, 855

Pamo, Gomez, on prolonged lactation, 394
Pancoast on horns, 226 ; on Millie-Christine,
179

Pancreas, anomidies of the, 291
Pantophobia, 880

Paracelsus on the dancing mania, 854, 855
Paramyoclonus multiplex, 859
Paraplegia, delivery during, 116
Parasites, human, 818
Parasitic terata, 189

Pare on an armless man, 265 ; on cardiac
injury, 617 ; on cranial fractures, 559 ;
on a dog-boy, 162; on double herniaph-
rodities, 165 ; on false tongue, 566 ; on
hermaphroditism, 206 ; on ischiopagi,
181 ; on knife-swallowing, 635 ; on a
legless boy, 266 ; on maternal impres-
sions, 82 ; on a monster, 164 ; on multi-
ple birth, 154 ; on parasitic terata, 190;
on perverted appetites in pregnancy, 80 ;
on prolificity, 146 ; on quintuplets, 150 ;
on supernumerary limbs, 270 ; on teratol-
ogy, 164 ; on a three-headed sheep, 166 ;
on vicarious menstruation, 20 ; on worms
in a fetus, 112

Pareira on arsenic, 500

Park on hypertrophy of the digits, 276 ; on

rupture of the sciatic nerve, 592
Parker on foreign body in the nose, 564 ; on

hiccough, 813 ; on nose-making, 562
Parosmia, 875
Parr, Thomas, 373
Parravini on Cesarean section, 130
Parrot on vicarious menstruation, 18, 19 ;

on high falls, 704
Parry on protracted menstruation, 32 ; on a

viable ectopic fetus, 57
Parsley, idiosyncrasy to, 491
Parsons on pregnancy after ovariotomy, 46 ;

on superfetation, 48
Parsons, Walter, 329

Partridge on cryptorchids, 321 ; oti elephan-
tiasis of the scrotum, 801 ; on gangrene
of the penis, 682; on rupture of the tri-
ceps tendon, 593

Parturition, difficulties of, 113 ; painless,
113 ; rapid, 116

Parvin on maternal impressions, 84 ; on a
"turtle man," 267; on viable ectopic
fetus, 57 ; on vicarious menstruation, 27

Paschal on protracted pregnancy, 70

Pastorello on defect of the skin, 217

Pastrana, Julia, 229

Paternal impressions, 85

Paternity, possibilities of, 157

Paterson on hernia of the stomach, 287

Patterson on anomalies of the gall-bladder,
290 ; on self-performed operations, 709

Patzki on wound of the liver, 654

Paull on amazia, 297

958

INDEX.

PauUini on anomalous urine, 383 ; on in-
fantile beard, 228 ; on vicarious menstrua-
tion, 24, 27

Pavy on fissure of tlie sternum, 282

Payne on anomalous vaginal opening, 306 ;
on delivery by the rectum, 120

Pea sprouting in tbe nose, 564

Peabody on arrow-wound, 712

Pean on splenectomy, 657

Pearl-divers, 515

Peai-s on absence of the ovaries, 309
Pearse on foreign body in the vagina, 694
Pearson on child-bearing after the meno-
pause, 29

Pechlin on painless births, 113 ; on venesec-
tion, 709 ; on vicarious menstruation, 25
Peck on delivery of ectopic fetus, 53
Pedestrians, 458 ; long-distance, 459
de Pedro, Martin, on triple monster, 167
Peebles on ischuria, 793
Peeuash, 822

Peeples on precocious menstruation, 30
Pelargus on abortion, 110
Pelvic organs, accidental extraction of the,
139

Pelvis, foreign body in the, 678

Penada on infantile menstruation, 29

Peney on infibulation, 753

Penis, absence of, 314 ; amputation of, 680 ;
self-performed, 732 ; artificial, 318 ; avul-
sion of, 680, 686 ; liitteu off, 680 ; double,
194 ; fracture of, 679 ; gangrene of, 682 ;
gunshot wound of, 681 ; injuries to, 679,
680; large, 316; long-continued erection
of, 683 ; luxation of, 681 ; ossification of,
316 ; regeneration of, 682 ; retraction of,
681 ; rudimentary, 314 ; torsion of, 316 ;
palme, 316

Penrose on anomalies of the ureter, 294 ; on
excision of the ureter, 669

"Pepin," 263

Pepper on orbital injury, 529

Pepys on the black death, 896

Percy on depraved appetite, 411 ; on ossi-
fied men, 787 ; on deformity of the penis,
44 ; on polymazia, 300 ; on vitality of
spermatozoa, 40

Percy and Laurent on merycism, 862 ; on
nostalgia, 876

Perfect on delayed menstruation, 33

Pericardium, injury to the, 623

Periesophagitis from foreign bodies, 571

Perineum, birth through the, 121

Peritonitis in the thorax. 613

Perrin on foreign bodies in tlie glottis, 583 ;
on injury to the bladder, 672

Pershing on acromegaly, 803

Perspiration, anomalous, 385 ; postmortem,
523

Perverted appetites, 405; in pregnant

women, 80
Pessaries, long retention of, 693
Pestonji on neuropathic plica, 849
Peter on foreign 1)ody in the brain, 561
Peterman on colored saliva, 383
Peters on quinin, 509
Petersen on protracted menstruation, 33
Petrequin on gynecomazia, 395
Petrifaction, 788

Petritus on quintuplets, 150

Petroueon bloody sweat. 391

Pettigrew on the " biped-armadillo," 823

Petty on triplets, 148

Pettyjohn on teeth-replantation, 728

Pencil on polymazia, 299

Pfau on twin birth, 142

Phares on multiple fractures, 700

Pharynx, foreign bodies in the, 570

Phenol, poisoning by, 498

Pliilib on adhesions of the tongue, 255

Philipeaux on fetus in fetu, 200

Pliilipsou on hyperthermy, 422

Philippart on precocious pregnancy, 37

Pliillips on absence of tlie uterus, 311 ; on

hermaphroditism, 311 ; on lithotomy

during pregnancy, 106
Phobophobia, 880 "
Phosphorescent anomalies, 429
Pliosphorus, poisoning by, 508
Physicians, longevity among, 380
Physiologic and functional anomalies, 383
Pica, 412

Picardet on urethral anomaly, 318
Pi cat on obesity, 355
Pick on horn of the penis, 225
Pierce on fasting, 419

Pigne on delivery by a bull-horn, 133 ; on

double brain, 249
Pignot on twin parturition, 142
Pig-tail in the rectum, 645
Pike on foreign bodies in the hand, 599
Pilcher on amazia, 297 ; on removal of the

breast during pregnancy, 105
Pilocarpin, untoward action of, 508
Pim on hernia, 665

Pinard on ectopic gestation, 58 ; on post-
mortem birth, 124

Pinart on twin birtli, 142

Pincott on twin birth, 143

Pineal gland, calculus in the, 792

Pinel on the effects of cold, 430 ; on male
menstruation, 28

Pinkerton on avulsion of the thumb, 590

Pins, pricks of, causing death, 737 ; self-
mutihition Mnth, 735 ; swallowed, 736 ;
wanderings of, in the bod.y, 736

Pippiugskold on conception after ovariot-
omy, 46

Pisciculture, 44

Pityriasis nigra, 841

Placenta, passages of drugs through the,
98 ; previa, 108

Plagues, 891 ; chronologic table of, 898 ;
in London, 895

Plancus on supernumerary leg, 269

Playfair on cardiac anomaly, 269 ; on post-
mortem Cesarean section, 136 ; on uterine
decidua, 109

Plemons, Rosa liCe, 364

Plexiform neuroma, 770

Plica polonica, 848

Pliny on Cesarean section, 128 ; on fecun-
ditv in the old, 38 ; on giants, 324 ; on
longevitv, 377 ; on menstrual supersti-
tions, 17 ; on quintuplets, 150 ; on short
pregnancy, 65 ; on snperfetatiou, 46 ; on
twelve children at a birth, 147

Plocquet on injury during pregnancy, 98

1

INDEX.

959

Plot on longevity, 377 ; ou maternal im-
pressions, 82

Plutarch ou monsters, 1G3

I'neuniouectoniy, 608

I'lU'umonia in the fetus, 91

Potle ou tibrouui molluscum, 762

Poisoned arrows, 711

Poisonings, untoward, 496

Pollailou on avulsion oi" tlie finger, 589 ; on
conception after ovariotomy, 46 ; on
ovariotomy during pregnancy, 104 ; on
orbital injury, 529; on removal of the
breast during pregnancy, 105

Polaud on knife-swallowing, 635 ; on rup-
ture of the ureter, 668

Pole ou ascaris lumbricoides, 819

Politzer on acanthosis nigricans, 841 ; on
dermoids, 205

Pollock on rupture of the lung, 609

Polydactylisni, 273

Polydipsia, 404; in pregnancy, 80

Polymazia, 298

Polyorchids, 320

Polyphagia, 411, 632-642

Poncet on coitus, 512

Pooley on stigmata, 389

Pope on lead-poisoning, 503

Popotf on ectopia of the testicle, 688

Porak on placental absorption, 93

" Porcupine-man," 823

Porro on anomalous esophagus, 284

Portal on hair on the tongue, 256 ; on rup-
ture of the si)leen, 656

Posey on coloboma, 260

Pospichilli, Joseph, 467

Post on menstruation during pregnancy, 29 •
on small infant, 348; on vicarious men-
struation,25 ; on wound of the bladder, 672

Postmortem auonialies, 522 ; births, 124 •
Cesarean section, 135 ; delivery' 123 ;
growth of hair and nails, 523 ; menstrua-
tion, 27 ; movements, 522 ; sweat, 391

Pot on the head, 587

Potovski on pseudoacroraegaly, 805 ; on
ovariotomy during pregnancy, 104 ; on
the priu(;ipal plagues, 898

Potter on suture of the liver, 652 ; on
wound of the diaphragm, 613

Pouch in the larynx of criminals, 585

Poulet on foreign bodies in the bladder,
677 ; in the ear, 541 ; in the esophagus
572 ; in the rectum, 646 ; in the vasiua!
694 ° '

Povall on submersion, 531

Powell on scalp-injury, 545

Powers and White on excision of the larynx
584 '

Pozzi on hermaphroditism, 211

Prankard on polyorchism, 320

Precocious development, 343 ; impreo'na-
tion, 34 ; menstruation, 29

Pregnancy, accidents during, 98-103 • co-
existence of, with extensive tumors of
the uterus, 106; combined extrauterine
and uterine, 54 ; in a double uterus 311 •
extrauterine, 50 ; imaginary, 73 ; injuries
during, 98; long, 59; operations during,
103 ; after ovariotomy, 45 ; short, 6;?'-
unconscious, 72 '

Preismanu on odors after coitus, 399

Premature births, 65 ; burial, 519

Prenatal anomalies, 50

Prentiss ou ergot, 503 ; on pilocarpin, 508 ;
on sudden canities, 237

Preputial calculi, 791

Presentiment of death, 889

Preston on skin-shedding, 832

Pr6ville, Adelaide, 210

Priapism, 683 ; in leukemia, 684 ; postmor-
tem, 523 ; theories of long-continued,
684

Price on rupture of the kidney, 667
Prichard on albinism, 221
Prideaux on precocious menstruation, 31
Primperosius on retention of ectopic fetus,
62

"Princess Topaze," 343

Prochaska on cannibalism, 410 ; on vesical
fusion, 295

Prognathism, 252

Progressive tu oscular atrophy, 859

Prolapse of the pelvic organs, 139 ; of the
uterus in labor, 140

Proliticity, 144; animal, 160; climatic and
racial influences on, 145 ; experiment in,
158 ; by single births, 157 ; general his-
toric observations relative to, 144 ; gen-
eral law and influence of war on, 145 ;
legal encouragement of, 146 ; old explana-
tion of, 146 ; old records of great, 147

Proudfoot on iutrauteriue fracture, 97

Proust ou double consciousness, 886

Prowse on impalement, 650

Prowzowsky on injury during pregnancy,

Prudden on neuromata, 770

Pruuer-Bey on the odor of negroes, 399

Prussic acid, tolerance of, 499

Pryor on a precocious boy, 346

Pseudocyesis, 73 ; case of Queen Mary, 77

Puech on multiple births, 155 ; on postmor-
tem Cesarean section, 136

Pulse, suspension of the, 516

Pupils, anomalous, 259

Purcell on double uterus, 311 ; on injury
during pregnancy, 99

Purdon ou chromidrosis, 385

Purple ou cardiac injuries, 620, 622

Purser on double gall-bladder, 290

Putnam on nosencephaly, 246 ; on pseudo-
cyesis, 78

Putrefaction, retardation of, 523

Pye-Smith on aneurysm, 779

Pygmalion, a modern, 882

Pygmy people, 333

Pygojiagous twins, 174

Pyle on ainhum, 829; on laminectomy,

bbl ; on morphin-poisoning, 506 : on run-

ture of the lung, 609
Pyloroplasty, 644
Pyrophobia, 880

Q.

Quadriceps tendon, rupture of, 593
Quadruplets, 148
Queen Mary, case of, 77
Queen on brain-injury, 548

960

INDEX.

Quinan on vaccination, 907
Quiniu, idiosyncrasy to, 509
Quintuplets, 150 ; repeated, 150, 154
Quirke on fetal variola, 90

R.

Rabies, 719

Racbitis, 601

Radica-Doddica, 171

Raggi on claustropbobia, 878

Ragozin on fetouiancy, 213

Rains on premature rupture of the fetal

membranes, 108
Rake on ascarides, 820 ; on circumcision,

755

Ramsbotham on combined fetation, 55
Ramsey on eventration, 292
Raraskill on unilateral sweating, 387
Randall on cardiac injury, 618
Ranney on hiccough, 813 ; on ovarian cyst,
783

Raspail on lightning-stroke, 727
Rause on precocious menstruation, 31
Raux-Tripier on protracted pregnancy, 71
Raven on retraction of the penis, 681
Rawdon on dwarf, 341

Rayer on accidental growth of hair, 235 ;
on alopecia, 228 ; on canities, 236 ; on
elephantiasis arabum, 798 ; on elephanti-
asis of the breast, 800 ; on excessive den-
tition, 244 ; on hirsuties, 232 ; on human
odor, 399 ; on long hair, 234 ; on neurosis
of the skin, 838 ; on nigrities, 842 ; on
the "porcupine-man," 823
Raymau on male menstruation, 28
Raymond and Vulpian on sudden canities,
236

Raynaud's disease, 836

Reamy on cystotomy during pregnancy, 105

R6carnier, IVladame, 304

Rectum, birth by the, 120 ; foreign bodies

in the, 645
Redard on skin-grafting, 729
Reed on transplantation of the ureter, 669
Reichel and Anderson on parasitic terata,

189

Reid on protracted pregnancy, 70

Reifsnyder on ovarian cyst, 783

Rein on operation during pregnancy, 105 ;

on ovariotomy in children, 707
Reiss on postmortem birth, 125
Remy on profuse lactation, 394
Renal vessels, absence of the, 668
Renauldin on small penis, 314
Resnikoflf on protracted pregnancy, 71
Reta on birth by the rectum, 120
Retention of extrauterine fetus, 62 ; of uter-
ine fetus, 63
Retina, hemophilic purpura of the, 816 ;

injuries to the, from lights, 537
Reuther on injury during pregnancy, 98 _
Reverdin on scalp-injury, 543; on skin-
grafting, 731
R6volat on constipation, 794
Rey on anal operation during pregnancy,
i05

a Reyes on abortion by the mouth, 52
Reyssie on exophthalmos, 527
Rhades on unconscious pregnancy, 73
Rheumatic alfection of the testicles, 688
Rhinolith, 564
Rhiuophyma, 561, 563

Rhodiginus on double hermaphrodite, 165 ;
on monster, 163, 164 ; on precocious boys,
344

Rhodius on anomalous sweat, 385 ; on horns,
222 ; on vicarious menstruation, 24

Ril)es on face injuries, 585

Ribs, anomalies of the, 281

Rice, idiosyncrasy to, 491

Rice on brain injury, 550 ; on early concep-
tion after labor, 46 ; on large infant, 349

Richard on injury during pregnancy, 100

Richards on self-mutilation, 733

Richardson on aural anomaly, 261 ; on
brain-in jurv, 549 ; on lasting, 419 ; on
hyperidrosis, 387 ; on injury during preg-
nancy, 98 ; on postmortem perspiration,
522

Richeborg, 340

Richelot on mottled hair, 238

Richter on postmortem birth, 126 ; on vicari-
ous menstruation, 20

Rickets, 601 ; fetal, 602

Ricketts on skin-grafting, 730

Rider on Ibreign bodies in the eye, 532

Riders, 460

Rieken on opium, 505

Riker on anomaly of the nose, 252

Riolau on absence of the hair, 228 ; on
conception with the hymen intact, 40 ; on
defective nymphse, 306 ; on hermaphro-
ditism, 207

Ritta-Christina, 184

Riverius on worms in the bladder, 676

Robb on double vagina, 305

Robbins on sexual desire after castration,
687

Robert on gynecomazia, 395 ; on polymazia,

302 ; on supernumerary mammaj, 301
Roberts on cardiac injury, 618 ; on polypus

in a pregnant womb, 106
Robertson on precocious pregnancy, 37
Robson on removal of the breast during

pregnancy, 105
Rockwell on multiple births, 155
Rocquefort on longevity, 374
Rodbard on expulsion of ectopic fetus, j^3
Rode on foreign body in the urethra, 678
Rodenbaugh on a bean sprouting in the

bowel, 641
Rodenstein on ovarian cyst, 783
Rodet on obstetric customs, 113
Rodgers on skin-grafting, 729
Rodrigue on intrauterine fracture, 97
Rodrigues on fetus in fetu, 202
Rodsewitch on delayed menstruation, 33
Roe on conception with imperforate uterus,

41 ; on double voice, 257
Roellinger, Jacques, 698
Roger of Wendover on double monster, 184
Rogers on enlarged clitoris, 309 ; on evis-
ceration, 651 ; on fetus in fetu, 201
Rogowicz on postmortem birth, 124
Rohan, family of, 239

INDEX.

961

Rohe oil cholera, 908 ; ou inoculation, 905 ;

on sinull-pox, 904
Kolliukiiis on postmortem birth, 125
Ronime on wounds of the liver, 653
Ronjiier ou impreguatiou with hymen integ-
rum, 40

Rooker on spontaueous amputation, 598
Roosa on a kiss in tlic oar causing deafness,
537 ; on rupture of the tympanum, 538 ;
on sudden deafness, 538
Rootes on birth in tiie membranes, 123
Rope-walkers, 449
Rosa-Josepha Bhizek, 179
Rosary (220 cm. long) swallowed, 638
Rosenberg on repeated Cesarean section, 130
Rosenbladt on vicarious menstruation, 26
Rosenthal on l)enzin-pois()ning, 501
Ross on extrauterine gestation, 51 ; on in-
jury during coitus, 692 ; on pregnancy in
double uterus, 49 ; on translixion of the
abdomen, 648 ; on triplets, 148
Rosse on chemic coloration of the hair, 241 ;

on postmortem growth of theliair, 523
Rosset on combined fetation, 56
Rossi on anomalous vaginal opening, 306
Rossow Ibothers, 343
Rostan on gangrene of the penis, 682
Rouhont on anomalies of the nails, 241
Rousseletou " dance of the eggs," 452
Ronsset on menstruation during pregnancy,

Routh on short pregnancy, 66

Rouxeau on vicarious menstruation, 20

Rowland on hiccough, 812

Rowlett on precocious pregnancy, 36

Roy on death from laughter, 524 ; on extra-
oral dentition, 245

Rndbeck on prolihcity, 146

Ruddock on lung injury, 611

Rudolph on dry births, 123

Rnetf on ischiopagus, 181 ; on monster, 163

Ruelie on precocious l)oy, 345

Rumination in man, 862

Rundle ou anomalous bullet-injury, 652

Rnnge ou merycism, 863

Runners, Indian, 457 ; physiology of, 461

Running, 455 ; influence of the spleen on,
461 ; modern records of, 459

Rupture, 662 ; of the abdominal walls from
coughing, 666 ; premature of the fetal
membranes, 108; of the uterus during
pregnancy, 137

Rush on fecundity in the old, 39 ; on twin-
sympathy, 887

Russ on aphasia from snake-bite, H74

Russell on ami)utation during pregnancy,
105 ; on anomalous position of tlie tes-
ticles, 322 ; ou aspiration during preg-
nancy, 105 ; on ischuria, 794 ; on polv-
orchids, 321, 420 . i J

Ruttel ou precocious pregnancy, 35 • on
short pregnancy, 66

Ruysch ou super fetation, 47

Ryan on protracted menstruation, 32

Ry<l.ygier on celiotomy during pregnancy.

61

s.

Sabatier on foreign body in the ear, 539

Sachse on injury during pregnancy, 98

Saillant on anomalous nails, 242

St. Braun, Cesarean section on a dwarf, 129

Saint- Foix on tickling to death, 524

St. Martin. Alexis, 630

de Saint-Mouliu ou menstruation during
l^regnancy, 29

St. Vitus' (iauce, 853

"Salamanders," human, 424

Sale on a case of cut-throat, 574

Salicylic acid, untoward action of, 499

Saliva, colored, 383

Salivary calculi, 792

Sahuou, Dr. W. R., 380

Salninth (m abortion by tlie mouth, 52 ; on
elephantiasis of the breast, 800 ; on extra-
uterine pregnancy, 50 ; ou male menstrua-
tion, 28 ; on migratory menstruation, 27 ;
on vicarious menstruation, 26

SaKatoric spasm, 859

Salter on leaiuiess, 364

Salzer on pria])ism, 684

Samelson on delivery during sleep, 115

"Samson," 463, 465, 467

Samter on opium-eating, 507

Sanders on seijaratiou of the symphysis
pubis, 141

Saudi fort on double aorta, 286 ; on super-
numerary kidney, 293
Sandow, Eugene, 467

Sands on horns, 224 ; on self-mutilation,
733

Sangalli on supernumerary penis, 198
Sanger ou double vagina, 305 ; on triple

ectopic gestation, 57
Sangster ou dermoids, 205
Sankey on anomalous suicides, 743
Sautorini on protracted pregnancy, 70
Santos, dos, Jean Baptista, 196
Sarcocele, 689

Sarcomata, 772 ; pigmentosum diffusum

multiplex, 772
Sargent on thoracic; peritonitis, 613
Saucerotte ou cardiac injuries, 617
Saulquin on absence of the tongue, 245
Saunderson, 439

Saunois on supernumerary mamma, 301

Saviard on auencei)haly, 246 ; on fetus in
an umbilical ab.scess, 122 ; ou super-
numerary digits, 274

Savill on epidemic exlbliative dermatitis, 836

Savitzky on gynecomazia, 395

Savonarola on precocious pregnancy 35

Saxo on giants, 325 '

Seal]!, abnormal development of, 222 • ele-
phantiasis of, 798 ; injuries of, 542

Scalping, 747

Scanzoni ou amazia, 297

Scars, exhibition of,' 745

Scatologic rites, 40fi

Schacher ou superfetation, 47

Schaelfer on hypertrophy of the breast
760 ; on scalp-injury, 543 '

Schauf hausen on dwarfs, 337

Schauta on exostosis oil the sacrum, 138 •
on the symphysis, 141 '

962

INDEX.

Schede on alopecia, 227

Scheideniautel on perverted appetite in

prej^nancy, 80
Schell on gunshot Avound of the abdomen,

651

Schenck on absence of the liver, 290 ; on
canities, 238 ; on elephantiasis of the
lace, 800 ; on parasitic terata, 189 ; on
postmortem birth, 12(3 ; on superfetation,
46 ; on vicarious menstruation, 20

Scherer on supernumerary digits, 275

Schlegel on albinism, 220

Schleiser on rupture of the spermatic
arteries, 689

Schmidt on precocious menstruation, 30 ;
on precocious pregnancy, 35

Schmidtmuller on rupture of the esopha-
gus, 628

Schmiegelow on foreign body in the ear,
542

Schneider on electric anomaly, 429 ; on
paternal impression, 85 ; on protracted
pregnancy, 70

Schobinger on tongue-swallowing, 565

Schoepfer on fecundity in the old, 39

Schott on bearded Avomen, 299

Schrader on spontimeous human combus-
tion, 427

Schreiber on rupture of the uterus, 137

Schrell on hermaphroditism, 209

Schrumpf on penis palme, 316

Sohuh on abortion in twin pregnancy, 111

Schultze on delivery during sleep, 115

Schulz on najvus pilosus, 233

Schurig on birth in the membranes, 122 ;
on black menstruation, 27 ; on concep-
tion during sleep, 45 ; on deficiency of
the funis, 109 ; on spontaneous human
combustion, 427

Schutz on regeneration of the penis, 682

Schwammerdam on pisciculture, 43

Schweiufurth on pygmies, 334

Schwimmer on universal sarcomata, 772

Sciatic nerve, injuries to the, 592

Scibelli on triple bladder, 295

Scleroderma, diffuse, 826; neonatorum,
826

Scoliosis, 281

Scott on delivery by cow-horn, 134 ; on
small infant, 348

Scottish Brothers, 184

" Scourge of St. Kilda," 817

Scrotum, anomalies of the, 321 ; avulsion
of the, 686 ; elephantiasis of the, 800 ;
iniuries to the, 685-

Scull on protracted sleep, 868

Scurvy, infiantile, 817

Second-sight, 535

Secretions, anomalies of the, 383

Sedo-wickon absence of the uterus, 311 ; on
albinism, 221 ; on congenital alopecia,
■227 • on telegony, 89 ; on urethral anom-
alies', 318

fieguin on aphasia, 873

Seiflfert on dermatolysis, 218

Seignette on innltiple births, 153

Self-decapitation, 577

Self-mutilation, 731

Self-performed major operations, 131, /08

Seminal flow, anomalies of the, 384

Seminal vesicles, anomalous, 323

Semple on lactation in the aged, 393 ; on
protracted menstruation, 32

Senn on dermoid cysts, 204 ; on extirpation
of the thyroid, 762 ; on sarcoma, 772 ; on
tumor of the thyroid, 761

Sennert on viable ectopic fetus, 57 ; on vi-
carious menstruation, 25

Senses, renovation of the, in old age, 378 ;
substitution of the, 432

Seuter on anomalous urination, 384

Sercombe on artificial palate, 256

Sermon on sudden birth, 116 *

Serpieri and Bali\a on self- performed Ces-
arean section, 132

Serres on anencephaly, 246

Seurat, 304

Seven at a birth, 152

"Seven Sutherland Sisters," 234

Severiuus on abortion, 110

Sewell on transfixion of the chest, 610

Sexdigitism, 275

Sextuplets, 152

Sexual ism and hair-growth, 228

Shah on evisceration, 651

Shark-bite, 721

Sharkey on hyperidrosis, 387

Shattuck on ectopia vesicae, 295

Sheep, three-headed, 166

Shive-Maon family, 231

Shock, death from, 525

Shooting, 452

Short on obesity, 358

Shoitt on sudden birth, 118

Siam, early menstruation in, 29

Siamese Twins, 168

Sibois on a fall during pregnancy, 101

Sigel)ert on multiple birth, 153

Sight, late restoration of, 535 ; idiosyncrasy
through the sense of, 487

Silex on lightning-blindness, 537

Simmons on conception with imperforate
vagina, 41 ; on vesical calculus, 790

Simon de Ronchard on quinin, 510

Simpson on birth through the perineum,
122 ; on fetal therapeutics, 92 ; on in-
trauterine amputation, 96 ; on neuroma
of the vulva, 771 ; on telegony, 88 ; on
vicarious menstruation, 26 ; on worms in
the uterus. 111
Sims, Marion, on artificial impregnation, 43
Sinclair on a leech in the nose, 563 ; on

self-mutilation, 734
Singultus, anomalous, 811 ; causing abor-
tion, no

Sippel on supernumerary ovary, 310
"Siren," 270

Skene on vicarious menstruation, 31
Skin, abnormal elasticity of, 217 ; anoma-
lous pigmentation of, 841 ; congenital
defect of, 221 ; fibromata of, 762 ; gan-
grene of, 836 ; impervious, 219 ; menstru-
ation from, 18 ; neuroses of, 837
Skin-diseases, anomalous, 823
Skin-grafting, 728 ; methods of, 731
Skin-shedding, 832
Skinner, Robert. 338, 340
Skinner on strj-chnin, 510

INDEX.

963

Skippon on discharge of the fetal bones, 53
Skoptzies, To?

Skull, extensive fractures of the, 558 ; basal
fractures of the, 559 ; injuries to the, 551
Skutsch ou Cesarian section, 130
Slee on foreign body in the nose, 560
Sleenuin on wolf-children, 440
Sleep, delivery during, 114 ; protracted, 867
Sleep-sickness, 872
Sleep-walking, 863

Slevogt on injuries during pregnancy, 98

Sloane on giants, 327 ; ou lactation in the
aged, 393

Slocum on sternal fissure, 283

Slusser on birth in the membranes, 123

Small-pox, 903 ; fetal, 90

Smart on arrow-wounds, 712

Smell, idiosyncrasy through the sense of,
482 ; loss of the sense of, 874 ; supersensi-
tiveness of. 398, 875

Smellie on super fetation, 48

Snietius on obesity, 358

Smith on armless monsters, 265 ; on bulimia,
403 ; on double penis, 198 ; on intrauter-
ine fractures, 97 ; on large infants, 349 ;
on a precocious boy, 344 ; on precocious
impregnation, 38 ; on rupture of the
uterus, 137 ; on sudden birth, 118 ; on
superfetation, 48

Smith and Norwell on sexdigitism, 275

Smyly on anomalous coloration of the hair,
240 ; on foreign l)ody in the eye, 533

Snake-bites, 715 ; causing abortion, 110 ;
aphasia from, 874

"Snake-boy," 835

Snakes swallowed, 636

Sneddon on gynecomazia, 396 ; on super-
numerary mammae, 301
Sneezing, anomalous, 813 ; causing abor-
tion, 110 ; in coitus, 511
Snell on foreign body in the eye, 532, 533
Snow on postmortem changes, 522
Snow-blindness, 537
Snyder on knife-blade in the chest, 614
Solingen on abortion, 110
Solly on a case of cut-throat, 576
Somnambulism, 863 ; birth in, 1 16
Soiinenschein on phosphorus, 508
Sonnini on anomalous mons veneris, 308
Sorrow causing death, 524
Sourrouille on atresia of the mouth, 254
Souvray, Thcrfese, 339
Spach, Israel, on extrauterine pregnancy,
50

Spaeth on injuries in coitus, 691, 692 ; on

premature fetus, 68
Spallanzani on artificial impregnation, 43
Sparkman on early conception after labor

46

Speech, loss of, 872
Spelling-book in the groin, 659
Spencer, Herbert, on ceremonial mutila-
tions, 745 ; on telegony, 86, 88
Speranza on human odors, 400
Sperling on triplets, 148
Spermatic vessels, injuries of the, 689
Spennatophobia. 880
Spermatozoa, vitality of, 40
Speth on hypertrophy of the breast, 760

Sphaceloderma, 836
Spider-bite, 713

Spiegelberg on fibroid blocking the pelvis,
107

Spinal canal, anomalies of the, 280
Spinal cord, injuries of the, 661
Spindler on vicarious menstruation, 24
Spine, curvatures of, 281 ; fracture of, lower,

659 ; upper, 578 ; operations on, 660
Spizharny on gastric fistula, 631
Spleen, anomalies of, 290 ; injuries of, 056 ;

influence of, ou running, 461 ; laceration

ol", in pregnancy, 103; large and small,

057 ; operations ou, 657 ; rupture of, 056 ;

during labor, 141
Splenectomy, 050 ; in malaria, 057
Spontaneous human combustion, 426
Squire on anomalous color of the hair, 240 ;

on postmortem section, 136
Stahl on protracted pregnancy, 72
Stalkartt on injuries to the testicles, 685
Stallcup on precocious pregnancy, 37
Stalpart on delivery by a cannon-ball, 134
Stanley on intrauterine fracture, 97
Stapedius on postmortem births, 126
Staples on injury during pregnancy, 102 ;

on pregnancy with stricture of the vagina,

42

Starkey on injuries of the vagina, 691

Starr on megalocephaly, 805

Staton on reunion of the hand, 588

Stature, anomalies of, 324

Steinam on paternal impression, 85

Steinhausen on ichthyosis, 823

Stelzner on cardiac injury, 622

Stengel on retention of the fetus, 64

Stepanoff on vicarious menstruation, 24

Stephens on horns, 226

Sternum, fissure of the, 282

Stevenson on hiccough, 812

Stewart on boxing the ears, 537 ; on fish in

the pharynx, 568 : on lightning-stroke,

724

Stigmata, 25, 388

Stings of insects, 713

Stoakley on precocious pregnanc^'^, 37

Stockard on fibrocyst of the uterus, 781

Stoll on cardiac injury, 622

Stolz on repeated Cesarean section, 130

Stoker, Mannetta, 340

Stoker on quintuplets, 151

Stokes on displacement of the heart, 026

Stomach, anomalies of, 286 ; digestion of,

628 ; extirpation of, 644 ; hernia of, 286,

287 ; rupture of, 629 ; wounds of, 630
Stone-in-the-bladder, 788
Stone on avulsion of the finger, 589 ; on

ovarian cyst, 783; on precocious bov,

345 ; on vaginal septa, 305
Stones in the rectum, 046, 648
Storck on painless birth, 113
Storer on retention of the fetus, 64 : on

vicarious menstruation, 26
Storrs on fracture of the femur, 594
Stony on ovariotomy during pregnancy, 104
Strabismus, 260
Strand on death from grief 524
Strasberger on protracted menstruation. 33
Strength, extraordinary, 463 ; fraudulent,

964

INDEX.

470 ; in thehands, 470 ; in the jaws, 468 ;
officially recorded feats of, 470
Stric ture of the ureter, 669 ; of the urethra,
680

"Strong men," 463
Strou;! on dry birth, 123
'■8tron<i woineu," 468
Struma, 761

Strut hers on double stomach, 286
Strychiiiu, idiosyncrasy to, and tolerance of,
510

Studlt-y on fracture of the penis, 141
Stuclsijaard on foreign body in the rectum,

64(5, 647
Sturgis on syphilis, 913
Stute on absence of the funis, 109
Subclavian artery, wound of, 627
Submersion, recovery alter, 513
Succi, 420

Sucklinji on fear-])sychoses, 877, 878

Suicides, anomalous, 742

Sulikowski on fetus in fetu, 201

Sullivan on anomalous effect of coitus, 511

Sulphuric acid, tolerance of, 499

Sulzl)eri>;or ou abortion, 110

Superl'etation, 46 ; with different colored
children, 48

Surjjical anomalies of the extremities, 588 ;
of the head and neck, 527 ; of the genito-
urinary system, 667 ; of the thorax and
abdomen, 606

Suspended animation, 513 ; pulse, 516

Sutton on monstrosity, 187

Swallowing loreign bodies, 637 ; live ani-
mals, 636 ; swords, 633 ; the tongue,
565

Swain on brain-injury, 549

Swan on multiple birth, 155

Swann, Anna, 332. 349

Swayne on postmortem birth, 126

Sweat, anomalous, 385 ; cadaveric, 391 ;

unilateral, 387
Sweatinsi sickness, 896 ; mortality of, 897
van Swieten on bloody sweat, 390 ; on
male menstruation, 28 ; on precocious
menstruation, 30 ; on vicarious menstrua-
tion, 19
Swimming. 461

Swingler on operation on a monster, 172
Swordr-ron lactation in infjints, 392
S w( )rd -s wa 1 lo wi ng, 63:5
Sycyanko on lightning-stroke, 726
Sykes on cretinism, 805
Svm on albinism. 221
Symes on hiccough, 811
Symonds on skin-grafting, 730
Syniphysiotomy, 141

Symphysis ])nbis, separation of, during

' labor, 1 41 >
Sypbiliophobia, 879

Svphilis, 912 ; acquired in tattooing, 751 ;
from a flea bite, 714 ; from a human bite,
719; ha;morrhagica neonatorum, 816

Sziirethy on foreign bodies in the vagina,
694

T.

Tactile sense, perversion of the, 875
Tagert on brain-injur}', 557
Tails, human, 277

Tait on excision of the liver, 653 ; on pre-
mature birth, 67 ; on rupture of the
spleen, 656 ; on surgery of the lung, 608 ;
on uterine myoma, 781 ; on viable ectopic
fetu.s, 57 ; on vicarious menstruation, 26

Takacs on unilateral sweat, 388

Talcott on ])rotracted pregnancy, 70

Talicotian method, 561

Talipes, 276

Tamburini on acromegaly, 803

Tanner, Doctor, 420

Tanner on unctonscious ]»regnancy, 72

Tansley on a diamond in the ear, 541

Tapeworms, 818

Tarautism, 854

Tarchanoif on music, 486

Tardieu on digitalis, 502 ; on extraction of

the uterus, 139 ; on intestinal injury,

643

Tarenta on fecundity in the old, 39
Tarnier on postmortem Cesarean section,
136 ; on premature births, 68 ; on pro-
tracted pregnancy, 71 ; on vicarious men-
struation, 26
Tarrare, 41 1

"Tarred and feathered" persons, 743
Tartar emetic, untoward action of, 499
Taruffi on dipliallic monster, 198 ; on tel-

egouy, 89
Tasker on unconscious pregnancy, 72
Tatevosolf on hiccough, 813
Tattooing, 749 ; syphilis from, 751 ; tuber-
culosis from, 751
Tauri-Mauri Indians. 457
Taussig on (|uinin, 510
Taylor on diphallic terata, 195 ; on foreign
body in the eye, 532 ; on hanging, 519 ;
on human combustion, 426 ; on injuries
to the vagina. 691 ; on nostalgia, 876 ; on
protracted pregnancy, 70 ; on short preg-
nancy, 65; on sudden birth, 119; on
suspended animation, 513 ; on venesec-
tion, 709
Teale on hyperthermy, 422
Tears, anomalies of the. 384
Tecontjeif on varnishing the skin, 743
Tedford on separation of the ovary, 689
Teeth, absence of, 243 ; anomalies of, 242 ;
at birth, 242 ; in the bronchus, 616 ;
extraoral, 244 ; knocking out, 747 ; re-
plantation of, 728 ; supernumerary, 244 ;
swallowed, 639
Telegony, 86

Temperature, anomalies of, 421
Temple on snake-bite. 717
Tenia, 818

Terata, classification of, 167; double her-
maphroditic. 165 ; among the lower ani-
mals, 166 ; major, 161 ; minor, 213

Teratogenesis, 166

Teratology, early, 164; scientific, 165
Teratoscopy, 21.3

Terrier on ovariotomy in age, 707 ; on sple-
nectomy, 657

INDEX.

965

Terrilon on foreign body in the bladder,

077 ; on ligature of tlie liver, (554
Terry ou elephantiasis of the hand, 798
Testa on postmortem menstruation, 27
Testicles, anomalies of, 319 ; anomalous po-
sition of, 322 ; atrophy of, G87 ; avulsion
of, 686 ; death from a blow ou, 525 ;
ectopia of, 688; injuries of, 685 ; inver-
sion of, 323 ; operations on anomalous,
322 ; retraction of, 688 ; rheumatic atfec-
tion of, 688
Testut and Marcond^s ou anomalous lung,
285

Tetanus neonatorum, 817
Tenfard on vicarious menstruation, 20
Thalassophobia, 877
Thanatophobia, 879

Thatcher on delivery by a covs'-horn, 134
Thebault on sudden birth, 120
Thevenot on giants, 325 ; on postmortem
births, 124

Thibaut de Chauvalon ou fecundity in the
old, 39

Thiernesse on combined fetation, 57
Thiei-sch on self-nmtilation, 732 ; ou skin-
grafting, 731
Thigli, mamma on the, 301
Thilenius on twin birth, 142
Thimble in tlie nose, 565
Thin people, 363

Thirst, excessive, 404 ; lack of, 405
Thirteen children at a birth, 154
Thomas, Edith, 437

Thomas on a case of cut-throat, 577 ; on
fetal dentition, 242 : on fetal therapeutics,
92

Thonika on anomalies of the ossicles, 263

Thompson on bee-stings, 714 ; ou cardiac
injury, 618 ; on vesical calculi, 790

Thoinson on achondroplasia, 602 ; on der-
moid cyst, 202 ; on mycosis fungoides,
850 ; on thoracic defects, 284

Thoracic duct, wounds of the, 657

Thorax, defects of, 284 ; foreign bodies in,
613 ; injuries of, 606 ; transfixion of, 610 ;
peritonitis in, 613

Thorbuni on fetal tlierapeutics, 92 ; on in-
jury to the cervical vertebrae, 580 ; ou
laminectomy, 661

Thoresby ou proliiicity, 157

Thoringtou on the ocnl.ir instillation of
atropine causing epileptic convulsions,
853

Tliorincaa on protracted pregnancy, 70
Thornton on canities, 238 : on postmortem

birth, 124
Three-headed monster, 167
Thudicum on brain injury, 549
Thnml), supernumerary, 275
Thurman on alopecia, 227
Thurston on placenta ])nevia, 108
Thyroid gland, extirpation of the, 762 •

tumors of the, 761 '
Thyroidectomy, 762
Thyroid-Ceodiiig in obesity, 356
Tichotniroff on absence of tlie lung, 285
Tickling to deatii, 524
Tidd on protracted pregnancy, 70
Tietze ou plexiform neuro-fibroma, 771

I Tiffany on injury daring pregnancy, 100,
103 ; on operations during pregnancy,
104, 105 ; on sarcoma, 777
"Tigretier," 854

Tilanus on hemihypertrophy, 350

Tilesius on liglitning stroke, 726

Tillaux on cardiac injury, 621

Tillet on heat, 425

Tinea nodosa, 849

Tinnitus auriuni, objective, 538

Tissot on somnambulism, 864

Titorier on rupture of the intestines, 645

Tizzoui on splenectomy, 657

Tocci Brothers, 186

Toes, supernumerary, 273

Toft, Mary, 163

Tolberg on conception with hymen integ-
rum, 41

Tolerance of drugs, 497

Tolifree on death from the wind of a can-
non-ball, 526

"Tom Thunil)," 342

Tomes on edentula, 243

Tomlinson on maggots in the nose, 564

Tommassini ou constipation, 794

Tompsett on absence of the kidney, 293,
on foreign body in tlie rectum, 646

Tongue, abnormal mobility of, 255 ; anky-
losis of, 255 ; artificial, 566 ; bifid, 255 ;
congenital absence of, 254 ; foreign body
in, 566 ; Jiair on, 256 ; hemiatrophy oi",
860; hypertrophy of, 566; injuries to,
565 ; large, 256 ; restitution of, 565 ;
speech without a, 254, 566 ; supernumer-
ary tongue, 255

Tongue-sucking, 565

Tongue-swallowing, 565

Tool-box in a convict's rectum, 647

Tooth in the larynx, 581, 582 ; in the nose,
244 (see Teeth)

Tooth-brush swallowed, 640 ; -handle in the
bladder, 677

Toplunn, Tliomas, 465

Torreau on anomalies of the ossicles, 263

"Totemism," 494

Touch, idiosyncrasy through the sense of,
488 ; perversion of the sense of, 875 '

Tousey on foreign bodv in the arm, 600

Townsend on bloodless laI)or, 123 ; on vis-
ceral hemorrhages in the new-born, 817

Tozzetti on ovarian cyst, 782

Trachea, Ibreign body in the, 580 ; wounds
of the, 575

Tracheotomy tube in the bronchus, 615

Trance, S67 ; deliverv during a, 114

Transfixion of the abdomen, 648 ; of the
brain, 545 ; of the thorax, 610

Trans] )osit ion of the viscera, 291

Tranbe on digitalis, ,502

Travers on wound of the stomach, 632

Trazegines, Jiimily of, 154

Trelat m\ hemihypertrophy, 350

Tremaine on arrow-wounds, 712

Treves on the "eleidiant-man," 827

Triceps tendon, rupture of the, 593

Trichinosis, 820

Tricomi on ligature of the liver, 654 • on

splenectomy, 657
•Trioen on injury to the crystalline lens, 533

966

INDEX.

Tripe on priapism, 684
Triple dentition, 243
Triple ectopic section, 57
Triple monsters, 167
Triplets, 148 ; repeated, 146
Troislontaiues on gangrene of the penis,
682

Tronipert on injury to the vagina, 690
Tnbby on suppression of the digits, 273
Tuberculosis, 913 ; from tattooing, 751
Tucker on supernumerary legs, 269
Tuffier on pneumonectomy, 608
Tufnell on multiple fractures, 702
Tuke on protracted sleep, 868 ; on somnam-
bulism, 865
Tulpius on anomalies of the nails, 241 ; on
deficient urethra, 317 ; on obesity, 352 ;
on perverted appetite of pregnancy, 80
Tumors, 759 ; coexisting with pregnancy,
106

Tupper on worms in the bladder, 676

TurnbuU on ascarides in the ear, 820

"Turtle-man," 84, 267
Turtle- woman," 267

Tweedie on conception with imperforate os
uteri, 41

Twelve children at a birth, 154

Twiggs on tapeworm, 818

Twin pregnancy, abortion in, 110

Twins, 148 ; borne by aged women, 40 ;
borne by a child-mother, 38 ; delivered
by Cesarean section, 129 ; of different
colors, 48 ; interval between the birth of,
142 ; morbid sympathy of, 887

Twitchell on sudden birth, 119

Two-headed animals, 166

"Two-headed Nightingale" (Millie-Chris-
tine), 179

Tyler on exophthalmos, 527

Tympanum, auomalies of, 263 ; perforation
of, 539 ; by ascarides, 820 ; rupture of, 537

Tynberg on a monster, 180

Typhus fever, 910

Tyson on multiple ureter, 294

U.

Umbilical calculi, 792

Umbilical cord, anomalies of, 109 ; knots
in, 109

Umbilical hernia, 662

Underbill on pseudocyesis, 78

Untoward action of drugs, 496

Ureter, anomalies of, 294 ; catheterization
of, 670 ; operations on, 669 ; penetration
of' 670 ; rupture of, 668, 669 ; stricture
of, 66J) ; transplantation of, 669

Ureterocystoneostomy, 669

Urethra, anomalies of, 317 ; calculus in,
791 ; duplication of 317 ; foreign bodies
in, 676 ; menstruation from male, 27 ;
passage of excrement through, 675 ; rup-
ture of, 679 ; slitting of, 754 ; stricture of,
680

Urination, anomalous, 383

Urine, retention and suppression of, 792

Urster, Barbara, 229

Usher on short pregnancy, 66

Uterus, absence of, 311 ; accidental extrac-
tion of, 139 ; anomalous positions of, 313 ;
bipartite, duplex, etc., 311 ; double, 311 ;.
tibrocyst of, 781 ; foreign body in, 695 ;
hernia of, 313 ; prolapse of, in labor, 140 ;.
rupture of, in pregnancy, 137 ; tumors of,
780 ; successful removal of, without inter-
rupting pregnancy, 106

Uvula, auomalies of, 256

V.

Vaccination, 906

" Vagabond's disease," 941

Vagina, absence of, 303 ; anomalous open-
ings of, 305 ; double, 304 ; excrement
from, 675 ; foreign bodies in, 692 ; injuries
of, 689 ; sloughing of parietes of, 691 ;
spontaneous rupture of, 138 ; transverse
septa of, 305

Vale on twin births, 143

Valentini on abortion, 110; on conception
during sleep, 45 ; on diphallic terata, 195

Valerian von Meister on regeneration of the
liver, 655

Valerius Maximus on postmortem birth,
125

Vallentini on living cyclopia, 258
Vallisneri on anomalous urine, 383 ; on

birth by the rectum, 121 ; on double

uterus, 311
Valsalli on sextuplets, 152
Van Bibber on birth in the membranes^

123 ; on superfetation, 48
Van Buren on supernumerary liver, 290
Van Buren and Keyeson diphallic monster,

196 ; on elephantiasis of scrotum, 802
Van Cuyck on anomalous esophagus, 284
Van der Veer on precocious menstruation,

31

Van Duyse on macrostoma, 253
Van Helmont on pygmies, 333
Van Owen on longevity, 375
Van Wy on dropsy, 786
Vanderpool on fracture of the odontoid pro-
cess, 578

Vanderveer on intrauterine fracture, 97

Vanini on telegony, 89

Vanmeter on skin-grafting, 729

Vanzetti on preputial calculi, 791

Varicella in the fetus, 91

Varicose veins, 778

Variola, 903 ; in the fetus, 90

Variot on lactation in infants, 392

Varnishing the skin, 743

Vassilet, Fedor, 156

Veazie on fracture of the penis, 679

Veit on multiple births, 148

Velasquez of Tarentum on protracted men-
struation, 33

Velpeau on diphallic monster, 196 ; on
fetus in fetu, 201 ; on polyphagia, 638

Venesections, extensive, 709

Venette on polyorchism, 320

Ventriloquists, 453 ; in China, 454

Vepan on quinin, 509

Verdile on pregnancy with hymen integ-
rum, 42

INDEX.

967

Verdu(! on injury during pregnancy, 98 ; on

vicarious ineustruatiou, 25
Verhie.ifhe on avulsion of the eye, 527
Venniform appendix, foreign body in the,

Verneuil on double monster, 317
Veronden on postmortem Cesarean section,
l;}7

Verrier on traninatisiu in pregnancy, 101
Vertebrtu, anomalies of tlie, 277 ; fracture

of the lower, G59 ; of the upper, 578 ;

transposition of the, 277
Vesalius on male menstruation, 28
Vesey on amputation dni iug pregnancy, 105
Vesliugius on postmortem birth, 12(>
Vespr6 on rupture of the uterus, 137
Vesti on abortion, 110 »
Vicarious menstruation, 18 : in the male,

28

Vicat on bearded women, 228

Vic(i d'Azir on absence of the vagina, 303

Victor on ascarides, 819

Vidal on fetal variola, 90 ; on horns, 224

Vieussens on hypertrophied liver, 655

Villemin on premature birth, 6G, 67

Villerm6 on anomalous coloration of the

hair, 240 ; on hirsuties, 233
Vincent on death from shock, 526
Vinnedge on multiple fractures, 702
Virchow onchondromata, 767 ; on hermaph-
roditism, 210 ; on human tails, 278 ; on
megalocephaly, 805 ; on microceijhaly,
248 ; on neuro-fibroma, 770
Virey on a dwarf, 341

Viscera, inversion of the, 166; transposition

of the, 291
Vite on cardiac injury, 619
Vocal bands, web of the, 256
Vogel on avulsion of the finger, 589
Voice, double, 257

Voight on longevity, 374 ; on supernumer-
ary digits, 274 ; on triple uterus, 313
Voigte ou horns, 224

Vomiting producing exophthalmos, 527 ;

causing rupture of the esophagus, 628 ;

of urine, 384 ; voluntary, 630
Von During on sclerodactylia annularis ain-

humoides, 832
Von Langenbeek on phenol, 498
Von Mayr on proliticity, 145
Von Quast on tumor of the pregnant uterus.

107

Vos on presentiment of death, 890

Vosberg on vesical calculi, 790

Voss on foreign body in the ear, 542

Vulpius on splenectomy, 656

Vulva, deficient, 303 ; neuroma of the, 771

w.

Wadham on aphasia, 873

Wagner on prolapse of the uterus, 140 ; on

suddeu birth, 117
Wagstaffe on horns, 226
Wainwright on injury during pregnancy.

Wakefulness, 863

Walford on longevity, 365 ; on multiple
birth, 153, 155 ; on prolificity, 157 ; on
spontaneous human combustion, 428
Walker on precocious pregnancy, 37
Wall on precocious menstruation, 30
Wallace on fecundity in the old, 39 ; on
quadrui)le amputation, 597 ; on rupture
ol' the abdominal parietes from coughing,
666

Waller, David, 492

Wallick, statistics of fetal imeumonia, 91
Walsh on arsenic, 500

Walter ou postmortem Cesarean section,
137

Walters on accidental extraction of the pel-
vic organs, 139

Walther on injury during pregnan(!y, 98 ;
on retention of the ectopic fetus, 63

Walton on urethral calculi, 791

Ward on dermoid cysts, 205 ; on rupture of
the kidney, 668

Waring on rhinolith, 564

Waruer ou precocious menstruation, 30 ; on
precocious pregnancy, 34 ; on super-
numerary auricle, 261

Warren, Charles, 473

Warren on aneurysm, 779 ; on anomalous
growth of bones, 605 ; on enchondroma,
768 ; ou fracture of the spine, 659 ; on
horns, 227 ; on hypertrophy of the breast,
760 ; on large infants, 348 ; on multiple
births, 155; ou " uoli-me-tangere, " 772;
on orbital injury, 531 ; on tumors of the
thyroid, 761

Warrington on self mutilation, 735

Wart-grafting, 730

Washington on leg-injur}', 593

Water-closet, birth in a, 120

Watering on multiple birth, 153

Watkins on death from shock, 525 ; on
human combustion, 426 ; on retention of
ectopic I'etus, 63

Watson on letal variola, 90 ; on foreign body
in the orbit, 531 ; on rupture of the ure-
thra, 679 ; on stricture of the ureter, 669

Webb, Captain, 461

Webb on aneurysm, 779 ; on maternal im-
pression, 8.3

Webber on epilepsy, 852

Weber on anomalous seminal vesicles, 323

Wedders, Thomas, 253

Wegelin ou postmortem birth, 124

Wehrle, Felix, 217

' ' Weichselzopf, ' ' 848

Weil on dermoid cyst 204

Weill on delivery during sleep, 115

Weinlechner on intrauterine amputation,
94

Weismann on telegony 86

Welch on hyperthermy, 423

Wells on dipygus, 194 ; on ovariotomy in
age, 707

Wendt on fetus in fetu, 201

Wenyon on foreign lK)dv'in the orbit, 530

Werder on ectopic fetus, 62

Werner on the funis, 109

West ou multiple fractures, 702 ; on spora-
dic cretuiism, 807

Westergaard on multiple births, 147

968

INDEX.

Westmoreland on multiple fractures, 701
Westphal on unusual birth, 1:20
Wetmoie on injury during pregnancy, 100
Whaley on dipygus, 194
"Wharton on foreign bodies in the brain,

5()1 ; on triple amputation, i^M
AVheat tlour, idiosyncrasy to,
Whmery on cond)ined I'etation, oG ; on rup-
ture of the uterus, 137
White on chromidrosis, 886 ; on discharge
of the fetal bones, 53 ; on lisli in the
pharynx, 5()8 ; on foreign body in tlie loot,
600 ; on foreign body in the intestines,
641 ; on lanunectomy, 661 ; on syphilis,
913 ; on tapeworm, 818 ; on vicarious
menstruation, 25
Whitehead on protracted menstruation, 32 ;

on wound of the liver, 653
Whitelaw on ischuria, 793
Whiteside on foreign body in bladder, 677
AVliitney on ectopic gestation, 54
Wicrski', 329

Wiglit on super fetation, 49
Wilcox on double vagina, 305

Wildberg on twin birth, 142

'• Wild-bovs," manufacture of, 448

" Wild-man," 232

Wilks on lightning-stroke, 725

Will on avulsion of the arm, 591

Willard on hiccough, 812 ; on infantile
spinal paralysis, 604

Willett on gangrene of the penis, 682

Williams on alopecia, 227 ; on foreign body
in the eye, 532 ; on obesity, 353 ; on pre-
cocious pregnancy, 37 ; on rupture of the
eso])hagus, 628 ; on tattooing, 752 ; on
wound of the spleen, 656

Willoughby on birth in the membranes,
122 "on postmortem births, 125 ; on sud-
den birth, 116

Wilson on abortion in twin pregnancy. 111 ;
on Idoody sweat, 391 ; on brain-injury,
549 ; on chromidrosis, 386 ; on ectopic
gestation, 58 ; on epistaxis, 534 ; on ec-
topic fetus, 53 ; on gastrotomy, 638 ; on
hair, 234 ; on horns, 223 ; on iscburia,
793 ; on precocious pregnancy, 37 ; on
rudimentary penis, 315 ; on rupture of
tympanum," 537 ; on sudden birth, 119

Wiltshire on gynecomazia, 396 ; on rupture
of the vagina, 138

Winckel's disease, 816

Winn on coitus, 511

Winslow on parasitic terata, 191

Winterbotham on foreign body in ear, 541

Wintbier on merycism, 862

Woakes on " ear sneezing," 815

Wolf-children, 444

Wolft" on antepartum crying, 128

Wolffius on precocious pregnancy, 35

Wolfiuson postmortem birth, 126

Wolfler on tumors of the thyroid, 761

Wood on croton oil, 504 ; on ergotism, 502 ;
on opium, 506 ; on premature rupture of
ietal membranes, 108; on strychnin, 510

Woodbury on transfixion of the abdomen,
649

Woodman on oxalic acid, 499 ; on poly-
mazia, 302

Woodruff on precocious menstruation, 31

Woods on precocious boys, 346

Woodson on inversion of the uterus, 140 ;^

on twins in the secundines, 123
Worbe on hermapbroditism, 208
Wordsworth on absence of the eyes, 257 ;

on foreign bodies in the orbit, 531
Worms, 818 ; in the bladder, 676 ; in the

ear, 538; in the fetus, 111, 112; in the

heart, 24 ; in the nose, 563, 821 ; in the

uterus. 111
Wrench on simulated symptoms, 583
Wright on epistaxis, 535 ; on rupture of the

heart, (525

Wrisherg on birth in the membranes, 122
Wroe on horns, 222
Wulf. on obesity, 353
Wunderlich on hyperthermy, 422
Wunschheiin on" rupture of the stomach,
629

Wygodzky on coiling of the funis, 96
Wyman on terata, 166
Wynter on longevity, 379

X.

Xeroderma pigmentosum, 842

Y.

Yale on pregnancy with unruptured hymen,

42

Yarrow ou poisonous snakes, 715

Yavorski ou niorphin, 506

Yaws, 839

Yellow fever, 910

Yellowlees on somnambulism, 866

Yonge on chromidrosis, 386

Youmans on telegony, 88

Young on fetus in ietu, 200, on injury to
the pericardium, 624 ; on superfetation,
48 ; on transposition of the viscera, 291

Ysabeau on late dentition, 243

" Yung-ti" sheep, 261

Z.

Zacchias on conception with liymen intact,
40 ; on protracted pregnancy, 68

Zacutus Lusitanus on chromidrosis. 385 ;
on horns, 222 ; ou a leech in the nose,
563 ; on male menstruation, 28 ; on pri-
apism, 683 ; on torsion of the penis, 316 ;
on vicarious menstruation, 25, 26

Zarete, Lucia, 343

Zeidler on wound of the liver, 653

Zesas on gastrostomy, 644

Zeuner on pedestrianism, 459

Ziemssen on na?vus pilosus, 233

Zi liner on wound of the aorta, 626

Zoo])hobia, 880

Zuboldie on delivery by a cattle-horn, 133
Zuccarelli on splenectomy, 657
Zuhmeister ou loreign body in uterus, 695
Zweifel on repeated Cesarean section, 130
on symphysiotomy, 141

STANDARD

MEDICAL, SURGICAL,

AND

HYGIENIC WORKS

PUBLISHED BY THE

REBMAN PUBLISHING COMPANY, Ltd.,

11, ADAM STREET, STEAA^B,
LONDON.

Ret^istered Teh'^raphic Addrc^^ ... ... " SQUAMA, LONDON."

THE RKBMAN PUBLISHING COMPANY in presenting this Price List to the
profession wish to state that for the sake of easier supervision they have
classified their publications under the heads of the following Sections :— Section A :
"BLUE COVER SERIES"; Section B: "Minor Publications RECENTLY
ISSUED " ; Section C : " Miscellaneous Publications " ; Section D : " Periodi-
cals"; Section E: "Specialities."

A double Index facilitates reference to the names of authors or the subjects of
the books.

The works enumerated under Section "A" are nearly all of uniform size and
make a very handsome library, treating as they do on the principal topics of
Medicine and Surgery. Most of them have been adopted as text-books at various
Schools and Universities, or are recommended by the teachers for the use of
students. They are sold by Subscription, and may be obtained through the Com-
pany's Representatives, or direct from the Company's Offices by remitting the
(juoted prices with the order. (See also foot note after Section A.)

Specimens of the plates, the illustrations, the text, and the binding will bs
shown to those who wish to see them, for which reason the Directors trust that the
Members of the Profession generally will extend the courtesy of granting an inter-
view to the Company's Representativps when thev call.

.lAsuAKV, ^' HEBIWAN,

MANAQINO DIRECTOR.

CLASSIFIED INDEX.

'I'lu- Books iTiavked * belong to the Blue Cover Series.
tf^^ See notice on page 9.

I'AGE

.. 16

Analysis.

BARKF.R SMITH ...

Bacteriology.

H1SENBERG ~ Bacteriological

Diagnosis ... ... 14

Chemistry.

ROBINSON and CRIBB — Law and
Chemistry of Food and Druors ... 12

Children.

*S'l'ARR— Diseases of Cliildren ... 7
CAPI»— The Daughter ... 14

*ROSS — Intestinal Intoxicilion ... 7

Diagnosis.

•*VlERORDT— Medical Diagnosis 8
I'URDY — Uranalysis and Urinary
Diagnosis ... ...11

Ear.

MYGIND— DeaL-Mutism .. 11

YEARSLEY— Injuries and Diseases
of the Ear ... ••• i.^

Electricity.

BIGELOW— Electro-Therapeutics 13

Embryology.

MANTON— Embrjology ... 15
Eye

JENNINGS — Colour Vision and

Colour Blindness ... ■■• »o

Fevers.

ESllNER— Handbook cr. ... 14

Genito-Urinary.

ULTZMANN — Neuroses of the
Genito-UrinarySysleinl.'l"rans'ated) i;;

Gynecology.

*BALD\— Gynecology .. 4

*SUTTON and GILES— Diseases of
VVonien ... •••7

Hygiene.

ROHE— Hygiene ... ... I?

MOORE — Meteorology ... 1 1

THRESH— Water Supplies ... 13
ROBINSON and CRIBB — Food

and Drugs ... ... 12

Life Insurance.
KEATING — Hew to examine for
Life Insurance ... ... 10

Materia Medica and Thera-

peuticjj.

SHOEMAKER— Materia Medica ... 13
* WARREN — Surgical Pathology
and Therapeutics ... ... 8

Medical Jnrisprudence. pace

^HAMILTON— System of Legal
Medicine ... ... 5

Medicine.

*GOULD— Year Book of Medicine 5
*PEPPER — 'I ext Book of Practice

of Medicine ... ... 6

SAjOUS — Annual of the Univjersal

Medical Sciences ... ... 15

Meteorology.

MOORE— Meteorology ... 11

Miscellaneous.

CATHELL— The Physician Himself 14

FIREBAUGH— Physician's Wife... 14

JAMES— Alaskana ... ... 14

THRESH— Water Supplies ... 13

Nervous Diseases.

EDINGER— CentralNervousSystem 14

Obstetrics.

GRANDIN and J ARM AN— Obstet-
ric Surgery ... ... 9

GRANDIN anil .| ARM AN— Preg-
nancy, Labour, and the Puerperal
State ... ... ••• 'o

»NOKRIS and DICKINSON— Text
Book of Obstetrics... ... 6

Pathology.

BOUCHARD and OLIVER— Auto-
intoxication ... ... 9

♦WARREN— Surgical Pathology .. 8

Phthisis.

lARUN'IOWSKY and BEALK —
Private Sanatoria for Consumptives
(Translated) ... .,10

Physiology.

SMl'ITl— Physiology oT the Domes-
tic Animals ... ... ' 5

i *1!0WKLL— Text Btiok of ... 5

I Skin.

j *PRINGLE — Skin Atlas, Saint
j Louis Hospital (Paris) ... 4

BURET— History ofSyphilis(Trans.) 9

Surgery.

GRANDIN and J .\R MAN— Obstet-
ric Surgery ... ... 9

*KEEN and W HITE— Text Book of U

MANLEY— Hernia ... ... 15

ROWLAND-Archives of Skiagraphy 16

SENN — Principles of Surgery ... 12

SENN— Syllabus of Surgery ... '2
*SUTTON and GILES— Diseases of

Women ... ... 7

♦WILSON— Applied therapeutics 8 ' *WARR EN— Surgical Pathology... -S

Veterinary. page

IIUIDKKOPFH — Age of the
Doniesiic Animals ... ... 14

SMITH— Physiology of the Donies-

Throat and Nose.

1 0 A 1. a nd WO L FKN I ) f-;N— Kespi ra-
tion in Singing ... ... 10

journal of laryngology, Rhinology,
and Otology ... ... 16

Transactions of the British T.;iryngo-
logical Association ... "... 15

Urine.

PURDV— Uranalysis, and Urinary
Diagnosis . . ... 1 1

Section A: "BLUE COVER SERIES."

I'At;!-:

tic.Animals

Specialities.

Pure Calf Lymph
Kapid Analysis

'5

16
16

BALDV— (.Mice, logv

GOULD— Yearbook ...

HAMIL'ION— Forensic Medicine..

HOWELL— Physiology

KEEN and WHITE— Surgery

NORRlSand DICKINSON — Ob&tet
rics ;..

PEPPER— Medicine ...

6 VIEHORDT— Medical Diagnosis
6 WARREN— Surgical Pathology .
WILSON — Applied Therapeutics .

Section B : MINOR PUBLICATIONS RECENTLY ISSUED-

PRINGLE- Atlas of Skin Diseases

(Saint I.ouis Hospital, Paris) ... 4
ROSS — Intestinal Intoxication ... -
STARK— Diseases of Children ... 7
SU TTON and GILES- Diseases of
Women

BO UC H A R D — A uto-In to x icatio n

BURE'i— History of Syphilis ' ...

GRANDIN and J A KM AN— Obstet-
ric Surgery

GRaNDIN and .jARMAN — Pieg-
nancy, Labour, and the Puerperal
State

.lARUNTOWSKV and BEALE —

Sanatoria
.lENNINGS— Colour Vision ..
.|OAL and WOLFENDEN- Respira-

tion in Singing

PA 01

1 o

10
10

1 o

KEATING — Life Insurance
MOORE— Meteorology • •
MYGIND— Deaf-Muti'sm
PURDY— Uranalysis ...
ROBINSON and CRIBB — Law and

Chemistry of Food ...
SENN — Principles of Surgery
SENN — Syllabus of Surgery
SHOEMAKER— MatiriaMedica.&c
THRESH— Water Supplies
YEARSLEV — Injuries and Diseases

of the Ear

... 8
.. 8
.. 8

PAGE
.. 10
.. I I
,. I I
I

Section C: MISCELLANEOUS PUBLICATIONS.

1 2
1 2
1 2

1.3

PAGE

BIGELOW — Electro-Therapeutics
CAPP-The Daug-hter ... ,4

CATHELL— Physician Himself ... 14

EISENBERG— Bacteriological Diag-
nosis ... ... J ,

EDINGER— Central Nervous Sys-
tem

ESHNER— Fevers
Fl R E B A U G H — Phy sicia n 's W if e

'4
14
'4

VACE

H Ul I) E KO PE R— A ge of the Dotties- -

Section D

tic Animals
.lAMES— Alaskana ...
MANLEY— Hernia ...
MANTON— Embryology
SAJOUS—Annual ,[[
SMITH— Physiology of the Domes-
tic Animals

UL'IZMANN-NeurosVs of Genito-
urinary System

PERIODICALS.

'4
'4

PACi !■:

Archives of Clinical Skiagraphy .. 16
Transactions of the British Laryngo-
logical Association ...

.lournal of Laryngology, Rhinologi,*' '^

and Otology

Rapid Analysis

Section E : SPECIALITIES.

Vaccine ...

PACK

. i(>

16

PAGE
... 16

4

Section A.—" Blue Cover Series."

A Pictorial Atlas of Skin Diseases and S3rphiliti<j AfP^c-

ti< ns. In photo-Vithochromes from nio.lds m tlie Museum oT the Saint Louis
Hospital, Paris ; with explanatory woodcuts and text, by K. Besnier, A. Four-
nier, Tenneson, Hallopcau, Du Castd, Henry Feulard, ^nd L. jacquet.
Authorised Enelish Translation edited by j. J. Pnngle, M.B., h. K.L.I. ,
Physician to the Department for Diseases of the Skin at the Middlesex Hospi-
tal, London.

This Atlas is published in 12 Parts, containing altogether 50 full-page Photc-
Lithochromcs taken from the famous Baietta Collection in tlie Museum of the Saint
Louis Hospital at Paris. The illu.strative woik is executed by the mostskiltul
Parisian artists. The coloured plates are accompanied by explanatory woodcuts,
wherever advisable, and by four to five pages of text, printed in hnglish type on
super- calendered paper of imperial 410. Price IDs. 6d. net per Fart.

"... By those who have fiad the advantage of seeing the Museum of the
Hospital, and especially the wonderful casts of morbid conditions of the skin by
Baretta, the opportunity of being reminded of their visit to the French centre of
dermatology will be much valued. In addition, this work promises to be a
valuable illustrated text-book of skin diseases. The Knglish edition is annotated
and superintended by Dr. |. J. Pringle, a guarantee that every care has been devoted
to this part of the work."-Br/^. Journal of Dermatologv.

" . . . It is truly an international work, which bids fair to n:ark an epoch in the
study of skin diseases."— Medical Journal.

.We have no hesitation in cordially recommending it to the favourable
notice of our readers as one of the finest dermatological Atlases wi.h which we are
acqua:miti\:'—Glasguiv Medical Journal. t , j •

'< One cannot express too much admiration for this beautiful ar.d inexpensive
Ai\as."—Edinburgli Medical Journal.

* Specimen Plate and Text will be forwardea
upon application free of change.

(# The above two Hues are printed in English Type, as used in the Text.)

BALDY— Gynecology (Medical and Surgical). Edited by J. M.
n V M D assisted hv Ilenry T. Bxford, M.D., Edwin Cag.n, M.D.. .]. H.

Krug E. E. Montgomery, M.D., William R. Pryor, M.D., and George

M. Tuttle, M.D.

One imnerial 8vo volnme. 360 illustrations (mostly original) in text and 37
coloured a'nd half-tone plates. Cloth. 800 pp. Price 34s.

The work is essentially of a practical character. It is well printed and
beautifully illustrated, and will be more especially valuable as a work of reference.

-{r""'"^' nature of the text may be judged from its authorship ; the distin-

cruished American authorities wfio have compiled this publication have done their

work well No undue importance is given to major operations, pessaries, oreccen.

worK wen. 1 "—British Medical Jouynal.

„c ,herap=u c mea,ur^.^.^^ an. comprehensive „„1, and we ihink Mly

emitled' to the place cUiraed tor « by the authors."-B.7(:s* Gy,<,,,lce,cal

Journal.

CK>UL]>— Tear-book of M«dioina and Surgery, 1896. ^^j.

lected and arranged by eminent Specialists and Teachers, under the editorial
charge of George M. Gould, M.D.

List of contributors '.—William Pepper, M.D., Alfred Stengel, M.D., William W.
Keen, M.D., J. Chalmers Da Costa, M.D., Barton Cooke Hirst, M.D., W. A. N.
Dorland, M.D., ,(. M. Baidy, M.D., Louis Starr, M.D., Thompson S. Westcott,
M.D., Archibald Church, M.D., Hugh j. Patrick, M.D., William A. Hardaway,
M:D., C. Finley Hersman, ^LD., Virgil p". Gibney, M.D,, Homer W. Gibney, M.D.,
Howard F. Hansell. M.D., Charles F. Clark, M.D., Charles H. Burnett, M.D., E.
Fletcher Ingals, M.D., T. Melville Hardie, B.A., M.B., John Guiteras, M.D., David
Riesman, M.D., Henry A. GrifHn, M.D., Van Horne Norrie, M.D., C. A. Hamann,
M.D., G. N. Stewart, M.D., Henry Leffmann, M.D.

One vol., imperial 870, 1183 pp., profusely illustrated with numerous wood-
cuts in text and 33 handsome half-tone and coloured plates. Cloth, 38s.

"... It is difficult to know which to admire most— the research and industry
of the distinguished band of experts whom Dr. Gould has enlisted in the service of
the Year Book or the wealth and abundance of the contributions to every depart-
ment of science that have been deemed worthy of analysis. ... It is emphatically
a book which should find a place in every medical library." — Lancet.

" It is a work of reference of the highest order, and not a literary review of all
published matter," — Jounial of Laryngologij.

KAMILTOir— A Syetem of Legal Uedicine. gy

McLane Hamilton, M.D., Consulting Physician to the Insane Asylums of New
York City, etc., etc., and Lawrence Godkin, Esq., of the New York Bar.
Widi the collaboration of Prof. James F. Babcock, Lewis Balch, M.D., Judge S.
E. Baldwin, Louis E. Binsse, Esq., C. F. Bishop, Esq., A. T. Bristow, M.D., B. f",
CardozQ, Esq., C. G. Chaddock, M.D., A. F. Currier, M.D., C. L. Dana, M.D., Geo.
Ryerson Fowler, M.D., W. T. Gibb, M.D., W. S. Haines, M.D., F. A. Harris, M.D.,
W. B. Hornblower, Esq., Chas. Jewett, M.D., P. C. Knapp, M.D., R. C. McMurtric,
Esq., C. K. Mills, M.D., J. E. Parsons, Esq., C. E. Pellew, E.M., Judge C. E. Pratt,
W. A. Purrington, Esq., B. Sachs, M.D., F. R. Sturgis, M.D., Brandreth Symonds,
M.D., V, C. Vaughan, M.D.

Illustrated with 14 coloured plates and 161 woodcuts and half-tone plates.
Fully indexed by 3,202 references. Royal 8vo, 2 Vols., pp. 1400. SOs. per
volume. Only sold in sets.

In these two volumes we have a work which covers the whole ground of medical
jurisprudence, and in which the different parts of the subject arc treated wi»h fair
ability and success by thirty different writers, some medical and others Iciral."— 77je
Times. **

$^ {JUST ISSUED.)
HOWELL— Fhyeiology. ^ ,

Bjr By Henry ]M3owduch, M.D., Professor
of Physiology, Harvard Medical School; John G. Curtis, M.D., Professor of
Physiology, Columbia University, N.Y. (Coll. of Phys. and Surjj.) : Henry H
Donaldson, Ph.D., Hea<i Professor of Neurolcgy, University of Chicago ;
W. H Howell, Ph.D., M.D., Professor of Physiology, Johns Hopkins Univer-
Mcy ; Frecenc S. Lee, Ph.D., Adjunct Prof. Physiology, Columbia University,
N Y. (Coll. o Phys. and Surg.); Warren P. l.ombant, M.D., Professor of
Physio ogy University of Michigan ; Graham Lusk, Ph.D., Professor of
Physiology. Yale Medical School ; W. T. Porter, M.D., Assistant Professor of
Physiology, Harvard Medical School ; Edward T. Rcichert, M.D., Professor
of Ihysiology, University of Pennsylvania; Hcnrv Scwall PhD MD

I'rofessLi ut Physiology, Medical Uepatliueiit, University ot Dsnvei. tdited.
by William H. Howelf, Ph.D., M.D., Professor of Physiology, Jolnis Hopkins
Universitv.

This work is Uic most notable attempt yet made hi America to combine in one
volume the entire subject of Human Physiology by well-known teachers
who have given especial study to that ))art of the subject upon which they write.
The completed work represents the present status of the science of IMiysiology,
particularly from the standpoint of the student of medicine and of the medical
practitioner.

The main divisions of the subject-matter are as follows: General Physiology of
Muscle and Nerve— Secretion- Chemistry of Digestion and Nutrition— Movements
of the Alimentary Canal, Bladder, and Ureter— Blood and Lymph— Circulation —
Respiration — Animal Heat— Central Nervous System — Special Senses -Special
Muscular Mechanisms— Reproduction— Chemistry of the Animal Body.

One Volume comprising 1,052 pages. Price, Cloth, 34s.

(JUST ISSUED. NEIV EDITION.)
KEEN and WHITE -A Textbook of Surgery. j^y chas. H.

Burnett, Phineas S. Conner, F. S. Dennis, W. W. Keen, Chas. B. Nancrede,
Koswell Park, F. ). Shepperd, L. A. Stimson, Wm. 'I'homson, J. C. Warren,
and ]. W. White. Edited by Wm. W. Keen. M.D., LL.D., and j. Wm.
W^hite, M.D.. Ph.D.

Extract from the London Lancet :— " If this textbook is a fair refiex of the present
position of Ameiican surgery, we must ad Tiit it is of a very high order of rherit,
and that English surgeons will have to look very carefully to their laurels if they
are to preserve a position in the van of surgical practice. . . ."

New revised and enlarged edition with appendix on X rays with special
plates. 2 volumes. Imperial 8vo, of about 700 pages each. Illustrated with
over 500 woodcuts in text, and 37 full-page coloured and half-tone plates.
Cloth. Complete, 42s.

NORRIS and DICKINSON -Obstetrics. j/^iled by R. C.
Norns M.D., and R. L. Dickinson, M.D. (Art Editor). Contributors: J. C.
Cameron, ISLD., E. P. Davis, M.D., C. W. Earle, M.D., j. H. Etheridge, M.D.,
H I Garrigues, M.D.. B. C. Hirst, M.D., C. jewett, M.D., H. A. Kelly, M.D.,
C. b. Palmer, M.D., T. Parvin, M.D., G. A. Piersol, M.D., E. Reynolds, M.D.,
and H. Schwarz, M.D.
The object of the work is to exemj)lify practical obstetrics, to represent the latist
advances in the science, and to elucidate the best modem methods oj procedure. The
more conspicuous feature of the treatise is its wealth of illustrative matter. It
will easily redeem its claim as the most sumptuously illustrated work on obstetrics

In^ two'^parts, Imperial 8vo, of about 600 pages each, with many illus-
trations in the 'text, and 56 full-page half-tone anji coloured plates, Cloth.
Price complete, 42s.

PEPPER A Treatise on the Theory and Practice of Medi-
cine Edited by Wm. Pepper, M.D.
List ok Autiiohs.— J. S. Billings, M.D., Hygiene. Francis Delaf^cld, M.D.,
Kidneys and Lungs. R. H. Fitz, M.D., Peritoneum, Liver, and Pancreas. James
W Holland M b., Urine. E. G. Jancway, M.D., Heart, Aorta, Arteries, and Veins.
Henry M Lyman, M.D., Diathetic Diseases. William Osier, M.D., Blood and
Suleen William Pepper, M.D., Fevers, Pharynx, ^:sophagus. Stomach, and Intes-
tines *W (iilmr.n Thompson. M.D.. Tulierculo.sis, Saofula, Syphilis. Diphtheria,

Erysipelas, Malaria, Cholera, and Yellow Fever. W. H. Welch, M.D., Inflamma-
tion, Embolism, Thrombosis, Fever, and Bacteriology. James 'I". Whittaker, M.D.,
Scarlatina, Measles, Kotheln, Variola, etc. James C. Wilson, M.D., Air Passages
and Pleura. Horatio C. Wood, M.D.. Nervous, Muscular, and Mental I>iseases.

In two Imperial 8vo volumes of 1000 pages each. Illustrated with wood-
cuts and full page coloured and half-tone plates. Price SOs. per volume.

" It is written in a thorougiily scientific as well as practical spirit. . . . It is not
only thoroughly up to date, but produced by writers wlio are known for their clinical
acumen and pathological learning, and will, without doubt, be studied as widely in
this country as in the land of its production,"— L««c^/.

" 'I'he articles are written in a practical spirit, and fairly reflect the present state
of medical knowledge." — British Medical Journal.

" We are glad to welcome the second volume of a work which represents truly
fhe best teaching of the science and art of medicine at the present tinie." — Bristol
M edico-Chirurgical Journal.

1^ (JUST ISSUED.)
BOSS — Intestinal Intoxication in Infants, y W Forbes
Koss, M.D. A short and practical treatise, well up to date, of those
conditions usually associated with Infantile Diarrhoea, Constipation, Atrophy,
Hickets, iVc, comprising the newest Treatment and Methods of Feeding;
and which ought to be serviceable and useful to the general practitioner.

Demy 8vo, about 150 pages. Cloth. Price Ts. 6d.

STARR-Diseases of ChUdren, including Special Chapters on
Essential Surgical Subjects. Diseases of the Eye, Ear, Nose, and 'I'hroat-
Diseases of the Skin ; and on the Diet, Hygiene and General Management of
Children. Edited by l.cuis ^tarr, M.D., and 6o Associates. Contributors :
John Ashurst, J. M. Da Costa, Baiton C. Hirst, H. M. Ljman, Chas. K.
Mills, F. A. Packard, Wm. Pepper, J. Lewis Smith, Louis Starr, las. Tyson. [.
W. White, Jas.C. Wilson, etc., etc. ' ^

In two parts, Imperial 8vo, of about 6C0 pages each. Profusely illustrated
with woodcuts and 28 half-tone ard coloured plates, Cloth, Price com-
plete 428.

" Dr. Starr lias succeeded in his aim to make the work fresh, comprehensive, and
authoritative, and we have not failed to find an adetjuate note upon the various
subjects which ought to find a place in such a volume."— i^/z^/i// Medical Journal.

(NOW IN PRESS.)
SUTTON— GILES -The Diseases of Women. a Handbook

for Students and Practitioners of Medicine. By J. Bland Sutton, F.K.C S.En-
Assistant-Surgeon Middlesex Hospital, and Surgeon Chelsea Hospital tor
Women, London ; and Arthur E. Gilts, M.D., B.Sc. Lond., F.K.C.S. Edin.
Assistant-Surgeon Chelsea I lospital for Women, London. ' ' * '

The aim of this book is to furnish students with those principles and facts oi

Gynaecology which will enable them to meet the require mcnts of the examination-

room and serve as a guide in practice.

It is taken for granted that the student is already familiar with the anatomy of

the pelvic Viscera and the physiology of the reproductive functions; hence these

subjects are dealt with very briefly.

of Tl!'." T!" ^oWomng Older :-I. 'I he Anat( my and Physiology

of the Reproductive Organs; 11. Methods of Examination - HI '1 he Malforma
tions <,f the Genital Organs; IV. Diseases of the Vulva'; V.' Defeases of X

s

Vagina; VI, Diseases of the Uterus; VII. Diseases of tlie Fallopian Tubes;
Vlll. Tubal Pregnancy; IX. Diseases of the Ovaries; X. Diseases of the Pelvic
Peritoneum; XI. Functional Disorders; XII. Diagnosis and Case-taking; XIll.
Vaginal Operations ; XIV. Abdominal Operations.

The whole will form one volume of about 450 pages, demy 8vo, with a
large number of illustrations, the majority of which have been drawn from
nature expressly for this book. Cloth.

VIEBOIIDT — Medical Diagnosis. By Dr. Oswald Vierordt,
Prof, of Medicine at the University of Heidelberg. Translated from the German
by Francis H. Stuart, A.M., M.D.
Third and Revised Edition. Royal 8vo, 700 pages. 178 coloured and
black and white woodcuts. Cloth. Price 24s.

" It is a book which cannot fail to be of the greatest utility, not only to the clinical
student, but also to the teacher and to the practitioner of medicine."—" Lancet "
Review of the German Edition,
WARREir— Surgical Pathology and Therapeutics. By John
Collins Warren, M.D., Professor of Surgery, Medical Department, Harvard
University.

Synopsis of Contents.
Part I.— Bacteriology— Surgical Bacteria — Hypersemia — Simple Inflammation
—Infective Inflammation— The Process of Repair — Gangrene— Shock— Fever-
Surgical Fevers — Septicaemia — Pyaemia — Erysipelas.

Part II.— Hospital Gangrene — '1 etanus — Hydrophobia — Acthio-mycosis —
Anthrax— Glanders— Snake-Bite— Tuberculosis— Surgical Tuberculosis of Joints
—Tuberculosis of the Soft Parts— Diseases of Bone— Tumours— Carcinoma —
Sarcoma — Benign Tumours — Aseptic and Antiseptic Surgery.

Appendix.— Blood Serum Therapy in Rabies— Tetanus— Treatment of Cancer-
Methods of Preparing Erysipelas Toxine— Examination of Tumours— Staining
Methods — Tumours — So-called Parasites of Cancer— Decalcification of Bone.

In two volumes. Royal 8vo, of over 400 pages each, with 135 illustrations,
most of which are coloured lithographs, printed in the text, drawn from
original specimens by Mr. Wm. J. Kaula. Piice complete, half Persia, 42s.

"... The whole work has been carefully written. The i)rinting and paper are
excellent, and a good index is supplied. . . ."—Lancet.

"... Certainly no ettort has been spared to render this a thoroughly comprehen-
sive text-book of surgical pathology, and whether used for examination purposes,
or as a guide in practical work, it will be found a reliable epitome of the most recent
additions to this science. . . ."—British Medical Journal.
^ (JUST ISSUED.)
WILSON— A Text-Book of Applied Therapeutics for the use
of Practitioners and Students. Edited by .J. C. Wilson, M.D.. Professor of the
Practice of Clinical Medicine in the Jefferson Medical College ; attending
Physician to the Hospital of the Jefferson Medical College, to the German
Hospital, and to the Pennsylvania Hospital, Philadelphia. Assisted by
Augustus A. Eshner, M.D., Professor of Clinical Medicine in the Philadelphia
Polyclinic ; attending Physician to the Philadelphia Hospital.
Among the fortv-two contributors to this great work are the following :— Sanger
Brown, M.D., John B. Chapin, M.D., J. C. Da Costa, M.D., F. X. Dercum, A.M.,
MD George bock, A.M., M.D., John Guitcras, M.D., Ernest Laplace, M.D., A.
lavcran M.D. (Paris), William Osier, M.D., F.R.C.P., Theophilus Parvin, M.D.,
LL.D., Btavau Rake, M.D. ('I rinidad), l.ouis Starr, M.D., Victor C. Vaughan,
M.D.,'Ph.D., .[as. T. Wliillakcr, M.D.

9

Extract from Preface, — " The extension of knowledge by research, and the
verification of facts by comparison and experiment, arc among the objects of the
Medical Sciences ; but the aim of Medicine is the application of knowledge to tiie
prevention, cure, and alleviation of disease. This boDk. written from the st^nd-
point of the practitioner, will contribute, it is hoped, to tliat aim. Its design is to
facilitate the application of the results of the lab )urs of the investigator to tfie uses
of the practising physician."

In two Imperial 8vo volumes of abaut 700 pages each, copiously illus-
trated with woodcuts and many half-tone plates. Price complete 436.

Special terms are offered to those who wish to purchase the complete library,
or a set of five or more of the books contained in the Blue Cover Series.

Section B.— Minor Publications Recently Issued.

BOUCHARD — Auto-Intoxication : Self-Foisoniug of the Indi-
vidual. Being a series of Lectures on Intestinal and Urinary Pathology. By
Prof. Bouchard, Paris, Translated from the French, with an Original Appen-
dix, by Thomas Oliver, M.D., Professor of Physiology, University of Durham,
Newcastle-upon-Tyne.

Koyal 8vo, 302 pages. Cloth. Price 10s.

The Thirty-two Lectures in this volume deal with the toxines, pathogenic pro-
cesses generally, elimination of poisons, preliminaries to the study of the toxicity of
emunctory products, intestinal antisepsis, and of various diseases due to bacillary
products.

"No one can read this work through without having his eyes opene.l and Hnding
an explanation of many a doubtful phenomenon that has often puzzled him in his
daily practice. — Lancet.

BURET— Syphilis in Ancient and Prehistoric Times, with

a Chapter on the Rational Treatment of Syphilis in the Nineteenth Centurv
By Dr. F. Buret, Pans, France. 'I ranslated from the French, with the author's
permission, with notes, by A, H. Ohmann-Dumesnil.

'"^''Tu'Tu ^1"^' ^''^ complete history of Syphilis from i.iehistoric times
up to the Christian Era,

12mo, cloth. 230 pages. Price 6s. 6d, Vol. II. and Vol. III. now ready
in One volume of 289 pp. Price 8s, 6d. ^

GANT and ALLINGH AM— Diagnosis and Treatment of

Diseases of the Rectum, Anus, and Contiguous Textures. By S. G. Cant
^'^"f^^f'^'" ^Itr^f" «f ^^'^^^ Anus, University and Woman's
H h'^ w°r^''\,y^''^: ^^'^'''^'"^ on "Cancer" and "Colotomy.'^bv

HnSM 1'''"'. Allingham, F.R.C.S.Eng., Surgeon to the Great Nonhern

Rectum; Surgical lutor to St. George's Hospital, etc, etc., London.
Illustrated with 16 full-page chromo-lithographic plates and 115 wooa
engravings in the text. Eoyal 8vo. 400 pages. Cloth Price ISs
GRANDIN and JARM AN— Obstetric Surgery, -n

H. Grandin, M,D., Obstetric Surgeon to the New York Maternity^Hosfital ^
Gynecologist to the French Hospital, etc. ; and George W |T man M D '
S^rHosSrr^^^^ Maternily Hospital Gyniologi:;: ^'f^^

10

With about 100 illustrations in the text, and 15 full-page photographic
plates. Royal 8vo. About 350 pages. Cloth. Price 14s.

"... 'f liis work, vviiUen fiuin tiie surgical point of view of ubstelricii, is one
which would be. read with great advantage by rising accoucheurs in general, but par
excellence by those who aspire to the important post of Obstetric Surgeon to a
hos\)'\tn\."—Jiristul Medico-Chiniri'icdl Jouyinil.

"This book deals witli election in obstetric surgery, and we heartily recommend
it as a safe and useful guide to those desirous of becoming acquainted with tlie
methods of modern operative surgery. . . . "—Dublin Juurnal of Medical Science.

GBANDIN and JABM AN -Pregnancy, Labour, and the

Puerperal State. By Egbert H. Grandin, M.D., Obstetric Surgeon to the New
York Maternity Hospital ; Gynaecologist to the French Hospital, etc. ; and
George W. Jarman, M.D., Obstetric Surgeon to the New York Maternity
Hospital; Gynecologist to the Cancer Hospital, etc.
With 41 full-page photographic plates. Royal 8vo, pp. 261. Cloth.
Price 14s.

{JUST ISSUED.)

JARUNTOWSKY — The Private Sanatoria for Consumptives

and the TreaUncnt adoi)led within them. With a detailed description ot
the principal German and Swiss Sanatoria, Cases most suitable for Treatment,
Cost of 'I'reatment, &c. By Dr. Arthur von jaruntowsky, of Poscii, formerly
assistant to Dr. Brehmer, at Goerbersdorf. Translated by K. Clifford Beale,
M.A., M.B., Cantab., F.R.C.P., Physician to the City of London Hospital for
Diseases of the Chest, Victoria Park, London, ike, &c.

Royal 8vo, pp. 48. Cloth. Price Is. 6d. net.

JENNINGS — Colour-Vision andColour-Blindness. a Practical
Manual for Hailway Surgeons. By ,|. Lllis Jennings, M.D.
Crown 8vo, 115 page?, 21 engravings, one coloured plate. Cloth. Price

58. 6d.

JOAL—WOLPENDEN— Respiration in Singing. Authorised

'IVanslalion from tiie French by K. N. Woltenden, M.D. Cantab.
For Specialists, Singers, Teachers, Public Speakers, etc. Illustrated.
Crown 8vo, 232 pages. Cloth. Price 4s.

"'Fhis little work, although intended primarily for singers, «ontains many
observations on respiration which are of interest both to the ,)hysu)logist ami
the \)h\'s\c\a.n." — Lancet . , ,. , , n i r a

The book, which has been neatly and efhciently published, will be found
to be'a'most valuable wurk, not only tor the ))upil or teacher of singing, but also for
any member of our profession desirous of obtaining a thorougfi knowledge of this
important subject.' -J ournal of Layyngologv, Rhinology, and Olulogy.

AU vocalists and teachers of singing who have any doubt concerning the
most" efficacious method of respiration may be earnestly recommended to read this
carefully prepared and well thought out little book. The treatise is of special value
to female vocalists, to whom much of the information is of vital importance fo. n
affects th<*ir general health as well as their artistit progress, . . . —Mnsual J.tmes.
KEATING — How to Examine for Life Insurance. ]3y John
M Keating, M.D., Fellow o£ the College of Physicians and Surgeons of Phila-
delphia ; Vice-President of the American Paediatric Society; Ex- President ot
the Association of t.ife Insurance Medical Directors.

11

Royal 8vo, 211 pages, with two large phototype illustrations, and a plate
prepared by Dr. McClellan from special dissections ; also, numerous cuts to
elucidate the text. Price in Cloth, lis.

I'arl 1., which has b^cii (.arefully prepared lioin llic best works on Fliysical
Diagnosis, is a short and succinct account ot the methods used to make examina-
tions ; a description of the normal conditions and of the earliest evidences of disease.

I'art II. contains the instructions of twenty-four Life Insurance Companies to their
medical examiners.

MOORE -Meteorology. Bv J. W. Moore, B.A., M.D., M.Ch.,
. Univ. Uubl.

One volunie, crown 8vo, 438 pages. Price 8s.

CoNTiCNTS.— Part I. - Introduction. I'art II. — Physical Properties of the At-
mosphere— Air — Temperature — Radiation— Atmospherical Pressure— A tmospheri-
cal Moisture (Atmidometry — Hyg-rometry — llyetometry) — Atmospherical Elec-
tricity. Part 111.— Weather and Climate. Part IV.— 'I'he Influence of Weather
and Season on Disease.

"Dr. Moore does not pre-suppose niucii knowledge on the part of his readers and
does not disdain to enter into minute details on the elementary laws of Physics —
the dirTerent kinds of thermometer, the history and princi()les of the barometer and
such like. ... We may say in conclusion that the work is well jirinted and
iiandsomely illustrated." — Lancet.

"This is a good and a pretty book and one which appeals specially to the
medical profession, being the work of an accomplished physician. Among the
merits of the book may be mentioned the minute and generally clear desciiptions
of the numerous meteorological instruments, which are very copiously illustrated.
The methods of using them are carefully described, and practical difficulties noticed
The volume is full of suggestive matter jov the Physician, who may be consulted about
residential or temporary health resorts." — British Medical Journal.

" The author gives a lucid and interesting account of modern meteoroloo^ical
methods and appliances." — The Times.

"It is to be hoped that this little book may meet with the popularity it deserves
It is well written and well illusliated.'' — Nature.

MYGIND-Deaf-Mutism. By HolgerMygind,xM.D. (Copenhagen).
Crown 8vo, over 300 pages. Cloth. Price 8s.

CosTiiNTS.— Introduction: Definition— Literature— Classification. Distribution-
Countries— Races— Religions— Sexes. Etiology and Pathogenesis: Natural In-
fluences—Unfavourable Social and Hygienic Conditions-Ileredity-Consanguinity
- Other Remote Causes— Immediate Causes— Morbid Anatomy— Symptoms and
Sefjuelae — Diagnosis— Prognosis — Treatment.

" 'I'he aim of the author of this book, which is a praiseworthy contribution to the
suoject, is to present to the public a description, exhaustive and systematically
arrange.l of ' D.af-Mutism,' considered as a Pathological coudit\u^^."~ British
.1/ eUical Journal.

"To such as wish to study the pathoh.gy of Deaf-Mutism the book will be of
great value."— J/ze British Dcaf-Mute.

" We congratulate Dr Mygind upon the successful completion of a task which
must have been at once laborious and interesting."- .V<t/K^^:
PURDY — Practical Uraualysis and Urinary Diagnosis. ^
Manual for the Use of Physicians and Students. By Charles W Pnrdv
M.D.. Author of " Diabetes : its Cause, Symptoms. and^LTment!^■etc etc'
3rd Edition With numerous illustrations, including several coloured DlatP«
Demy 8vo. About 363 pages. Cloth. Price 14s. s cveini coiourea plates

Part I.— Analysis of Urine. I'arl II.— Urinary Diagnosis.— Appendix : Examina-
tion of Urine fur Life-insurance.

" The method advocated in this book is certainly highly to be commended, for
It teaches not onlv how to detect, isolate, and determine the constituents of the
urine, normal and abnormal, but also how to determine the presence of disturbed
physiological processes, to detect the presence of pathological changes and to
measure the degree of both." — Lancet. ,

'■This work appears to be very thoroughly done and by one wiih very consiaer-
able experience."— i*)7//s/( Medical Journal.

BOBINSON— CRIBB— The Law and Chemistry relatuiflr to

Food. A Manual for the use of persons practically interested in the adminis-
tration of the law relating to the Adulteration and Unsoundness of too'l ^^'"1
Drugs. By 1 1. ISIansfield Kobinson, LL.D. (Lond.), and Cecil H. Cnbb, B.Sc.
(Lond.), K.l.C, F.C.S. .

Crown 8vo. Cloth. Price 8b.
Synopsis.

Introduction. Imvortance of subject (i) As regards liealth ; (2) lixpenditure
on food and administration of the law ; (3) As regards Commerce— suggested
amendments in the law and its administration.

Part I.— Law of Adulteration and Unsoundness.— A. Adulteration. B. Un-
soundness. C. Civil Remedies for Damages. D. Practical Forms.

Part II —Chapter 1.— The Aims and Objects of Adulteration, Ostensible and
Real- Fashion and Fancy in Adulteration— The Public Taste— Recent Develop-
ments—The General Effect of Food Legislation up to the present time. Chapter
II —The relation of the Public Analyst to the Local Body appointing him ana to
the General Public— Hints to Food Inspectors— Collection and Preservation of
Samples— Analysts' Certificates— Disputed Cases— The Government Referees.

Part HI.— Chemistry.

" The chapters are sensibly written, clear and free from ambiguity and
exaggeration, affording a valuable and indispensable collecti^on of material to those
cneaeed in the operation of the Food and Drugs Act, i^is,:'— Lancet.

. . . This able, well-arranged, and very useful book treats the subject in a fair
and "iriipartial spirit."— Mall Gazette.

SENN— Principle* of Surgery. By N. Senn, M.D.j Ph.D.

Second Edition. Koyal 8vo, 656 pages, with 178 fine wood engravings and
coloured plates. Price, cloth, 24s. 6d.

SENN— A Syllabus of Lectures on the Practice of Surgery,

arraneed in conformity with Keen and White's Textbook of Surgery. {Sec
above under Blue Cover Series.) By N. Senn, M.D., Ph.D.

Oblong 8vo. Limp Cloth. 10s. 6d.
" We have small blame and much praise to offer for this syllabus."— L/wr^oo/
Medico-Chirurgical Journul.

N B —This book was written to meet in the hrst place the requirements of the
Teacher of Surgery as a short Guide to aid him in the Lecture Room in prosecuting
the various subjects in a systematic, clear, succinct, and practical manner. On the
other hand the Student of Surgery who, during his early College experience, is often
hewildercd bv what he hears and reads, and who keenly experiences the want o
something which would enable him to separate the chaff from the wheat will hnd
that this little book meets his requirements. Since recitations are gradually displacing
didactic lectures, this Syllabus will prove pf special value for this mode of instruc
tion as well as the preparation of tlic student for tlic final examinations.

18

SHOEMAKER -Materia Medica and Therapeutics. With

Kspecial Reference to the Clinical Application of Diu^s. By John V. Shoe-
maker, A.M., M.D., I.I..D.

Fourth Edition. Thoroughly revised. Royal 8vo, 1,108 pp. Price, cloth, 28s.
THRESH Water Supplies, l^y J- Thresh, D.Sc. Lond.,

M D., F.l.t'., F.C.S.

Just Issued. Second revised Edition. Crown 8vo. Cloth. Price Ss.

Synopsis of contents : — Characters ot Waters fronn various Geological Sources —
Lakes, Rivers, Shallow, Deep, and Artesian Wells, etc. — Supplies to Cottages,
Mansions, Villages, 'I'owns — Pumps and Pumping Machinery, Turbines, Water-
wheels, Windmills, Rams, Gas, Air, and Steam Engines — Pollution of Water and
Kffect of Impurities upon Health, upon Individuals and Communities — Interpreta-
tion of Analyses — Significance of Nitrates, Nitrites, Chlorides, Phosphates, etc., and
of the Organisms found in Water — The various Methods of Purifying and Softening
Water.

This is an excellent addition to the literature on the subject of water supply.
The author's main object is to give those who are interested in puljlic health ques-
tions such information as may render them reasonably competent to form an
opinion as to the sufficiency of an existing or proposed water supply, chiefly in
rural districts." — British Medical Journal.

" It gives a full and ade(|uate account of everything appertaining to drinking,
water and water-.supply. Among many interesting chapters the most interesting
generally will be that on the interpretation of water analysis. ... It is a complete
and very scholarly treatise on one branch of public health work." — The Lancet.

" This treatise kuis recently presented by its author as a graduation thesis at the
University of Victoria, and has secured for him the gold medal at the M.D. Examina-
tion. This sufficiently vouches for the value of the treatise, and a careful perusal
of it confirms this judgment." — Public Health.

" This is a remarkable book. . . . One might well believe that parts of the book
were written by members of several professions, for Dr. Thresh seems equally
happy whether the subject of engineering, bacteriology, geology, chemistry,

medicine, or (that rarest of all) common sense — e.g. his chapter on wells. . . ."

Journal of the Sanitary Institute.

(IN THE PRESS.)

TEARSLJSY- Injuries and Diseases ot the Ear. Being
various papers on Otology. By Macleod Yearsley, F.R.C.S.
Crown 8vo, about 56 pp. Cloth, 2s,

Section C— Miscellaneous Publications.

BIGEIiOW International System of Electro-Therapeutics.

Chief Editor, Horatio R. Bigelows M.D. 38 Asswiatc Editors.
Eoyal 8vo, 1,200 pages, illustrated. Price, clcth, 34s.
" It is a great work .... great in excellence." — Lancet.
" This is truly a magnum opus."— British Medical Journal.

". . . It is but faint praise to say that this is the best work that we have hitherto
seen in the English— or, indeed, in any other— language on the application of the

'coming science' to the requirements of medical and surgical tlierapentics.''
— Viihliii Journal of Medical Scictice.

"To anvone who wants a standard work of reference we can strongly recommend
this hook."— Liverpool Medico-Chintr^ical Journal.

CAPP- The Daughter: Her Health, rducation, and Wed-
lock. Homely Suggestions to Mothers and Daughters. By W. M. Capp. M.D.
12mo. 150 pages. Clotli. Price 4s. net.

This is just such a book as a family physician would adv ise his lady patients to
obtain and read. It answers manv questions which every busy practitioner of
medicine has put to him in the sick room at a time when it is neither expedient nor
wise to impait the information sought.

CATHELL — Book on the Physician Himself, and Things that

Concern l;is Reputation and Success. By I). W. Cathell, M.D., Baltimore, Md.
Tenth edition, author's last revision. Koyal 8vo, 350 pp. Cloth, price lis. 6d.

EISENBEHG— Bacteriological Diagnosis. Tabular aids for
use in Practical Work. By James Eisenberg, Ph.D., M.D., Vienna. Authorised
translation of the second German F.dition, by Norval H. Pierce, M.D.
Royal 8vo. 200 pp. Cloth. Price 8s. 6d.

EDINGEB Twelve Lectures on the Structure of the

Central Nervous System. For Physicians and Students. By Dr. Ludwig
Edinger, Fiankfort-on-the-Main.
Second Revised Pklition. 1.13 Illustrations. Tran.slated by W. H. Vittum, M.D.
Edited bv C. E. Riggs. A.M.," M.D. The illustrations are the same as those used
i„ the latest Germarredition. Eoyal 8vo, 250 pages. Cloth. Price 10s.

ESHNER— Fevers, Including General Considerations, Typhoid
I'ever, Tvphus Fever. Influenza, Malarial Fever, Yellow Fever, Variola,
Relapsing^ Fiver, Weil's Disease, '1 hermic Fevtr, Dengue, Miliary Fever,
Mountain Fever, etc. By Jas. C. Wilson, M.D.. Solomon Solis Cohen, M.D..
C. Meiers Wilfon, M.D.. Augustus A. Eshner, M.D., W. Reynolds Wilson.
M 13. '"compiled from The Annml of the Universal Meilual 5f/fnffs (Sajous)
from 1888 to 1894, inclusive. By Augustus A. Eshner, M.D. With copious
commentaries and additions. Embellished by weed engravings and maps.
One Royal 8vo volume of about 600 psges. Cloth. Price I9e.

PIREBAUGH — The Physician's Wife, and the things that

pertain to her life. By Ellen M. PMrebaugh.

Crown 8vo, 200 pages. Beautifully illustrated. Price 68. 6d.

HUIDEKOPER — Age of the Domestic Animals. Being a
complete treatise on the dentition of the horse, ox, sheep, hog, and dog, and
on the various other means of determining the age of these animals. By
Hush Shippen Huidekoper, M.D., Veterinarian (Alfort, France).

Royal 8vo, 225 pages. Illustrated with 200 engravings. Cloth. Price 10s.

JAMES— Alaskana. Alaska in Descriptive and Legendary Poems.
By Bush rod W^ James, A.M., M.D.
Tastefully bound, with a rich and very unique ornamental gilt design on back
and side. Cloth. Full gilt edges 8s.

15

MANLEY — Heimia : Its Palliative and Radical Treatment

ill Adults, Children, and fnfaiits. By Thos. II. M.inlty, A.M., M.D., Visiting
Surgeon to Harlem Mospital, Member of the National Association of Railway
Surgeons, etc., etc.

Royal 8vo, 230 pages. Illustrated. Cloth. Price Ss. 6d.
M ANTON- A Syllabtis of Lectures on Hnman Embryology.

An introduction to the Study of Obstetrics and Gyi'secology, with a (>lo.ssary
of Embryological Terms. By Walter Porter Manton, M.D., Lecturer on
Obstetrics in Detroit College of Medicine ; Fellow of the Koyal Microscopical
Society, of the British Zoological Society, etc.

Interleaved for taking notes, and illustrated by outline drawings and photo-en-
gravings. 12mo, 250 pp., including the blank leaves for notes. Cloth, price 6s. 6d.

BOHE - Text-Book of Hygiene. A. Comprehensive Treatise on
tfv: Principles and Practice of Preventive Medicine from an American stand-
point. By George II. Rohc, M.D.

Third Edition. Illustrated. Boyal 8vo, 653 pages. Cloth. Price 17s.

" SAJOUS' Annual of the Universal Medical Sciences."

Issue 1896. and back issues since 1888.

5 Royal 8vo vols, in the set, 2,500 pages. Cloth, 87s. the set. Single vols,
at 21s. net, each.

" • • ■ The work is, so far as we know, the only Year Book published in the
English language which professes to deal in anything like a complete manner with
medical literature, and as a work of reference it will be found of inestimable value
It is thoroughly well arranged and compiled, and the general index, which extends
to 81 pages of treble columns, renders it easy to consult. . . ."—Brit. Med. Jouru.

SMITH— Physiology of the Domestic Animals. A Text-
Book for Veterinary and Medical Students and Practitioners, By Robert
Meade Smith, A.M., M.D.

Royal 8vo, 960 pages, profusely illustrated with more than 400 fine wood
engravings and many coloured plates. Price, cloth, 28s. ; sheep, 32s.

Transactions of the Meetings of the British laryngological

As.s<Kiation. Royal 8.0, Vol. I., ,891. >o8 pages. Vol. II., ,892, ,00 pages.
Vo 111., ,893, 84 pages. Vol. IV., ,894, 82 pages. Kach volume bound in
cloth, 2s. Dd. net.

ULTZMANN— The Neuroses of the Genito-ITrinary System

in the Male, vvith Sterility and Impotence. By Dr. R. Ultzmann. Vienna
iranslated, with the author's permission, by Gardner W. Allen, M.D.

Illustrated. 12mo. Cloth. Price 6s.

SvN-oP.s,s OF Co.vrKNTs.-First Part-I. Chemical Changes in the Urine in
Cases of Neuroses. II. Neuro.ses of the Urinary and of the Sexual Organs, class
fied as: i) Sensory Neuroses; (2) Motor Neuroses- (-^^ s-rre-rorv m'
Second Part-Sterility and Imp^teLi The treatment^^-'ill ' 'is d scd^^^^^

clearly and minutely. "escnt)ed

HI

Section D.— Periodicals.

"Journal of Laryngology, Rhinology, and Otology ;" an

Analytical Record of Current Literature relating to the Throat, Nose, and Ear.
Subscription £\ (Five Dollars) a year in advance, post free. Single copies, 2S.

" Archives of Clinical Skiagraphy." By Sydney Rowland, B.A.
Camb., Late Scholar of Downing College, Cambridge, and Shuter Scholar of
St. Bartholomew's Hospital, London; Special Commissioner to British Medi-
cal Journal for the Investigation of the Applications of the New Photography
to Medicine and Surgery.— A series of collotype illustrations, in Imperial 4to,
with descriptive text, illustrating the applications of the New Photography to
Medicine and Surgery. Price, per Part, 4s. net. Parts L, IL and IIL now ready.
The object of this pLblication is to put on record in permanent form some of the

most striking applications of the new photography to the needs of Medicine and

Surgery.

Section E.— Specialities.

Pure Calf Lymph Tubes at is. and 3s.

Pure Vaccine Cream Flacons at 2S. 6d.

Rapid Analysis by Thermometer. (Barker-Smith Method)
tJrea, Ammoniacal ^alts. Alcohol. One minute Analyses. Simplest,
cheapest, most rapid and satisfactory of all analytical methods. No chemi.stry
required. Nearly all the experiments can be performed in one minute, and
almost without cost or waste.
Aiconoi, Group.— No distillation is required. A publican can determine the
alcoholic percentage of any of the alcohols in one minute ; colour and sugar do not
affect the method, the quantity used is a tea spoonful. Tinctures, Raw Spirits,
Sweetened Spirits, Brandy, Whisky, Gin, Hollands, Port Wine, Sherry, Liqueurs,
Ale &c

Ai Bi-MiNoiD Group.— The percentage of Albumen or food value is determined
in a few minutes. Milk requires only two minutes. Milk, Condensed Milk, Meat
Extracts, Meal, Flour, Biscuits, Feeding Cake,, ^-c. , , , ., o 1 i, ^

Ammonia and Urta Group.— Acetate of Ammonia, Sal Volatile, Sulphate,
Chloride, Phosphate, Bromide, Nitrate, Benzoate. Their percentage of ammonia
or the strength of their solutions may be ascertained in one minute by the thermo-
meter and tables Percentage of Urea in Urine can be exactly determined in one
minute Peroxide of Hvdrogen solutions immediately determined. Chlorine
preparations (soda and lime) are just as easily estimated by reversmg the method.

Copyright of all Tables reserved. Students' Set complete, 6s. Each Set con-
tains : Experimental Phial, 'Iheimometer, Tables, and Pipette Measure.

••The method is extremely simple and very rapUl"— British Medical Journal.

" It is applicable to the estimation of urea and urine."— Lfl«rf/.

THE REBMAN PUBLISHING COMPANY, Ltd.

II, ADAN^SXREE'J\ STRAND, LONDON. W.C.
Registered Tehsy(iph^<^ Address, " Sqimnn, Lnvtdov:'

•*

(

/

. 'I ■ :

IS 7- lii s